Post-acute Care Facilities Research Articles

Carbapenemase-producing Enterobacteriaceae in an inpatient post-acute care facility: Impact on time to functional recovery.

The carriage of carbapenemase-producing Enterobacteriaceae (CPE) might lengthen the time to functional recovery (TTFR) for inpatients in post-acute care (PAC) units. We aimed to assess the impact of CPE carriage on TTFR in a PAC facility. This 2-year retrospective cohort study included 20 CPE-positive patients and 54 CPE-negative patients admitted to 3 PAC units (general, orthopaedic and neurological rehabilitation units) in a teaching hospital from January 2017 to December 2019. Potential risk factors and demographic data were collected from patients' medical records, the French national hospital discharge database, and the hospital's CPE surveillance database. Functional recovery was defined as the median difference in functional independence measure (FIM) between admission and discharge from each unit. Survival analysis and multiple Cox regression models were used to predict the TTFR and identify factors associated with functional recovery. The overall median [interquartile range] TTFR was 50 days [36-66]. Longer median TTFR was associated with CPE carriage (63 vs 47 days in the CPE-negative group; adjusted hazard ratio (aHR) 0.35, 95% CI 0.13-0.97) and presence of a peripheral venous catheter (aHR 3.51, 1.45-8.46); shorter TTFR was associated with admission to an orthopaedic versus general rehabilitation unit (aHR 3.11, 1.24-7.82). CPE carriage in inpatient PAC facilities was associated with long TTFR. Further studies are needed to explore the mechanisms involved in these adverse events and to identify possible preventive measures.

Barriers to Care for Nursing Home Residents With Substance Use Disorders: A Qualitative Study.

Over the past decade, the numbers of older adults with opioid and substance use disorders (OUD/SUD) have increased. As this population enters nursing homes (NHs) in increasing numbers, it is crucial to consider their capacity to manage issues related to OUD/SUD. This study aimed to examine current NH protocols for care coordination of residents with OUD/SUD as well as facility-related barriers to providing care to this vulnerable population within the NH. Twenty-four semistructured interviews were conducted with NH staff including directors of nursing, administrators, nurses, and physicians in July 2020. Staff were recruited from 11 different post-acute care and long-term care facilities located in urban and suburban communities of Chicago. Interviews were conducted virtually (via teleconference platform or by telephone) and subsequently coded using ATLAS.ti 8 (ATLAS.ti Scientific Software Development GmbH, Berlin, Germany) using constant comparative method. Qualitative analyses identified 3 themes around NH barriers to care for residents with SUD/OUD: (1) staff preparedness, (2) staff perceptions of addiction, and (3) overall lack of resources. Results revealed a strong need for the development of consistent policies, as well as standardized, educational interventions for NH staff that target SUD/OUD management in this vulnerable population. The evaluation and impact of persons with SUD/OUD entering NHs are an important topic that requires further study. More resources and staff training are necessary to ensure that residents with SUD/OUD have access to appropriate care within these settings.

Associations of discharge destination and length of stay in lower extremity free flap reconstruction

Patients with lower extremity defects requiring free flap reconstruction often have difficult postoperative courses with prolonged length of stay and need for transfer to a post-acute care facility. The primary aim of this study was to determine associations of preoperative and perioperative variables with length of stay and discharge destination in patients undergoing lower extremity free flap reconstruction. The secondary aim was to determine associations of various complications with their discharge destination. The 2011– 2017 NSQIP database was queried for CPT codes for free flap procedures and ICD-9/ICD-10 codes for lower extremities. Univariate and multivariate analyses were used to determine associations of preoperative and perioperative variables with length of stay and discharge destination in patients undergoing lower extremity free flap reconstruction and associations of complications with their discharge destination. A total of 420 patients were identified who underwent lower extremity reconstruction in 2011–2017. Of 79.8% were discharged home and 21.2% were discharged to destinations other than home. On multivariate analysis, female gender, age > 55, ASA class > 2 and dependent functional status were found to have independent associations with discharge to post-acute care facilities. ASA classification greater than 2, active smoking, and discharge to a post-acute care facility all were independently associated with prolonged length of stay. Increased length of stay and discharge to post-acute care facility are closely associated. Understanding variables that influence length of stay and need for discharge to post-acute care facilities can help identify patients that may be triaged through appropriate interventions and expectation management.

