Patient Length Of Stay Research Articles

PAIN IN INFLAMMATORY BOWEL DISEASE (IBD): DOES OPIOID USE PREDICT WORSE HOSPITAL OUTCOMES?

Abstract BACKGROUND Opioid use has been hypothesized to be a marker for increased severity of (IBD) for patients because those patients are more likely to require surgical intervention and have uncontrolled pain. Previous studies have not compared outcomes between patients with opioid use and dependence with IBD compared to patients with IBD not using opioids. Our study aims to investigate hospital mortality, hospital length of stay (LOS), and total charges between both patient groups. METHODS Data were extracted from the National Inpatient Sample (NIS) 2016-2019 Database. The NIS was searched for hospitalizations for adult patients with IBD, including ulcerative colitis (UC) and Crohn’s (CD), as a principal discharge diagnosis with opioid use and dependence as a secondary diagnosis using ICD-10 codes. The primary outcome was inpatient mortality. Multivariate logistic and linear regression analysis was used accordingly to adjust for confounders. STATA software was used for analysis. RESULTS Among 1,165,075 patients who had IBD, 33,195 (2.8%) had concomitant opioid usage and dependence. The adjusted odds ratio (OR) for inpatient mortality (OR +2.8, p<0.018), LOS (+1.47 days, p<0.0001), and total hospital charges (+8,982, p<0.0001) for IBD and opioid use compared to those with only IBD were all statistically significant. Independent positive predictors of increased mortality were the following: fistula formation (OR 3.06), hematochezia (OR 2.85), electrolyte abnormalities (OR 1.48), bowel resection (OR 1.37), older age (OR 1.05) [p <0.0001 for all]. Interestingly, colonoscopy (OR 0.48, p<0.0001) and females (OR 0.79, p<0.0001) had less mortality. Independent positive predictors of increased LOS and total hospital charges were the following: fistula formation (+4.9 days, +$53,176 p<0.0001 for both), bowel obstruction (+1.2 days, +$9,228 p<0.0001 for both), hematochezia (+1.0, +14,977 days, p<0.0001 for both), electrolyte abnormalities (+2.0 days, +$16,793, p<0.0001, for both), colonoscopy (+1.9 days, +14,796, p<0.0001 for both), bowel resection (+4.5 days, +66,206, p<0.0001 for both). Total charges were also increased for Asian patients (+11,388, p<0.0001) and Hispanic patients (+10,177, p<0.0001). CONCLUSION Our study shows that there is significantly increased mortality, hospital LOS, and total charges for the subpopulation of IBD patients with opioid use and dependence. The presence of fistula formation, hematochezia, electrolyte abnormalities, older age, and prior bowel resection also portends higher mortality. Pain is a common complaint in patients with IBD and leads to increased morbidity. Our study is significant because it illustrates the importance of pain management in IBD and highlights the detrimental outcomes that come with opioid use and dependence. Further randomized trials would be helpful to study this patient population.

Association Between Preoperative Blood Glucose Level and Hospital Length of Stay in Patients With Kidney Stones Undergoing Percutaneous Nephrolithotomy.

AimTo assess the effect of preoperative blood glucose (POBG) levels on the length of stay (LOS) in patients with kidney stones undergoing percutaneous nephrolithotomy (PCNL).MethodsWe conducted a retrospective study of patients who underwent PCNL at the Zhongda Hospital of Southeast University from 2013 to 2019. The relationship between POBG level and LOS was investigated by dose-response analysis curves of restricted cubic spline function.ResultsWe included 310 patients and divided them into three groups (<5.04, 5.04 to <6.88, ≥6.88 mmol/L) according to the POBG levels. Patients with POBG levels ≥6.88 mmol/L (adjusted odds risk [aOR] 1.67; 95% CI 0.83–3.33) had a 67% higher risk of LOS > 2 weeks than patients with POBG levels <5.04 mmol/L. A positive dose-response analysis curve was observed between POBG and the adjusted risk of LOS >2 weeks. Similar results were observed in the subgroups analysis.ConclusionWe demonstrated that higher POBG levels were significantly associated with longer LOS in patients with kidney stones undergoing PCNL.

Retrospective trends in length of stay and bowel management at discharge from inpatient rehabilitation among individuals with spinal cord injury.

