Prolonged Length Of Stay Research Articles

The Association Between Elevated Thyroid-Stimulating Hormone Levels and Prolonged Length of Stay Among Adult Diabetic Patients Hospitalized in Internal Medicine Departments: A Large Historical Cohort Study

Background/Objectives: Type 2 diabetes mellitus (DM2) and hypothyroidism are two of the most common endocrine disorders in clinical practice. Hospital length of stay (LOS) is a quality metric of the health systems. We evaluated the association between elevated thyroid-stimulating hormone (TSH) levels and prolonged LOS among all adult patients (age ≥ 18 years) with DM admitted to our Internal Medicine departments between 2014 and 2022. Methods: Data on patient characteristics, LOS, and in-hospital mortality were collected. A TSH level > 4.7 μIU/mL was considered as being elevated. A LOS > 75th percentile and in-hospital mortality were defined as being prolonged. Univariate and multivariable analyses were applied, and propensity score matching controlled for differences between patients with normal and those with elevated TSH levels. Results: Of the 19,066 study participants (median age 75.6 years, IQR 75.9–83.3), 1524 (7.9%) had elevated TSH levels, and prolonged LOS was significantly more common among them (before matching: 38.6% vs. 29.1%, p < 0.001; after matching: 38.7% vs. 32.6%, p = 0.001). After adjustment for potential confounders, elevated TSH levels were also associated with prolonged LOS (OR = 1.22, 95% CI 1.07–1.39, p = 0.002). Conclusions: Elevated TSH levels in diabetic patients hospitalized in Internal Medicine departments are associated with prolonged LOS, emphasizing the importance of identifying hypothyroidism among them.

EGS SO11 - A Retrospective Review of Perioperative Outcomes after Laparoscopic Cholecystectomy in Older Patients

Abstract Background Laparoscopic cholecystectomy is the definitive treatment for gallstone-related disease. With an increasingly aging population, a growing number of elderly patients are presenting acutely with gallstone pathology. However, rates of perioperative mortality and complications are significantly higher in elderly patients undergoing laparoscopic cholecystectomy (Kamarajah et al). We aim to evaluate peri-operative outcomes in elderly patients presenting with acute gallstone disease who have been clinically evaluated to be appropriate for emergency cholecystectomy, and explore the impact of frailty on these outcomes. Method A retrospective study was performed on patients over the age of 75 presenting acutely with gallstone disease over a 3-year period. Data on perioperative complications, mortality at 1 year, post-operative length of stay (LOS) and 90-day readmissions were collected and analysed. The patient’s pre-operative fitness was categorized using the ASA classification of physical status and the Clinical frailty score (CFS); a 9-point scale quantifying frailty based on function. Statistical significance was assessed to determine differences between the age or frailty score groups. Results 592 patients attended hospital with gallstone-related pathology; 99 patients underwent emergency laparoscopic cholecystectomy, 486 patients were managed conservatively, and 25 patients had cholecystostomies. The post-operative mortality rate was 4%, post-operative complication 19.2% and readmission rate 11.1%. Post-operative LOS was significantly longer in frailer patients (p=0.02299). There were no statistically significant differences in mortality or post-operative complications between the CFS3 or less and CFS4 or more groups, although a general trend towards higher rates of complications and mortality was noted with increasing frailty. Conclusion Patients over 75 years of age should be carefully considered before proceeding with surgical management. Although older and frailer patients exhibited increased rates of complications and mortality post-operatively, these didn't reach statistical significance, reflecting the role of clinical decision-making regarding surgical fitness. Even for a pre-selected patient group, there is statistically significant prolonged post-operative LOS in frailer patients. This suggests a need for comprehensive preoperative assessment in this population, and a combination of CFS and ASA may be key determinants. Further studies assessing frailty and non-operative outcomes are required to substantiate these findings and guide clinical management in this population.

QLTI-11. PREDICTORS OF PROLONGED LENGTH OF STAY IN LASER INTERSTITIAL THERMAL THERAPY FOR INTRACRANIAL PATHOLOGIES: A SINGLE CENTER EXPERIENCE