Nonmedical Discharge Barriers in Prolonged Stays on a General Medicine Ward: A Retrospective Review

Background: Prolonged stays negatively impact patient outcomes and are costly for the healthcare system. Nonmedical barriers to discharge, such as lack of insurance or post-acute care facility acceptances, are increasingly recognized as causes of prolonged stays beyond medical necessity. Methods: A retrospective chart review of patients admitted over a two-year period with stays beyond 30 days on a general medicine floor of an urban academic hospital was conducted. Demographic, clinical and administrative data were recorded. Barriers to discharge were characterized at days 30, 60, and 90 of admission. Nonmedical barriers were recorded for patients who stayed beyond medical readiness for discharge. Results: Out of 2866 admissions, 101 hospitalizations (3.5%) of 97 patients were prolonged, accounting for a total of 6518 (27.2%) of 23,934 inpatient days. Of the prolonged stays, 37 stays lasted longer than 60 days and 17 lasted longer than 90 days. At lengths of stay day 30, 60, and 90, the proportion of admissions that were prolonged beyond medical necessity by nonmedical factors were 36.6%, 59.5%, and 52.9% respectively. The most common nonmedical barrier to discharge at all three timepoints was barriers to facility placement. Conclusions: A small proportion of prolonged stay patients make up a disproportionately high number of inpatient days, with nonmedical factors contributing to more than half of cases beyond 60 days. The rising prevalence of nonmedical barriers, particularly the lack of facility acceptances, highlights the need to examine delays at the systems-level.

Moving Forward Into the Future: Nurses and Nurse Leaders at Leading US Public Health System Implementing Foundational Transformation to Advance Health Equity.

The nation's largest public health care system, New York City Health + Hospitals (NYC H + H), is engaged in a fundamental transformation of its nursing culture, actualizing many of the recommendations in the National Academies, The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity. NYC H + H and its more than 9600+ nurses and 970+ social workers share a common public health mission, vision, and values to deliver essential health care services to the most vulnerable and disadvantaged members of society, regardless of ethnicity, culture, creed, gender, age, sexual orientation, income, immigration, or insurance status. This mission dovetails with all of the recommendations in the Future of Nursing report. Systemwide implementation of these recommendations is proceeding, with some programs further advanced than others. This article highlights the system's diversity, equity, and inclusion initiatives; nursing professional development; collaboration with academic partners; labor contract provisions to support recruitment and retention campaigns; technological advances to remove barriers to patient care; and nurse residency program and professional-shared governance implementation. NYC H + H safeguards 1.4 million patients annually, caring for 1 in every 6 New Yorkers through 11 essential hospitals, 5 post-acute care facilities, more than 70 community centers, and correctional health services in city jails.

Nursing Leadership at Nation's Leading Public Health System Addressing Health Equity and Social Determinants of Health at the Administrative Level and at the Bedside.

New York City Health + Hospitals (NYC H + H) is the largest public health care system in the United States, safeguarding 1.4 million patients annually, caring for 1 in every 6 New Yorkers through 11 essential hospitals, 5 post-acute care facilities, more than 70 community centers, and correctional health services in city jails. The 9600+ nurses and 970+ social workers represent the largest segment of the system's 40 000 employees, charged with delivering essential health care services to the most vulnerable and disadvantaged members of society, regardless of ethnicity, culture, creed, gender, age, sexual orientation, income, immigration, or insurance status. NYC H + H is in the process of reinventing nursing culture with a renewed focus on achieving true nursing excellence, emphasizing professional evidence-based best practices and a compassionate care delivery model, putting nurses in the forefront of all efforts to address the social determinants of health and the devastating consequences of health disparities. Systemwide implementation of foundational transformation is positioning nursing in the vanguard of the system's commitment to equity and diversity in the workplace, recognizing unconscious bias, calling out bigotry, and rooting out systemic racism, all key recommendations in the National Academies, The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity.