Retrospective observational cohort study. To describe the trend in length of stay (LOS) and its association with the rate of individuals needing total assistance with bowel management upon discharge from inpatient spinal cord injury (SCI) rehabilitation facilities. Participants enrolled in the National Spinal Cord Injury Model Systems (NSCIMS) database. The NSCIMS database was used to obtain bowel management characteristics from individuals (n = 15,975) aged 15 years or older discharged from inpatient rehabilitation facilities between 1988 and 2016 with known demographic factors and LOS. Levels of bowel management were defined from the functional independence measure (FIM) based on the level of assistance required to complete a bowel program. To control for changes in participant population and injury characteristics over the study period, the inverse probability of treatment weight (IPTW) technique was used. Linear and logistic regressions and the Spearman correlation coefficient were used for statistical analyses. The LOS significantly decreased more than ¾ of a day on average each year from 1988 (LOS: 83.16 days) to 2016 (LOS: 50.53 days). Concurrently, the odds of needing total assistance in bowel management at discharge increased 4.1% each year. The correlation between these trends was moderate (-0.63). Association analyses yielded that a 1-day decrease in average LOS was associated with a 0.53% increase in those needing total assistance for bowel management at discharge. Over the years, as inpatient rehabilitation LOS decreased, rates of those needing total assistance for bowel management at discharge increased.

Association Between Patient Diversity in Hospitals and Racial/Ethnic Differences in Patient Length of Stay.

Hospitals serving a disproportionate share of racial/ethnic minorities have been shown to have poorer quality outcomes. It is unknown whether efficiencies in inpatient care, measured by length of stay (LOS), differ based on the proportion patients served by a hospital who are minorities. To examine the association between the racial/ethnic diversity of a hospital's patients and disparities in LOS. Retrospective cross-sectional study. One million five hundred forty-six thousand nine hundred fifty-five admissions using the 2017 New York State Inpatient Database from the Healthcare Cost and Utilization Project. Differences in mean adjusted LOS (ALOS) between White and Black, Hispanic, and Other (Asian, Pacific Islander, Native American, and Other) admissions by Racial/Ethnic Diversity Index (proportion of non-White patients admitted to total patients admitted to that same hospital) in quintiles (Q1 to Q5), stratified by discharge destination. Mean LOS was adjusted for patient demographic, clinical, and admission characteristics and for individual intercepts for each hospital. In both unadjusted and adjusted analysis, Black-White and Other-White mean LOS differences were smallest in the most diverse hospitals (Black-White: unadjusted, -0.07 days [-0.1 to -0.04], and adjusted, 0.16 days [95% CI: 0.16 to 0.16]; Other-White: unadjusted, -0.74 days [95% CI: -0.77 to -0.71], and adjusted, 0.01 days [95% CI: 0.01 to 0.02]). For Hispanic patients, in unadjusted analysis, the mean LOS difference was greatest in the most diverse hospitals (-0.92 days, 95% CI: -0.95 to -0.89) but after adjustment, this was no longer the case. Similar patterns across all racial/ethnic groups were observed after analyses were stratified by discharge destination. Mean adjusted LOS differences between White and Black patients, and White and patients of Other race was smallest in most diverse hospitals, but not differences between Hispanic and White patients. These findings may reflect specific structural factors which affect racial/ethnic differences in patient LOS.

Comparison of Hospital Length of Stay and Supportive Care Utilization Between Patients Treated with CPX-351 and 7+3 for Therapy-Related Acute Myeloid Leukemia or Acute Myeloid Leukemia with Myelodysplasia-Related Changes.

