Readmission Rates Research Articles

Early ward discharge clinic: facilitating discharges and prompt follow-up for medical inpatients in a district general hospital

Early discharge and follow-up for medical admissions could facilitate reduced length of stay and improve patient satisfaction. However, evidence to confirm this is lacking. Peterborough City Hospital (PCH) designed an...

Venous Thromboembolic Events Following Revisional Gastric Bypass: An Analysis of the MBSAQIP Database from 2015 to 2019 Using Propensity Matching.

Primary bariatric surgery is associated with moderate-to-high risk of venous thromboembolic events (VTE); however, the risk for revisional surgery lacks granularity. Our primary objective was to define the risk of VTE following revisional Roux-en-Y gastric bypass (RYGB) compared to primary RYGB. Adults who underwent primary or revision/conversion RYGB between January 1, 2015, and December 31, 2019, with a BMI ≥ 35kg/m2 were identified in a bariatric specific database. VTE was defined as pulmonary embolus and/or deep venous thrombosis. Thirty-day VTE and transfusion rates were compared between the two groups using propensity score matching of 3:1. Primary RYGB was performed in 197,186 (92.4%) patients compared to 16,144 (7.6%) in the revisional group. Patients in the revisional group had fewer comorbidities than those undergoing primary RYGB. In the matched cohort of 64,258 procedures, there were 48,116 (74.9%) primary RYGB cases compared to 16,142 (25.1%) RYGB revisions. The rate of VTE was similar in the revisional surgery group compared to the propensity matched primary RYGB group (0.4% vs. 0.3%, p > 0.580); however, transfusion was more common in the revisional group (1.4% vs. 1.0%, p = 0.005). Revisional group had higher rates of readmission, reoperation, increased length of stay, and operation length ≥ 180min compared to matched primary RYGB group (p < 0.001). VTE rates for both primary and revisional RYGB are similar. Revisional RYGB cases impose increased risk of bleeding among other outcomes. Thus, identifying those at higher risk of complications is critical.

Impact of the Hospital Frailty Risk Score on Outcomes following Primary Total Elbow Arthroplasty

The Hospital Frailty Risk Score (HFRS) has demonstrated strong correlation with adverse outcomes in various joint replacement surgeries, yet its applicability in total elbow arthroplasty (TEA) remains unexplored. The purpose of this study is to assess the association between HFRS and postoperative complications following elective primary TEA. The Nationwide Readmissions Database was queried to identify patients undergoing primary TEA from 2016 to 2020. The HFRS was used to compare medical, surgical, and clinical outcomes of frail vs. non-frail patients. Mean and relative costs, total hospital length of stay (LOS), and discharge disposition for frail and non-frail patients were also compared. We identified 2,049 primary TEA in frail patients and 3,693 in non-frail patients. Frail patients had increased complication rates including acute respiratory failure (13.6% vs. 1.1%; p < 0.001), urinary tract infections (12.3% vs. 0.0%; p < 0.001), transfusions (3.9% vs. 1.1%; p < 0.001), pneumonia (1.1% vs. 0.2%; p < 0.001), acute respiratory distress syndrome (3.2% vs 0.6%; p < 0.001), sepsis (0.7% vs. 0.1%; p < 0.001), and hardware failure (1.2% vs 0.1%; p < 0.001). Frail patients also experienced higher rates of readmission (37% vs. 25%; p < 0.001) and death (1.7% vs. 0.2%; p < 0.001), while being less likely to undergo revision (6.5% vs. 17%; p < 0.001). Frail patients incurred higher healthcare costs ($28,497 vs. $23,377; p < 0.001) and longer LOS (5.3 days vs. 2.6 days; p < 0.001), with reduced likelihood of routine hospital stays (36% vs. 71%; p < 0.001) and increased utilization of short-term hospitalization (p < 0.001), care facilities (p < 0.001), and home health care services (p < 0.001). HFRS is a validated indicator of frailty and is strongly associated with increased rates of complications in patients undergoing elective primary TEA. These findings should be considered by orthopedic surgeons when assessing surgical candidacy and discussing treatment options in this at-risk patient population.

