Months Of Index Admission Research Articles

HPB SO09 - Review of the management and the outcome of acute pancreatitis in a tertiary centre in the United Kingdom

Abstract Background Acute idiopathic pancreatitis (IP) is a challenging condition in surgical practice. We undertook a prospective review of all patients presenting with idiopathic pancreatitis to identify the natural course of the disease. Method Fifty-nine patients were identified within a 12-month period from a prospectively maintained database. Patients were diagnosed with idiopathic pancreatitis (IP) following a standardised protocol excluding other causes of pancreatitis. Results Over one year, a total of 373 new patients with acute pancreatitis were admitted. IP constituted 15.8% of admissions; 15.2 % of which presented with severe pancreatitis. Average LOS for the index IP admission was 7.05 days, compared with 6.4 days for the rest of cohort. 8.47% with IP were re-admitted within 3 months of index admission, increasing to 13.6% over 12 months. Overall, 16.9% developed long term complications including pancreatic insufficiency or chronic pancreatitis over 12 months compared to 15.3% in the rest of AP cohort. The mortality rate was 3.4% and 12.1% in the IP and AP cohort respectively. Conclusion Idiopathic pancreatitis constitutes a larger burden than expected in a large prospective cohort of patients with AP. Patients with IP have a longer LOS and a high risk of long-term sequelae.

Risk factors for Relative and Absolute Hypoglycemia in Patients Treated for Diabetic Ketoacidosis and Hyperosmolar Hyperglycemic Syndrome.

Introduction: Glycemic management in the intensive care unit is an evolving practice area. This evolution has included the refinement of blood glucose targets, matching glycemic management to premorbid status, and investigations into the impact of glycemic variability and relative hypoglycemia on ICU outcomes. The interplay between these phenomena and absolute hypoglycemia has yet to be investigated in hyperglycemic emergencies. Objectives: To examine the incidence of and risk factors for relative hypoglycemia and absolute hypoglycemia in patients admitted to an intensive care unit for the management of hyperglycemic emergencies. Methods: This was a retrospective, single-center, exploratory analysis of adults admitted to the medical intensive care unit for diabetic ketoacidosis or hyperosmolar hyperglycemic syndrome. The primary outcome was the incidence of relative hypoglycemia, defined as a blood glucose level 30% lower than baseline. The baseline was determined by the estimated average blood glucose calculated from hemoglobin A1c within 3 months of index admission. Secondary outcomes were ICU length of stay, glycemic variability, and incidence of absolute hypoglycemia.Results: Relative hypoglycemia was observed in 60% of patients in the cohort. Longer insulin infusion duration and higher hemoglobin A1c levels were found to statistically increase the risk of developing relative hypoglycemia. Higher glycemic variability and longer ICU length of stay were associated with the risk of developing absolute hypoglycemia. Conclusions: Relative hypoglycemia is a frequent occurrence in this patient population. Hemoglobin A1c and duration of the insulin infusion statistically influenced the risk of developing relative hypoglycemia. Higher glycemic variability and longer ICU stay were significantly associated with developing absolute hypoglycemia. While relative hypoglycemia is common in hyperglycemic emergencies, the clinical impact remains uncertain and warrants additional investigation.

Post-hospitalization Short Versus Long Steroid Taper Strategies in Patients With Acute Severe Ulcerative Colitis: A Comparison of Clinical Outcomes.

