Readmission Rates Research Articles

Appraisal of the Impact of the Race-Neutral Estimated Glomerular Filtration Rate Waiting Time Modification on Transplant Wait Time and Outcomes for Black Kidney Candidates: Importance of Transplant Readiness on the Waitlist.

In July 2022, the Organ Procurement Transplant Network (OPTN) mandated race-neutral eGFR calculations when evaluating kidney transplant (KT) candidates, replacing historic race-based estimates. This modification also required transplant programs to identify KT candidates on their waitlist who would have benefitted from an earlier waitlist qualification date using race-neutral calculations. This retrospective study analyzed Black patients listed for KT at our center between 2000 and 2023, recalculating their eGFR using race-neutral formulas. KT recipients with modified wait times (N=26) were compared to two control groups: Black recipients without modifications (N=21) and non-Black recipients (N=89). Postoperative outcomes, including complications and readmission rates, were analyzed across groups. Of 126 Black patients evaluated, 60.3% qualified for wait time modifications, with a median gain of 570 days (1.6 years) per patient, totaling 62,057 days (180.7 years). Within 6 months of receiving additional time, 26 patients (34%) were transplanted, mostly from deceased donors (92%) with a median kidney donor profile index (KDPI) of 66%. Black KT recipients with modifications had significantly higher BMI, diabetes, and peripheral vascular disease compared to controls. Readmission rates were higher among Black KT recipients with modifications, though no significant differences in graft loss or mortality were observed. Race-neutral eGFR recalculations substantially improved Black KT candidates' ability to receive a KT, addressing historical disparities in KT. However, higher comorbidities and readmissions among these patients suggest the need for thorough transplant readiness evaluations prior to waitlist activation.

Prescribing patterns of SGLT-2 inhibitors and their association with heart failure readmissions: a single-center cross-sectional study from a low- and middle-income country

ABSTRACT Objectives Sodium-glucose cotransporter 2 (SGLT2) inhibitors have been shown to reduce cardiovascular death and heart failure (HF) hospitalizations in patients with reduced and mildly reduced or preserved ejection fraction. This study assesses the effectiveness of SGLT2 inhibitors in reducing HF readmission rates and examines prescription patterns in hospitalized patients. Methods This single-center retrospective cross-sectional study evaluated the impact of SGLT2 inhibitors on HF readmission rates when initiated during index hospitalization or within 14 days of discharge. Patients were divided into an SGLT2 group and a non-SGLT2 group, with 6-month readmission rates compared to the groups. Results Of the 234 patients, 85 (36.3%) were prescribed SGLT2 inhibitors, while 149 (63.7%) were not. SGLT2 inhibitors were prescribed less frequently to patients with chronic kidney disease (CKD) and patients admitted under cardiology services were more likely to receive SGLT2 inhibitors. Among those prescribed SGLT2 inhibitors, the median ejection fraction was significantly lower compared to those not prescribed, while the median estimated glomerular filtration rate was higher. There were 107 total readmissions (45.7%), with most (55%) occurring within 30 days of the index hospitalization. Total readmissions and 30-day readmissions were significantly lower in the SGLT2 inhibitor group (31.8% vs 53.7%, p = 0.001) and (33.33% vs 62.50%, p = 0.029), respectively. Heart failure readmissions were also lower in the SGLT2 group (29.6% vs 21.3%, p = 0.37). Conclusion Our study demonstrated a significant reduction in heart failure readmission rates among patients prescribed with SGLT2 inhibitors. However, we also observed a gap in the prescription of SGLT2 inhibitors.

Independent predictors of functional loss and refractures in patients with femur fracture: Follow-up at 6 and 18 months in a Fracture Liaison Service.