Postacute AKI Follow-Up Reduces 30-Day Readmission Rate

Postacute AKI Follow-Up Reduces 30-Day Readmission Rate

Readmission and mortality before and after introduction of orthogeriatric home visits: A retrospective cohort study in hip fracture patients

IntroductionOrthogeriatric collaboration in hip fracture patients during admission is well established, however, orthogeriatric involvement after discharge is not common. The aim of this study was to explore the association of orthogeriatric home visits with 30-day and 120-day readmission and mortality in ≥ 65-year-old patients surgically treated for hip fractures. Materials and MethodsA cohort of patients who underwent acute hip fracture surgery in an usual care period from January 2018 to December 2018 was compared with a cohort of patients in an intervention period from June 2020 to June 2021. During the intervention period, patients were offered orthogeriatric home visits at day 2 and 9 after discharge. The home visits were performed by orthogeriatric nurses, in close collaboration with geriatricians and orthopedic surgeons based in the local hospital. Readmission was defined as ≥ 12 h hospital stay, regardless of reason. For the main analysis, we applied Cox-regression models adjusted for age, sex, New Mobility Score, Cumulated Ambulation Score regained, cognitive function, Charlson Comorbidity Index, complications, medication, discharge destination and emergency department visits. ResultsIn total, 292 patients were included during the usual care period, and 308 patients during the intervention period. Thirty- and 120-day readmission rates were 27.7 % and 41.4 % in the usual care cohort vs. 21.8 % and 35.1 % in the home visit cohort. Adjusted Hazard Ratios for readmission in the intervention cohort after 30 and 120 days were 0.67 (CI95 %: 0.48–0.93) and 0.71 (CI95 %: 0.54–0.93) respectively. Thirty- and 120-day mortality rates were 7.2 % and 20.9 % in the usual care cohort versus 5.8 % and 13.3 % in the intervention cohort. Adjusted Hazard Ratios for mortality in the intervention cohort after 30 and 120 days were 0.68 (CI95 %: 0.35–1.31) and 0.56 (CI95 %: 0.37–0.84) respectively. ConclusionsIn a period where hip fracture patients were offered two home visits after discharge, we observed lower 30- and 120- day readmission, and lower 120-day mortality, calling for more studies with a randomized design.

Community paramedicine program and outcomes of referred coronary artery bypass grafting patients.

Community paramedicine is a field in its infancy. The use of community paramedics has expanded in recent years as an alternative or adjunct to home health in the continued drive to decrease health disparities and complications. In current practice, they function in a position like a home healthcare nurse with an expanded scope of practice, such as providing specialized follow-up care, for example with postoperative care for patients who have undergone major surgery or recent hospitalization. This study assesses if community paramedics are a valid option in reducing rehospitalization of patients who underwent a coronary artery bypass grafting (CABG) procedure. A retrospective chart review between 2021 and 2022 was performed on all patients who underwent CABG in Bismarck, North Dakota, along with obtaining a referral for the community paramedics spanning urban and rural areas. A comparison was made between individuals who saw the community paramedics in their post-care versus those who continued with the standard of care. There were 80 participants and 38 location-matched controls. All variables were found to be statistically insignificant except for the number of walk-in visits (urgent care), in which 7 out of 38 sought medical attention in the controls and 4 out of 80 sought medical attention in the participants. The proportions of inpatient readmission rates and emergency department (ED) visits were similar. Given that paramedicine is in its infancy, the emergence of other variations of the community paramedic certification has brought a discussion of their scope of practice. While walk-in visits, even with the limitations, showed significant improvement with the addition of community paramedics, more research is still needed to show their effectiveness in reducing readmission to hospital. Additionally, the patients who sought help from community paramedics may be more likely than the controls to seek help from medical professionals. This study provided a novel look into the effect that community paramedics can have on patients in urban and rural areas in regard to reducing postoperative complications and minimizing unnecessary advanced healthcare utilization.

