30-day Hospital Readmission Rates Research Articles

P-209. Evaluation of Hospitalized Clostridioides difficile (C. difficile) Polymerase Chain Reaction (PCR) Positive/Enzyme Immunoassay (EIA) Negative Patients

Abstract Background Differentiating true infection versus colonization is challenging in C. difficile PCR positive/EIA negative patients. Prior studies estimate 50% of these patients have true infection and warrant treatment. The aim of this study was to describe treatment practices for hospitalized C. difficile PCR positive/EIA negative patients at ChristianaCare. Methods A single health system, retrospective study was conducted between January to December 2022. PCR positive/EIA negative patients were categorized as treated or not treated for C. difficile infection (CDI). The primary outcome was the percentage of patients treated for CDI. Secondary outcomes that influence the decision to treat including age, sex, immunocompromised status, white blood cell (WBC) count, systemic antibiotic use, Infectious Diseases (ID) consultation, or recurrent CDI were evaluated. Hospital length of stay (LOS) and 30-day hospital readmission rates were also collected. ChristianaCare’s C. difficile scoring tool was used to categorize patients as low, medium, and high risk for true CDI. Results Of the 101 patients included in this study, 82 (81%) of PCR positive/EIA negative patients were treated for CDI (95% CI [0.73, 0.89]). Treated patients were more likely to have received antibiotics within the last 30 days (p=0.014) and have an ID consultation (p=0.013). There were no statistically significant differences between treated and not treated groups based on age, sex, immunocompromised status, elevated WBC, recurrent CDI, hospital LOS, 30-day hospital readmission, and inpatient all-cause mortality. No patients had real-time documentation of the C. difficile scoring tool score. All retrospective, manually calculated high risk patients utilizing the C. difficile scoring tool were treated (20.7%). Conclusion We observed a higher percentage of treatment in patients who were C. difficile PCR positive and EIA negative compared to prior studies. Treated patients were more likely to have antibiotic use within the last 30 days and an ID consultation. Other risk factors commonly used to diagnose CDI did not impact treatment decisions. Opportunity to improve education using the ChristianaCare C. difficile scoring tool to assess CDI risk in patients and guide testing and treatment decisions is warranted. Disclosures All Authors: No reported disclosures

P-1768. Evaluation of Pharmacist-Driven Automatic 5-day Stop Dates for Ceftriaxone in Respiratory Tract Infections

Abstract Background Despite 2019 ATS/IDSA CAP guideline support for a 5-day treatment duration, compliance with these recommendations remains suboptimal. Patients that receive extended courses of antibiotics are at increased risk for adverse outcomes, longer hospitalization stays, and development of antimicrobial resistance. The objective of this study was to compare hospital length of stay (LOS) and length of therapy (LOT) before and after a pharmacist-driven automatic stop date protocol for ceftriaxone for CAP and COPD exacerbations. Methods A retrospective cohort study conducted at Texas Health Harris Methodist Hospital Fort Worth evaluated patients before June 2023, and after November 2023. Patients were excluded if treatment indications were for non-respiratory indications, received ≤2 ceftriaxone doses, admitted into the ICU, LOS ≥10 days, or if placed on hospice within 72 hours of admission. Pharmacists then adjusted ceftriaxone orders to 5 total days for CAP and COPD exacerbations. The primary outcome was hospital LOS and LOT. Secondary outcomes included 30-day all-cause in-hospital mortality and 30-day hospital readmission due to infections. Results 295 patients were included in the final analysis with 145 patients in the pre- and 150 patients in the post-group. After implementation of the protocol, a statistically significant reduction in hospital LOS was observed in the post-group (4 days vs 5 days, p < 0.0001). There was also a statistically significant reduction in median LOT for CAP and COPD (5 days vs 7 days, p < 0.0001). No increase in 30-day all-cause mortality (0% vs 4%, p =0.012) or 30-day hospital re-admission rates due to infections (3% vs 8%, p =0.033) were observed in the post- compared to the pre-group. Conclusion Based on the results of this study, implementation of a pharmacist-driven automatic 5-day stop date protocol for ceftriaxone is an effective antimicrobial stewardship initiative that can help increase compliance to guideline recommendations for CAP and COPD while also decreasing hospital LOS. Additionally, this initiative was not associated with increased rates of mortality or hospital re-admissions compared to longer durations and influenced discharge antibiotic prescription habits. Disclosures All Authors: No reported disclosures

Mild acute biliary pancreatitis: still a surgical disease. A post-hoc analysis of the MANCTRA-1 international study