In elderly patients hospitalized for a femur fracture, this study aimed to evaluate the functional evolution, and to estimate the incidence of second fractures at 6 and 18 months after hospital discharge. A longitudinal prospective study was designed at an Orthogeriatric Unit after implementing a Fracture Liaison Service (FLS). The variables collected included the baseline demographic and clinical characteristics of the patients, and the outcome variables on discharge, at 6 and 18 months of follow-up. Logistic regressions models were applied to identify independent predictors of functional evolution. 478 patients were admitted. Independent predictors of functional loss at follow-up were institutionalisation, severe dependence either prior to and on discharge, delirium, protein malnutrition, prior acute myocardial infarction, GFR<30ml/min/1.73m2 and not receiving treatment for osteoporosis on discharge. Patients attending follow-up appointments presented improved compliance with osteoporosis treatment both at 6 and 18 months. A lower number of 2nd fractures were recorded at 18 months for patients who attended their appointments (4.8% vs 12.1%, p=0.01). At 6 and 18 months follow-up, a lower rate of readmission was recorded (7% vs 15.3%, p=0.006), (9.6% vs 25.6%, p<0.0001), respectively. The independent predictors of functional loss at 6 and 18 months were institutionalisation, severe dependence either prior to and on discharge, delirium, protein malnutrition, prior acute myocardial infarct, GFR<30ml/min/1.73m2 and not receiving treatment for osteoporosis on discharge. A lower incidence of refractures, a lower readmission rate and a better treatment compliance were observed in patients attending follow-up visits.

Cayley–Purser secured communication and jackknife correlative classification for COVID patient data analysis

Internet of Medical Things (IoMT) is a group of medical devices that connect the healthcare information technology to minimize the redundant hospital visit and healthcare system troubles. IoMT connect the patients to the doctor and transmit the medical data over the network. The spread of corona virus has put the people at high risk. Due to increasing number of cases and its stress on health professionals, IoMT technology is used in many healthcare centers. But, the security level and data classification accuracy was not improved by existing methods during the data communication. In order to solve these issues, Cayley–Purser Cryptographic Secured Communication based Jackknife Correlative Data Classification (CPCSC-JCDC) method is designed. The key objective of CPCSC-JCDC method is to collect the patient information through IoMT devices and send to the doctor in more secured manner. Initially in CPCSC-JCDC method, the patient data is collected. After the data collection process, the data gets encrypted with help of public key of the patient by using cayley–purser cryptosystem. After the encryption process, the data is sent to the doctor. The doctor receives and decrypts the patient data by using their private key. After decryption process, the doctor analyses the patient data and classifies the data as emergency case or normal case by using jackknife correlation function. This helps to minimize the patient readmission rate and increase the patient satisfaction level. Experimental evaluation is carried out by Novel Corona Virus 2019 dataset using different metrics like data classification accuracy, data classification time and security level. The evaluation result shows that CPCSC-JCDC method improves the security level as well as accuracy and minimizes the time consumption during data communication than existing works.

Call to Action: Standardizing Follow-Up Care for Infants Prenatally Exposed to Opioids.

Between 2007 and 2017, rates of neonatal opioid withdrawal syndrome (NOWS) have drastically increased. Although current evidence suggests that chronic prenatal opioid exposure may result in adverse neurodevelopmental consequences, there is no standardized protocol for the follow-up care of affected patients. We call on the American Academy of Pediatrics to develop a standardized protocol for the follow-up care of infants prenatally exposed to opioids that also supports families and providers. More specifically, special consideration should be given to identifying and providing solutions to barriers of care for families, as well as for providers. Educating families on the importance of follow-up care would also be beneficial, as well as educating providers on how to address family barriers. Prioritizing and attending to this call to action will allow for improvement in practice and patient care over time and potentially reduce hospital readmission rates commonly associated with NOWS.

Same Day Discharge After Robotic Radical Prostatectomy.

This review evaluates the current landscape of same-day discharge (SDD) following robotic-assisted laparoscopic prostatectomy (RARP), highlighting perioperative management strategies and proposing future research directions. RARP has been shown to improve perioperative outcomes including reduced blood loss, postoperative pain, and hospital length of stay (LOS) when compared to open radical prostatectomy. Recently, the question of the feasibility of SDD for RARP has been proposed, aiming to reduce postoperative complications, hospital-acquired infections, and healthcare costs. The advent of single-port robotic systems aims to further minimize postoperative morbidity. Recent literature has reported SDD for RARP is safe and feasible in appropriately selected patients, with postoperative outcomes, including complication and readmission rates, similar to inpatient RARP. Our findings show SDD can be safely implemented without compromising patient outcomes, as evidenced by similar complication, readmission, and emergency department visit rates compared to inpatient cohorts. Future research should be aimed to refining patient selection criteria, enhancing opioid-free anesthesia pathways, and exploring new surgical technologies to improve SDD outcomes.

Comparing Outcomes of Per-Oral Image-Guided Gastrostomy With Radiologically Inserted Gastrostomy at a Quaternary Australian Hospital.