Abstract INTRODUCTION Laser interstitial thermal therapy (LITT) offers a minimally invasive approach for treating intracranial pathologies, often with shorter hospital stays than traditional craniotomies. Yet, some patients still face prolonged length of stay (PLOS), highlighting the need to identify contributing factors and improve post-LITT outcomes. OBJECTIVE To evaluate factors contributing to PLOS following LITT for intracranial pathologies. METHODS A retrospective review was conducted between 2013-2023 for patients undergoing LITT for intracranial pathology at a tertiary care center. PLOS was defined as discharge >2 days. Multivariate logistic regression analyzed variables as contributors to PLOS including ICU LOS (hours), preoperative maximum tumor diameter (cm), lesion location, lesion pathology (high grade glioma (HGG)/glioblastoma (GBM) vs. other), and mFI-11 score (binary ≥ or < 75th percentile). RESULTS The cohort consisted of 288 patients, with 29% (83/288) and 71% (205/288) having PLOS and non-PLOS, respectively. Mean age was similar between the PLOS (63-years) and non-PLOS (60-years) groups (p=0.09). The PLOS group had a 55% male predominance compared to 57% female in the non-PLOS group. Greater mFI-11 scores showed increased risk of PLOS [4.01, (2.11, 7.60), p<0.000]. Lesions having a subcortical location [3.43 (1.70, 6.95), p=0.001] or diagnosis of HGG or GBM [2.87 (1.54, 5.34), p=0.001] had increased risk of PLOS. Importantly, maximum pre-operative diameter did not significantly alter risk of PLOS [1.05 (0.98, 1.13), p=0.151]. CONCLUSION For the first time, we show that patient comorbidities, subcortical lesion location, HGG/GBM pathology, and greater time spent in the ICU portend increased risk of PLOS following LITT. Future work should validate our model with the goal of optimizing post-operative patient management and resource allocation.

QLTI-18. TREATMENT AND OUTCOMES OF FRAIL PATIENTS WITH NEWLY DIAGNOSED HIGH-GRADE GLIOMAS: SHOULD WE CONSIDER CHANGING OUR TREATMENT APPROACH?

Abstract BACKGROUND Patients with newly diagnosed high-grade glioma (HGG) and low Karnofsky Performance Status (KPS) often face challenges in receiving cancer-directed therapy. They are excluded from prospective trials, limiting the chance of developing novel therapeutic approaches. METHODS We retrospectively reviewed charts of patients with functional debility and newly diagnosed HGG who received radiotherapy (RT) while admitted to the inpatient service at Memorial Sloan Kettering between 2013 and 2023. Multivariable analyses were performed which associated patient demographics, KPS, histology, genetic and molecular pathology, RT duration and dose, chemotherapy, palliative/supportive care consultation, and advanced care planning documentation with overall survival (OS) and discharge location, separately. RESULTS Fifty-four patients were identified; median age was 68 years (range:21-86) and 28 (52%) were women. Median KPS was 50 (range:30-70). Per WHO 2021 criteria, 47 (87%) were glioblastoma, IDH wild-type and 7 (13%) were HGG not otherwise specified, diagnosed by biopsy in 30 (56%), subtotal resection in 23 (43%), and gross total resection in one. MGMT promoter methylation was performed in 39/54 and was hypermethylated in 15 (38%). All patients received RT and 52 (96%) with concurrent temozolomide; 47/54 (87%) completed planned RT, with the median dose of 4,005 cGy in 15 fractions. 13 (24%) received bevacizumab. The median length of stay (LOS) was 29 days (range:20-65). Only 17 (31%) had palliative care consultation prior to discharge. The median OS (mOS) from the last radiation treatment was 4.21 months (95% CI: 2.73, 6.63). In multivariable Cox and logistic regression, respectively, lower KPS remained the sole factor significantly associated with increased risk of death (p=0.004) and decreased chance of return home (p=0.040). CONCLUSION In our patient cohort, treatment was associated with prolonged LOS and poor outcomes. A clinical trial should be considered to evaluate shorter RT courses and early palliative care consultation in this patient population.

Injury epidemiology and emergency department length of stay in trauma hospital in Addis Ababa, Ethiopia.