BackgroundThe current standard of care for mild acute biliary pancreatitis (MABP) involves early laparoscopic cholecystectomy (ELC) to reduce the risk of recurrence. The MANCTRA-1 project revealed a knowledge-to-action gap and higher recurrence rates in patients admitted to medical wards, attributable to fewer ELCs being performed. The project estimated a 35% to 70% probability of narrowing this gap by 2025. This study evaluates the safety of suboptimal ELC implementation and identifies risk factors for recurrent acute biliary pancreatitis (RAP) in patients not undergoing ELC after an MABP episode.MethodsWe conducted a post-hoc analysis of the MANCTRA-1 registry, including MABP patients who did not undergo ELC during the index hospitalization, excluding those with related complications. The primary outcome was the 30-day hospital readmission rate due to RAP. We performed multivariable logistic regression to find risk factors associated with the primary outcome.ResultsBetween January 2019 and December 2020, 1920, MABP patients from 150 centers were included in the study. The 30-day readmission rate due to RAP was 6%. Multivariable logistic regression found the admission to a medical ward (internal medicine or gastroenterology) (OR = 1.95, p = 0.001) and a positive COVID-19 test (OR = 3.08, p = 0.029) as independent risk factors for RAP.ConclusionOur analysis offers valuable insights into the management of MABP, particularly in centers where ELC cannot be fully implemented due to logistical and clinical constraints, worsened by the COVID-19 pandemic. Regardless of the admitting ward, prompt access to surgical care is crucial in reducing the risk of early recurrence, highlighting the need to implement surgical consultation pathways within MABP care bundles.

A 5-Year Review of Characteristics and Outcomes of Trauma Surgery Patients Leaving Against Medical Advice.

The objective of this study was to characterize the demographic, social, economic, and clinical factors of trauma surgery patients leaving against medical advice (AMA). Data were retroactively obtained from a level-one trauma center in a medium-sized metropolitan area from January 2017 to December 2021. The sample population consisted of patients admitted or treated by the trauma surgical service. In the 5-year study period, 130 surgical patients left AMA and met the inclusion criteria for this study. The average patient was 38.8 years old. The majority were male (77.7%) and White (47.7%). It was found that 74.6% of patients had insurance, 23.6% were experiencing homelessness, and 6.2% required an interpreter. A large percentage of patients had a past medical history significant for depression (31.5%), anxiety disorders (25.4%), and substance use disorder (68.5%). Analysis of the hospital time course of this patient population indicated that patients were most often admitted to trauma surgery (70.0%) and most often required consults by neurosurgery (28.5%). Procedures were performed for 81.5% of patients and social services were consulted for 60.8% of patients. Only 50.8% of patients who left AMA were noted to receive discharge instructions. Nearly half (44.6%) of the patients returned to a hospital to receive additional care within 1 month of their initial AMA discharge date. A concerning number of trauma surgery patients left without discharge instructions, possibly leading to a high rate of 30-day hospital readmission. Future studies are needed to examine and further characterize the relationship between discharge protocol and outcomes of patients leaving AMA.

Survival models and longitudinal medical events for hospital readmission forecasting

BackgroundThe rate of 30-day all-cause hospital readmissions can affect the funding a hospital receives. An accurate and reliable readmission prediction model could save money and increase quality-of-care. Few projects have explored formulating this task as a survival prediction problem, where models can exploit a real-valued time-to-readmission target. This paper demonstrates the effectiveness of a survival-inspired readmission model, especially when paired with a longitudinal patient representation that is agnostic to disease-cohort and predictive task.MethodsWe forecast readmissions for a population-level cohort of 421,088 patients discharged in 2015 and 2016 from hospitals in Alberta, Canada. Clinical features and sequences of historical medical codes (calculated from at least four full years prior to discharge) from linked administrative sources serve as model inputs. We trained binary 30-day readmission models (XGBoost and a Deep Neural Network) and time-to-event readmission models (CoxPH and N-MTLR) with and without machine-learned medical knowledge at initialization, then compared against the popular LACE-based model using the AUROC score at 30 days (AUROC@30). Survival models are additionally evaluated using concordance, Integrated Brier, and L1-loss scores.ResultsAll models that utilize sequence features markedly out-perform even the best models trained on only clinical features. Further, a time-to-event target improves predictive performance at 30 days, given the same model inputs and architecture. N-MTLR, using solely sequence inputs and initialized with pre-learned medical knowledge, achieves an average AUROC@30 of 0.8460 over five folds with a standard deviation of 0.003. All trained models match or out-perform the LACE baseline of 0.6587±0.003.ConclusionSequences of administrative medical codes contain rich predictive information for forecasting readmissions, and embedding medical knowledge a priori using machine learning provides readmission models an advantageous foundation for training. When combined with a model that can leverage a time-to-event target, excellent performance is possible on the 30-day all-cause readmission task using only administrative data.