PurposeCPX-351 is dual-drug liposomal encapsulation of daunorubicin and cytarabine at a fixed synergistic 1:5 molar ratio. This study determined current real-world use of CPX-351 versus conventional 7+3 (cytarabine+daunorubicin) therapy and evaluated hospital length of stay (LOS) and supportive care utilization in t-AML and AML-MRC.Patients and MethodsThis retrospective, observational study utilized the Premier Healthcare Database and included patients who were aged ≥18 years with t-AML or AML-MRC and treated with CPX-351 or 7+3 between August 1, 2017 and February 28, 2019. All patients treated with 7+3 were required to be eligible for CPX-351 based on its FDA-approved indication. Outcome variables were annualized and adjusted for patient, hospital, and clinical confounding factors. The primary outcome was inpatient LOS. Secondary outcomes included use of blood products and use of anti-infectives.ResultsThe study included 195 qualifying patients treated with CPX-351 and 160 patients treated with 7+3 who were eligible for CPX-351. Approximately one-third of the patients treated with CPX-351 were administered therapy in a hospital-based outpatient setting, and all patients treated with 7+3 received it in the inpatient setting. The regression-adjusted annualized inpatient LOS was shorter with CPX-351 than 7+3 (mean of 183.7 vs 197.1 days, p<0.001). The difference in mean-adjusted LOS was most pronounced for t-AML, with a mean-adjusted LOS of 168.9 versus 192.5 days for CPX-351 versus 7+3, respectively (nominal p<0.001). Supportive care utilization, including the number of administrations of red blood cells, the number of administrations of platelets, and the number of days on anti-infectives, was similar between treatment groups.ConclusionCPX-351 was associated with a shorter inpatient LOS than 7+3. Supportive care use, including blood products and anti-infectives, was similar for CPX-351 and 7+3. These findings suggest CPX-351 conveys resource advantages over 7+3 in patients with newly diagnosed t-AML and AML-MRC.

Meta-Analysis the Effectiveness of Ivermectin Use on the Length of Stay in Inpatients of COVID-19

Background: COVID-19 is a common problem in global health. COVID-19 is a disease that infects the respiratory tract caused by the Coronavirus virus. Symptoms range from mild to severe and life-threatening pneumonia can occur. At the beginning of the PSBB, information circulated that Ivemectin could treat COVID-19 infections. Ivermectin is an antiparasitic drug that can be used as prophylaxis and therapy for coronavirus disease 2019. Ivermectin is an alternative therapy for COVID-19 because there is a previous drug, chloroquine, which can be used to treat COVID-19. This study aims to estimate the effectiveness of Ivermectin on the duration of hospitalization of patients with COVID-19 based on the results of previous similar studies. Subjects and Method : This study is a meta-analysis with the following PICO, population: COVID-19 patients. Intervention: ivermectin. Comparison: standard therapy. Outcome: shorter duration of hospital stay. Meta-analyses and systematic studies using the PubMed, Scopus, Scholar, Springlink, Cochrane, Clinical Key, and Science Direct databases. Keywords using Ivermectin AND RCT AND COVID-19 AND “Coronavirus Disease” AND “NCOV disease” AND “COVID-19 treatment”. The article under study is a full-text article with a randomized controlled clinical trial (RCT) study design. Articles were collected using PRISMA diagrams and analyzed using Review Manager 5.3. Results A total of 9 Randomized Control Trial (RCT) studies from Europe, America, Asia and Africa were selected for systematic review and meta-analysis. COVID-19 patients receiving Ivermectin therapy decreased the duration of hospital stay by 1.52 units compared to standard therapy and this result was statistically significant (SMD= -1.52; 95% CI= -2.34 to -0.70; p= 0.003). Conclusion: Ivermectin can reduce the duration of hospital stay for COVID-19 patients. Keywords: COVID-19, ivermectin, duration hospital stay Correspondence: Masromi Hendria Wijayanto. Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami 36A, Surakarta 57126, Jawa Tengah. Email: masromi­hendria@gmail.com. Mobile: 0895402471549. Indonesian Journal of Medicine (2022), 07(02): 200-208 https://doi.org/10.26911/theijmed.2022.07.02.08

The Relationship Between Preoperative Physical Activity With American Society of Anesthesiologists Score and Postoperative Length of Stay in Patients Undergoing Radical Prostatectomy.

The relationship between preoperative physical activity (PA) and hospital length of stay (LOS) following radical prostatectomy (RP) is poorly understood. In addition, the relationship between PA and the American Society of Anesthesiologists Physical Status score (ASA PS), an established prognosticator of surgical risk, has not been studied. The authors assessed the relationship between leisure-time PA (LTPA), ASA PS, and LOS in individuals undergoing RP. This retrospective cohort study was conducted using data from an institutional database. Ordinal logistic regression was used to assess the relationship between preoperative LTPA and physical status as indicated by the ASA PS. Binary logistic regression was used to assess the relationship between preoperative LTPA and LOS. A sample of 1064 participants were included in the analyses. The participants in the highest preoperative LTPA quartile had 45% reduced odds (P = .015) of a worse ASA PS classification compared with participants in the lowest quartile. The participants engaging in vigorous LTPA preoperatively had 35% lower odds (P = .014) of a >2-day LOS following RP compared with participants who were not engaging in preoperative vigorous LTPA. Our findings suggest that total and vigorous preoperative LTPA is associated with improved preoperative American Society of Anesthesiologists scores and LOS following RP, respectively.