Injuries are a major cause of health problems in low- and middle-income countries than in high-income nations. This study aimed to describe injuries and identify factors associated with the emergency department (ED) length of stay (LoS). This study was conducted at the Addis Ababa Burn, Emergency, and Trauma (AaBET) hospital in Addis Ababa, Ethiopia. All injured patients who visited the ED between April 1, 2021, and March 30, 2022, were included in the study. Data were collected through a retrospective medical record review. Descriptive statistics were used to present the data and a multivariable binary logistic regression model was used to assess factors associated with LoS in the ED. A total of 6991 (86.8%) injured patients were studied out of 8055 patients who visited the ED. The majority of the patients were male, 5184 (74.2%), and aged between 18-44 years, 4368 (62.4%). The most common mechanism of injury was road traffic accidents, 2693 (38.5%), followed by falls, 1523 (21.8%). The most commonly reported injured body parts were the head (2179, 31.2%). Of the total injured patients, 101 (1.8%) died. The LoS in the ED was greater than 24 hours for 24.4% (95% CI: 23.3-25.5) of the injured patients, with a mean duration of 2.51 (SD = 5.18) days. Factors significantly associated with a prolonged LoS (>24 hours) in the ED included being residing in outside Addis Ababa in Oromia [AOR: 1.61, 95% CI (1.38-1.88)], Amhara [AOR: 1.56, 95% CI (1.14-2.14)] and other [AOR: 3.93, 95% CI (2.73-5.64)], male [AOR: 1.30, 95% CI (1.09-1.54)], aged 60 years or older [AOR: 1.38, 95% CI (1.03-1.85)]; sustaining injuries from road traffic accident [AOR: 2.43, 95% CI (1.19-4.94)], being triaged to orange [AOR: 3.03, 95% CI (2.40-3.83)] and red zones [AOR:3.37, 95% CI (2.65-4.28)]; having fracture injuries [AOR: 1.95, (1.34-2.83)]; and experiencing contusions and crushing injuries [AOR: 2.63 (1.57-4.42)]. Injuries are the major share of cases among ED patients at AaBET hospital. Patients were staying in the ED for longer than the recommended 24 hours by the Ethiopian health system. Intervention measures focusing on injury prevention are necessary to reduce the patient burden on the hospital and strengthen the hospital's capacity to reduce prolonged LoS.

QOL-15. PATIENT-REPORTED PHYSICAL HEALTH-RELATED QUALITY OF LIFE PREDICTS SHORT-TERM POSTOPERATIVE OUTCOMES IN A HETEROGENEOUS COHORT OF BRAIN TUMOR PATIENTS

Abstract Patient-reported outcome measures (PROMs) are increasingly used to assess patients’ perioperative health. The PROM Information System 29 (PROMIS-29) is a well-validated global health assessment instrument for patient physical health, though its utility in cranial neurosurgery is unclear. To investigate the utility of preoperative PROMIS-29 physical health (PH) summary scores in predicting postoperative outcomes in brain tumor patients. Adult brain tumor patients undergoing resection at a single institution (January 2018-December 2021) were identified and prospectively received PROMIS-29 surveys during pre-operative visits. PH summary scores were constructed and optimum prediction thresholds for length of stay (LOS), discharge disposition (DD), and 30-day readmission were approximated by finding the Youden index of the associated receiver operating characteristic curves. Bivariate analyses were used to study the distribution of low (z-score≤-1) versus high (z-score>-1) PH scores according to baseline characteristics. Logistic regression models quantified the association between preoperative PH summary scores and post-operative outcomes. A total of 157 brain tumor patients were identified (mean age 55.4±15.4 years; 58.0% female; mean PH score 45.5 + 10.5). Outcomes included prolonged LOS (24.8%), non-routine discharge disposition (37.6%), and 30-day readmission (19.1%). On bivariate analysis, patients with low PH scores were significantly more likely to be diagnosed with a high-grade tumor (69.6% vs 38.85%, p=0.010) and less likely to have elective surgery (34.8% vs 70.9%, p=0.002). Low PH score was associated with prolonged LOS (26.1% vs 22%, p<0.001), nonroutine discharge (73.9% vs 31.3%, p<0.001) and 30-day readmission (43.5% vs 14.9%, p=0.003). In multivariate analysis, low PH scores predicted greater LOS (odds ratio [OR]=6.09, p=0.003), nonroutine discharge (OR=4.25, p=0.020), and 30-day readmission (OR=3.93, p=0.020). The PROMIS-29 PH summary score predicts short-term postoperative outcomes in brain tumor patients and may be incorporated into prospective clinical workflows.

The incidence of atrial fibrillation and its impact on the length of stay following valvular heart surgery.

There is minimal evidence regarding predictors, preventative measures and treatments of new onset of post-operative atrial fibrillation (POAF) in patients undergoing valvular heart surgery. This study aimed to determine the incidence of new onset atrial fibrillation (AF) and its impact on outcomes and length of stay (LOS) for patients following valvular heart surgery. A single-centre, retrospective study was conducted. New onset AF was observed in 51/120 (42.5%) patients. Baseline and surgical characteristics were similar between patients who did and did not develop AF, although suggestive older age may increase the risk of developing POAF (p=0.06). New onset AF was significantly associated with longer intensive care unit (ICU) LOS-median increase of 2 days (p=0.002)-and overall hospital LOS-median increase of 1.5 days (p=0.006). Patients who received double valve surgery spent 2.5 times longer in the ICU compared to patients who had an aortic valve replacement (AVR) (p=0.033). The incidence of new onset AF following valvular heart surgery was high, with associated prolonged ICU and hospital LOS. Patients undergoing double valve surgery were more likely to have a longer ICU LOS compared with those who received an AVR.