Per-oral Image-guided gastrostomy (PIG) is an alternative to conventional radiologically inserted gastrostomy (RIG). PIG is less frequently used in Australia, despite a favourable complication profile reported within the literature. This case control study compares success and complication rates of these procedures at a quaternary Australian Hospital. Retrospective review of electronic medical records (EMR) was performed for patients undergoing radiological-guided gastrostomy between January 2019 and January 2023. Clinical notes, operation reports, radiology reports and discharge summaries at the time and for subsequent readmissions within 3 months were reviewed. Outcomes measured included procedural indication, technical success rate, major and minor complications, readmission or death within 3 months. 216 radiological guided gastrostomies were attempted (age 65.6 ± 12.6; range 20-93; 81 female and 135 male). Sixteen cases were abandoned prior to insertion. Gastrostomy was successful in 133/136 PIG (97.8%) and 63/64 RIG (98.4%). The most frequent indication for PIG was dysphagia secondary to Motor Neuron Disease (107/136) and for RIG was head and neck malignancy (41/64). There were significantly more major complications (15.6% vs. 6.6%, p = 0.043) and minor complications (14.0% vs. 2.9%, p = 0.003) with RIG compared to PIG. Tube malpositioning, leak/peritonitis, aspiration pneumonitis and tube dislodgement were significantly increased in RIG. There was no significant difference in readmission rate (5.1% for PIG vs. 9.4% for RIG) or mortality (2.2% vs. 7.8%). Compared to conventional RIG, PIG showed a similar primary success rate and decreased incidence of both major and minor complications.

Evaluating Outcomes of Same Day Discharge After Minimally Invasive Colectomy: A Nationwide Analysis.

Advances in Enhanced Recovery After Colectomy protocols have enabled same day discharge (SDD) in some patients. Current literature is limited to single institutions limiting generalizability. We employed a nationally-representative dataset to compare outcomes between SDD patients and patients with a short-term hospital stay (discharged on postoperative day 1 or 2). We conducted a retrospective study using the American College of Surgeons National Surgical Quality Improvement Project (ACS-NSQIP) Targeted Colectomy Participant User Files (2017-2021). We included patients ≥18 years who underwent elective minimally invasive colectomy. We excluded patients with severe comorbid conditions or in-hospital complications. We performed a 1:1 propensity-match adjusting for patient, diagnosis, and procedure- type characteristics. Our primary outcome was 30-day readmission and secondary outcome was post-discharge complications. We identified 22,482 patients, 740 (3.3%) of which were SDD patients. A higher proportion of patients with SDD underwent right colectomy (76.4% vs36.4%, P < 0.001) and carried a diagnosis of a benign neoplasm (53.0% vs18.1%, P < 0.001). After propensity matching there was no significant difference in the rate of 30-day readmission between the 2 groups (3.4% vs4.7%; P = 0.23). Additionally, there was no significant difference in rates of anastomotic leak (0.7% vs0.8%; P = 0.58) or colonic ileus (1.4% vs1.8%; P = 0.58). Post-discharge bleeding complications were higher in SDD patients (0.5% vs0%; P = 0.045). SDD following minimally invasive colectomy is not associated with higher readmission, anastomotic leak, or SSI when compared to patients discharged on postoperative day 1/2. SDD after minimally invasive colectomy may be considered for patients without severe comorbid conditions.

Surgical Adverse Events for Primary Tumors of the Spine and Their Impact on Outcomes: An Observational Study From the Primary Tumors Research and Outcomes Network.