Surgical management of candy cane syndrome after Roux-en-Y bypass

BackgroundCandy cane (CC) syndrome is a complication that occurs following Roux-en-Y bypass (RYGB), implicated as a long, small-bowel blind limb at gastrojejunostomy possibly caused using circular staplers. ObjectivesWe aimed to report our experience with CC resection and improving outcomes following RYGB. SettingUniversity hospital. MethodsWe performed a retrospective analysis of patients who underwent CC resection at our institution from 2017 to 2023. Patient’s charts were then reviewed to evaluate for symptoms, operative, and weight data. Only patients with an afferent blind limb in the most direct outlet from the gastroesophageal junction (GJ) visualized in upper gastrointestinal (GI) study and endoscopy were included. ResultsTwenty-nine patients had presented with symptoms of and underwent surgery of resection of the CC (83% female; 50.3 ± 12.9 years) within 11 ± 6 years after initial RYGB. In addition, 58.6% underwent a concomitant procedure (10 hiatal hernia repair, 4 redo-GJ, and 3 internal hernia reduction and defect closure). The mean length of the CC was 7.5 ± 3.9 cm. Resection of CC was performed in 62.1% as stapling only, 34.5% as stapling and oversewing, and 3.4% as oversewing only. The 30-day hospital readmission rate was 7.4% (n = 2). At 8.5-month follow-up, there was a significant reduction (P < .005) of bloating, nausea or vomiting, and dysphagia; however, abdominal pain and diarrhea slightly decreased. The estimated weight loss percentage was 29.4% ± 5.6%, and body mass index decreased from 32.1 ± 7.3 kg/m2 to 29.1 ± 4.7 kg/m2. ConclusionsResection of blind afferent limb can be managed safely with excellent outcomes and resolution of symptoms, even if major procedures are performed concomitantly. Surgeons should resect excess Roux limb in the initial RYGB to decrease the likelihood of this syndrome.

Comparative Effectiveness of Transcatheter Aortic Valve Replacement (TAVR) in Nonagenarians Compared with Younger Patients

Background: TAVR has garnered worldwide acceptance as a suitable alternative to surgical AVR in many clinical situations, particularly in the elderly. Our goal was to study whether some of the known benefits from TAVR might be superseded by risks in the nonagenarian population [1]. Methods: Using Cox proportional hazards method, we retrospectively analyzed 1246 patients age &gt; 50 years undergoing TAVR at our institution from the STS/ACC TVT database between 2010-2020. Patients age &gt; 90 were compared with younger patients with coprimary endpoints of inpatient mortality and major bleeding requiring transfusion, 1-yr mortality, and 30-day all cause readmission. Results: Baseline demographic, clinical characteristics, and unadjusted outcomes in primary endpoints are presented in Table 1. Primary endpoints did not differ across the two groups. Inpatient mortality (Odds Ratio 2.23 [0.62, 8.00]; p=0.22), 1-year mortality (HR 1.64 [0.78, 3.44]; p =0.19), and 30-day hospital readmission rates (HR 0.84 [0.39, 1.81]; p=0.66) were similar prior to and after adjustment for baseline differences. Conclusions: In our study, no differences in hard clinical endpoints were detected between a younger and advanced aged population of patients treated with TAVR. Our study highlights that TAVR can be safely performed in patients of extreme age with clinical outcomes similar to a younger patient population when properly selecting patients for this procedure.

Integrating Quantitative Data and Qualitative Insights to Understand 30-Day Readmission Rates: A Mixed-Methods Study.

The rate of patients readmitted to hospitals within 30 days of discharge is a critical indicator of healthcare quality. This study explored the factors contributing to 30-day hospital readmission rates nationally and at Arrowhead Regional Medical Center (ARMC) through a mixed-methods research design. Quantitative analysis utilized data from the Centers for Medicare & Medicaid Services (CMS) database, focusing on patient demographics, principal diagnoses, length of stay, and hospital characteristics. Multivariate regression and descriptive statistics were employed to identify predictors of 30-day readmission. The qualitative analysis sought to understand the specific medical conditions and patient profiles linked to higher readmission rates. The findings revealed that older age, specific principal diagnoses (e.g., heart failure, pneumonia, chronic obstructive pulmonary disease (COPD)), and longer initial hospital stays were associated with an increased likelihood of 30-day readmission. Gender disparities and hospital size/type also influenced readmission rates. These results provide valuable insights into the complex interplay of individual patient characteristics and hospital attributes in driving readmissions. The study's mixed-methods approach yielded a comprehensive understanding of the quantitative patterns and qualitative factors contributing to 30-day hospital readmission rates, offering important implications for healthcare quality improvement initiatives.