Impact of Postpartum Hospital Length-of-Stay on Infant Gut Microbiota: A Comprehensive Analysis of Vaginal and Caesarean birth

BackgroundThe primary concern with prolonged hospitalization following birth is the risk of acquiring hospital-acquired infections (HAIs) caused by opportunistic bacteria, which can alter the early establishment of gut microbiota. ObjectiveThis study aimed to assess the association between postpartum hospital length-of-stay (LOS) and the composition of gut microbiota at 3 and 12 months of age according to birth mode. MethodsA total of 1313 Canadian infants from the CHILD Cohort Study were involved in this study. Prolonged hospital LOS was defined as > 2 days following vaginal and > 3 days after caesarean section (CS) birth. Infants' gut microbiota was characterized by Illumina 16S rRNA sequencing of faecal samples at 3-4 months and 12 months. FindingsFollowing a prolonged hospital LOS, vaginally-delivered (VD) infants with no maternal intrapartum antibiotic (IAP) exposure had a higher abundance of bacteria in their gut known to cause HAIs, including Enterococcus at 3 and 12 months, Citrobacter at 3 months and C. difficile at 12 months. Enterococcus or Citrobacter abundance at 3 months significantly mediated the association between LOS, and low abundance of Bacteroidaceae, or higher Enterococcaeae/Bacteriodaceae or Enterobacteriaceae/Bacteroidaceae abundance ratios at 12 months of age in VD infants without IAP exposure. HAI-causing Enterobacteriaceae were also more abundant in later infancy with a longer hospital LOS following CS. In the absence of exclusive breastfeeding for 3 months or any breastfeeding at 12 months, the Porphyromonadaceae (of Bacteroidota) become depleted in CS infants with a prolonged LOS. ConclusionsProlonged hospital stay after birth is associated with infant gut dysbiosis.

Association Between Congenital Heart Disease-Related Diagnosis Codes and Trauma Surgery Outcomes.

Congenital heart disease (CHD) is one the most common congenital anomalies, with a prevalence of 8-10 cases per 1000 live births in the United States. Congenital heart disease has been recognized as a risk factor for poor perioperative and postoperative outcomes in non-cardiac surgery. We aimed to determine if documentation of CHD-related diagnosis codes was associated with similar risks for trauma surgery. Data were acquired from the 2010-2019 American College of Surgeons' Trauma Quality Programs Participant Use Files. This study included trauma patients of all ages with one or more surgical procedures and at least one documented non-trauma (comorbidity) International Classification of Diseases code. Patients were stratified based on presence of CHD-related comorbidity codes vs any other comorbidity. Outcomes included mortality, hospital length of stay (LOS), discharge disposition, and in-hospital complications. Using 1:1 propensity score matching, we matched 215 cases with CHD-related comorbid diagnoses to non-CHD controls. Compared to patients with other comorbidities, patients with CHD-related comorbidites were less likely to be discharged home to self-care (odds ratio: 0.44, 95% confidence interval [CI]: 0.25, 078 P = .005) and tended to have prolonged hospital LOS (incidence rate ratio [IRR]: 1.06, 95% CI: 1.001, 1.13, P = .046). We present the first quantitative multicenter analysis correlating documentation of comorbid CHD-related diagnoses with higher risk of adverse outcomes after trauma surgery. These results support the need to routinely acknowledge and document CHD as comorbidity in trauma admissions that could lead to surgical intervention and for trauma centers to prepare for patients with a possible CHD comorbidity.

A Risk Prediction Model for Prolonged Length of Stay After Minimally Invasive Valve Surgery.

Minimally invasive surgery determines shorter postoperative hospital length of stay (LOS) even in cardiac surgery. Potential preoperative factors affecting LOS are still not known in minimally invasive heart valve surgery (MIVS). We aimed to identify preoperative variables influencing prolonged LOS in MIVS. We reviewed 189 patients who underwent MIVS via minithoracotomy at our institution. Prolonged LOS was defined as more than 7 postoperative days. Poisson and logistic regression were used to screen the predictors. The mean postoperative LOS was 9.13 days, and 64 patients (33.9%) experienced a prolonged LOS. These patients were older, more frequently in New York Heart Association (NYHA) class III or IV, showed worse left ventricular ejection function (LVEF), and had a higher incidence of reoperation and chronic kidney disease (CKD). At univariate analysis, the most significant preoperative factors affecting prolonged LOS were age (odds ratio [OR] = 1.04), NYHA class III or IV (OR = 3.03), reduced LVEF (OR = 3.22), CKD (OR = 2.7), and redo surgery (OR = 3.6). After adjustment, the most significant preoperative factors predicting prolonged LOS were age (OR = 1.03, 95% CI: 1.01 to 1.06, P = 0.02) and redo surgery (OR = 3.33, 95% CI: 1.29 to 8.9, P = 0.01). The most important factors affecting prolonged LOS after MIVS were represented by age and redo surgery, although other preoperative characteristics such as reduced LVEF, NYHA class III or IV, and CKD play a significant role in delaying recovery after MIVS. Further larger studies are needed to better identify potential preoperative predictors of prolonged LOS after MIVS.