Ulcerative colitis (UC) is a chronic inflammatory colon disease characterized by relapsing flares and remission episodes. However, the optimal steroid tapering strategy in patients hospitalized for acute severe UC (ASUC) remains relatively unknown. We aim to examine the clinical outcomes in patients hospitalized for ASUC regarding variable prednisone taper regimens upon discharge. We retrospectively reviewed all adult patients admitted to our facility with ASUC between 2000 and 2022. Patients were divided into 2 groups based on the duration of steroid taper on discharge (< 6 and > 6 weeks). Patients who had colectomy at index admission were excluded from the analysis. The primary outcome was rehospitalization for ASUC within 6 months of index admission. Secondary outcomes included the need for colectomy, worsening endoscopic disease extent and/or severity during the follow-up period (6 months), and a composite outcome as a surrogate of worsening disease (defined as a combination of all products above). Two-sample t-tests and Pearson's chi-square tests were used to compare the means of continuous and categorical variables, respectively. Multivariate logistic regression analysis was performed to identify independent predictors for rehospitalization with ASUC. A total of 215 patients (short steroid taper = 91 and long steroid taper = 124) were analyzed. A higher number of patients in the long steroid taper group had a longer disease duration since diagnosis and moderate-severe endoscopic disease activity (63.8 vs. 25.6 months, p < 0.0001, 46.8% vs. 23.1%, P = ≤ .05, respectively). Both groups had similar disease extent, prior biologic therapy, and the need for inpatient rescue therapy. At the 6-month follow-up, rates of rehospitalization with a flare of UC were comparable between the 2 groups (68.3% vs. 68.5%, P = .723). On univariate and multivariate logistic regression, escalation of steroid dose within four weeks of discharge (aOR 6.09, 95% CI: 1.82-20.3, P = .003) was noted to be the only independent predictor for rehospitalization with ASUC. This is the first study comparing clinical outcomes between post-discharge steroid tapering regimens in hospitalized patients for ASUC. Both examined steroid taper regimens upon discharge showed comparable clinical results. Hence, we suggest a short steroid taper as a standard post-hospitalization strategy in patients following ASUC encounters. It is likely to enhance patient tolerability and reduce steroid-related adverse effects without adversely affecting outcomes.

Outcomes for sigmoid volvulus managed with and without early definitive surgery: 20-year experience in a tertiary referral centre.

Sigmoid volvulus is rare in Western countries. Patients at risk of sigmoid volvulus are often older with significant co-morbidity. Without sigmoid colectomy there is a high recurrence rate, but indications for surgery are controversial. A retrospective observational study was conducted by reviewing clinical records of patients admitted to Waikato Hospital 1 January 2000 to 1 January 2020 with a diagnosis of sigmoid volvulus. Patient characteristics, clinical features, investigations, management, and outcomes were recorded. One hundred and thirty-two patients (87 male) were included with 203 volvulus episodes. Median age 76 years, median Charlson co-morbidity index (CCI) 4. Median follow-up 11 years. 44/132 (33.3%) had surgery during the index admission, two had elective surgery and the remainder had planned non-operative management. 73/132 (55.3%) had surgery at any stage. 42/86 (48.8%) patients managed non-operatively recurred; 66.7% of recurrences were within 6 months. Forty-three (32.6%) died within 12 months of index admission; 28 (21.2%) died during an admission for volvulus. On univariate analysis higher age and abnormal vital signs were associated with inpatient and 12-month mortality; higher CCI was associated with 12-month mortality. On multi-variate analysis increasing age in years was associated with increased risk of death (HR 1.089 [1.052-1.128, P < 0.001]). Normal vital signs at presentation were associated with decreased risk of death (HR 0.147 [0.065-0.334, P < 0.001]). Sigmoid colectomy should be considered at index presentation with sigmoid volvulus. Half of patients managed non-operatively recurred, with two-thirds recurring within 6 months. The mortality rate remains high for subsequent volvulus episodes.

Modifiable factors associated with pediatric asthma readmissions: a multi-center linked cohort study

Objectives To (a) identify rates of hospital readmission and emergency department (ED) re-presentation for asthma within a 12-month period, (b) estimate the effects of modifiable hospital, general practitioner (GP) and home environmental factors on hospital readmission, ED re-presentations and rescue oral corticosteroid use. Methods We recruited 767 children aged 3–18 years who were admitted to 3 hospitals in Victoria, Australia between 2017 and 2018 with a validated diagnosis of asthma on chart review. Primary outcome was hospital readmission with asthma within 12 months of index admission. Secondary outcomes were ED re-presentation for asthma and rescue oral corticosteroid use. All outcomes were identified through linked administrative datasets. Their caregivers and 277 nominated GPs completed study surveys regarding the home environment and their usual asthma management practices respectively. Results Within 12 months of an index admission for asthma 263 (34.3%) participants were readmitted to a hospital for asthma, with participants between the ages of 3–5 years accounting for 69.2% of those readmitted. The estimated effect of GP reported guideline discordant care on the odds of readmission was OR 1.57, 95% CI 1.00–2.47, p = 0.05. None of the hospital or home environmental factors appeared to be associated with hospital readmissions. Conclusions Hospital readmissions among Australian children with asthma are increasing, and linked datasets are important for objectively identifying the health services burden of asthma. They also confirm the important role of the GP in the management of pediatric asthma.