S77 Comparative Analysis of ERCP and PTBD for Biliary Interventions for Readmission Rates and Patient Outcomes

S77 Comparative Analysis of ERCP and PTBD for Biliary Interventions for Readmission Rates and Patient Outcomes

Medical- and Implant-Related Complications Following Total Joint Arthroplasty in Patients Who Have Chronic Lymphocytic Leukemia

BackgroundChronic lymphocytic leukemia (CLL) is highly prevalent in the Total Joint Arthroplasty (TJA) age group but has not been properly evaluated. This study aims to assess: 1) 90-day medical complications; 2) implant-related complications; 3) healthcare utilization; and 4) time to revision in CLL and non-CLL TJA. MethodsChronic Lymphocytic Leukemia cases undergoing total knee arthroplasty (TKA) and total hip arthroplasty (THA) were identified using diagnostic and procedural codes. CLL TKA and THA patients were matched 1:5 with controls based on demographics and comorbidities. Outcomes included 90-day medical complications, 2-year implant complications, length of stay (LOS), 90-day readmission, and time to revision. ResultsThe CLL TKA patients had significantly higher odds of 90-day medical complications compared to controls, notably pneumonia (OR, 9.2; CI, 7.1 to 12.0; P < 0.001) and myocardial infarction (OR, 5.5; CI, 3.9 to 7.9; P < 0.001). Similarly, CLL THA patients had greater odds of 90-day medical complications, especially pneumonia (OR 10.0; CI 8.2 to 12.2; P < 0.001) and acute kidney injury (AKI) (OR 6.3; CI 5.1 to 7.8; P < 0.001). CLL TKA patients faced higher odds of periprosthetic fracture, mechanical loosening, and prosthetic joint infection, while THA patients had increased periprosthetic fractures. Revisions occurred earlier for THA than TKA (337 ± 547 days versus 643 ± 774 days). CLL patients had longer LOS (TKA: 5.9 ± 6.5 versus 3.1 ± 1.6 days; P < 0.001) (THA: 6.3 ± 12.9 versus 3.0 ± 2.4; P < 0.001) and higher 90-day readmission rates (OR, 1.3; CI, 1.1 to 1.5, P < 0.001). ConclusionsOrthopaedic surgeons should consider CLL status for informed patient counseling and complications mitigation.

S1176 Readmission Rates in the Inflammatory Bowel Disease Population After Coronary Artery Bypass Grafting: A Nationwide Analysis

S1176 Readmission Rates in the Inflammatory Bowel Disease Population After Coronary Artery Bypass Grafting: A Nationwide Analysis

Impact of a pilot advanced provider-based comprehensive management program to support patients with immunotoxicity-related adverse events in a cancer care setting.