Factors influencing hospital stay duration in an elective cardiac surgery cohort

Abstract Cardiac surgery has become more complex in recent years, with increases in patient age, complexity, and associated costs. The use of a multidisciplinary strategy to analyze and standardize patient management offers significant benefits. The development of Enhanced Recovery After Surgery (ERAS) programs has proven useful in various types of surgery, recently including cardiac surgery, yielding good results. One of the primary objectives of ERAS programs is the reduction of the Inpatients' length of stay (LOS), with the subsequent improvement in the patient experience and a reduction in costs. The aim of this study is to analyze preoperative and postoperative factors related to the LOS reduction in a cohort of elective cardiac surgery patients included in the Cardiac ERAS program at our hospital. All patients included in the ERAS program, corresponding to elective cardiac surgery, were included in the analysis. 138 patients were divided into four quartiles based on the inpatient’s LOS. An extensive search was conducted in our quality control database, which contains 470 variables on the factors more strongly associated with LOS. The results were analyzed using Chi-Square test for categorical and the Kruskal-Wallis test for continuous variables, generally of non-normal distribution. The results are summarized in the table. Age, poor mobility, surgery other than coronary bypass, and reoperation were the non-modifiable factors most associated with a prolonged LOS. Lower preoperative hemoglobin and albumin levels were associated with an increase in LOS. A class 3 or 4 NYHA functional class, chronic pulmonary disease, and anticoagulation use were associated with higher LOS. Classic cardiovascular risk factors, such as dyslipidemia, hypertension, and tobacco use, were not associated with differences in hospitalization duration. Postoperative and intraoperative factors associated with higher LOS included extubation in the operating room or within six hours, ICU stay duration, mobilization on postoperative days one and two, time to oral food tolerance and gut motility recovery, hyperglycemia on postoperative day one, the duration of arterial, venous, and urinary catheters, the amount of fluids on postoperative day one and the opioid use in POD 2. The complications most associated with a prolonged duration were any infectious complication, any respiratory complication, reoperation, readmission to intensive care, transfusion after 12 hours or at any time during hospitalization, prolonged postoperative sedation, and any rhythmic complication. Conclusion In our cohort of elective patients for cardiac surgery, factors traditionally addressed by ERAS programs were identified as being associated with a longer inpatient’s length of stay. Pre-operative nutritional and anemia optimization, early extubation and mobilization, and the prevention of respiratory and infectious complications should be targeted to improve hospital stay duration.

Perioperative and functionnal outcomes of robot-assisted laparoscopic versus open ureterovesical reimplantation for benign lower ureteral pathologies: a single-center comparative study.

The robot-assisted laparoscopic(RALUVR) and open(OUVR) approaches have both been described for ureterovesical reimplantation to treat benign lower ureteral pathologies. Thus, we aimed to compare the perioperative and functional outcomes of RALUVR vs. OUVR. We performed a retrospective comparative study including all consecutive patients treated with RALUVR or OUVR for benign lower ureteral pathologies between January 2013 and December 2022 at our center. Logistic regression analyses were used to assess the predictors of complication ≥ Clavien-Dindo(CD)III within 90 days, prolonged length of stay(LOS), and 90-day overall success. The Kaplan-Meier method and Cox regression analyses were used to assess vesicoureteral reflux-free(VU-RFS) and stenosis-free(SFS) survivals. Overall, 44 patients underwent RALUVR(n = 19; 43%) and OUVR (n = 25; 57%). In univariable logistic regression analyses, the use of RALUVR vs. OUVR was not significantly associated with postoperative complications ≥ CDIII (OR = 0.98; 95% CI=[0.17-5.09]; p = 0.98), and 90-day overall success (OR = 1.43; 95% CI=[0.24-11.28]; p = 0.7). Despite a shorter median LOS after RALUVR vs. OUVR (4 vs. 10 days, respectively; p < 0.001), multivariable logistic regression analysis showed no impact of the surgical approach on prolonged LOS (OR = 0.51, 95% CI=[0.03-13.86]; p = 0.65). No significant difference was observed in 2-year VU-RFS (72.9% vs. 100%, respectively; p = 0.2) and 2-year SFS between the RALUVR and OUVR groups (85.7% vs. 87.7%, respectively; p = 0.8). In Cox regression analysis, the use of RALUVR vs. OUVR was not significantly associated with VU-RFS (HR = 4.26; 95% CI=[0.38-47.84]; p = 0.24) or SFS (HR = 1.32; 95% CI=[0.22-8.01]; p = 0.76). We observed that RALUVR provides similar perioperative and functional outcomes as compared to OUVR, except for potentially shorter LOS.

