Median Length Of Stay For Patients Research Articles

Body Mass Index (BMI) Does Not Affect Survival and Length of Stay (LOS) in Septic Shock Patients

Purpose: 65.7% of US adults age 20 years and older are overweight (BMI 25-30) and 30.6% are obese (BMI >30). These statistics are reflected in the ICU patient population. We studied the effect of BMI on survival and LOS in patient with septic shock. Methods: Subjects were patients from the ICU Project Impact Database admitted to Cooper University Hospital ICU in septic shock over a three year period from 2008-2011. A total number of 293 patients were evaluated and separated based on whether they survived or not. Variables analyzed “BMI, length of stay, and others thought to play a role in mortality septic shock lactate, chronic kidney disease (CKD), cirrhosis”. BMI was classified into four groups: underweight (<18); normal (18-24.9); overweight (25-29.9) and obese (>30). Univariate analysis was used to compare the two groups (alive or deceased) for any significant differences. Subsequently, each of the variables found to be significantly different [p<0.05] were then analyzed using multivariate analysis to evaluate whether any were independent predictors of mortality in patients with septic shock. Results: When comparing mortality in septic shock patients with normal BMI (40%) using univariate analysis there was a trend for a decreased mortality in underweight (30.8%; p=0.526) and obese patients (35.6%; p=0.561) although not statistically significant. When evaluating median LOS in patients among all BMI classifications there was no significant difference in median ICU LOS or hospital LOS. Variables found to be statistically significant in relation to mortality were patients with CKD (Deceased 25% vs. Alive 15%) [p= 0.05], Multiple Organ Dysfunction (MOD) >2 (Deceased 87% vs. Alive 76.2%) [p=0.03] and elevated lactate on admission (Deceased 3.5 vs. Alive 2.7) [p=0.05]. Age, APACHE II, and cirrhosis were also found to be significant. When looking at differences in percent mortality using multivariate analysis, only age (Deceased 66.03 vs. Alive 58.49) [p=0.00], APACHE II (Deceased 23.95 vs. Alive 17.49) [p=0.00] and presence of cirrhosis (Deceased 9.4% vs. Alive 0.7%) [p=0.03] were found to be independent predictors of mortality in Septic shock patients. Conclusion: There was a trend for a protective effect on mortality in septic shock patients who were underweight BMI although this trend was not statistically significant. There was no significant difference among the BMI groups in relation to ICU or hospital LOS. The study was sufficiently powered to detect a difference between BMI groups suggested by the finding of significant independent predictors for mortality in septic shock with age, APACHE score, and presence of cirrhosis all of which had previously been reported.Table: No Caption available.Table 2: . No Caption available.

Implementation of an Acuity Adaptable Patient Care Unit is Associated with Improved Outcomes after Major Pulmonary Resections

Many centers have adapted an Acuity Adaptable Cardiothoracic Unit (AACU) to fast track cardiac surgery patients, yet few data exist on the impact of such a unit on general thoracic surgery outcomes. We examined the effects of implementing an Acuity Adaptable Cardiothoracic Unit on patients undergoing major pulmonary resections. We reviewed data from an IRB-approved, prospective thoracic surgery database for patients during the 3-y periods pre- and post-adoption of an Acuity Adaptable Cardiothoracic Unit. As surrogate endpoints to quality and cost, we examined length of stay, place of discharge, readmission rate, and 30-d mortality during these two time periods. A total of 488 patients underwent major pulmonary resections (416 lobectomies, 72 pneumonectomies) in this 6-y time period. Patients cared for in the AACU model had a shorter length of stay (LOS) compared with patients in a traditional ICU/general care model. The mean and median LOS for patients in the AACU model was 4.2 ± 0.3 d and 3 d, and for the traditional ICU/general care model these were 7.8 ± 1.2 d and 5 d, respectively (P < 0.001). Relative risk of readmission was 0.86 (95% CI = 0.45, 1.66, P = 0.392) and 30-d mortality was 0.49 (95% CI = 0.14, 1.68, P = 0.205) for patients in the AACU model compared with patients in the traditional ICU/general care unit. Implementation of an Acuity Adaptable Cardiothoracic Unit is associated with reduced length of hospital stay in patients undergoing major lung resections, without increased risk of readmission or 30-d mortality. Future studies will evaluate post-operative events unique to an AACU model.