Health literacy and long-term health outcomes following myocardial infarction: protocol for a multicentre, prospective cohort study (ENHEARTEN study)

IntroductionLow health literacy is common in people with cardiovascular disease and may be one factor that affects an individual’s ability to maintain secondary prevention health behaviours following myocardial infarction (MI)....

Acute Pancreatitis During COVID-19 Pandemic: An Overview of Patient Demographics, Disease Severity, Management and Outcomes in an Acute District Hospital in Northern Ireland.

BackgroundAcute pancreatitis (AP) is a common disease requiring admissions under surgical and critical care units. The two most common causes are alcohol and gallstones. Coronavirus disease 2019 (COVID-19) pandemic had a significant impact on service delivery and patient management throughout all surgical specialties. In this study, the primary aim was to ascertain the incidence of COVID-19 in acute pancreatitis patients. Secondary objectives were to study aetiology, demographics, severity, 30-day mortality, outcomes and management of acute pancreatitis patients from 1st March, 2020 till 31st August, 2020.MethodsA retrospective observational review of all patients admitted under the General Surgical team was performed. Information regarding demographics, severity of AP (using Glasgow score, Atlanta classification and CT severity index score), ICU admission and organ support, treatment modalities and follow-up data for outcomes was collected based on data collection tool used by COVID-PAN study and results were compared to outcomes results of COVID-PAN study.ResultsForty-three (43) patients were admitted with AP. Only one patient (2.3%) was diagnosed with COVID-19 at the time of pancreatitis. Gallstones were noted to be the most common cause of AP in our population. Mortality was 7% (3 patients). Five patients (11%) needed ITU admission due to organ dysfunction. Three patients (7%) developed ARDS.ConclusionThe overall incidence of COVID-19 in pancreatitis in our population of the study was low. The incidence of COVID-19 during the first wave in Derry/Londonderry area was low and this may explain why the incidence was low in our study as well. Patients with AP in our target population were mostly elderly, one in five had moderate to severe or severe pancreatitis and in 16.3% the aetiology could not be identified. As observed in other centres globally, urgent cholecystectomy for gallstone pancreatitis faced significant delays with no patients being offered index cholecystectomy and only 4 out of 19 patients having undergone interval cholecystectomy within six months of index admission for gallstone pancreatitis in our centre.

Predictors of Hospitalization for Children With Croup, a Population-Based Cohort Study.

We sought to determine predictors of hospitalization for children presenting with croup to emergency departments (EDs), as well as predictors of repeat ED presentation and of hospital readmissions within 18 months of index admission. We also aimed to develop a practical tool to predict hospitalization risk upon ED presentation. Multiple deterministically linked health administrative data sets from Ontario, Canada, were used to conduct this population-based cohort study between April 1, 2006 and March 31, 2017. Children born between April 1, 2006, and March 31, 2011, were eligible if they had 1 ED visit with a croup diagnosis. Multivariable logistic regression was used to determine factors associated with hospitalization, subsequent ED visits, and subsequent croup hospitalizations. A multivariable prediction tool and associated scoring system were created to predict hospitalization risk within 7 days of ED presentation. Overall, 1811 (3.3%) of the 54 981 eligible children who presented to an Ontario ED were hospitalized. Significant hospitalization predictors included age, sex, Canadian Triage and Acuity Scale score, gestational age at birth, and newborn distress. Younger patients and boys were more likely to revisit the ED for croup. Our multivariable prediction tool could forecast hospitalization up to a 32% probability for a given patient. This study is the first population-based study in which predictors of hospitalization for croup based on demographic and historical factors are identified. Our prediction tool emphasized the importance of symptom severity on ED presentation but will require refinement before clinical implementation.