Evaluation of Plasma-Lyte Versus Lactated Ringer's in Surgical Intensive Care Unit Trauma Patients as Fluid Resuscitation.

In critically ill patients, fluid resuscitation with balanced crystalloids close to plasma osmolarity have a lower risk of electrolyte imbalances and demonstrated better clinical outcomes compared to normal saline (NS). While lactated ringer's (LR) has shown benefit over NS, plasma-lyte (PL) with a higher osmolarity and different electrolyte formulation is hypothesized to be superior. We performed a retrospective observational cohort study over 37 months at a tertiary hospital. Inclusion criteria were hospitalization in the surgical intensive care unit (SICU), trauma indication, ≥18 years old, and received either PL or LR. All PL administrations and every fifth patient with LR as resuscitation were included in order to match the sample size in each group. Primary outcomes were SICU length of stay (LOS), hospital LOS, and mortality. Secondary outcomes were biomarker changes from baseline. There were 113 patients in both PL and LR groups. The PL arm had higher APACHE II scores (16 vs 13, P = .033) and were more likely ventilated (39.3% vs 20.4%, P = .002) compared to LR. Median hospital LOS (12.0 vs 8.0, P < .001) and SICU LOS (6.0 vs 3.0, P < .001) are significantly longer in PL group compared to the LR group. However, there was no difference in in-hospital mortality (5.3% vs 3.5% P = .519) and SICU mortality (9.7% vs 5.3%, P > .208) between PL and LR. Overall, PL use was associated with prolonged hospital and SICU LOS. PL use did not demonstrate mortality benefit. However, patients were more critically ill in PL group based on higher APACHE II scores and higher rates of mechanical ventilation, which could be contributing to these unfavorable outcomes.

The association between early postoperative food intake and postoperative hospital length of stay in patients undergoing cardiac surgery: A retrospective observational single-center study

Background & AimsPerioperative nutritional status is critical during the postoperative recovery process in patients undergoing cardiac surgery. Several studies on patients undergoing cardiac surgery have reported low energy intake in early postoperative food intake via oral nutrition; however, no study has shown an association of low energy intake with postoperative hospital length of stay (LOS). This study aimed to determine whether early postoperative low food intake was associated with prolonged postoperative hospital LOS in patients undergoing cardiac surgery. MethodsThis was a retrospective, observational, single-center study conducted in patients aged ≥18 years undergoing elective cardiac surgery from January 1, 2020, to May 31, 2023. Patients were categorized by food intake as food intake < 50% (low food intake group) and ≥ 50% (adequate food intake group) at lunch on postoperative day (POD) 3. The primary outcome of this study was the postoperative hospital LOS. A generalized linear model was used to examine the association between food intake and postoperative hospital LOS using the following explanatory variables: age, European System for Cardiac Operative Risk Evaluation (EuroSCORE) II value, preoperative risk of malnutrition, activities of daily living status, Sequential Organ Failure Assessment score, and C-reactive protein level. ResultsOf the 315 patients, 104 (33.0%) had a food intake of <50% on POD3. There were no significant differences in age, sex, EuroSCORE II value, and comorbidities between the two groups. Patients in the low-food intake group had a significantly lower Barthel Index (6.7% vs. 1.4%, p = 0.017) and a higher malnutrition risk according to the Mini Nutritional Assessment Short Form score (40.4% vs. 28.2%, p = 0.043). Food intake of <50% on POD3 was associated with prolonged postoperative hospital LOS (β = 1.135 [95% confidence interval: 1.004–1.262], p = 0.018). ConclusionsLow food intake on POD3 is associated with prolonged postoperative hospital LOS in patients undergoing elective cardiac surgery. Early postoperative food intake should be closely monitored in patients after elective cardiac surgery.

Medical and social factors associated with prolonged length of stay for chronically ventilated children.