National survey of health services provided by pediatric post-acute care facilities in the US.

The need for pediatric post-acute facility care (PAC) is growing due to technological advances that extend the lives of many children, especially those with complex medical needs. The objectives were to describe [1] the types and settings of PAC; [2] the clinical characteristics of the pediatric patients requiring PAC; and [3] perceptions of PAC care delivery by clinical staff. An online survey was administered between 6/2018 to 12/2018 to administrative leaders in PAC facilities that have licensed beds for children and who were active members of the Pediatric Complex Care Association. Survey topics included types of health services provided; pediatric patient characteristics; clinical personnel characteristics; and perceptions of pediatric PAC health care delivery. Leaders from 26 (54%) PAC facilities in 16 U.S. states completed the survey. Fifty-four percent identified as skilled nursing facility/long-term care, 19% intermediate care facilities, 15% respite and medical group homes, and 12% post-acute rehabilitation facilities. Sixty-nine percent of facilities had a significant increase in the medical complexity of patients over the past 10 years. Most reported capability to care for children with tracheostomy/invasive ventilation (100%), gastrostomy tubes (96%), intrathecal baclofen pump (89%), non-invasive positive pressure ventilation (85%), and other medical technology. Most facilities (72%) turned away patients for admission due to bed unavailability occasionally or always. Most facilities (62%) reported that insurance reimbursement to cover the cost of providing PAC to children was not acceptable, and most reported that it was difficult to hire clinical staff (77%) and retain staff (58%). PAC in the U.S. is provided to an increasingly medically-complex population of children. There is a critical need to investigate financially-viable solutions for PAC facilities to meet the patient demands for their services and to sufficiently reimburse and retain staff for the challenging and important care that they provide.

Which Geriatric Variables Most Strongly Inform Discharge Disposition After Emergency Surgery?

Older adults account for an increasing proportion of emergency surgical procedures and have longer hospital lengths of stay than their elective counterparts. Identifying those at greatest risk of discharge to a postacute care facility would improve postoperative planning. We aimed to examine the role of preoperative cognitive and functional status on discharge disposition after emergency surgery in older adults. We used American College of Surgeons National Surgical Quality Improvement Program Geriatric Pilot Project data from 2014 to 2018 to identify patients ≥65y who underwent inpatient emergency surgery. The primary outcome was nonhome discharge, defined as discharge to an acute rehabilitation facility, a skilled nursing facility, or a nonhome unskilled facility. Logistic regression controlling for patient characteristics was used to determine the association of preoperative geriatric-specific variables with nonhome discharge. Of 3494 patients, 53.9% were not discharged home. In multivariable analysis, a fall within the past year (odds ratio [OR] = 5.3, 95% confidence interval [CI] = 4.4-6.5) was most strongly associated with nonhome discharge. The outcome was also independently associated with preoperative use of a mobility aid (OR = 2.0, 95% CI = 1.7-2.4), partially dependent functional status (OR = 1.8, 95% CI = 1.4-2.5), and surrogate consent (OR = 1.4, 95% CI = 1.1-1.8), but not cognitive impairment (OR = 1.0, 95% CI = 0.7-1.3). Assessing for a history of falls and impaired mobility at the initial surgical evaluation can rapidly identify patients most likely to need postacute care. Further work is needed to assess the association between pre-existing cognitive impairment and discharge disposition after emergency surgery.