Hospital Network Centralization of Primary Total Joint Arthroplasty Is Associated With Reduced Early Complication Rates But Not Reduced Readmission or Reoperation Rates: A Retrospective Database Study

Background: Hospital networks centralize primary total joint arthroplasty (TJA) within their existing systems to develop specialized service lines with higher surgical volumes to reduce adverse events. It is not known what role hospital network centralization has had on primary TJA outcomes. Purpose: We sought to determine whether the degree of hospital network centralization for primary TJA is associated with (1) 90-day postoperative complication rates, (2) 90-day hospital readmission rates, or (3) 1-year revision rates. Methods: We conducted a retrospective database study of Medicare Part A beneficiaries who underwent inpatient primary TJA for osteoarthritis in 2016 and 2017 ( n = 523,142 patients); individual hospital-level characteristics and hospital networks were also identified ( n = 360 unique networks, n = 3339 hospitals). Patients having surgery at a hospital that was not a member of a health care network were excluded ( n = 163,998 patients) because we wanted to examine only the role of network structures on outcomes; this resulted in a cohort of 359,144 patients. Hospital network centralization, which was defined as the percentage of total network cases performed at the highest volume hospital and categorized into quartiles (eg, lowest 25% of networks by concentration, 26%–50% of networks by concentration, etc). Primary outcomes included postoperative 90-day complications, 90-day readmissions, and 1-year revisions. Multivariable logistic and linear regressions evaluated associations of hospital network centralization with outcomes and controlled for relevant patient-level and hospital-level covariates, including hospital network volumes. Results: Odds of 90-day complications were lower in the most centralized hospital networks than in least centralized networks (odds ratio [OR] = 0.85; 95% confidence interval [CI]: 0.75, 0.95). Degree of centralization was not associated with readmissions or 1-year revision rates. Non-modifiable patient and individual hospital characteristics appeared to have a greater association with complications, readmissions, and early revision rates than hospital network centralization or volume. Conclusion: This retrospective database study found that increased centralization of primary TJA within a hospital network was associated with lower 90-day complication rates but not with 90-day readmission or 1-year revision rates. This suggests that structural changes within hospital networks may be beneficial to reduce early complications in this patient population. In addition, our findings suggest that risk adjustment in assessing non-modifiable patient and hospital risk factors may be important when assessing TJA outcomes.

SP4.14 - Mild acute biliary pancreatitis: still a surgical disease. A post-hoc analysis of the MANCTRA-1 international study

Abstract Aims The current standard of care for mild acute biliary pancreatitis (MABP) involves early laparoscopic cholecystectomy (ELC) reducing the risk of early recurrence. The MANCTRA-1 project disclosed a discrepancy in translating this evidence into clinical practice, estimating a 35 to 70% probability of narrowing this gap within 2025. This study assesses the safety of suboptimal ELC implementation in MABP, looking for risk factors for recurrent acute biliary pancreatitis (ABP) in patients awaiting interval cholecystectomy after an uneventful episode of MABP. Methods We conducted a post hoc analysis of the MANCTRA-1 registry. Clinicaltrials.gov ID NCT04747990. We included MABP patients who did not undergo ELC during the index hospitalization, excluding those who experienced disease-related complications. The primary outcome was the 30-day hospital readmission rate due to ABP recurrence. We performed univariable and multivariable logistic regression to identify risk factors for 30-day ABP recurrence. Results Between January 2019 and December 2020, a total of 2,253 MABP patients from 150 centres were included. The 30-day readmission rate due to ABP recurrence was 6%. The multivariable logistic regression showed that admission to a medical ward (internal medicine or gastroenterology) odds ratio (OR) 1.62 (95%[CI] 1.1;2.37), p=0.01 was an independent risk factor for 30-day ABP recurrence. Conclusion Our real-world analysis provides valuable insights to manage MABP, particularly in centres where ELC strategies cannot be fully implemented due to organizational and clinical constraints. Despite the admitting ward, it underscores the importance of timely access to surgical care in reducing the risk of early recurrence, disclosing the need to implement surgical consultation pathways in ABP care bundles.