Secondary care usage and characteristics of hospital inpatients referred to a UK homeless health team: a retrospective service evaluation

BackgroundUK “Pathway” teams offer specialist hospital care coordination for people experiencing homelessness. Emergency healthcare use is high among homeless people, yet “homelessness” is not routinely coded in National Health Service (NHS) data. Pathway team records provide an opportunity to assess patterns in admissions and outcomes for inpatients identified as homeless.MethodsRetrospective analysis of patients referred to “Pathway” homelessness teams in seven UK hospitals to explore the patterns of hospital admission, morbidity, secondary healthcare utilisation and housing status. Each patient was individually identified as experiencing homelessness. Within a six-month period, demographic data, reason for admission, morbidity, mortality and secondary care hospital usage 120-days before and 120-days after the index admission was collected.ResultsA total of 1009 patients were referred, resulting in 1135 admissions. Most admissions had an acute physical health need (94.9%). Co-morbid mental illness and/or substance misuse was common (55.7%). Reasons for admission included mental and behavioral disorders (overdose, alcohol withdrawal or depression, 28.3%), external causes of morbidity and mortality (assault or trauma, 18.7%), and injury, poisoning and external causes (head injury, falls and fractures, 12.4%). Unplanned Emergency Department attendances reduced after index admission and unplanned hospital admissions increased slightly. Planned admissions doubled and total bed days increased. Housing status was maintained or improved for over 60% of inpatients upon discharge. Within 12 months of index admission, 50 patients (5%) died, 15 deaths (30%) occurred during the index admission.ConclusionsDisengagement with health services is common among homeless people. Many deaths are due to treatable medical conditions (heart disease, pneumonia, cancer). Observed increases in planned admissions suggests intervention from Pathway teams facilitates necessary investigations and treatment for homeless people. Equity, parity of care, and value should be inbuilt interventions for inclusion health groups and evaluations need to move beyond simply seeking cost reductions.

Previous Antithrombotic Therapy, Particularly Anticoagulant, Is Associated with Unfavorable Outcomes in Patients with Primary Spontaneous Intracerebral Hemorrhage Receiving Craniotomy: A Nationwide Population-Based Cohort Study

The impact of antithrombotic agents on patients with primary intracerebral hemorrhage (ICH) remains controversial, especially patients who require emergent craniotomy. This study was undertaken to evaluate clinical outcomes in operated patients with ICH with and without previous antithrombotic agents. This is a retrospective cohort study. Between January 2001 and December 2013, all patients with ICH who received emergent craniotomy and who were present in Taiwan's National Health Insurance Research Database were screened and divided into those with previous antiplatelet therapy, anticoagulant therapy, and nonantithrombotic therapy according to their health care claims data within 3 months of index admission. The primary end points included in-hospital mortality and complications and short-term outcome. Of 18,872 eligible patients, 16,251 (87.1%) did not receive any antithrombotic therapy, 2267 patients had antiplatelet therapy, and 354 patients had anticoagulation therapy. After propensity score matching, significantly more blood transfusions and craniectomies were identified in the patients with previous antithrombotic treatment compared with those undergoing nonantithrombotic therapy. Compared with the nonantithrombotic treatment cohort, patients under previous anticoagulant treatment had significantly higher in-hospital mortality (odds ratio, 2.12; 95% confidence interval, 1.45-3.10). Furthermore, during the 6-month follow-up period, previous anticoagulant therapy was independently associated with a greater risk of all-cause mortality (P= 0.001). The in-hospital and 6-month all-cause mortality of patients with previous antiplatelet treatment was not significantly different from patients with nonantithrombotic treatment. These findings suggested an increased risk of in-hospital mortality and poor short-term outcome among operated patients with ICH with previous antithrombotic therapy, particularly anticoagulant therapy, but not with antiplatelet therapy.