Comparison of total joint arthroplasty care patterns prior to the Covid-19 pandemic and after resumption of elective surgery during the Covid-19 Outbreak: A retrospective, large urban academic center study

BackgroundAfter the suspension of elective surgeries was lifted in June 2020 in New York State, challenges remained regarding coordination of total joint arthroplasty (TJA) cases. Using the experience from a high-volume health system in New York City, we aimed to describe patterns of care after resumption of elective TJA. MethodsWe retrospectively assessed 7,699 TJAs performed before and during the COVID-19 pandemic. Perioperative characteristics and clinical outcomes were compared between TJAs based on time period of performance: 1) pre-pandemic (PP, June 8th–December 8th, 2019), 2) initial period post-resumption of elective surgeries (IR, June 8th–September 8th, 2020), and 3) later period post-resumption (LR, September 9th–December 8th, 2020). ResultsLOS > 2 days (83%, 67%, 70% for PP, IR, LR periods respectively) and discharge rates to post-acute care (PAC) facilities were lower during the pandemic periods (ORIR vs. PP: 0.48, 95% CI: 0.40–0.59, p < 0.001; ORLR vs. PP: 0.63, 95% CI: 0.53–0.75, p < 0.001). Compared to the pre-pandemic period, the risk for 30-day readmission was lower during the IR period (OR: 0.62, 95% CI: 0.40–0.98, p = 0.041) and similar during the LR period (OR: 0.96, 95% CI: 0.65–1.41, p = 0.832). ConclusionsDespite decreased LOS and discharge to PAC for TJAs performed during the pandemic, 30-day readmissions did not increase. Given the increased costs and lack of superior functional outcomes associated with discharge to PAC, these findings suggest that discharge to PAC facilities need not return to pre-pandemic levels.

Predicting the regional impact of interventions to prevent and contain multidrug-resistant organisms

Background: Multidrug-resistant organisms (MDROs), such as carbapenem-resistant Enterobacterales (CRE), can spread rapidly in a region. Facilities that care for high-acuity patients with long average lengths of stay (eg, long-term acute-care hospitals or LTACHs and ventilator-capable skilled nursing facilities or vSNFs) may amplify this spread. We assessed the impact of interventions on CRE spread within a region individually, bundled, and implemented at different facility types. Methods: We developed a deterministic compartmental model, parametrized using CRE data reported to the NHSN and patient transfer data from the CMS specific to a US state. The model includes the community and the healthcare facilities within the state. Individuals may be either susceptible or infected and infectious. Infected patients determined to have CRE through admission screening or point-prevalence surveys at a facility are placed in a state of lower transmissibility if enhanced infection prevention and control (IPC) practices are in place. Results: Intervention bundles that included periodic point-prevalence surveys and enhanced IPC at high-acuity postacute-care facilities had the greatest impact on regional prevalence 10 years into an outbreak; the benefits of including admission screening and improved interfacility communication were more modest (Fig. 1A). Delaying interventions by 3 years is predicted to result in smaller reductions in prevalence (Fig. 1B). Increasing the frequency of point-prevalence surveys from biannually to quarterly resulted in a substantial relative reduction in prevalence (from 25% to 44%) if conducted from the start of an outbreak. IPC improvements in vSNFs resulted in greater relative reductions than in LTACHs. Admission screening at LTACHs and vSNFs was predicted to have a greater impact on prevalence if in place prior to CRE introduction (~20% reduction), and the impact decreased by approximately half if implementation was delayed until 3 years after CRE introduction. In contrast, the effect of admission screening in ACH was less (~10% reduction in prevalence) and did not change with implementation delays. Conclusions: Our model suggests that interventions that limit unrecognized MDRO introduction to, or dispersal from, LTACHs and vSNFs through screening are predicted to slow distribution regionally. Interventions to detect colonization and improve IPC practices within LTACHs and vSNFs may substantially reduce the regional burden. Prevention strategies are predicted to have the greatest impact when interventions are bundled and implemented before an MDRO is identified in a region, but reduction in overall prevalence is still possible if implemented after initial MDRO spread.Funding: NoneDisclosures: None

The Interrelationships between the length of stay, readmission, and post-acute care referral in cardiac surgery patients