乳がん患者における術前の2ステップ値と術後の在院日数との関連

乳がん患者における術前の2ステップ値と術後の在院日数との関連

Obese gastroparesis inpatient admissions: trends and outcomes from 2007-2017 in the United States.

BackgroundThe aim of this study was to investigate obese gastroparesis (GP) hospitalizations in the United States (US).MethodsWe analyzed the National Inpatient Sample (NIS) from 2007-2017 to identify all adult obese (body mass index ≥30 kg/m2) GP hospitalizations. These were compared with non-obese GP hospitalizations. The demographic trends, adverse outcomes, and healthcare burden were analyzed.ResultsFrom 2007-2017, obese GP hospitalizations accounted for 13.75% of all GP hospitalizations in the US. There was an increasing trend in obese GP hospitalizations, from 2286 in 2007 to 47,265 in 2017 (P=0.0019), and in the proportion of obese GP hospitalizations, from 6.16% in 2007 to 17.96% in 2017 (P<0.001). Males, Blacks, Hispanics, and Asians showed a rising trend in obese GP hospitalizations. Although rates of upper endoscopy declined from 8.28% in 2007 to 5.36% in 2017 (P<0.001), obese GP hospitalizations had higher rates of upper endoscopy utilization (6.05 vs. 5.42%, P<0.001) compared to the non-obese cohort. Inpatient mortality for obese GP hospitalizations increased from 0.64% in 2007 to 1.10% in 2017 (P<0.001). Furthermore, we noted a rising trend in mean length of stay (LOS), from 4.64 in 2007 to 6.05 days in 2017 (P=0.0029), and mean total hospital charge (THC), from $22,306 in 2007 to $62,220 in 2017 (P<0.001) for obese GP hospitalizations.ConclusionsThe prevalence of obese GP hospitalizations along with inpatient mortality, LOS, and THC rose significantly. However, the overall rate of upper endoscopy utilization has decreased for these patients.

Brain tumor craniotomy outcomes for dual-eligible medicare and medicaid patients: a 10-year nationwide analysis.

Dual-eligible (DE) patients, simultaneous Medicare and Medicaid beneficiaries, have been shown to have poorer clinical outcomes while incurring higher resource utilization. However, neurosurgical oncology outcomes for DE patients are poorly characterized. Accordingly, we examined the impact of DE status on perioperative outcomes following glioma, meningioma, or metastasis resection. We identified all admissions undergoing a craniotomy for glioma, meningioma, or metastasis resection in the National Inpatient Sample from 2002 to 2011. Assessed outcomes included inpatient mortality, complications, discharge disposition, length of stay (LOS), and hospital costs. Multivariable regression adjusting for 13 patient, severity, and hospital characteristics assessed the association between DE status and outcomes, relative to four reference insurance groups (Medicare-only, Medicaid-only, private insurance, self-pay). Of 195,725 total admissions analyzed, 3.0% were dual-eligible beneficiaries (n = 5933). DEs were younger than Medicare admissions (P < 0.001) but older than Medicaid, private, and self-pay admissions (P < 0.001). Relative to other insurance groups, DEs also exhibited higher severity of illness, risk of mortality, and Charlson Comorbidity Index scores as well as treatment at low-volume hospitals (all P < 0.001). DEs had lower mortality than self-pay admissions (odds ratio [OR] 0.47, P = 0.017). Compared to Medicare, Medicaid, private, and self-pay admissions, DEs had lower rates of discharge disposition (OR 0.53, 0.50, 0.34, and 0.27, respectively, all P < 0.001). DEs also had higher complications (OR 1.23 and 1.20, respectively, both P < 0.05) and LOS (β = 1.06 and 1.13, respectively, both P < 0.01) than Medicare and private insurance beneficiaries. Differences in discharge disposition remained significant for all three tumor subtypes, but only glioma DE admissions continued to exhibit higher complications and LOS. DEs undergoing definitive craniotomy for brain tumor had higher rates of unfavorable discharge disposition compared to all other insurance groups and, especially for glioma surgery, had higher inpatient complication rates and LOS. Practice and policy reforms to improve outcomes for this vulnerable clinical population are warranted.