In‐hospital complications after transcatheter aortic valve implantation revisited according to the valve academic research consortium definitions

To determine the occurrence of in-hospital complications after transcatheter aortic valve implantation (TAVI) according to the Valve Academic Research Consortium (VARC) criteria in addition to the length of stay (LOS). The absence of uniformity in endpoint definitions challenges the comparison between previously reported major adverse cerebro- and cardiovascular event rates after TAVI. To address this, in 2009, the VARC was established aiming to provide standardized endpoint definitions for TAVI clinical trials. Between November 2005 and September 2010, we prospectively enrolled 150 consecutive patients who underwent TAVI with the Medtronic CoreValve System in our institution. Complications, prosthetic valve associated endpoints, and therapy-specific endpoints were defined according to the definitions provided by the VARC. The mean age (±SD) was 81 (±7) years and 55% were female. Thirty-day or in-hospital mortality was 11%, and the 30-day combined safety endpoint was 22%. Seventy-six patients (51%) had ≥1 cardiovascular and/or noncardiovascular complication of whom 16 also underwent a new permanent pacemaker implantation (PPI). In the 74 patients with uneventful TAVI, 12 patients (8%) underwent PPI. TAVI was truly uneventful in 62 patients (41%). Bleeding complications were observed most frequently (31%), followed by acute kidney injury (18%), vascular complications (16%), and stroke/TIA (11%). The median LOS in patients with a complicated and a truly uncomplicated TAVI was 14.0 (8.0-20.5) and 8.0 (7.0-10.8) days, respectively (P < 0.001). TAVI was associated with ≥1 cardiovascular and/or noncardiovascular event in 51% of the patients; new PPI was needed in another 8%, and TAVI was truly uncomplicated in 41%. Complications and need for new PPI significantly prolonged LOS.

Increased Mortality and Length of Stay Among Patients With Inflammatory Bowel Disease and Hospital-Acquired Infections

Hospitalized patients with inflammatory bowel disease (IBD) could be at increased risk for hospital-acquired infections (HAIs). By using HAI outcome data from Pennsylvania, we examined the influence of HAIs on in-patient mortality and length of stay (LOS) in the hospital among patients with IBD. Data were generated by linking the Clinical Research Databases from CareFusion (formerly MediQual), which includes all acute care hospitals in Pennsylvania, with publicly reported HAI data from Pennsylvania. The study population included all patients discharged in 2004 with International Classification of Diseases, 9th Clinical Modification codes of 555.x or 556.x (2324 IBD cases from 161 hospitals). Controls were selected using risk-score matching with a 5:1 ratio. Mortality and LOS end points were estimated and corroborated with regression methods. Among the IBD patients studied, there were 20 deaths and 22 reported cases of HAI. The mortality from HAI among patients with IBD was 13.6%, compared with 0.9% among controls (P = .0146, Fisher exact test). The odds ratio for mortality was 17.2 (95% confidence interval, 1.7-174.3). The median LOS for patients with IBD and HAI was 22 days, versus 6 days for controls (P < .001, Wilcoxon). Of the 22 cases with HAIs, 15 were urinary tract infections, 5 were blood stream infections, and 2 were from multiple sources. Results from a population-based data set indicate that mortality and LOS are increased among IBD patients who develop HAIs. A majority of the HAIs were from urinary sources. Although HAIs are low-frequency events, increased vigilance to avoid HAI among patients with IBD could improve outcomes.

Does early review by a respiratory physician lead to a shorter length of stay for patients with non-severe community-acquired pneumonia?

Background:The aim of this study was to evaluate whether patients with non-severe community-acquired pneumonia (CAP) have a shorter length of stay (LOS) when initially seen by a respiratory physician compared...