Prolonged hospital stays, and readmission contribute to substantial healthcare cost. Hence, an assessment of the optimal inpatient length of stay (LOS) associated with lower readmission rate is important for healthcare providers. Post-acute care (PAC) facilities have promising potential to shorten the LOS; however, currently their influence on overall patient outcomes is not well understood. The primary goal of this study is to highlight the interrelated risk factors of LOS and readmission for cardiac patients. The study also examines the influence of PAC referral on LOS and readmission. In this paper, a cohort of 13,982 Coronary Artery Bypass Graft (CABG) and Valve Replacement (VR) patients from 49 hospitals in the U.S. were analyzed with respect to the association of healthcare delivery, demographics, PAC referral, and clinical conditions with LOS and readmission. A generalized linear mixed model and multinomial logistic regression model were developed to evaluate the readmission and LOS associative risk factors, respectively. Referral to PAC was included as a vital predictor in both models to examine its impact on optimal LOS and improving patient outcomes. The results indicate a non-uniform care distribution across census divisions and an inverse relationship between LOS and readmissions. The analytics showed that higher LOS patients were more often referred to PAC and yet they were more prone to readmission except for the patients who were referred to Long Term Care (LTC). This study identifies the effects of healthcare delivery, demographic, comorbidity, and PAC referral factors on readmission and LOS, so that personalized acute and post-acute care coordination can be achieved to improve overall patient outcomes. Interventions such as treating CABG and VR patients with multiple comorbidities for longer time in acute hospitals and increasing LTC referral can result in significant improvement.

The Role of Clinical Leaders in Workforce Development and Retention in Post-Acute and Long-Term Care

The Role of Clinical Leaders in Workforce Development and Retention in Post-Acute and Long-Term Care

The CNA Crisis: Turning Ideas Into Action

The CNA Crisis: Turning Ideas Into Action

Abstract 232: Determinants Of Discharge Disposition In High-risk Myocardial Infarction And Heart Failure

Background: Discharge to home is a quality metric tracked by several health systems, payers, and certifying bodies. We examined the factors determining discharge to home versus post-acute care facilities (Nonhome) in a Medicare Fee-for-service (MFFS) population with acute myocardial infarction (AMI) and acute decompensated heart failure (ADHF). Methods: All MFFS patients who had a DRG of 280, AMI with major comorbidities (MCC), and DRG 292, ADHF with shock, complication, or comorbidity (CC), in Allegheny Health Network hospitals between 2018-2020 were included in the study. Clinical characteristics, discharge location, 30-day readmission, and 1-year mortality rates were obtained retrospectively. Results: There were 144 patients in the AMI group (56% male) and 67 patients in the ADHF group (42% male). Our MFFS numbers were lower than other metropolitan areas due to our area's high use of Medicare Advantage plans. Discharge to nonhome locations occurred in 35% of AMI and 34% of ADHF patients. Lower mean age (73 vs. 77), higher functional status prior to admission, admission from home, and normal diet consumption were more likely in-home discharges in both AMI and ADHF(p&lt;0.05). Comorbidities including hypertension, diabetes, CKD, COPD, and clinical characteristics including LVEF, NYHA class, BMI, anemia were similar between home and nonhome groups. Prior hospitalization for a cardiac cause occurred more often in home discharges only in AMI groups (53% vs. 27% p=0.004) but not in ADHF. Independent predictors of nonhome discharge in AMI and ADHF are shown in the table. No differences in 1-year mortality and 30-day readmission rates were noted between home and nonhome discharges. Conclusions: In a high-risk population of AMI with comorbidities and ADHF with shock, nonhome discharge was best predicted by functional status prior to admission. Heightened focus on physical therapy and rehab in-hospital can promote discharge to home regardless of clinical characteristics.