Association between emergency department length of stay and patient outcomes: A systematic review.

In this review, we investigate associations between time spent in the emergency department (ED) and patient reported outcomes. ED staff provide initial assessment, treatment and referral to patients presenting with an acute status to the hospital 24 h a day. ED length of stay, including ED boarding, and treatment received in the ED may affect patient outcomes. In this review we considered published studies that explored the association of ED length of stay of individuals of any age with their subsequent outcomes, including mortality and inpatient length of stay (IPLOS). Joanna Briggs Institute methods for systematic reviews of association were followed. Search strategies were developed to identify studies published in English since 2000 for inclusion. Two reviewers assessed the studies for inclusion and methodological quality and extracted data independently. In total, 34 studies were included in the review, including one case-control, one analytical cross-sectional, and 32 retrospective cohort studies, with a total sample size of 2,308,840 patients. Overall, there were variable associations of time spent in the ED and mortality, IPLOS, time-to-treatment and adverse events. However, findings indicated that older people are at risk for longer ED stays. They may also experience higher mortality. Specific focus should be placed upon elderly people in the ED, to reduce their exposure to the ED environment where possible and to implement focused initiatives that address their specific and complex treatment needs. We conclude that the diversity of individual settings and health systems will require locally defined and relevant solutions to locally identified issues.

Effect of a Multiorgan Focused Clinical Ultrasonography on Length of Stay in Patients Admitted With a Cardiopulmonary Diagnosis

There are accumulating data about the utility of diagnostic multiorgan focused clinical ultrasonography (FCU) in the assessment of patients admitted with cardiopulmonary symptoms. To determine whether adding multiorgan FCU to the initial clinical evaluation of patients admitted with cardiopulmonary symptoms reduces hospital length of stay, hospital readmissions, and in-hospital costs. This is a prospective, parallel-group, superiority, randomized clinical trial with a 1:1 allocation ratio. The study was conducted at The Royal Melbourne Hospital, a tertiary public hospital located in Melbourne, Victoria, Australia. Adults aged 18 years or older admitted to the internal medicine ward with a cardiopulmonary diagnosis were enrolled between September 2018 and December 2019 and were followed up until hospital discharge. Data analysis was performed from August 2020 to January 2021. The intervention involved an internal medicine physician-performed heart, lung, and 2-point vein compression FCU in addition to standard clinical evaluation. The primary outcome was the difference in the mean length of hospital stay, defined as the number of hours from admission to the internal medicine ward to hospital discharge. A difference of 24 hours was defined as clinically important. Secondary outcomes included hospital readmissions at 30 days and hospital care costs. A total of 250 participants were enrolled and 2 were excluded, leaving 248 participants (mean [SD] age, 80.1 [11.0] years; 121 women [48.7%]) in the final analysis. There were 124 patients in the intervention group and 124 patients in the control group. The most common initial diagnoses were acute decompensated heart failure (113 patients [45.5%]), pneumonia (45 patients [18.1%]), and exacerbated chronic pulmonary disease (32 patients [12.9%]). The length of hospital stay was 113.4 hours (95% CI, 91.7-135.1 hours) in the FCU group and 125.3 hours (95% CI, 101.7-148.8 hours) in the control group (P = .53). The 30-day readmission rate was not different between groups (FCU vs control, 20 of 124 patients [16.1%] vs 15 of 124 patients [12.0%]), nor were total in-hospital costs (FCU vs control, A$7831.1 [95% CI, A$5586.1-A$10 076.1] vs A$7895.7 [95% CI, A$6385.9-A$9.405.5]). In this randomized clinical trial, adult patients admitted to an internal medicine ward with a cardiopulmonary diagnosis, who underwent multiorgan FCU of the heart, lungs, and lower extremities veins during their initial clinical assessment, did not have a shorter hospital length of stay by more than 24 hours, compared with patients who received standard care. Australian New Zealand Clinical Trials Registry Identifier: ACTRN12618001442291.

