Prolonged Hospital Stay Research Articles

Predictors of Mortality and Prolonged Hospital Stay after Diagnosis of Perioperative Myocardial Infarction in Patients Undergoing Isolated Coronary Artery Bypass Crafting

Objective: To determine predictors of mortality and prolonged hospital stay in patients presenting perioperative myocardial infarction (PMI) after CABG.

The filtration renal function and diabetes mellitus type 2 as predictors of postoperative complications after coronary artery bypass grafting

2 ) was revealed more frequently in diabetes group (29.0 и 20.9% respectively, р=0.014). Incidence of complications after CABG was increased in case of diabetes mellitus type 2 (OR 1.537; р=0.011), preoperative GFR decrease on every 5 ml/min/1.73 m 2 (OR 1.050; р=0.041) and augmentation of cardiopulmonary bypass time on every 5 minutes (OR 1.059; р=0.004). In other analysis independent predictors included preoperative renal dysfunction — OR 1.564, р=0.026, diabetes mellitus type 2 requiring insulinotherapy (OR 2.403; р=0.043). Besides, decrease of GFR on every 5 ml/minн/1.73 m 2 was associated with increased incidence of acute renal failure after CABF (р=0.031), hospital death (р=0.026), need for renal replacement therapy (р=0.043). Also frequency of hyperglycemia 1st day after surgery and opportunity of prolonged hospital-stay were increased in case of decreased GFR (р=0.009 and р=0.013 respectively). It was concluded that diabetes mellitus type 2 and GFR are predictors of postoperative complications after CABG. Risk of acute renal failure, hyperglycemia after CABG, need for renal replacement therapy and mortality are increased in case of decreased GFR.

Polyuria in Hantavirus Infection Reflects Disease Severity and Is Associated with Prolonged Hospital Stay: A Systematic Analysis of 335 Patients from Southern Germany

Background/Aims: Puumala virus (PUUV) infection leads to nephropathia epidemica (NE), especially in endemic areas in Central Europe. The clinical course of NE is characterized by acute kidney injury (AKI) with thrombocytopenia followed by polyuria to a different degree. The prevalence of polyuria and its associated risk factors have not been reported in a large cohort of NE patients. Methods: Clinical and laboratory data during the acute phase of the disease were obtained from the medical reports and files of 335 patients who received in-hospital treatment during acute hantavirus infection. Comprehensive statistical models were developed to estimate the probability of polyuria. Results: The median age at diagnosis was 47 years (interquartile range, IQR 40-59) and 48% of the patients developed polyuria with a urinary output of 5,100 ml/day (IQR 4,200-7,300). The hospital stay was significantly longer in the polyuric group compared to the nonpolyuric group [8 days (IQR 6-10) vs. 6 days (IQR 5-8); p = 0.04]. Using logistic regression analysis, male gender (odds ratio, OR = 1.6; 95% confidence interval, CI 1.05-2.58; p = 0.03), oliguria/anuria during NE (OR = 2.56; 95% CI 1.65-4.01; p < 0.001), severe AKI (OR = 1.87; 95% CI 1.22-2.9; p < 0.001), and hematuria (OR = 1.78; 95% CI 1.02-3.15; p = 0.04) were significantly associated with the development of polyuria. In a multivariate model, the probability of polyuria was 0.19 (SEM ± 0.05) in female patients presenting with mild/moderate AKI without anuria/oliguria. Conclusions: Almost 50% of hospitalized NE patients developed polyuria, which was associated with a prolonged hospital stay. The probability of the development of polyuria was lowest in female patients with mild/moderate, non-oliguric/anuric AKI.

Team consistency and occurrences of prolonged operative time, prolonged hospital stay, and hospital readmission: a retrospective analysis.