This study seeks to determine the overall and post-intensive care unit (ICU) length of stay (LOS) for children with tracheostomies and chronic mechanical ventilation. We hypothesized that medical and social factors would be associated with prolonged LOS. This single-center retrospective review included children who were discharged after initiation of chronic ventilation via tracheostomy over an 8-year period (2015-2022). Patients were divided into two groups for analysis, those who had been previously home before admission (HBA) and those who had not (Not HBA). Medical and social determinants of health (SDOH) data were obtained from the electronic medical record for univariate and multivariable analyses. A total of 161 patients were included. HBA subjects (n = 52) were expectedly older at the time of tracheostomy. Not HBA subjects (n = 109) were more likely to be born prematurely and have sequelae of premature birth. Overall and post-ICU LOS increased for both groups during the study period. In the HBA subgroup, congenital heart disease and younger age were associated with longer overall LOS with these factors and the absence of gastric fundoplication being associated with longer post-ICU LOS. For Not HBA patients, younger age, pulmonary hypertension, seizures, and several SDOH were associated with longer overall LOS, whereas only SDOH were associated with a longer post-ICU LOS. Overall and post-ICU LOS for all children hospitalized for tracheostomy and chronic mechanical ventilation are increasing. Prolonged LOS is significantly associated with several medical factors and SDOH.

Analysis of selective neurocritical care admission costs following elective endovascular treatment of unruptured intracranial aneurysms.

No consensus exists on the necessity of neurocritical care unit (NCU)-level care following unruptured intracranial aneurysm (UIA) treatment. We aim to identify patients requiring NCU-level care post-treatment and determine potential cost savings utilizing a selective NCU admission protocol. A retrospective analysis of all UIA patients who underwent endovascular treatment at a single center from 2017-2022 was conducted. Data on demographics, preprocedural variables, radiographic features, procedural techniques, intra/postoperative events, and length of stay (LOS) were collected. Multivariable analysis was performed to identify patients requiring NCU-level care post-treatment. Cost analysis using hospital cost data (not charges/reimbursement) was performed using simulated step-down and floor protocols for patients without NCU indications following a hypothetical six-hour post-anesthesia care unit observation period. Of 209 patients, 179 were discharged within 24 h and 30 had prolonged LOS. In our analysis, intra- and postoperative events independently predicted prolonged LOS. In our subanalysis, 47 patients demonstrated NCU needs: 24 with intraoperative indications, 18 with postoperative indications, and five with both. Of the 23 with postoperative indications, 20 were identified within six hours, while three were identified within six to 24 h. The median variable cost per patient for the current NCU protocol was $31,505 (IQR, $26,331-$37,053) vs. stepdown protocol $29,514 (IQR, $24,746-$35,011;p = 0.061) vs. floor protocol $26,768 (IQR, $22,214-$34,107;p < 0.001). Total variable costs were $6,211,497 for the current NCU protocol vs. $5,921,912 for the step-down protocol (4.89% savings) and $5,509,052 for the floor protocol (12.75% savings). Most patients requiring NCU-level care following UIA treatment were identified within a six-hour postoperative window. Thus, selective NCU admission for this cohort following a six-hour observation period may be a logical avenue for cost reduction. Our analysis demonstrated 5% and 13% savings for uncomplicated patients using step-down and floor admission protocols, respectively.

In-hospital mortality, readmission, and prolonged length of stay risk prediction leveraging historical electronic patient records.

This study aimed to investigate the predictive capabilities of historical patient records to predict patient adverse outcomes such as mortality, readmission, and prolonged length of stay (PLOS). Leveraging a de-identified dataset from a tertiary care university hospital, we developed an eXplainable Artificial Intelligence (XAI) framework combining tree-based and traditional machine learning (ML) models with interpretations and statistical analysis of predictors of mortality, readmission, and PLOS. Our framework demonstrated exceptional predictive performance with a notable area under the receiver operating characteristic (AUROC) of 0.9625 and an area under the precision-recall curve (AUPRC) of 0.8575 for 30-day mortality at discharge and an AUROC of 0.9545 and AUPRC of 0.8419 at admission. For the readmission and PLOS risk, the highest AUROC achieved were 0.8198 and 0.9797, respectively. The tree-based models consistently outperformed the traditional ML models in all 4 prediction tasks. The key predictors were age, derived temporal features, routine laboratory tests, and diagnostic and procedural codes. The study underscores the potential of leveraging medical history for enhanced hospital predictive analytics. We present an accurate and intuitive framework for early warning models that can be easily implemented in the current and developing digital health platforms to predict adverse outcomes accurately.

Time-To-Event Analysis Of Factors Influencing Delay In Discharge From A Subacute Complex Discharge Unit During The Pandemic