Risk Factors for Community-Acquired Extended-Spectrum Beta-Lactamase-Producing Enterobacteriaceae Infections-A Retrospective Study of Symptomatic Urinary Tract Infections.

BackgroundCommunity-acquired extended-spectrum beta-lactamase–producing Enterobacteriaceae (ESBL) infections are an evolving public health problem. Identifying predictive risk factors may improve patient management.MethodsWe identified 251 adult inpatients admitted to a 22-hospital system with an ESBL urinary tract infection (UTI) between 2001 and 2016. Cases were matched 1:1 with controls who had a UTI at admission with non-ESBL Enterobacteriaceae. Cases with a history of ESBL infections or hospitalization within 3 months of index admission were excluded. Univariate and multiple logistic regression were used to identify risk factors associated with ESBL UTIs.ResultsIn univariate analysis, history of repeated UTIs, neurogenic bladder, urinary catheter presence at admission, and exposure to outpatient third-generation cephalosporins or fluoroquinolones within 3 months were associated with higher risk of ESBL UTIs. When controlling for severity of illness and comorbid conditions, history of repeated UTIs (adjusted odds ratio [aOR], 6.40; 95% confidence interval [CI], 3.42–12.66; P < .001), presence of urinary catheter at admission (aOR, 2.36; 95% CI, 1.15–4.98; P < .05), and prior antibiotic exposure (aOR, 7.98; 95% CI, 2.92–28.19; P < .001) remained associated with risk of ESBL infection.ConclusionsPatients in the community with indwelling urinary catheters, history of recurrent UTIs, or recent antimicrobial use are at higher risk for de novo ESBL Enterobacteriaceae UTIs.

213 - Discharge Readiness Assessment and 6-month Readmission Risk in Acute Decompensated Heart Failure

Background: Attention has been paid recently to the short-term effects of discharging patients admitted for acute decompensated heart failure (ADHF) prior to achieving euvolemia, but long-term effects remain unknown. This study evaluated the influence of the discharge volume status assessment on readmissions over 6 months. Methods: This was a retrospective cohort study of 100 consecutive adult patients discharged from a single academic hospital admission for management of ADHF from May, 2014 to June, 2015. Exclusion criteria included characteristics of the patient (ESRD on HD, congenital heart disease, or LVAD in place) and the hospitalization (discharge within 6 months of index admission or surgery/death during hospitalization). Baseline characteristics were obtained from the admission H&P and primary data reports. Discharge characteristics were obtained solely from the discharge summary (DS). Co-primary outcomes were 6-month readmission for all-cause and HF as primary diagnosis, assessed by chart review. Comparisons were made by chi-square testing for categorical variables and independent samples t-testing or Kruskal-Wallis testing for continuous variables. Results: Mean age was 62.1 years (SD 15.3), 44% were women, and the average BMI was 33.9 kg/m2 (SD 11.6). Hypertension (87%), history of tobacco use (68%), hyperlipidemia (59%), coronary artery disease (44%), and diabetes (42%) were common. Ejection fraction was preserved (>40%) in 46%. All-cause 6-month readmission occurred in 51% and HF-related 6-month readmissions occurred in 38%. In the DS physical exam, traditional markers of volume status were documented at similar rates in those who were and were not readmitted, except for absence of edema, which was more commonly documented in those not readmitted (82.6 vs. 56.3%, P = .04). A clear discussion in the DS that the patient had achieved euvolemia was similarly documented between those readmitted and those not (17.6 vs. 18.4%, P = .93). In the DS assessment section, no markers of volume status to justify discharge reached statistical significance except dyspnea resolution, which was more commonly cited in those not readmitted (40.8 vs. 23.5%, P = .06). These differences remained significant if HF was the primary readmission diagnosis. Conclusions: The presence or absence of clinical euvolemia as measured by DS physical exam and heart failure assessment was not associated with readmission rate. This long-term outcome possibly reflects long-term disease severity rather than the management practices during a singular admission.

Unwarranted Variation in the Quality of Care for Patients With Diseases of the Thoracic Aorta.