65 &amp; Thrive: Improving Patient Length of Stay, Readmission, and Quality of Care by Becoming an Age-Friendly Hospital

Data indicates that older persons will increase in numbers along with having an increase of life expectancy in the United States. Kaiser Permanente Los Angeles Medical Center’s Utilization Department developed “65 & Thrive”—an age-specialized initiative to provide holistic care that preserves independence, quality of life, prevents functional and cognitive decline, and promotes both patients and their families to continue thriving. The initiative’s focus is guided by the 5 M’s model on mobility, medication, mentation, multi-morbidity, and what matters. Case management staff were given age-sensitivity trainings, improved workflows and made assessments that identified, addressed, and secured resources for patients throughout their hospitalization. Silver Angel volunteers were specially trained to prevent physical and mental decline and focused on activities to prevent delirium, depression and falls. The volunteers visited with patients daily for these interactions. The initiative was piloted in April 2020 on a stroke telemetry unit and since then the hospital has seen a significant decrease in the overall annual readmission rates by 3.1% when compared to 2019. The average length of stay for older adult patients; however, increased from 4.05 to 4.83 days unfortunately due to COVID-19. This initiative demonstrates the necessity to expand “65 & Thrive” throughout the hospital and ultimately to other Kaiser Permanente medical centers to best provide holistic care to older adults.

65 &amp; Thrive: Improving Patient Length of Stay, Readmission, and Quality of Care by Becoming an Age-Friendly Hospital

Despite its importance for health and wellbeing, oral health quality of life (OHQoL) has received little attention in lower-income countries, such as Colombia. This study describes the prevalence of older adults’ OHQoL and variability by socioeconomic status. We use data from the 2015 SABE-Colombia (N=18,700), a nationally representative survey of community-dwelling Colombians ages 60 and older. We used the Simple Count Geriatric Oral Health Assessment Index (SC-GOHAI), a self-reported measure of frequent oral health problems such as chewing, swallowing, and speaking designed to assess OHQoL. The scale ranges from 0-12; higher scores indicate worse OHQoL. About 69% of older Colombians reported at least one OHQoL problem. The most common issues were difficulty chewing hard food and speaking. High education and income were associated with better OHQoL and smoking were associated with worse OHQoL. Oral health may therefore reflect another dimension of social and health inequality for older Colombians.

Factors Affecting Inpatient Mortality and Length of Stay in Nonmetastatic Colorectal Cancer: Insights from the National Inpatient Sample.

The objective of this study was to assess the effect of opioid use and other factors on inpatient length of stay (LOS) and mortality among patients hospitalized with nonmetastatic colorectal cancer (NMCRC). We analyzed discharge encounters collected from the 2016 to 2017 National Inpatient Sample (NIS) to evaluate the effect of long-term opioid use (90 d or longer) and cancer-related complications on LOS and mortality among hospitalized patients with NMCRC. A total of 94,535 patients with NMCRC were included in the analysis. Long-term opioid users had a shorter average LOS and reduced inpatient mortality as compared with nonopioid users (5.97±5.75 vs. 6.66±6.92 d, P<0.01; and adjusted odds ratio=0.72, 95% confidence interval: 0.56-0.93, respectively). Factors that significantly increased both LOS and mortality included infection, venous thromboembolism, and chemotherapy-induced neutropenia; the average LOS was 2.7, 2.6, and 0.7 days longer, and the adjusted odds ratio for risk of inpatient mortality was 3.7, 1.2, and 1.2, respectively (P<0.05), for patients admitted with these cancer-related complications. Long-term opioid use is associated with decreased LOS and inpatient mortality among patients with NMCRC. Individuals admitted for cancer-related complications face a longer LOS and increased mortality as compared with those admitted without these morbidities.