Human factors research has suggested benefits of consistent teams yet no surgical team consistency measures have been established for teamwork improvement initiatives. Retrospective analysis was conducted of teams performing consecutive elective procedures of unilateral primary total knee and hip replacement between June 2008 and May 2010 at a large tertiary medical center. Surgeons who performed fewer than 50 cases of the procedures during the study period were excluded. A team was defined as consistent when its nurse and surgical technologist members were both among the three most frequent working with the surgeon during the study period. Odds ratios for prolonged operative time (in the longest quartile), prolonged hospital stay (longer than median), and 30-day all-cause readmissions were adjusted for patient characteristics (sex, age, comorbidity, American Society of Anesthesiology status), surgery characteristics (procedures, time of day), and surgeons. Inconsistent teams performed 61% of the 1,923 cases with eight surgeons, each of which worked with a median of 43.5 (range, 28-58) nurses and 29 (range, 13-47) technologists. Inconsistent teams were associated with higher likelihood of prolonged operative time [odds ratio 1.52, 95% confidence interval (CI) 1.20-1.91], higher likelihood of prolonged hospital stay (odds ratio 1.51, 95% CI 1.23-1.86), and more readmissions (adjusted odds ratio 1.42, 95% CI 1.07-1.89). Team consistency was an independent predictor of prolonged operative time, prolonged hospital stay, and 30-day hospital readmission in elective, primary, unilateral total knee, and hip replacement procedures, after adjusting for patient and surgery characteristics and surgeons.

Prolonged Hospital Stay, an Adverse Effect of Strict National Policy for Controlling the Spread of Highly Resistant Microorganisms

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Prolonged hospital stay, an adverse effect of strict national policy for controlling the spread of highly resistant microorganisms.

Prolonged hospital stay, an adverse effect of strict national policy for controlling the spread of highly resistant microorganisms.

Dissociation of Early Shock in Takotsubo Cardiomyopathy from either Right or Left Ventricular Systolic Dysfunction

Takotsubo cardiomyopathy (TTC) is often associated with hypotension and shock. However, development of hypotension/shock in TTC is not closely related to extent of left ventricular (LV) hypokinesis. We sought to determine whether additional right ventricular (RV) involvement in TTC might contribute to hypotension and shock development and thus to prolonged hospital stay (PHS). We evaluated 102 consecutive TTC patients with acute transthoracic echocardiography (TTE) to detect RV hypokinesis. Correlates of hypotension, shock and PHS were identified by univariate and multivariate analyses. Of the 102 patients evaluated, 33% had RV hypokinesis but only 9% had extensive RV involvement. Within the first 24 hours of admission, severe hypotension (systolic blood pressure (SBP) ≤ 90 mmHg) occurred in 21% of the patients and shock (hypotension + peripheral organ hypo-perfusion) in 16.6% of cases. RV involvement was a univariate but not a multivariate correlate of either hypotension or shock and did not result in PHS. On the other hand, RV involvement predicted more extensive LV hypokinesis and LV systolic dysfunction. In TTC, RV hypokinesis occurs in approximately 33% of cases and correlates with more severe LV wall motion abnormality but not with development of hypotension or shock. These data therefore reinforce previous findings that hypotension/shock in TTC are not purely by impaired cardiac output.

PM117 Predictors of Prolonged Hospital Stay Following Transcatheter Aortic Valve Implantation

PM117 Predictors of Prolonged Hospital Stay Following Transcatheter Aortic Valve Implantation

Pre-operative Serum Albumin and Neutrophil-Lymphocyte Ratio are Associated with Prolonged Hospital Stay Following Colorectal Cancer Surgery

Pre-operative Serum Albumin and Neutrophil-Lymphocyte Ratio are Associated with Prolonged Hospital Stay Following Colorectal Cancer Surgery

Initial Presentation to a Non-tertiary Hospital Results in a Prolonged Pre-operative Hospital Stay and an Increased Risk of Nosocomial Infections in Patients Requiring In-patient Transfer to a Tertiary Centre for Cardio-Thoracic Surgery: A Multi-centre Analysis in Metropolitan Melbourne

Initial Presentation to a Non-tertiary Hospital Results in a Prolonged Pre-operative Hospital Stay and an Increased Risk of Nosocomial Infections in Patients Requiring In-patient Transfer to a Tertiary Centre for Cardio-Thoracic Surgery: A Multi-centre Analysis in Metropolitan Melbourne