Aggressive resection for primary tumors of the spine are associated with a high rate of adverse events (AEs), but the impact of AEs on patient-reported outcomes (PROs) remains unknown and is critical to the shared decision-making. Our primary objective was to assess the impact of surgical AEs on PROs using an international registry. Assessing the impact on clinical outcomes and identifying risk factors for AEs were our secondary objectives. Patients who underwent surgery for a primary spinal tumor were selected through the Primary Tumor Research and Outcomes Network. Our primary outcome was the impact of AEs on PROs at 3 and 12 months after surgery (measured with Spinal Oncology Study Group Outcomes Questionnaire, Short-Form 36, and EuroQol 5 Dimension). We also assessed the impact on clinical outcomes (local control, surgical margins, readmission, reoperation, and mortality). We stratified our results according to severity of AEs, histology, and type of resection. 374 patients met inclusion criteria (219 males/155 females). The mean age of the cohort was 48.7 years. The most frequent histology was chordoma (37.3%) followed by chondrosarcoma (8.8%). Sixty-seven patients (17.9%) experienced at least 1 intraoperative AE and 117 patients (31.3%) had at least 1 postoperative AE within 3 months. Overall, 159 patients (42.5%) experienced AEs. The readmission rate was significantly higher in patients who experienced AEs (Any AE: 10.1% vs no AE: 1.9% within 3 months; P = <0.001). PROs were not significantly affected by AEs in most questionnaires. Local control, risk of reoperation, mortality, and achieving preplanned margins were similar between AE groups. The rate of surgical AEs is considerable in this population. Surgical AEs seem to be associated with a higher number of readmissions, but do not seem to result in significant differences in PROs or in a higher risk of reoperation, mortality, and failure to achieve preplanned margins.

Retrospective analysis of patients with immediate decannulation in severe acquired brain injury (RAPID-SABI)

Objective: To examine an early decannulation protocol in adult severe acquired brain injury (SABI) patients. Design: Retrospective, observational cohort study. Subjects/patients: Tracheotomized SABI patients ≥ 18 years admitted to a neurorehabilitation unit. Methods: Primary outcome measure was difference in survival rate within first year of discharge. Secondary outcome measures were respiratory infections treated with antibiotics, rate of re-cannulation, time from admission to decannulation, length of stay, difference in rate of re-admission due to pneumonia within first year of discharge and difference in rate of tracheal tube dependency within first year of discharge. Results: No statistical significance in survival rate within the first 12 months from discharge was found. Median time from admission to decannulation was 32 days (interquartile range [IQR] 14–61) vs 9 days (IQR 0–13) in the control and intervention group, respectively (p &lt; 0.0003). Median length of stay was 66 days (IQR 54–92) in the control group vs 60 (IQR 48–75) days in the intervention group (p = 0.168). Conclusion: A new early decannulation protocol omitting evaluation of tolerance to tracheostomy tube capping and fiberoptic endoscopic evaluation of swallowing was non-inferior to previous procedures in survival rate within first year of discharge. The early decannulation protocol allowed for significantly earlier decannulation.

Medication-focused telehealth interventions to reduce the hospital readmission rate: a systematic review.

Transition of care from hospital to community is a period that carries significant risk for medication errors, potentially leading to hospital readmission, and causing financial and emotional strain on patients and caregivers. Telehealth technologies offer promising solutions to reduce hospital readmission. Therefore, the goal of this systematic review was to examine the effect of interdisciplinary telehealth post-discharge services that include a medication-focused component on hospital readmissions. Following the PRISMA guidelines, a search was conducted in five scientific databases using keywords related to hospital readmission, medication therapy, and telehealth interventions. The review focused on randomised controlled trials published between 2000 and 2023, written in English. Out of 1,144 papers screened, 23 were included in the review. These studies targeted telehealth service provision to people over 60 years old with chronic illnesses. Various post-discharge telehealth interventions, including medication-focused components, were examined. Most of the interventions were multifaceted, embedded medication-focused interventions with reminders for diet, exercise, symptom check-ups, and education. Among the 23 included papers, 10 studies demonstrated success in reducing readmissions. Seven of these studies targeted patients with heart failure (HF). Overall, this review highlights the potential of telehealth medication-focused interventions in reducing hospital readmission rates in patients with HF.

Utility of Preoperative Hypoalbuminemia as Independent Predictor of Post-Conversion and Revisional Bariatric Surgery Outcomes: MBSAQIP Registry Analysis.