BackgroundThoracic aortic disease has a high mortality. We sought to establish the contribution of unwarranted variation in care to regional differences in outcomes observed in patients with thoracic aortic disease in England.Methods and ResultsData from the Hospital Episode Statistics (HES) and the National Adult Cardiac Surgery Audit (NACSA) were extracted. A parallel systematic review/meta‐analysis through December 2015, and structure and process questionnaire of English cardiac surgery units were also accomplished. Treatment and mortality rates were investigated. A total of 24 548 adult patients in the HES study, 8058 in the NACSA study, and 103 543 from a total of 33 studies in the systematic review were obtained. Treatment rates for thoracic aortic disease within 6 months of index admission ranged from 7.6% to 31.5% between English counties. Risk‐adjusted 6‐month mortality in untreated patients ranged from 19.4% to 36.3%. Regional variation persisted after adjustment for disease or patient factors. Regional cardiac units with higher case volumes treated more‐complex patients and had significantly lower risk‐adjusted mortality relative to low‐volume units. The results of the systematic review indicated that the delivery of care by multidisciplinary teams in high‐volume units resulted in better outcomes. The observational analyses and the online survey indicated that this is not how services are configured in most units in England.ConclusionsChanges in the organization of services that address unwarranted variation in the provision of care for patients with thoracic aortic disease in England may result in more‐equitable access to treatment and improved outcomes.

Middlemore Hospital experience with tubo-ovarian abscesses: an observational retrospective study.

AimThe aim of this paper was to study the characteristics of patients presenting to Middlemore Hospital with tubo-ovarian abscess (TOA) and to compare the outcomes of conservative medical management versus medical management with surgical drainage and medical management with radiological drainage.MethodsAll patients admitted with a radiologically or surgically proven TOA between January 01, 2008 and December 31, 2010, were included and followed up until June 30, 2011. The total number of patient/index admission was 174.ResultsThe mean age of patients was 37.8 years. One hundred thirty patients had medical treatment only with hospitalization and antibiotics, and 44 patients were managed with antibiotics and surgical drainage. Complete resolution of TOA was 77.3% (99/128) for patients managed medically and 93.2% (41/44) for patients managed surgically. When the two groups were compared, patients who were managed surgically were more likely to have complete resolution of TOA within 6 months of index admission with an odds ratio (OR) of 4 and a P-value of 0.029. There was no statistically significant difference in the secondary outcomes namely of readmission with TOA (OR: 0.47) and the need for repeat surgical or radiological drainage (OR: 1.48). Nonetheless, the relative duration of hospitalization was longer for the surgical group with a P-value of <0.0001. The C-reactive protein and the size of TOA were the significant factors involved in the resolution of TOA.ConclusionThe results of this study confirmed our initial hypothesis that we should consider surgical drainage more often, probably earlier, especially for the younger patients still desiring fertility preservation and for larger abscesses. Laparoscopic surgical drainage is safe and could be used as the procedure of choice. Conservative medical management is still acceptable with good cure rates of 77%. C-reactive protein and the size of the abscess were the important factors to consider when managing patients with TOA.

Prescription of emergency antiepileptic medication after a first childhood seizure: analysis of routine administrative data.

UK guidelines do not recommend prescribing emergency antiepileptic drugs after first simple febrile seizures or for single afebrile seizures. Non-adherence to the guidelines could result in substantial health service cost. Scottish national hospital discharge records were used to identify children aged one month to 4 years admitted for a first febrile seizures or single afebrile seizures between April2009 and March2012. Prescriptions for antiepileptic drugs within 12 months of index admission were identified on the national community prescribing database by matching unique patient identifiers. There were 1,978 and 663 children admitted for febrile seizures and single afebrile seizures, respectively. Onepercent of children admitted with febrile seizures and 1.7% with single afebrile seizures had a subsequent community prescription record for emergency antiepileptic drugs within 12 months of index admission. Total cost of emergency antiepileptic drugs following febrile seizures and single afebrile seizures for the study period was just over £900. Health care providers and policy makers can be reassured that emergency antiepileptic drugs are not being inappropriately overprescribed for febrile seizures and single afebrile seizures.