Risk analysis of pulmonary resection for elderly patients with lung cancer

The indications for pulmonary resection in elderly patients with lung cancer concomitant with another disease are unclear. We conducted this retrospective study to establish the risk factors of complications and survival to improve patient selection. The subjects were 295 patients aged ≥ 75 years, who underwent pulmonary resection for lung cancer. We assessed comorbidity according to the Charlson comorbidity index (CCI) and examined risk factors for morbidity and the prognostic factors. Postoperative complications developed in 55 patients (morbidity 18.6 %). The median survival time was 59.3 months and the 5-year survival rate was 69.7 %. Multivariate logistic regression analyses selected smoking and thoracotomy as risk factors for complications, and a history of cerebrovascular disease, cancer stage, and thoracotomy as risk factors for a prolonged hospital stay (PHS). Video-assisted thoracic surgery (VATS) decreased the risk of morbidity and PHS, and influenced survival. Multivariate analysis with the Cox proportional hazard model identified CCI ≥ 2, morbidity, and PHS as unfavorable survival factors, in addition to age ≥ 80 and cancers that were non-adenocarcinoma or advanced. Although CCI ≥ 2 was associated with poorer survival, it was not necessarily a risk factor of postoperative complications or PHS. Performing VATS when possible could reduce the incidence of postoperative complications and PHS in elderly patients.

Association of Hyperglycemia with Prolonged Hospital Stay But No Effect on Engraftment After Autologous Hematopoietic Stem Cell Transplantation

To determine the effect of hyperglycemia, which is associated with poor outcome of various diseases, on the outcome of hematopoietic stem cell transplantation (HSCT). We examined the influence of blood glucose concentration (BGC) on the outcome of autologous HSCT. Patients had at least one BGC determination every morning during their hospitalization. The relationships of BGC with time to engraftment and length of hospital stay (LOHS) after transplantation were analyzed. The correlation of LOHS after transplantation was found only with posttransplant averaged BGC (P=.0004) in patients without diabetes (N = 240) but not with pretransplant averaged BGC or BGC on the morning of transplantation. The correlation remained significant after adjustment for sex, age, and body mass index (P=.0002) and for use of glucocorticoids and total parenteral nutrition (P=.04). No correlation was observed, however, between BGC and timing of engraftment. We further analyzed the entire data set of subjects (N = 335) on the basis of posttransplant morning BGC and divided these patients into 2 groups: those with BGC <150 mg/dL and those with BGC ≥150 mg/dL. No difference in engraftment time was noted between these 2 groups, but a correlation was observed with LOHS after transplantation (14 ± 4 days versus 17 ± 6 days, respectively; P<.0001). We observed that posttransplant averaged BGC significantly correlated with LOHS after transplantation. BGC, however, had no effect on the timing of engraftment. Thus, our results suggest that better glycemic control could potentially shorten hospital stay after HSCT.

Factors Associated with Prolonged Hospital Stay in a Geriatric Ward of a University Hospital in Japan