31 Background: Immune checkpoint inhibitors (ICIs) have revolutionized the treatment of many types of cancers. Despite the clinical benefits of the targeted therapy, its use is associated with a spectrum of autoimmune side effects known as immune-related adverse events (irAEs). Toxicities are distinct from those associated with standard chemotherapy, and, if unrecognized and not managed aggressively, can become life-threatening. Early recognition and management of these toxicities, as well as approaches toward cautious retreatment following resolution is essential in clinical practice. Methods: As part of larger effort to provide efficient and proactive care to patients, advanced provider-based comprehensive management program was established in an academic hospital ambulatory setting to identify and manage the full spectrum of unique toxicities of patients receiving standard-of-care ICIs. The goal of the program was to manage patients with severe toxicity including seamless transitions of care between outpatient and inpatient settings to obviate the need for future acute care utilizations. The program provided real-time guidance to providers with clinical questions on use of ICIs, actively navigated patients with suspected immunotherapy toxicity and assessed ongoing education needs for both outpatient and inpatient services. A retrospective analysis of 2-year post implementation of the program was performed with inpatient to outpatient referrals as primary outcome and median length of stay and 30-day readmission rate as secondary outcomes. Results: A total of 388 inpatient admissions (222 Year-1 and 166 Year-2) were included. Preliminary analysis revealed a 25% decrease in immunotoxicity related inpatient admissions (admission rate decreased from 2.8 to 1.9) while patients treated with immunotherapy increased by 7%. The number of ambulatory encounters with the navigator increased by 40% (362 vs 509). The median length of stay for those on the dedicated program decreased by 27.3% (5.5 vs. 4 days) and the 30-day readmission rate decreased by 15.8% (24.3 vs. 20.5) from Year 1 to Year 2. Conclusions: Preliminary analysis suggests the program improved patient care, provided timelier follow-up and management, and reduced the delay to return to anti-cancer treatment. The ambulatory program provided proactive intervention, diagnosis, and management of immunotherapy related toxicities, preventing hospitalization and readmission to the hospital. Although initial findings suggest improved preliminary outcomes, further analysis is required to make any causal inference on the true and sustainable impact of the intervention.

Unintended readmissions and reoperations within 30 and 90 days following adult spinal deformity surgery.

This study investigated the rates and etiologies of unintended readmissions and reoperations within 30 and 90 days after adult spinal deformity (ASD) surgery. The authors aimed to identify the risk factors for readmission and reoperation by analyzing patient demographic and surgical characteristics. This retrospective cohort study included 307 consecutive patients who underwent surgery for ASD from 2012 to 2022 at a single academic institution. Data were collected on patient demographic characteristics, comorbidities, operative details, and postoperative complications. Chi-square and multivariable logistic regression models were used to identify the risk factors associated with 30- and 90-day readmissions and reoperations. The mean ± SD age at surgery was 66.6 ± 10.5 years, and the majority (80.8%) of patients were female. The 30-day and 90-day readmission rates were 11.7% and 15.3%, respectively. Multivariable regression for 30-day readmissions revealed that length of hospital stay (LOS) after index surgery of > 20 days (OR 2.48) and surgical factors such as vertebral column resection (VCR) (OR 4.26) and pelvic fixation (OR 4.38) were risk factors. Other factors such as the American Society of Anesthesiologists Physical Status Classification System (ASA) class, prior spine surgery, and age were not associated with 30-day readmissions. Ninety-day readmission was associated with high ASA class (OR 2.37) and LOS > 20 days (OR 2.82). The 30- and 90-day reoperation rates were 7.8% and 10.1%, respectively. The variables associated with 30-day reoperations were intraoperative VCR (OR 3.34) and LOS > 20 days (OR 9.38). Ninety-day reoperations were associated with dural tears (OR 3.33) and LOS > 20 days (OR 3.68). This study provides valuable insights into the incidence of unintended readmission and reoperation within 30 and 90 days after ASD surgery in an Asian population. By identifying the associated risk factors, healthcare providers can customize surgical strategies and optimize perioperative care to effectively mitigate these events.

General versus disease-specific medical oncology consults and impact on inpatient quality of care.