Anastomotic conversions and revisions remain crucial in addressing complications or sub-optimal outcomes following primary bariatric procedures. Preoperative malnutrition, proxied by hypoalbuminemia, has traditionally been considered a risk factor for postoperative morbidity. This study investigates the validity of this association in revisional and conversion metabolic/bariatric surgery (MBS). A retrospective cohort analysis was performed on 58,327 MBS revisions and anastomotic conversions from the 2020-2022 MBSAQIP registry. Approximately all cases studied were performed laparoscopically (98.8%). A preoperative albumin level of 3.5 g/dL was used as a threshold to identify patients with hypoalbuminemia. We utilized descriptive statistics, univariate and multivariable logistic regression, and 1:1 nearest neighbor matching in complete-case analyses to explore the relationship between albumin levels and postoperative outcomes. While univariate analyses illustrate an association between hypoalbuminemia and postoperative morbidity, multivariable regression and 1:1 matched analysis showed hypoalbuminemia is not an independently significant driver of 30-day overall postoperative complications (including leaks), reoperation, or reintervention. However, 1:1 matched analysis demonstrated significantly increased odds of 30-day postoperative superficial surgical site infection (SSI) (OR 8.138, p=0.049) and readmission (OR 1.75, p=0.045) associated with albumin levels lower than 3.5 g/dL. Following adjustment for confounding patient factors, hypoalbuminemia alone did not arise as an independent predictive factor for the 30-day major complications such as leak, reoperation, or re-intervention after revisional and anastomotic conversion MBS, although there maybe increase in SSI and readmission rates.

Trends in Outpatient Radical Prostatectomy and Same-Day Discharge for Prostate Cancer: Analysis of the National Inpatient Sample and Nationwide Ambulatory Surgery Sample.

Interest has grown in optimizing radical prostatectomy (RP) pathways for prostate cancer, and RP has been removed from the Centers for Medicare & Medicaid Services inpatient-only list. We aim to determine national trends in outpatient RP. The National Inpatient Survey and Nationwide Ambulatory Surgery Survey were queried to categorize RPs between 2016 and 2020 as inpatient RP and outpatient RPs, comprising same-day discharge (SDD) and ambulatory encounters. Trends in outpatient RP over time were analyzed. Multivariable logistic regression analysis identified factors associated with SDD. Multivariable generalized linear models were used to compare total hospital charges between SDD and inpatient RPs. In a cohort of 362,123 RPs from 2016 to 2020, outpatient RPs increased from 4.8% to 53.7% (P < .01) and SDD increased from 0.03% to 2.0% (P < .01). Minimally invasive surgery (OR, 1.59, P < .01), highest quartile annual hospital caseload (OR, 1.98, P = .01), and low hospital bed count (OR, 1.96, P = .03) were associated with SDD. Less than 20% of centers used SDD, although a select few hospitals discharged more than 50% of RPs the same day. Ambulatory ($63,060) and SDD ($63,332) RPs had lower total charges compared with inpatient RPs ($69,951). Multivariable analysis demonstrated that SDD was associated with a reduction in total charges (OR, 0.88, P < .01). Over 50% of RPs are now performed as ambulatory or SDD encounters. SDD RP is more common in high-volume facilities with lower bed counts. Although our data suggest lower hospital charges, further study is warranted to evaluate the impact of SDD on readmission rates and direct patient costs.

K-means clustering to identify high risk of early revisits in patients with drug-related problems attending the emergency department

ObjectiveDrug-related problems (DRPs) are a frequent reason for visits to the emergency department (ED). However, data about the characteristics associated with early revisits are limited. We aimed to identify clinical...

Resources and Readmission for COPD Exacerbation in Pneumology Units in Spain: The COPD Observatory Project

Chronic obstructive pulmonary disease (COPD) represents one of the most frequent causes of hospital readmissions and in-hospital mortality. One in five patients requires readmission within 30 days of discharge following an admission for exacerbation. These ‘early readmissions’ increase morbidity and mortality, as patients often do not recover their baseline lung function. The identification of factors associated with increased risk has been a major focus of research in recent years. Studies describe patient-related predictors, although some studies also suggest that better-resourced centres provide superior care. Objective: To describe resources, performance, and care provided in pneumology units in Spain, assessing their association with 30-day readmission for COPD and in-hospital mortality. Methods: This survey was conducted in 116 hospitals responsible for the COPD pathway in pneumology units/departments from November 2022 to March 2023. Results: Of the 116 participating hospitals, 56% had a pneumology department while 25.9% had a pneumology section. The vast majority were public and university hospitals. The number of beds allocated to pneumology/100,000 inhabitants was 6.6 (3.1–9.2) and pulmonologist staffing was 3.3 (2.6–4.1) per 100,000 inhabitants. There was an intermediate respiratory care unit (IMCU) dependent on the pneumology department in 31.9% of units and a respiratory team for 24 h emergency care in 30% of units, while only 9.5% had interventional pneumology units for bronchoscopic procedures. COPD rehabilitation programmes were offered in 58.6% of pneumology units. The average rate of patients on ventilatory support in acute failure was 13.8 (9.2–25) per 100 discharges, with a 30-day COPD readmission rate of 14.9%, with significant differences according to the level of complexity (p = 0.041), with a mean length of stay of 8.72 (1.26) days. The overall in-hospital mortality in pneumology units was 4.10 (1.18) per 100 admissions. In the adjusted model, having a discharge support programme and interventions performed during admission (number of patients with ventilatory support) were predictors of a favourable outcome. Hospital stay was also maintained as a predictor of an unfavourable outcome. Conclusions: There is significant variability in resources and the organisation of care in pneumology units in Spain. The availability of a discharge support programme and greater use of ventilatory support at discharge are factors associated with a lower 30-day COPD readmission rate in the pneumology unit. This information is relevant to improve the care of patients with COPD and as a future line of research.