We read with interest the article by Lakhan and colleagues,1 which showed the high prevalence and worsening of geriatric syndrome during acute care hospitalization. Because falls, incontinence, impairment in activities of daily living (ADLs), and other geriatric syndrome components increase the care burden and limit discharge planning in acute care hospitals, geriatric syndrome might cause prolonged hospital stays. A prolonged hospital stay is one of the major determinants of medical cost and is thus a serious problem in geriatric medicine. Previous studies have shown that clinical events during hospitalization,2, 3 basic ADLs,4 and nonmedical factors such as delayed transfer to a nursing facility or disagreement on the discharge plan among family members5 are risk factors for prolonged hospital stay. Furthermore, because older adults have multiple comorbid conditions and are susceptible to adverse drug reactions (ADRs), these factors might be related to length of hospital stay. To test this hypothesis, the association between geriatric conditions such as geriatric syndrome, ADLs, and ADRs and prolonged hospital stay were comprehensively investigated using the database of the geriatric ward of the University of Tokyo Hospital from 1995 to 2010. The ethics committee of the Graduate School of Medicine, University of Tokyo approved this study. All records of patients aged 65 and older from 1995 to 2010 were reviewed. Data on length of stay, acute hospitalization, ADRs, body mass index (BMI), number of diseases and drugs, geriatric syndrome, and Barthel Index were collected. Twenty-three components of geriatric syndrome such as falls, cognitive impairment, urinary incontinence, constipation, and insomnia were included in the analysis. Records lacking information on any of the variables were excluded. Cases of scheduled short-term hospitalization were excluded. Finally, the records of 1,616 patients were analyzed (mean age 78.3 ± 7.0, 52% male). All data were obtained soon after admission. Values are expressed as means ± standard deviations and were analyzed using JMP version 9.0.2 (SAS Institute, Inc., Cary, NC). P < .05 was considered statistically significant. Mean length of stay was 27.3 ± 22.6 days (range 1–322 days). The results of univariate and multivariate analyses for length of stay are shown in Table 1. Multiple stepwise regression analysis showed that ADRs, number of diseases, and number of geriatric syndrome components were positively associated with longer hospital stay, whereas age, BMI, and Barthel Index were negatively associated. The number of geriatric syndrome components was significantly associated with hospital stay independent of number of diseases. The present analysis demonstrated that geriatric factors such as ADRs, multiple diseases, low BMI, ADL dependence, and number of geriatric syndrome components were associated with longer hospital stay in a large group. The finding that ADRs are a risk for prolonged hospital stay is consistent with a previous report,6 and ADL dependence has been reported as a risk in a smaller group.4 Furthermore, the number of geriatric syndrome components and undernutrition were risk factors for prolonged hospital stay in a large-scale study. Frailty, which is also known to be a risk factor,7 was not examined independently in the present study, but ADL dependence and undernutrition, both of which are major components of frailty, were found to be risk factors, so it is reasonable to assume that frailty was associated with length of hospital stay in the current cohort as well. The present study revealed that the accumulation of geriatric syndrome components was a risk factor for prolonged hospital stay independent of multiple diseases and, presumably, frailty. Thus, geriatric syndrome should be comprehensively managed during hospitalization. The reason for the negative association between age and length of stay is unclear, but the presence of young-old patients with disability or complicated conditions on the geriatric ward might have influenced the results. In summary, the present study provides new insight into the significance of geriatric conditions in relation to prolonged hospital stay in older adults. ADL dependence, undernutrition, ADRs, and geriatric syndrome should be carefully assessed and interventions provided when caring for older inpatients. Conflict of Interest: The editor in chief has reviewed the conflict of interest checklist provided by the authors and has determined that the authors have no financial or any other kind of personal conflicts with this paper. Author Contributions: TK: acquisition of subjects and data analysis, interpretation of data, and drafting of manuscript. MA: coordinator of study concept and design, and study supervision. YK, KY, and HY: acquisition of subjects and data. ME: data analysis and interpretation of data. YO: study supervision. Sponsor's Role: The sponsors had no role in the design, methods, data collections, analysis, and preparation of this paper.

Su1557 Major Complication and Open Approach are Predictors of Prolonged Hospital Stay After Pancreaticoduodenectomy

Su1557 Major Complication and Open Approach are Predictors of Prolonged Hospital Stay After Pancreaticoduodenectomy

Clinical Predictors of Prolonged Hospital Stay after Acute Stroke: Relevance of Medical Complications

Purpose: This study aims to identify clinical predictors of prolonged hospital stay after acute stroke based on data collected from a prospective hospital-based acute stroke registry. Methods: All patients with first-ever ischemic stroke and primary intracerebral hemorrhage included in the Sagrat Cor Hospital of Barcelona stroke database over a 17-year period were assessed. Prolonged hospital stay was defined as hospitalization for longer than 12 days after admission. Demographic data, cardiovascular risk factors, clinical factors, neuroimaging findings, and outcome were compared in patients hospitalized for more or less than 12 days. Logistic regression analysis was used to assess the independent influence of statistically significant variables in the bivariate analysis and duration of hospitalization. Results: Of a total of 3112 acute stroke patients included in the study, prolonged hospital stay was recorded in 1536 (49.4%). Male sex (OR = 1.16), limb weakness (OR = 1.79), vascular complications (OR = 2.68), urinary complications (OR = 2.56), and infectious complications (OR = 1.78) were independently associated with longer stay, whereas symptom free at discharge (OR = 0.45) and lacunar infarction (OR = 0.43) were inversely associated with prolonged hospitalization. Conclusion: In-hospital medical complications (vascular, urinary, and infectious) are relevant factors influencing duration of hospitalization after acute stroke. Therefore, prevention of potentially modifiable risk factors for medical complications is an important aspect of the early management of patients with stroke.