Reducing 30-Day Readmissions in Patients With Alcohol Use Disorder

The 30-day hospital readmission rate for alcohol use disorder (AUD) at a Veteran’s Affairs hospital is 2% higher than the national benchmark. This quality improvement project aimed to implement a holistic approach to care of veterans with AUD through optimization of the Clinical Institute Withdrawal Assessment for Alcohol Scale-Revised protocol and development of a revised and evidence-based alcohol withdrawal syndrome order set. After implementation, there was a statistically significant decrease in 30-day readmissions and an increase in prescription of adjuvant therapies such as gabapentin and hydroxyzine. This quality improvement project improved the processes of care related to treatment of veterans with AUD admitted with alcohol withdrawal syndrome.

537. ASSESSING THE EFFECT OF HIATAL HERNIA SIZE ON PERIOPERATIVE OUTCOMES AND HOSPITAL READMISSION RATES AFTER PRIMARY REPAIR

Abstract Background Minimally invasive hiatal hernia (HH) repair remains the gold standard for correcting mechanical defects due to its safety and favorable clinical outcomes (i.e., relief of patient symptoms). However, several operative factors, including the HH size, may negatively impact the postoperative course. We aimed to determine if an increase in HH size was related to an increased risk of perioperative complications or hospital readmissions. Methods After IRB approval, we performed a retrospective analysis using a prospectively maintained database containing demographic, perioperative, and clinical data from all patients who underwent HH repair by a single experienced foregut surgeon between September 2016 and July 2023. Four groups were defined based on the proportion of stomach at the thoracic cavity determined during the surgery: A (small HH: &amp;lt;25%), B (moderate HH: 25-49%), C (large HH: 50-74%), and D (intrathoracic stomach [ITS]: ≥75%). Non-parametric tests were used to assess differences between the groups, and logistic regressions were used to determine the relevant odds ratios (OR). Results A total of 391 patients who underwent primary HH repair met the inclusion criteria (73.7% women; mean age 64.4±12.5 years; mean BMI 28.9±4.9 kg/m2). The distribution of groups was: A (n=160, 40.9%), B (n=63, 16.1%), C (n=64, 16.4%), and D (n=104, 26.6%). Patients presenting with ITS (group D) were older, had longer operative duration, greater blood loss (p&amp;lt;.001), and a significantly increased risk of presenting with early postoperative complications (OR 2.78 [CI95: 1.52-5.06]) and being admitted to the ICU (OR 12.35 [CI95: 3.41-44.71]). Conclusion The HH size, defined by the proportion of the stomach at the thoracic cavity, is associated with an increased risk of early postoperative complications and ICU admission; moreover, a trend toward higher 30- and 90-day hospital readmission rates was noted. This factor may be a consequence of the progressive nature of the disease; hence, it should be considered when choosing between continued medical observation and surgical treatment of patients presenting with asymptomatic HH. An early intervention may reduce the risk of postoperative comorbidity.

Readmissions in Sepsis Survivors: Discharge Setting Risks.

Sepsis is a complex condition with high morbidity and mortality. Prompt treatment can improve survival, but for survivors the risk of deterioration and readmission remains high. Little is known about the association between discharge setting and readmission among sepsis survivors. To examine 30-day hospital readmission rates in adult sepsis survivors by the type of setting to which patients were discharged. The Medical Information Mart for Intensive Care database was used to identify adult sepsis survivors and evaluate 30-day readmission by discharge setting. A χ2 contingency analysis was used with each factor and presence/absence of readmission. The Kruskal-Wallis test was used to compare readmissions across discharge settings. From our sample (N = 7107; mean age 66.5 years; 46.2% women), 23.6% (n = 1674) were readmitted within 30 days and of those readmitted, 30% were readmitted between 1 and 3 times. Discharge setting (P < .001) and age (P = .02) were significantly associated with readmission, but sex, ethnicity, and insurance type were not. High numbers of readmissions were seen in patients discharged to skilled nursing facilities (29.6%), home health care (26.9%), and home (15.0%). Similar high comorbidity burden and acuteness of illness were seen in patients discharged to these settings. Sepsis survivors discharged to skilled nursing facilities, home health care, and home are at high risk for 30-day readmission. The rates of readmission from home health care and home settings were alarming. Often patients are discharged to inappropriate settings, placing them at risk for residual sepsis and readmission. Future research should focus on appropriate timing of hospital discharge and transition to the most appropriate discharge setting.