Transitional Care Interventions in Improving Patient and Caregiver Outcomes After Discharge: A Scoping Review

Background. Caregivers play a fundamental role in the complexity of the transitional process between different healthcare settings. Current research shows that caregiver preparedness can affect the quality and efficacy of post-hospital care, therefore highlighting the need to integrate caregiver roles into the design of transitional care processes. This study aims to map existing evidence on effectiveness of transitional care interventions in improving post-discharge outcomes, as well as the influence of caregiver involvement on both patients and caregivers’ outcomes. Methods. Referring to PRISMA-ScR guidelines, a systematic search was conducted between January and February 2024 on Scopus, WoS and PubMed. In order to be included in the systematic search, a study was required to use a RCT design, as well as to describe a transitional care intervention targeting caregivers or patient–caregiver dyads applied in the inpatient setting, lastly the study had to include follow-ups after discharge. There were no limitations on the country or publication year. Results. The review has included 51 RCTs of transitional care interventions, discussing caregivers’ roles in improving dyad outcomes after discharge. Although the review highlighted a heterogeneity in the transitional care interventions, it was observed that the interventions shared some common components categorized in the following clusters: need assessments, providing information, psychological support, self-management training, and monitoring or follow-up. Conclusions. This review emphasizes the important role of caregivers in the transition from hospital to home, addressing a significant gap in the literature. It highlights the effectiveness of transitional care interventions in improving patients’ quality of life and functional abilities while reducing caregivers’ burden and depression. Further research should focus on assessing the efficacy of these interventions in relation to healthcare utilization, hospital readmission rates, and emergency department visits.

Hospitalization for cardiovascular disease in the year after delivery of twin pregnancies.

Increased cardiovascular demand in twin pregnancies, even those without hypertensive disease of pregnancy (HDP), may pose a greater risk for cardiovascular complications compared with singletons. In this study, the risk of cardiovascular disease (CVD)-related hospitalizations and mortality within the year following delivery in relation to HDP was compared between twin and singleton pregnancies. Using the Nationwide Readmissions Database of US hospitals from 2010 to 2020, the rates of CVD readmission in four exposure groups (twin deliveries with and without HDP and singleton deliveries with and without HDP) were estimated. Cox proportional hazard regression models were used to determine associations with singletons without HDP as the reference. Of 36 million delivery hospitalizations, the rates of CVD readmission in twin and singleton pregnancies were 1105.4 and 734.1 per 100 000 delivery admissions, respectively. Compared with singletons without HDP, the adjusted hazard ratio (HR) of CVD readmission was highest for twins with HDP [HR 8.21, 95% confidence interval (CI) 7.48-9.01], followed by singletons with HDP (HR 5.89, 95% CI 5.70-6.08) and then twins without HDP (HR 1.95, 95% CI 1.75, 2.17). Compared with singletons without HDP, twin pregnancies, even in the absence of HDP, are associated with increased risks for CVD complications in the first year post-partum. These findings highlight the increased strain twin pregnancies place on the maternal cardiovascular system. These findings advocate the need for appropriate pre-conception counselling for those with cardiovascular risk factors undergoing infertility treatment, which increase the risks of multi-foetal gestation, and increased post-partum surveillance in twin pregnancies.

COPD Burden of disease from 2017 to 2022: analysis of 44260 hospitalization in the Italian Apulian region.