Predictive Factors of Prolonged Hospital Stay in Tonsillectomy Patients

Objective: Tonsillectomy remains one of the most common surgeries performed in the pediatric population. Factors that are predictive of a prolonged stay after tonsillectomy are useful in planning postop care. Method: A retrospective chart review was completed inclusive of all pediatric patients who had tonsillectomy at a tertiary medical center from March 10, 2010, to January 1, 2011. Preoperative variables were analyzed to determine predictors of extended hospital stay (defined as &gt; 24 hours). Results: A total of 210 patients were reviewed. Thirty-three patients (15.7%) had hospital stays greater than 24 hours. Indications for tonsillectomy included obstructive sleep apnea (69.5%), tonsillitis (9.5%), and asymmetry (1.9%). Twenty-eight (84.8%) patients had extended stays for poor oral intake. Fever and respiratory complications accounted for 0.06% respectively. Patients with extended stays were younger ( P &lt; .001), weighed less ( P &lt; .001), and had higher apnea-hypopnea indices ( P = .043). Patients with a history of sickle cell crises or bronchodilator use, along with those who had state funded insurance ( P &lt; .05), were more likely to have extended stays. Conclusion: Factors from the history and physical of patients may predict which patients are at higher risk for extended hospital stays after tonsillectomy. Predictors of extended stays include younger and smaller children, those with a prior history of sickle cell crises, those using bronchodilators, and those with state funded health insurance.

Blood Transfusion After Pediatric Cardiac Surgery Is Associated With Prolonged Hospital Stay

Red blood cell transfusion is associated with morbidity and mortality among adults undergoing cardiac surgery. We aimed to evaluate the association of transfusion with morbidity among pediatric cardiac surgical patients. Patients discharged after cardiac surgery in 2003 were retrospectively reviewed. The red blood cell volume administered during the first 48 postoperative hours was used to classify patients into nonexposure, low exposure (≤15 mL/kg), or high exposure (>15 mL/kg) groups. Cox proportional hazards modeling was used to evaluate the association of red blood cell exposure to length of hospital stay (LOS). Of 802 discharges, 371 patients (46.2%) required blood transfusion. Demographic differences between the transfusion exposure groups included age, weight, prematurity, and noncardiac structural abnormalities (all p<0.001). Distribution of Risk Adjusted Classification for Congenital Heart Surgery, version 1 (RACHS-1) categories, intraoperative support times, and postoperative Pediatric Risk of Mortality Score, Version III (PRISM-III) scores varied among the exposure groups (p<0.001). Median duration of mechanical ventilation (34 hours [0 to 493] versus 27 hours [0 to 621] versus 16 hours [0 to 375]), incidence of infection (21 [14%] versus 29 [13%] versus 17 [4%]), and acute kidney injury (25 [17%] versus 29 [13%] versus 34 [8%]) were highest in the high transfusion exposure group when compared with the low or nontransfusion groups (all p<0.001). In a multivariable Cox proportional hazards model, both the low transfusion group (adjusted hazard ratio [HR] 0.80, 95% confidence interval [CI]: 0.66 to 0.97, p=0.02) and high transfusion group (adjusted HR 0.66, 95% CI: 0.53 to 0.82, p<0.001) were associated with increased LOS. In subgroup analyses, both low transfusion (adjusted HR 0.81, 95% CI: 0.65 to 1.00, p=0.05) and high transfusion (adjusted HR 0.65, 95% CI: 0.49 to 0.87, p=0.004) in the biventricular group but not in the single ventricle group was associated with increased LOS. Blood transfusion is associated with prolonged hospitalization of children after cardiac surgery, with biventricular patients at highest risk for increased LOS. Future studies are necessary to explore this association and refine transfusion practices.