Impact of pharmacist-led transitions of care model on length of hospital stay and 30-day readmission rates at a quaternary care hospital: A pilot study

BackgroundData about the impact of pharmacist-led transitions of care (TOC) approach are not well established. ObjectivesThe objective of this pilot study was to evaluate the impact of pharmacist-led TOC enhanced workflow on the length of hospital stay (LOS) and the 30-day hospital readmission rates (HRRs). MethodsThis is a quality improvement pilot project conducted at a quaternary care hospital in the United Arab Emirates over 6 weeks on a medical floor and 4 weeks on a cardiac floor. TOC was defined as admission medication reconciliation (AMR) and discharge medication reconciliation (DMR). ResultsThe median LOS was statistically significantly lower in patients who received AMR on the medical floor (4 days [3-8]) than those who did not (7 days [4-20]) (P < 0.001). The median LOS on the cardiac floor was not statistically significantly affected—3 (1.75-8) versus 3 (1-8) (P = 0.736). However, the multivariate linear regression model, adjusting for the number of interventions, indicated that LOS was statistically significantly lower on both floors; AMR was an independent risk factor for reducing the LOS on the medical floor (B = −8.37 [95 CI −11.37 to −5.36], P = .001) and on the cardiac floor (B = −2.76 [95% CI −5.23 to −0.28], P = 0.029). The 30-day HRR was not different on the medical floor but was numerically lower on the cardiac floor in patients who received DMR alone (12.9%) than in those who did not (17.2%) (P = 0.476). However, the multivariate logistic regression analysis, adjusting for number of interventions, indicated that the pharmacist-led AMR and DMR combined were numerically associated with lower rates of 30-day HRR with respective odds ratios of 0.64 (95% CI 0.3–1.38) and 0.83 (95% CI 0.4–1.9) (P = 0.83) on the medical floor and of 0.96 (95% CI 0.3–2.6) and 0.7 (95% CI 0.3–1.8) (P = 0.28) on the cardiac floor. In addition, the impact of the described pharmacist-led TOC approach on health care costs at the hospital was quantifiable and reflected a median medications utilization cost of $1142.95 (639.69-2444.88) when TOC is performed versus $1371.54 (402.92-4277.39) without TOC (P < 0.001) on the medical floor and of $4728.98 (2436.66-6846.34) versus $5252.79 (3907.63-7784.57) (P < 0.001) on the cardiac floor throughout the study time period. ConclusionPharmacist-led TOC interventions, specifically AMR, significantly reduced the LOS on the medical and the cardiac floors, whereas both AMR and DMR represented promising predictors of decreased 30-day HRR on the studied floors. Furthermore, the TOC interventions were generally associated with a statistically significant financial impact on both studied floors.

Mais Complicações em Mulheres após Revascularização do Miocárdio Mesmo com Tempos Cirúrgicos Reduzidos: Atenção por Equidade e Melhoria da Qualidade

Abstract Background Analyses of extensive registries indicate adverse outcomes for women undergoing coronary artery bypass grafting (CABG) surgery, while randomized studies often lack representativeness. Objective To compare adjusted hospital outcomes between men and women undergoing CABG. Methods From July 2017 to June 2019, 3991 patients underwent primary isolated CABG, both electively and urgently, in 5 hospitals in the state of São Paulo, Brazil. To mitigate demographic differences between men and women, populations were adjusted using propensity score matching (PSM). The outcomes considered for analysis were those used by the STS Adult Database. The analyses were performed using R software, with a significance set at p&lt;0.05. Results After PSM (1:1), each group included 1089 patients. Regarding intraoperative variables, men exhibited longer cardiopulmonary bypass (CPB) time (p&lt;0.001), surgical time (p&lt;0.001), a higher number of distal anastomoses (p&lt;0.001), and increased use of arterial grafts. Regarding outcomes, women had a higher incidence of deep sternal wound infection (p=0.006), prolonged Intensive Care Unit stay (p=0.002), increased need for an intra-aortic balloon pump (p=0.04), higher blood transfusion rates (p&lt;0.001), higher 30-day hospital readmission rates after surgery (p=0.002) and higher mortality rate (p=0.03). Conclusions Although men had longer CPB times, a greater number of arterial grafts, and a greater number of distal anastomoses, immediate results after CABG were poorer in women.

More Hospital Complications in Women after Cabg Even for Reduced Surgical Times: Call to Action for Equity in Quality Improvement.