321 Background: Hospitalization is a time of crisis for patients and caregivers. Subspeciality oncologists may bring more timely, effective support compared to a general oncologists. Attendings, fellows and advance practice providers (APPs) may benefit from focused expertise for consultative care and education. Methods: Subspeciality oncology consults launched July 2023, with consults staffed by 4 oncologists from: 1) breast 2) head and neck/thoracic 3) gastrointestinal and 4) genitourinary/melanoma. Previously, 3 oncologists staffed all patients, regardless of primary malignancy. Throughout the study period, oncologists were supported by at least 1 fellow or 1 APP. Using Epic and Tableau, we collected LOS, time to consult (TTC), ICU rate, hospice referral rate, 30-day readmission, 30-day emergency department (ED) visit data. Using Qualtrics, we collected fellow, attending, and APP satisfaction feedback pre- and post-intervention. Data was analyzed using R-4.40. Oncologists, fellows, and APPs completed Qualtrics surveys pre- and post-intervention regarding their experience. Results: Subspeciality oncology consults were associated with a significant decrease in LOS, TTC, and ICU rate. Median LOS decreased by 2.0 days (P&lt;0.001), with median TTC decreasing by 1.0 hour (P=0.003). ICU rate decreased from 27.5% to 16.4% (P&lt;0.001). There was no difference in hospice referrals or 30-day ED visits. A significant increase in 30-day readmission during post-intervention was observed (Table). Oncologists reported a high level of satisfaction with the program. Oncologist, fellow, and APP overall experience and educational rankings increased after the introduction of subspeciality consults. Inpatient productivity measured by wRVU increased by 30% following the intervention, without associated changes to outpatient productivity. Conclusions: Transition to a subspeciality oncology consult model improved inpatient quality of care, as well as clinician experience. Additionally, inpatient productivity increased without decrease in outpatient metrics. Subspeciality medical oncology consultation can improve inpatient quality of care, education, clinician satisfaction and productivity. Subspeciality oncology consult outcomes. General Consults (Baseline)* Subspeciality Consults (Intervention) P-value Median TTC (Hours) 4.0 (1.5-6.0)** 3.0 (0-5.0)** P=0.003 Median LOS (Days) 7.0 (4.0-13.0)** 5.0 (3.0-10.0)** P&lt;0.001 ICU Rate 148 (27.5%) 161 (16.4%) P&lt;0.001 Hospice Referral Rate 56 (10.4%) 95 (9.7%) 0.655 30-Day Readmission Rate 136 (25.3%) 301 (30.7%) 0.028 30-Day ED Rate 157 (29.2%) 315 (32.1%) 0.247 *Baseline data reflects outcomes for general oncology consult staffing, prior to initiation of subspeciality consult model (pre-intervention). **Interquartile Range (IQR).

A Higher Area Deprivation Index is Associated with Increased Medical Complications and Emergency Department Utilizations after Total Hip Arthroplasty

IntroductionThe Area Deprivation Index (ADI) is a weighted index comprised of 17 census-based markers of material deprivation and poverty. The purpose of this study was to determine whether patients undergoing total hip arthroplasty (THA) in areas of high ADI (greater disadvantage) were associated with differences in 90-day: 1) medical complications; 2) emergency department (ED) utilizations; and 3) readmissions. MethodsA nationwide database was queried for primary THA patients from 2010 to 2020. The ADI is reported on a scale of 0 to 100, with higher numbers indicating greater disadvantage. Patients undergoing primary THA in regions associated with high ADI (90%+) were compared to those of lower ADI (0 to 89%). A total of 138,670 patients were evenly matched between the two cohorts following 1:1 propensity score matching by age, sex, and Elixhauser Comorbidity Index (ECI). Primary endpoints were 90-day medical complications, ED utilizations, and readmissions. Multivariable logistic regression models calculated the odds ratios (OR) and 95% confidence intervals (95% CI). P-values less than 0.01 were statistically significant. ResultsPatients undergoing THA from high ADI had significantly higher rates and odds of developing any medical complications (13.00 versus 11.91%; OR: 1.09, P < 0.0001), including acute kidney injuries (1.83 versus 1.52%; OR: 1.20, P < 0.0001), myocardial infarctions (0.35 versus 0.24%; OR: 1.45, P = 0.0003), and surgical site infections (0.94 versus 0.76%; OR: 1.23, P = 0.0004). High ADI patients had significantly higher rates and odds of ED visits within 90 days (3.94 versus 3.67%; OR: 1.08, P = 0.008). There was no significant difference in readmissions (5.44 versus 5.69%; OR: 0.95, P = 0.034). ConclusionsSocioeconomically disadvantaged patients have increased odds of 90-day medical complications and ED utilizations, despite comparable 90-day readmission rates. Measures of neighborhood disadvantage may be valuable metrics to inform healthcare policy and improve post-discharge care.