Rehabilitation Length of Stay, Body Mass Index, and Functional Improvement Among Adults With Traumatic Spinal Cord Injury

ObjectiveTo examine the modifying effect of body mass index (BMI) on the association between rehabilitation length of stay (LOS), severity of injury, and motor FIM (mFIM) improvement in patients with traumatic spinal cord injury (TSCI). DesignRetrospective cohort study. SettingSeventeen SCI Model Systems (SCIMS) centers in the United States. ParticipantsA total of 3413 patients (N=3413) who had a TSCI were admitted to an SCIMS between October 2011 and August 2018. InterventionsNot applicable. Main Outcome MeasuresThe mFIM (12 items) improvement by discharge. Four rehabilitation LOS groups split by quartiles were created for each neurologic severity of injury group (C1-C4 level with American Spinal Injury Association Impairment Scale [AIS] ABC, C5-C8 AIS ABC, T1-S3 AIS ABC, AIS DE). The interrelationship among rehabilitation LOS, BMI, and mFIM improvement were examined using multivariate linear regressions. A stratified analysis was performed to examine the association between rehabilitation LOS and mFIM improvement by BMI status (underweight or normal weight, overweight, obesity) and neurologic groups. ResultsA total of 1099 (32.2%) and 821 (24.1%) patients were overweight and had obesity, respectively. Patients with obesity had less improvement in mFIM than those who were underweight or normal weight (unit of mFIM improvement, −3.71). After stratifying by BMI status, among patients with obesity, those with the longest rehabilitation LOS showed greater improvement in mFIM than those in the shortest LOS (unit of mFIM improvement=4.78). ConclusionsLonger inpatient rehabilitation LOS may benefit patients with TSCI by increasing mFIM improvement by discharge. Obesity is negatively associated with mFIM improvement.

Abstract 10124: Chronic Kidney Disease as Predictor for Length of Stay in Patients with New-Onset Atrial Fibrillation with Rapid Ventricular Response

Background: Atrial fibrillation with rapid ventricular response (AFib with RVR) is an arrhythmia caused by the atria of the heart beating chaotically and irregularly and is frequently associated with worse outcomes in chronic kidney disease (CKD). We sought to investigate the length of stay (LOS) in patients presenting at the emergency department with Afib with RVR and a history of CKD. Methods: Comorbidity, clinical outcomes and length of stay (LOS) were analyzed retrospectively in a cohort of 1638 patients presenting with new-onset of Afib with RVR at the emergency department from 2013 to 2018. Patients with a history of CKD vs. no history of CKD were compared using descriptive statistics, chi-square and Mann-Whitney tests. Results: The 343 patients admitted with a history of CKD had a median [IQR] glomerular filtration rate of 42 [29.4-51], were older 76(10.4) vs. 70.4(14) years of age, p&lt;.0001, were more likely to be African American 12.5% vs. 6.7% p=0.025,OR 1.99 [1.352-2.93] and had a higher median (IQR) CHA 2 DS 2 -VASc score of 5[4-6] vs. 4[2-5] (P&lt;.0001), and their median LOS was 4[2-6] vs.3[1-4] (Fig 1). Conclusion: CKD patients admitted with new-onset of Afib with RVR required additional care and longer LOS. Prevalence of other comorbidities is higher in this population, including heart failure and hypertension (most common), and thyroid disorder and COPD (least common).

Abstract 13415: Initial Diuretic Dosing and Length of Stay in Patients Hospitalized for Congestive Heart Failure

Background: Among patients hospitalized for heart failure, a prior randomized trial suggests the initial dose of diuretics may have implications on time to decongestion and length of hospital stay. Little is known about the dosing of intravenous loop diuretics in routine clinical practice and the association between diuretic dosing and hospital length of stay. Methods: We identified 12,209 patients admitted with heart failure at 12 Allina Health hospitals in central Minnesota and western Wisconsin between January 1, 2017 and December 31, 2020. We excluded patients on observational status, no or unknown home loop diuretic dosing, no intravenous loop diuretic within 24 hours of admission, and patients who received inotropes or dialysis within 24 hours of admission. Initial diuretic dose was compared to home dose in furosemide equivalents using the Diuretic Strategies in Patients with Acute Decompensated Heart Failure trial logic and categorized into below home dose, equivalent to home dose, or above home dose. We describe patient characteristics and length of stay by category of initial diuretic dose. Results: Among 3,580 admitted for heart failure, initial diuretic dose was below home dose in 555 (15%) patients, equivalent to home dose in 756 (21%) patients, and above home dose in 2269 (64%) patients. Baseline characteristics by category of initial diuretic dose are presented in the Table. Mean length of stay was longest in patients receiving a diuretic dose that was below home dose (6.4 days) and shortest in patients receiving a dose above home equivalent (5.0 days) (Table). Conclusions: In a cohort of patients admitted for heart failure, more than 1 in 3 patients received an initial dose of intravenous loop diuretics that was equivalent to or below their home diuretic dose and this was associated with a longer length of hospital stay. These findings may represent a quality improvement opportunity in the care of patients hospitalized for heart failure.