Prolonged Hospital Stay and the Resident Duty Hour Rules of 2003

Resident duty hour reforms of 2003 had the potential to create a major impact on the delivery of inpatient care. We examine whether the reforms influenced the probability of a patient experiencing a prolonged hospital length of stay (PLOS), a measure reflecting either inefficiency of care or the development of complications that may slow the rate of discharge. Conditional logistic models to compare PLOS in more versus less teaching-intensive hospitals before and after the reform, adjusting for patient comorbidities, common time trends, and hospital site. Medicare (N = 6,059,015) and Veterans Affairs (VA) (N = 210,276) patients admitted for medical conditions (acute myocardial infarction, heart failure, stroke, or gastrointestinal bleeding) or surgical procedures (general, orthopedic, and vascular) from July 2000 to June 2005. Prolonged length of stay. Modeling all medical conditions together, the odds of prolonged stay in the first year post reform at more versus less teaching intensive hospitals was 1.01 (95% CI: 0.97-1.05) for Medicare and 1.07 (0.94-1.20) for the VA. Results were similarly negative in the second year post reform. For "combined surgery" the post year 1 odds ratios were 1.04 (0.98-1.09) and 0.94 (0.78-1.14) for Medicare and the VA respectively, and similarly unchanged in post year 2. Isolated increases in the probability of prolonged stay did occur for some vascular surgery procedures. Hospitals generally found ways to cope with duty hour reform without increasing the prevalence of prolonged hospital stays, a marker of either inefficient care or complications.

Alcohol Withdrawal and Prolonged Hospital Stay in a Patient with Neuroimaging Abnormalities: A Case Report

A hospital stay of 30 days was required in a 47-year-old woman with alcohol withdrawal. Magnetic resonance imaging (MRI) findings revealed a focal brain stem lesion and multiple focal supracortical abnormalities. Could asymptomatic neuroimaging abnormalities predict risk of complicated alcohol withdrawal? Future clinical observations and longitudinal studies may wish to address this potential risk factor.

Abstract 4497: Non-Selective NSAIDs Increase Incidence of Peri-Procedural Infarct and Prolong Hospital Stay after Percutaneous Coronary Interventions

Non-steroidal anti-inflammatory drugs (NSAIDs) increase risk of CV events. We sought to evaluate hospital outcomes associated with NSAID therapy in patients undergoing percutaneous coronary interventions (PCI). Data on NSAID use in single institution treated, consecutive PCI patients (treatment period 2004 –2006, rofecoxib-treated subjects excluded) was merged with NY State Angioplasty Registry database, and studied with ANOVA, chi-square, Kaplan-Meier, and logistic regression analyses. Of 2933 ASA-treated PCI patients (29% females) only 78 (2.7%) were treated with non-selective (ns) NSAIDs and 15 (0.5%) with Celecoxib. Most commonly used ns-NSAIDs were Ibuprofen (n=47) and Ketorolac (n=16). Most common indications for NSAIDs were musculoskeletal pain (35%) or “non-cardiac” chest pain (9%). NSAID-treated patients were younger (56+/−12 in ns-NSAID, 60+/−12 in Celecoxib, and 62+/−12 years old in “no NSAID” groups; p&lt;0.001). More NSAID-treated patients had a history of myocardial infarction (p&lt;0.001) or reduced ejection fraction (p=0.008). NSAIDs treatment did not affect post-PCI in-hospital mortality (p=0.769). However, post-procedural myocardial infarction (MI) was more common in ns-NSAID-treated patients (5% in ns-NSAID, 0% in Celecoxib, and 1% in “no NSAID” groups, p=0.002), odds ratio 5.4 (95%CI of 1.9 –15.9, p=0.002). Post-procedural length of stay in survivors was also significantly longer in the ns-NSAID group (3.9+/− 3.4 days), as compared to Celecoxib (1.1+/− 0.3 days) or “no NSAID” groups (2.2 +/−3.3 days; p&lt;0.001). Ns-NSAID treatment remained predictive of prolonged hospital stay (p=0.011) after adjustment for age (p=0.033), ejection fraction (p&lt;0.001), and history of previous (p&lt;0.001) or post-procedural MI (p=0.001). We observed an increased incidence of peri-procedural MI and longer post-PCI length-of-stay in patients treated with non-selective NSAIDs, but not with Celecoxib. Poor outcomes in ns-NSAIDs treated PCI patients may be due to attenuation of aspirin’s anti-platelet effects by ns-NSAIDs. Pending results of the randomized trials, providers should limit use on non-selective NSAIDs in patients with coronary artery disease undergoing PCI.