S338 Assessing the Post-Procedural Communication as a Tool to Reduce the 7-Day Readmission Rate Following Outpatient Colonoscopy: Fellow-Initiated Quality Improvement Project

S338 Assessing the Post-Procedural Communication as a Tool to Reduce the 7-Day Readmission Rate Following Outpatient Colonoscopy: Fellow-Initiated Quality Improvement Project

Primary and incisional hernias should be considered separately in clinical decisions and research: A nationwide register-based cohort study

BackgroundVentral hernias of umbilical, epigastric, and incisional types pose varied surgical challenges. Recent debates and research suggest that treatment strategies and outcomes may vary significantly based on hernia type and width. This study investigated whether differences in the risk of surgical outcomes among primary and incisional hernias are solely due to the hernia type. The primary outcome was reoperation for recurrence, and the secondary outcome was 90-day postoperative readmission. MethodsThis study was based on prospectively collected data from the Danish Ventral Hernia Database linked with the Danish Civil Registration system and the National Patient Register. Data spanned from 2007 to 2022 and included patients with umbilical, epigastric, or incisional hernias. The 3 hernia types were analyzed for the risk of reoperation for recurrence, adjusted for sex, age, emergency repair, width, use of mesh, and Charlson comorbidity index. ResultsWe included 57,312 hernias: 34,147 umbilical, 9,433 epigastric, and 13,722 incisional hernias. Compared with patients with umbilical hernias, patients with epigastric hernias had a lower risk of reoperation (hazard ratio: 0.88, 95% confidence interval: 0.79–0.99) and those with incisional hernias had an increased risk (hazard ratio: 2.93, 95% confidence interval: 2.57–3.33). Postoperative 90-day readmission rates were also higher for patients with incisional hernias than for patients with umbilical and epigastric hernias. ConclusionIncisional hernias exhibited a higher risk of reoperation for recurrence and 90-day postoperative readmission, underscoring their unique nature in terms of both origin and clinical behavior. The findings suggest that primary and incisional hernias should be separate entities in medical practice and research.

The impact of admitting ward on resource utilization and outcomes among hospitalized cancer survivors.

36 Background: With improvements in both early detection and cancer treatment, there is a growing population of cancer survivors; with a corresponding increase in acute care use. However, models of inpatient care delivery for cancer survivors differ between hospitals and regions, which may impact resource use and outcomes. Understanding how different models influence outcomes may help define optimal models for cancer inpatient care delivery. Methods: We created a multicenter cohort of all cancer patients admitted to medical wards across 26 hospitals in Ontario, Canada from 2015 to 2022, and deterministically linked population level administrative data including ambulatory oncology data, with each hospital’s patient-level electronic information (pharmacy, orders, notes, labs/imaging and results). Multivariable regression models compared characteristics and outcomes between patients admitted on oncology wards vs non-oncology wards adjusting for age, sex, income quintile, rurality, immigrant status, receiving IV systemic therapy within 120 days and comorbidity scores. Results: In total, there were 370,118 hospitalizations from 191,990 unique patients. Among these hospitalizations, 38,075 episodes (10%) were on an oncology ward. Median time from cancer diagnosis to hospitalization was 4 years; 10% received IV systemic therapy within 120 days and 16% within 1 year. The most common disease sites were GU (21%), GI (20%), breast (12%) and lung (10%). The most common discharge diagnoses from oncology wards were inpatient chemotherapy (9%), febrile neutropenia (7%), NHL (4%), AML (4%), myeloma (3%); while for non-oncology wards were heart failure (5%), palliative care (4%), UTI (2%), pneumonia (2%), acute renal failure (2%). In general, cancer patients admitted on oncology wards were younger (64 vs 76), had shorter length of stay (LOS; 9.6 vs 10.1 days), less in-hospital mortality (8% vs 11%), greater 30-day re-admission rates (30% vs 15%) and were more likely to undergo CTs (28% vs 21%), MRIs (11% vs 9%) and interventional procedures (8% vs 6%) (p&lt;0.001, all). Subgroup analysis focusing on the top 5 discharge diagnoses from non-oncology wards, showed that despite no difference in in-hospital mortality rates (aOR 0.92 95% CI [0.58-1.46] p=0.73), admission to a non-oncology ward for those diagnoses was associated with shorter LOS (aOR 0.84 [0.78-0.90] p&lt;0.001), reduced 30-day re-admission rates (aOR 0.60 [0.48-0.75] p&lt;0.001), and reduced use of CTs (aOR 0.60 [0.49-0.74] p&lt;0.001), MRIs (aOR 0.36 [0.25-0.52] p&lt;0.001), and interventional procedures (aOR 0.43 [0.29-0.64] p&lt;0.001). Conclusions: There are differences in resource use and outcomes for cancer survivors hospitalized on oncology versus non-oncology wards, including for patients with the same discharge diagnosis. To optimize inpatient cancer care delivery for hospitalized cancer survivors, further exploration of care models is needed.