Increased Length of Stay of Critically Ill Patients in the Emergency Department Associated with Higher In-hospital Mortality.

ABSTRACTObjectivesEmergency department (ED) length of stay (LOS) is defined as the time a patient is registered to the time the patient is shifted to a hospital bed or discharged. Increasing demand for quality emergency care has resulted in increased wait times due to demand and supply mismatch. It is perceived that longer LOS in the ED of critical patients leads to poor outcomes. Our goal was to study the impact of LOS in the ED on the patients who required critical care admissions.MethodsThis was a retrospective study conducted in the ED of a tertiary center. Data were collected using electronic health records (EHR) for patients admitted to the intensive care units (ICUs). Patient's LOS in ED was divided into 0–4, 4–8, 8–12, 12–24, and >24 hours. ED LOS was calculated from the registration time to the time patient was handed over in the ICU. Patients were divided into four categories (1–4) based on their criticality. LOS in ED, mortality, and total hospital LOS were analyzed in the study.ResultsThree thousand four hundred and twenty-nine patients were enrolled in the study. Mean age was 62.69 years (95% CI 62.11–63.26). A total of 42.09% (95% CI 40.5–43.8) were Category 1 patients. Overall mortality rate was 52.46% (95% CI 50.79–54.13). LOS of 48.15% (95% CI 46.54–49.88) patients in the ED was between 0 and 4 hours, 19.90% (95% CI 18.62–21.29) between 4 and 8 hours, 8.21% (95% CI 7.35–9.19) between 8 and 12 hours, 15.50% (95% CI 14.34–16.77) between 12 and 24 hours, and 8.13% (95% CI 7.27–9.10) >24 hours. Mortality for LOS of 0–4 hours was 51.30% (95% CI 48.89–53.70), 54.03% (95% CI 50.28–57.73) for 4–8 hours, 48.94% (95% CI 43.16–54.75) for 8–12 hours, 51.50% (95% CI 47.26–55.72) for 12–24 hours, and 60.57% (95% CI 54.73–66.13) for >24 hours.ConclusionWe concluded that the longer the critically ill patients are boarded in the ED, the higher is the chance for mortality. Processes should be implemented to ease the throughput from the ED.How to cite this articleVerma A, Shishodia S, Jaiswal S, Sheikh WR, Haldar M, Vishen A, et al. Increased Length of Stay of Critically Ill Patients in the Emergency Department Associated with Higher In-hospital Mortality. Indian J Crit Care Med 2021;25(11):1221–1225.

A Risk Prediction Model for Prolonged Length of Stay in Patients with Acute Exacerbations of Chronic Obstructive Pulmonary Disease: A Retrospective Study of 225 Patients in a Single Center in Kunming, China.

BackgroundWe aimed to develop an effective prediction model of prolonged length of stay (LOS) in patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD).Material/MethodsWe systematically enrolled 225 patients admitted for AECOPD to our hospital and divided them into a normal LOS group (≤7 days) and prolonged LOS group (>7 days). To analyze differences in laboratory data at different times, 3 logistic regression models were established. To develop the prediction model, all variables with statistical significance were included in the model. The area under the curve (AUC) was used to evaluate discrimination, and the Hosmer-Lemeshow test was used to assess the calibration of the model.ResultsFactors found to be independently associated with the increased risk of prolonged LOS included the use of corticosteroids during hospitalization, elevated HCO3−, decreased pH, and reductions in platelets (PLTs) and procalcitonin (PCT) between the fourth and first day of hospitalization. The risk prediction model including these factors had an AUC of 0.795, suggesting the good discrimination of our model. The Hosmer-Lemeshow test also showed good calibration of the model, which confirmed its good predictive performance.ConclusionsA clinical prediction model was developed with good predictive performance, which could help clinicians identify patients with a higher risk of prolonged LOS, help shorten hospital stay, reduce the disease burden of patients, and improve the outcomes of AECOPD.