Body mass index is a predictor of discharge to a postacute care facility following total shoulder arthroplasty

BackgroundThe purpose of this study is to evaluate the effect of body mass index (BMI) on discharge to a postacute care (PAC) facility following elective total shoulder arthroplasty (TSA). MethodsThe National Surgical Quality Improvement Program database was queried to identify adult patients (>18 years old) who underwent inpatient TSA for primary osteoarthritis between 2005 and 2018. Hemiarthroplasty, revision TSA, trauma indications, and outpatient procedures were excluded. Patient and perioperative data were identified. Univariate analysis and multivariate logistic regression were used to assess the relationship between BMI and discharge to PAC facilities. ResultsA total of 10,198 patients with a primary TSA were identified. The majority (93%) of patients were discharged home vs. 7% to PAC facilities. Patients discharged to PAC had significantly higher mean BMI (P = .006). After controlling for demographic and comorbid factors, BMI was the only modifiable risk factor that was independently associated with an increased risk of discharge to a PAC. For every increase in BMI point, there was an increased risk of discharge to a PAC by 2.9% (odds ratio [OR] 1.029, confidence interval [CI] 1.016-1.041, P < .001). Additional covariates associated with PAC discharge were older age (OR 1.113, CI 1.099-1.127, P < .001), female gender (OR 3.037, CI 2.489-3.705, P < .001), and dependent functional status (OR 8.322, CI 5.544-12.492, P < .001). ConclusionMost patients undergoing TSA were discharged home following surgery. While age, sex, and functional status also affect disposition, elevated BMI is the only modifiable risk factor that independently predicts PAC discharge. Consideration of patient BMI prior to elective TSA may greatly improve discharge planning and management of patient expectations.

Innovations in Fatality Management During the COVID-19 Pandemic.

Innovations in Fatality Management During the COVID-19 Pandemic.

Ethnic, clinical, and pharmacological predictors of high social dependence in COVID-19 patients admitted to post-acute care

The COVID-19 epidemic affected both acute hospitals and post-acute care, which experienced various degrees of overcrowding. We evaluated all the patients admitted to a post-acute care facility during the second wave of the epidemic to detect features possibly associated with social frailty. We analyzed the socio-demographic characteristics and comorbidities of the patients and the pattern of their previous hospitalization as available in their discharge letter. In addition, we evaluated their clinical features and tests on admission to post-acute care. We found that COVID-19 patients without social problems had distinctive features. Those with a higher need for specific pharmacological treatments during their stay in an acute hospital were less likely to be admitted to post-acute care for concomitant social problems ( p &lt; 0.05 for all types of medication). They were also more likely to be native (p = 0.02), obese (p = 0.009), and with hypertension (p = 0.03). Patients with social problems usually stayed longer and were less frequently discharged home with a negative swab (p = 0.0009). In COVID-19 patients, recognition of distinctive features predicting that their need for a longer hospital stay is due to social problems can lead to more appropriate discharge and to more appropriate use of post-acute care.

Associations with Discharge to Post-Acute Care Facilities Among Patients Undergoing Open Reduction Internal Fixation of Distal Radius Fractures.

Introduction: Distal radius fractures are a common injury of the hand and wrist that often require intensive rehabilitation. We sought to identify risk factors associated with discharge to a post-acute care facility following distal radius fracture repair. Methods: The 2011 to 2016 National Surgical Quality Improvement Program® (NSQIP) database was queried for all Current Procedural Terminology (CPT) codes that corresponded with open distal radius fracture repair. Patients with concomitant traumatic injuries were excluded. Patient demographics, comorbidities, perioperative factors, laboratory data, and surgical details were collected. Our primary outcome was to determine postoperative discharge destination: home versus a post-acute care facility, and to identify factors that predict discharge to post-acute care facility. Secondary outcomes included unplanned readmission, reoperation, and complications. Results: Between 2011 and 2016, a total of 12,001 patients underwent open distal radius fracture repair and had complete information for their discharge. Of these analyzed patients, 3.24% (n = 389) were discharged to rehabilitation facilities. The following factors were identified on multivariate analysis to have an association with discharge to a post-acute care facility: 65 years or older, White race, underweight, using steroids preoperatively, American Society of Anesthesiologists (ASA) classification > 2, admitted from a nursing home or already hospitalized, anemic, undergoing bilateral surgery, wound classification other than clean, and complications prior to discharge. Conclusion: Factors identified by our study to have associations with discharge to post-acute care facilities following distal radius fracture repair can help in appropriate patient counseling and triage from the hospital to home versus a post-acute care facility.