Acute estradiol and progesterone therapy in hospitalized adults to reduce COVID-19 severity: a randomized control trial.

COVID-19 outcomes are less severe in women than men suggesting that female sex is protective. The steroids estradiol (E2) and progesterone (P4) promote anti-inflammatory immune responses and their therapeutic use for COVID-19 has been under investigation. The aim of the study was to evaluate the efficacy of a short systemic E2 and P4 combination in mitigating COVID-19 severity in hospitalized men and women. In a phase 2, single center, double blind, randomized placebo-controlled trial, ten male and female participants hospitalized for COVID-19 with scores 3-5 on the 9-point WHO ordinal scale were randomized to receive either (1) E2 cypionate (5mg, IM) and micronized P4 (200mg, PO), or (2) placebo-equivalent, in addition to standard of care (SOC). The primary outcome was the proportion of patients whose WHO scores improved to 1-2 on the day of discharge. Secondary outcomes included length of hospital stay (LOS), days on oxygen therapy (DOT), readmission rates (RR), adverse events (AEs), and change in circulating biomarkers using untargeted proteomics and cytokine profiling. There were no significant changes between the groups in primary outcome, LOS, DOT, RR or AEs. The E2P4 group exhibited a decrease in biomarker pathways of respiratory and gastrointestinal disease inflammation, infection by coronavirus, and immune cell trafficking and inflammatory response. A short-term E2P4 treatment in patients hospitalized for COVID-19 decreases biomarkers of inflammation. Considering the availability, low cost, and safety of E2 and P4, our results warrant additional studies to explore their effects in mitigating other viral pandemics. Clinical Trial Registration NCT04865029, ClinicalTrials.gov; (First trial registration 29/04/2021).

Appendiceal Neoplasm in Conservatively Managed Acute Appendicitis: A Retrospective Observational Study.