Analyses of extensive registries indicate adverse outcomes for women undergoing coronary artery bypass grafting (CABG) surgery, while randomized studies often lack representativeness. To compare adjusted hospital outcomes between men and women undergoing CABG. From July 2017 to June 2019, 3991 patients underwent primary isolated CABG, both electively and urgently, in 5 hospitals in the state of São Paulo, Brazil. To mitigate demographic differences between men and women, populations were adjusted using propensity score matching (PSM). The outcomes considered for analysis were those used by the STS Adult Database. The analyses were performed using R software, with a significance set at p<0.05. After PSM (1:1), each group included 1089 patients. Regarding intraoperative variables, men exhibited longer cardiopulmonary bypass (CPB) time (p<0.001), surgical time (p<0.001), a higher number of distal anastomoses (p<0.001), and increased use of arterial grafts. Regarding outcomes, women had a higher incidence of deep sternal wound infection (p=0.006), prolonged Intensive Care Unit stay (p=0.002), increased need for an intra-aortic balloon pump (p=0.04), higher blood transfusion rates (p<0.001), higher 30-day hospital readmission rates after surgery (p=0.002) and higher mortality rate (p=0.03). Although men had longer CPB times, a greater number of arterial grafts, and a greater number of distal anastomoses, immediate results after CABG were poorer in women.

VPExam in Heart Failure Innovating Virtual Cardiac Care

Telehealth and Virtual care are growing fields of importance, but the loss of comprehensive physical exam creates barriers to managing complex patients especially those with heart failure. Disruptive digital tools such as VPExam virtual care combine augmented reality instruction of visuals with bluetooth stethoscopes and ECGs to improve accuracy by assessing volume status, cardiopulmonary auscultation, arrythmia detection, and providing structured data including remote patient monitoring (RPM) data, vitals, medication reconciliation, and labs. VPExam intervention has significantly improved outcomes for high-risk and underserved populations with heart failure discharged to Skilled Nursing Facilities and Home Care. VPExam QI revealed workflows for both routine and urgent cardiology consultation following heart failure hospitalizations resulted in moderate significance modification in clinical management in 84% of encounters, while being associated with a 40% relative risk reduction in 30-day hospital readmission rate and a 56% relative risk reduction in 30-day mortality rate. The review summarizes both challenges to cardiac transitions of care and the evolution of cardiac virtual care with actionable physical exam data to optimize readmissions and mortality that is especially relevant to the underserved populations of skilled nursing facilities and home bound patients served by home care agencies.

Implementing primary care follow-up for high-risk vascular surgery patients

Background: The Centers for Medicare and Medicaid Services consider the 30-day hospital readmission rate an outcome of care measure; a high rate is associated with high-cost and bed utilization. Purpose: The Division of Vascular Surgery at a large academic medical center implemented a 15-week quality improvement project in the fall of 2022 to reduce readmissions among patients deemed high-risk for readmission and discharged to home. Methods: The discharging provider utilized the “HOSPITAL Score for Readmission” tool to identify patients at high-risk for unplanned 30-day readmission to receive the intervention, which included follow-up with a primary care provider (PCP) within two weeks of hospital discharge to address non-surgical medical conditions that may have been exacerbated during the hospital stay. A hospital based transitional care clinic bridged medical care for identified patients without an established PCP or whose PCP could not accommodate an appointment until PCP assumption of care. Discharging providers included 11 nurse practitioners and 2 surgery residents; each received a one-on-one educational teaching session and a weekly reminder e-mail through week 9. Results: A total of 158 vascular surgery patients (low and high-risk) were discharged home over 15 weeks with 30 patients (19%) having an unplanned readmission within 30-days from discharge. Adherence issues with the intervention among staff allowed for the high-risk group to be divided into those who did not receive the intervention versus those who did. The high-risk patients who did not receive the intervention had a higher readmission rate (30.4%) than the high-risk patients who did receive the intervention (21.4%). Conclusions: Numerous acute and chronic medical problems were treated at the PCP/transitional care clinic visits, which may have contributed to the reduction in rate of readmissions occurring within 30-days for those patients. Increased usage of the transitional care clinic identified a gap that patients continue to require assistance with establishing care with a PCP and further process change in the future is needed to ensure successful transition for all patients.

Neighborhood Deprivation is Associated With Hospital Length of Stay, Discharge Disposition, and Readmission Rates for Patients Who Survive Hospitalization With Traumatic Brain Injury.