Reverse shoulder arthroplasty for rotator cuff tears with and without prior failed rotator cuff repair: A large-scale comparative analysis

BackgroundLarge-scale data assessing the effect of a prior failed rotator cuff repair (RCR) on the outcome of reverse shoulder arthroplasty (RSA) is currently lacking. Therefore, this study aimed (1) to assess the course of patients undergoing RCR, specifically focusing on the need for conversion to RSA within two years, and (2) to compare outcomes following RSA performed for rotator cuff tears (RCTs) with and without prior RCR. MethodsThis retrospective cohort study included data from the CMS Data Set (2016–2018). For the first study objective, we included patients undergoing an RCR; these were followed for 24 months to identify a conversion to RSA. For the second study objective, we included RSAs for RCTs, stratified by those with and without a prior RCR (preceding 24 months). Outcomes (hospitalization cost, institutional post-acute care discharge, 90-day readmission and health resource utilization up to 6 months post-RSA) were compared between propensity score-matched groups. ResultsOut of 33,244 RCRs, 433 (1.3%) patients underwent RSA conversion within two years. Among 7534 RSA cases for RCTs, 245 (3.3%) had an RCR in the preceding two years. In the propensity score analysis, except for a minimal increase in the number of physical rehabilitation visits (RR 1.10; p = 0.0009), no differences were observed between those with and without prior RCR in terms of other RSA outcomes. These included hospitalization cost, discharge to institutional post-acute care facility, 90-day readmission and 6-month post-op cost ConclusionRotator cuff repair in elderly patients, when utilizing currently employed indication criteria, results in low conversion rates to RSA within 2 years postoperatively. Furthermore, large dataset outcomes after RSA for RCT such as cost, post-acute care discharge, physical rehabilitation, and readmission rates appear not to be negatively affected by the presence of a prior RCR. Level of evidenceLevel 3 evidence; Retrospective cohort study.

Cognitive Impairment in Convalescent COVID-19 Patients Undergoing Multidisciplinary Rehabilitation: The Association with the Clinical and Functional Status.

Background. Cognitive impairment has been reported in the aftermath of severe acute respiratory syndrome due to coronavirus 2 (SARS-CoV-2) infection. We investigated the possible association between cognitive impairment and the main clinical and functional status variables in a cohort of convalescent COVID-19 patients without premorbid diseases potentially affecting cognition. Methods. We consecutively screened for inclusion of convalescent COVID-19 patients referring to a post-acute care facility for pulmonary rehabilitation. All the enrolled patients were assessed for cognitive functions. We also investigated features of psychological distress (anxiety, depression, symptoms of posttraumatic stress disorder and quality of life) and cardiac and pulmonary functional status. Results. The 63 enrolled patients (mean age 59.82 ± 10.78, male gender = 47) showed a high frequency of depressive symptoms (76.2%) and anxiety (55.5%), and a high prevalence of symptoms of posttraumatic stress disorder (PTSD, 44.4%). About half of the total sample showed reduced cognitive efficiency (RCE, 44.4%) in the domains of spatial and verbal long-term memory and executive functions. Patients with RCE more frequently showed alteration of blood pressure (BP) circadian rhythm (p = 0.01), higher levels of D-Dimer (p = 0.03), had experienced a severe illness (p = 0.02), had longer disease duration (p = 0.04), more clinically relevant symptoms of PTSD (p = 0.02), more frequent cognitive complaints (p = 0.002), higher anxiety scores (p = 0.01) and lower quality of life (p = 0.02) than patients with normal cognitive efficiency. Conclusions. Our findings indicated a possible association between the RCE after COVID-19 and some cardiological variables, including some indirect measures of a residual autonomic disorder, such as the presence of an altered BP circadian rhythm. Future research studies with large samples are needed to provide valid conclusions.