Introduction Appendiceal neoplasms are more prevalent in patients ≥ 40 years old who present with complicated appendicitis, especially if managed conservatively. Routine interval appendicectomy is not recommended. Follow-up bowel screening using both a CT scan and colonoscopy is recommended. Following the COVID-19 pandemic, many units have increased their utilization of non-operative management of acute appendicitis (NOM).This provides an optimal population sample to study the incidence of unexpected appendiceal malignancy compared to a similar cohort that underwent operative management. The primary outcomes of interest include the incidence of appendiceal malignancy following NOM, efficacy of bowel screening, and rates of re-admission. Methods A retrospective, observational study on patients admitted with acute appendicitis from January 2020 to December 2021. All patients diagnosed with acute appendicitis aged 40 years and older were included in the study, while those under 40 or without a diagnosis of acute appendicitis were excluded. Results We had 211 cases of acute appendicitis. 125 (59%) of which were managed operatively, while 86 cases (41%) were managed NOM. We found six cases (7%) of appendiceal malignancy in the NOM cohort, compared to two cases (1.6%) in the operatively-managed cohort. A routine follow-up colonoscopy failed to reveal any sinister pathology. All six cases underwent interval appendicectomy through which the malignancy was detected. 39 cases (45%) of NOM had at least one episode of re-admission, with 32 (37%) of them being in the first year. Conclusion NOM of acute appendicitis in adults ≥ 40 years old is associated with an increase in unexpected appendiceal malignancy, none of which were detected on follow-up colonoscopy.We emphasize the need for closer surveillance and potentially more aggressive follow-up strategies, including routine interval appendicectomy, for older patients undergoing NOM of acute appendicitis.

Outpatient Endocrine Protocol and Testing Coincides with Reduced Length of Postpituitary Surgery Admission

Abstract Objective The study objective was to compare the length of stay (LOS) and the proportion of one-night admissions before and after the implementation of an endocrine monitoring protocol following endoscopic transsphenoidal surgery (ETSS) for pituitary adenoma. Methods Patients who underwent transsphenoidal pituitary adenoma resection between July 1, 2018, and September 9, 2022, were identified, and divided into two cohorts before and after the implementation of the monitoring protocol. The overall LOS and number of nights of admission were recorded. Readmission within 30 days after surgery was also recorded. The number of outpatient laboratory tests performed and the time to the first test were also noted. Results Thirty patients were identified in the preprotocol group and 60 in the postprotocol group. The average admission length in the preprotocol group was significantly longer than the average admission length in the postprotocol group (2.4 vs. 1.7 days, p = 0.004). The percentage of one-night admissions increased from 13 to 57% (p &lt; 0.001). There were no significant differences in readmission rates between the two groups (p = 0.681). The number of laboratory encounters increased from a mean of 1.38 to 2.40 (p = 0.030), while the time to the first test decreased from a mean of 3.43 to 2.36 days (p = 0.049). Conclusion Patients admitted after ETSS for pituitary adenoma had shorter hospital stay and greater proportion of one-night admission with the implementation of an endocrine monitoring protocol. The all-cause readmission rate was not statistically different between the two groups. Through aggressive outpatient laboratory monitoring, one-night admission for ETSS may be feasible.

Length of Stay, Readmission Rates, and Mortality Are Similar Between Hospitalized Individuals With Sickle Cell Disease With and Without COVID-19.

Background We sought to clarify the impact of COVID-19 on clinical outcomes in sickle cell disease patients, given their baseline hypercoagulable state in combination with COVID-19-related coagulopathies and other complications. Methods Retrospective chart review of two groups of sickle cell disease patients hospitalized between March 2020 to December 2021: Group 1 did not have COVID-19 (n = 95) and Group 2 did (n = 73). Results Groups 1 and 2 were similar in terms of age, race, sex, comorbid illnesses, genotype, hydroxyurea use, and opioid use. Group 1 and 2 patients had a mean hospital length of stay of 7.05 and 7.64 days, respectively (p = 0.981). ICU-level care was required for six (6.3%) Group 1 patients and four (5.5%) Group 2 patients (p = 1.000). Readmissions within 30 days occurred for 25 (26.3%) Group 1 patients, and 18 (24.7%) Group 2 patients (p = 0.807). Death occurred for one (1.05%) Group 1 patient and one (1.4%) Group 2 patient (p = 1.000). There were no significant differences in commonly ordered initial laboratory values (total bilirubin, hemoglobin, hematocrit, creatinine, lactate dehydrogenase, and D-dimer) between Group 1 and Group 2 patients. Conclusions We observed no significant differences in clinical outcomes among sickle cell disease patients hospitalized due to COVID-19 compared to those without COVID-19.