Introduction Natural history of COPD is characterized by a progressive decline in pulmonary function and recurrent exacerbations, requiring frequent hospital admissions in medical wards. Great heterogeneity still exists between studies hindering our understanding of the true, global burden of AECOPD on healthcare systems over COVID19 pandemic. We aim to describe the AECOPD in souther Italian region from 2017-2022 and to detail the location of admission, rate and characteristics of deaths and use of noninvasive respiratory supports. Methods Retrospective, cross-sectional study carried out in collaboration with the Apulian Regional Observatory for Epidemiology over the second semester of 2023. Selected records with specific ICD9 codes related to AECOPD and its clinical details, related complications, number of re-hospitalization, and noninvasive respiratory supports use described as "principal" or "secondary" or "other diagnosis" were considered. Results From 2017 to 2022 a total of 29,917 patients with AECOPD were admitted in hospital and they generated a total of 44,260 hospitalization. The male gender represented 60.9% of total, mean age 77.1±11.2 years; Deaths were 3743, complicated by other comorbidities in 54% of cases. Readmissions rate was 8.5%. Deaths allocation was: Intensive care 37.7 %, General medicine 33%, Respiratory ward 13.5% etc. Noninvasive respiratory supports were used in 47% of cases. Discussion This prolonged and deeply characterized clinical observation of AECOPD admissions including COVID19 pandemic years in Apulia region shows that they present with older age, affected by onemore comorbidities with more severe disease requiring in almost half percentage of case the use of respiratory support ( HFNC and NIV). However, the high rate of deaths highlights the urgent need to further support the most severe cases who deserve more tailored ward allocation and care management.

Optimal Management of the Inpatient With Decompensated Cirrhosis.

Over the past several years, there has been a wealth of new data pertaining to the management of complications of cirrhosis, resulting in several important updates to best practices and consensus guidelines. Despite these advancements and numerous recent targeted quality initiatives, hospitalizations resulting from complications of cirrhosis remain frequent, costly and associated with poor patient outcomes. An emphasis on evidence-based management of hospitalized patients with decompensated cirrhosis has the potential to decrease readmission rates and length of stay while improving overall patient outcomes. Herein, we provide an updated, evidence-based overview of the optimal inpatient management of the most frequently encountered complications associated with cirrhosis.

GLP-1 Receptor Agonist Medications Alter Outcomes of Spine Surgery: A Study Among Over 15,000 Patients.

retrospective cohort study. To investigate the relationship between perioperative Glucagon-Like Peptide-1 Receptor Agonists (GLP-1 RAs) and postoperative outcomes after spinal fusion in obese and diabetic patient populations. GLP-1 RAs have been shown to be beneficial when used perioperatively in clinical orthopaedic arthroplasty literature. Minimal evidence exists showing efficacy with respect to spinal fusion. This retrospective, multi-center study accessed the TriNetX platform, using the research database to identify diabetic patients who underwent spinal fusion between 2008 and 2022. Cohorts were created based on Body-Mass-Index (BMI) and GLP-1 RA usage. Propensity score matching was employed to create balanced cohorts utilizing BMI, Hemoglobin A1c (HbA1c), surgical intervention, as well as other demographic characteristics. Orthopedic outcomes were compared between GLP-1 RA users and non-users. The primary outcomes included post-operative infection, readmission, revision surgery, and quality of life metrics. After matching, the study cohort consisted of 2,263 patients, with 1,560 classified as obese. GLP-1 RA use was associated with significantly reduced post-operative infection rates (obese: HR=0.168 (0.086, 0.328), not obese: HR=0.250 (0.102, 0.612)), fewer revisions (obese: HR=0.505 (0.368, 0.693), not obese: HR=0.439 (0.272, 0.708)), decreased postoperative readmission rates (obese: HR=0.283 (0.243, 0.329), not obese: HR=0.241 (0.193, 0.301)), and reduced mobility abnormalities (obese: HR=0.355 (0.230, 0.549), not obese: HR=0.508 (0.269, 0.959)). No significant differences were observed in rates of fracture rates between GLP-1 RA users and non-users. GLP-1 RA use in spinal fusion patients was associated with improved post-operative outcomes, including lower infection rates, fewer revisions, and better quality of life metrics. These findings suggest that GLP-1 RAs may be a valuable adjunctive therapy in managing surgical outcomes in diabetic and obese patients undergoing spinal fusion. Further prospective and animal-based studies are needed to confirm these findings and explore the underlying mechanisms.