Traumatic brain injury (TBI) is a leading cause of disability in the United States. Limited research exists on the influence of area-level socioeconomic status and outcomes after TBI. This study investigated the correlation between the Area Deprivation Index (ADI) and (1) 90-day hospital readmission rates, (2) facility discharge, and (3) prolonged (≥5 days) hospital length of stay (LOS). Single-center retrospective review of adult (18 years or older) patients who were admitted for TBI during 2018 was performed. Patients were excluded if they were admitted for management of a chronic or subacute hematoma. We extracted relevant clinical and demographic data including sex, comorbidities, age, body mass index, smoking status, TBI mechanism, and national ADI. We categorized national ADI rankings into quartiles for analysis. Univariate, multivariate, and area under the receiver operating characteristic curve (AUROC) analyses were performed to assess the relationship between ADI and 90-day readmission, hospital LOS, and discharge disposition. A total of 523 patients were included in final analysis. Patients from neighborhoods in the fourth ADI quartile were more likely to be Black ( P = .007), have a body mass index ≥30 kg/m 2 ( P = .03), have a Charlson Comorbidity Index ≥5 ( P = .004), and have sustained a penetrating TBI ( P = .01). After controlling for confounders in multivariate analyses, being from a neighborhood in the fourth ADI quartile was independently predictive of 90-day hospital readmission (odds ratio [OR]: 1.35 [1.12-1.91], P = .011) (model AUROC: 0.82), discharge to a facility (OR: 1.46 [1.09-1.78], P = .03) (model AUROC: 0.79), and prolonged hospital LOS (OR: 1.95 [1.29-2.43], P = .015) (model AUROC: 0.85). After adjusting for confounders, including comorbidities, TBI mechanism/severity, and age, higher ADI was independently predictive of longer hospital LOS, increased risk of 90-day readmission, and nonhome discharge. These results may help establish targeted interventions to identify at-risk patients after TBI.

Post-acute care facility utilization and outcomes among Medicare beneficiaries undergoing inpatient cancer surgery.

11088 Background: Patients with cancer using post-acute care facilities have poor outcomes, including delayed return home and increased health care utilization. However, little is known about post-acute care use and outcomes among patients with cancer undergoing surgery. Methods: We examined Medicare claims of 100% of fee-for-service Medicare beneficiaries from 2010-2022, to identify patients who underwent inpatient cancer-directed surgery and were thus eligible for a post-acute facility stay. We used billing codes within 3 days of hospital discharge to identify post-acute facility stays, defined as skilled nursing facility (SNF), long-term acute care hospital (LTACH), or inpatient rehabilitation facility (IRF) stays. We used logistic regression to identify patient sociodemographic and clinical factors associated with post-acute care facility use. We also compared hospital readmissions within 30 days and days at home (defined as days not in an acute or post-acute facility) in the 90 days after discharge by setting, using Chi-square and Wilcoxon rank sum tests. Results: We studied 1,637,792 Medicare beneficiaries who underwent inpatient cancer surgery from 2010 to 2022. About half (48.9%) were women; median age was 73.0 years. The most common cancer diagnoses were colorectal (28.4%), lung (14.4%), and prostate (12.1%), and 22.7% had a Charlson comorbidity index (CCI) of ≥3. Overall, 16.0% of patients were discharged to a post-acute care facility (11.4% SNF, 4.5% LTACH/IRF). Discharge to post-acute care was greater among patients who were aged ≥80 vs 65-69 (Adjusted Odds Ratio[AOR] 3.85, 95% Confidence Interval[CI] 3.79,3.90), had CCI ≥3 versus 0 (AOR 2.92, 95%CI 2.88,2.95), were dual-eligible (AOR 2.01, 95%CI 1.99,2.04), or had metastatic cancer (AOR 1.26, 95%CI 1.24,1.28). Patients undergoing brain or spinal surgeries for primary or metastatic cancers had highest odds of PAC facility utilization. Compared to those discharged home, patients discharged to post-acute care facilities had a higher 30-day hospital readmission rates (18.6% vs. 9.5%, p&lt;0.0001), and fewer days at home in the 90 days after discharge from their index surgical admission (median 68 vs. 90 days, p&lt;0.0001). Conclusions: Patients with cancer undergoing inpatient surgery who are older, have comorbidities, or have advanced disease have higher rates of post-acute care facility use, and such post-acute care is associated with higher hospital readmissions and fewer post-operative days at home. Further work is needed to improve pre-operative decision-making and optimization as well as to develop supportive care and rehabilitative interventions that can improve post-operative outcomes for patients who need post post-acute care.