Impact of an inpatient geriatric consultative service on outcomes for cognitively impaired patients.

Impact of geriatric consultative services (GCS) on hospital readmission and mortality outcomes for cognitively impaired (CI) patients is not known. Evaluate impact of GCS on hospital readmission and mortality among CI inpatients. Secondary data analysis of a prospective trial of a computerized decision support system between July 1, 2006 and May 30, 2008. Study conducted at Eskenazi hospital, Indianapolis, Indiana, a 340-bed, public hospital with over 2300 yearly admissions of patients ages 65 years or older. There were 415 inpatients aged 65 years and older with CI enrolled from July 2006 to March 2008. Thirty-day and 1-year mortality and hospital readmission following the index admission. Cox proportional hazard models were used to determine the association between receiving GCS, readmission, or mortality while adjusting for demographics, discharge destination, delirium, Charlson Comorbidity Index, and prior hospitalizations. The propensity score method was used to adjust for the nonrandom assignment of GCS. Patients receiving GCS were older (79 years old, 8.1 standard deviation [SD] vs 76 years old, 7.8 SD; P < 0.001) with higher incidence of delirium (49% vs 29%; P < 0.001). No significant differences were found between the groups for hospital readmission (hazard ratio [HR] = 1.19; 95% confidence interval = 0.89-1.59) and mortality at 12 months of index admission (HR = 0.91; 95% confidence interval = 0.59-1.40). However, a significant increase in readmissions was observed for the GCS group (HR = 1.75; 95% confidence interval = 1.06-2.88) at 30 days postdischarge. One-year postdischarge outcomes of CI patients who received GCS were not different from patients who did not receive the service. New models of care are needed to improve postdischarge readmission and mortality among hospitalized patients with CI.

PTH-144 Nationwide Study Of Emergency Admissions To Acute Hospitals In England For Anorexia Nervosa: Implications For Marsipan

IntroductionPatients with anorexia nervosa (AN) develop significant physical complications leading to emergency admission (EmAd) to acute hospitals. There are few data on national burden, institutional case volume, frequency, nature or...

Risk of venous thromboembolism among hospitalized medically ill patients

The 90-day risk of venous thromboembolism (VTE) among medically ill patients admitted to a hospital was estimated and is discussed. Patients aged > or =40 years who were hospitalized between January 1, 1998, and June 30, 2002, for reasons other than traumatic injury, labor and delivery, mental disorder, or VTE and who did not undergo surgery were identified in a large U.S. healthcare claims database. Patients receiving anticoagulants in the 90-day period preceding hospital admission were excluded. We estimated the percentage of study subjects who developed clinical deep-vein thrombosis (DVT) or pulmonary embolism (PE) within 90 days of hospital admission using Kaplan-Meier methods. We also estimated hazard ratios (HRs) for potential risk factors for VTE using univariate and stepwise multivariate Cox proportional hazards regression models. Among 92,162 study subjects, 1468 (1.59%) developed clinical DVT or PE within 90 days of hospital admission; 18% of these events occurred postdischarge. In multivariate analyses, significant risk factors for clinical VTE included: 1) history of cancer (HR, 1.67; 95% confidence interval [CI], 1.45-1.93); 2) history of VTE within six months of index admission (HR, 6.14; 95% CI, 4.74-7.96); 3) operating room procedure within 30 days of index admission (HR, 1.81; 95% CI, 1.47-2.24); 4) peripheral artery disease during index admission (HR, 1.68; 95% CI, 1.28-2.21); and 5) heart failure during index admission (HR, 1.72; 95% CI, 1.52-1.95). The risk of clinical VTE among medically ill patients admitted to a hospital, although less than that of patients undergoing major surgery, is not negligible. Patients with a history of recent VTE or surgery, those who are admitted to the intensive care unit, those with an admitting diagnosis of heart failure, and those with active cancer are at especially high risk of VTE and deserve increased consideration for prophylaxis.