Abstract Background Length of stay (LOS) is the most common outcome measure of effectiveness in discharge planning. It refers to the time expressed in days between admission to and discharge from the hospital. During the COVID-19 pandemic, the average inpatient LOS was 5.8 days, representing a slight increase in the average inpatient LOS of 5.7 days between 2016–2019. Tackling delays in patient discharge is an ongoing challenge, and with the emergence of the COVID-19 pandemic, there has been significant disruptions in discharge planning, discontinuity and incoordination between subacute complex discharge units and community care. Methods Our study analysed delaying factors amongst patients with LOS &amp;gt; 15 days during the COVID-19 pandemic using time-to-event analysis. Kaplan–Meier’s plot compared factors causing a delay in discharge to the single factors: age, gender, and multimorbidity. A multivariate Cox regression analysis adjusted to age, gender, and multimorbidity predicted factors affecting LOS. Results A total of 390 patients were admitted between March 2020 – February 2021 to a subacute complex discharge unit in an Irish tertiary centre hospital: 326 (83.6%) were &amp;gt;65 years of age and 233 (59.7%) were female. The median (IQR) age was 79 (70–86) years with a median (IQR) of 19.4 (10–41) days. A total of 237 (60.7%) events were uncensored, with LOS &amp;gt; 15 days, of which 138 (58.2%) were female and 124 (52.32%) had &amp;gt; 4 comorbidities; 153 (39.2%) were censored into LOS ≤ 15 days, and death occurred in 19 (4.8%). Conclusion Our study is the first to analyse common factors delaying discharge from a complex discharge unit. Further research is required to explore multimorbidity as a risk factor for mortality in patients with prolonged LOS within a complex discharge unit and target gender-specific frailty measures to achieve high-quality patient management.

Factors Affecting Length of Stay for Children Hospitalized After Pediatric Surgical Procedures.

Understanding the postoperative length of stay (LOS) by surgical procedure is important for hospital medicine clinicians involved in surgical co-management. We assessed variation in postoperative LOS for children after elective surgical procedures and risk factors for prolonged LOS. This study is a retrospective analysis of pediatric patients undergoing elective surgical procedures between January 1, 2018 and October 1, 2021 with postoperative hospitalization for recovery at a freestanding children's hospital. The postoperative LOS (number of days) was compared across types of surgery and by the number of chronic conditions (assessed with the Agency for Healthcare Research and Quality Condition Indicator system) using multivariable quantile regression. The median (interquartile range) LOS across all 347 types of surgical procedures combined was 2 (interquartile range 1-4). Surgical procedures (n = 85) with a median LOS between 3.0 and <5.0 days (eg, spinal fusion, Chiari decompression) accounted for 20.9% of all hospitalizations (N = 12 139) and 23.1% of all postoperative bed days. Procedures (n = 46) with a median LOS of ≥5.0 days (eg, femoral osteotomy, bladder reconstruction) accounted for 15.0% and 46.8% of all hospitalizations and bed days, respectively. After controlling for the type of procedure, having ≥4 (versus none) chronic conditions was significantly associated with experiencing a prolonged LOS (90th percentile: 5.2 days); patients with 4 to 6, versus no, chronic conditions stayed a median of 1.4 (95% confidence interval [CI] 0.7-2.2) days longer, those with 7 to 9 chronic conditions stayed a median of 1.9 (95% CI 1.0-2.7) days longer, and those with ≥10 chronic conditions stayed a median of 4.0 (95% CI 3.3-4.7) days longer. Hospital medicine clinicians can use the type of surgery in combination with the number of chronic conditions to estimate postoperative LOS after elective surgical procedures in children.

Predicting extended hospital stay following revision total hip arthroplasty: a machine learning model analysis based on the ACS-NSQIP database.

Prolonged length of stay (LOS) following revision total hip arthroplasty (THA) can lead to increased healthcare costs, higher rates of readmission, and lower patient satisfaction. In this study, we investigated the predictive power of machine learning (ML) models for prolonged LOS after revision THA using patient data from a national-scale patient repository. We identified 11,737 revision THA cases from the American College of Surgeons National Surgical Quality Improvement Program database from 2013 to 2020. Prolonged LOS was defined as exceeding the 75th value of all LOSs in the study cohort. We developed four ML models: artificial neural network (ANN), random forest, histogram-based gradient boosting, and k-nearest neighbor, to predict prolonged LOS after revision THA. Each model's performance was assessed during training and testing sessions in terms of discrimination, calibration, and clinical utility. The ANN model was the most accurate with an AUC of 0.82, calibration slope of 0.90, calibration intercept of 0.02, and Brier score of 0.140 during testing, indicating the model's competency in distinguishing patients subject to prolonged LOS with minimal prediction error. All models showed clinical utility by producing net benefits in the decision curve analyses. The most significant predictors of prolonged LOS were preoperative blood tests (hematocrit, platelet count, and leukocyte count), preoperative transfusion, operation time, indications for revision THA (infection), and age. Our study demonstrated that the ML model accurately predicted prolonged LOS after revision THA. The results highlighted the importance of the indications for revision surgery in determining the risk of prolonged LOS. With the model's aid, clinicians can stratify individual patients based on key factors, improve care coordination and discharge planning for those at risk of prolonged LOS, and increase cost efficiency.