Readmission Rates For Patients Research Articles

Effectiveness of Palliative Care in Heart Failure Patients in Preventing Readmission: A Systematic Review

Palliative care is an essential part of the management of heart failure patients. By integrating palliative care in treating heart failure patients, patients experience calm and feel a safe atmosphere both physically and psychosocially, and with other problems, and make patients have the same understanding from a medical perspective. To summarize the results of studies related to palliative care in heart failure patients and to identify specific and effective practices in preventing readmission. Systematic search of the PubMed, Science Direct, and ProQuest databases searching for articles that included heart failure and palliative care. Palliative care is a critical component of health care for heart failure patients. In this article, the authors summarize the effectiveness of patient-focused palliative care and the palliative team in preventing readmissions and improving patients' quality of life when palliative care is applied in health care. Implementing palliative care in patients with heart failure is highly recommended for enhancing the patient's quality of life (QoL) and preventing or reducing patient readmission rates if appropriately implemented. Focusing on improving the abilities and skills of the palliative team is also something that needs to be considered. Also, knowledge, understanding, and involvement of the patient's family in patient care at home are significant.

Comparison of 30-day Readmission Rates and Inpatient Cardiac Procedures for Weekday Versus Weekend Hospital Admissions for Heart Failure

BackgroundWhether the timing of hospital presentation impacts care delivery and clinical outcomes for patients hospitalized for heart failure (HF) remains a matter of debate. In this study, we examined all-cause and HF-specific 30-day readmission rates for patients who were admitted for HF on a weekend vs admitted for HF on a weekday. Methods and ResultsWe conducted a retrospective analysis using the 2010–2019 Nationwide Readmission Database to compare 30-day readmission rates among patients who were admitted for HF on a weekday (Monday to Friday) vs patients who were admitted for HF on a weekend (Saturday or Sunday). We also compared in-hospital cardiac procedures and temporal trends in 30-day readmission by day of index hospital admission. Among 8,270,717 index HF hospitalizations, 6,302,775 were admitted on a weekday and 1,967,942 admitted on a weekend. For weekday and weekend admissions, the 30-day all-cause readmission rates were 19.8% vs 20.3%, and HF-specific readmission rates were 8.1% vs 8.4%, respectively. Weekend admissions were independently associated with higher risk of all-cause (adjusted odds ratio [aOR] 1.04, 95% confidence interval [CI] 1.03–1.05, P < .001) and HF-specific readmission (aOR 1.04, 95% CI 1.03–1.05, P < .001). Weekend HF admissions were less likely to undergo echocardiography (aOR 0.95, 95% CI 0.94–0.96, P < .001), right heart catheterization (aOR 0.80, 95% CI 0.79–0.81, P < .001), electrical cardioversion (aOR 0.90, 95% CI 0.88–0.93, P < .001), or receive temporary mechanical support devices (aOR 0.84, 95% CI 0.79–0.89, P < .001). The mean length of stay was shorter for weekend HF admissions (5.1 days vs 5.4 days, P < .001). Between 2010 and 2019, 30-day all-cause (18.5% to 18.2%, trend P < .001) and HF-specific (8.4% to 8.3%, trend P < .001) readmission rates decreased among weekday HF admissions. Among weekend HF admissions, the HF-specific 30-day readmission rate decreased (8.8% to 8.7%, trend P < .001), but the all-cause 30-day readmission rate remained stable (trend P = .280). ConclusionsAmong patients hospitalized for HF, weekend admissions were independently associated with excess risk of 30-day all-cause and HF-specific readmission and a lower likelihood of undergoing in-hospital cardiovascular testing and procedures. The 30-day all-cause readmission rate has decreased modestly over time among patients admitted on weekdays, but has remained stable among patients admitted on weekends.

A-BBL: A Risk Prediction Model for Patient Readmission based on Electronic Medical Records

With the spread of medical digitization, electronic health record data has been accumulated in large quantities, laying the foundation for intelligent medical changes. ICU data is mined and analyzed to identify the risk of patient readmission in a timely manner, prevent and control the deterioration of patients' conditions, and reduce the burden of patient costs. However, due to the poor quality of medical data, potential information cannot be effectively mined. In view of the above problems, a patient readmission risk prediction model A-BBL is proposed. By extracting and analyzing the patient 's discharge summary information, the readmission risk of discharged patients within 30 days is predicted. The A-BBL model consists of three parts: firstly, BioBert is used to pre-train the medical text data, extract the semantic information of the medical text, and then generate the corresponding word vector. Then, the sequence model BiLSTM is used to capture the context information and model the input sequence. Finally, the self-attention mechanism is used to extract the key information in the input sequence, enhance the vector representation ability of the sequence, thereby improving the performance and accuracy of the model, so as to predict the readmission rate of patients. Based on the MIMIC-III real medical data set, the A-BBL model for patient readmission prediction proposed in this paper is verified. Compared with the baseline model, the accuracy is improved by 7.2 %. This study can help medical staff better understand and pay attention to the progression of critically ill patients, im-prove the survival rate of patients, and reduce the readmission rate of patients.

114. A Nationally Validated Novel Risk Assessment Score for Prediction of Unplanned Reoperations and Readmissions in Hand Surgery

PURPOSE: Risk predictors are an emerging tool as the need for granular, individualized risk estimation remains necessary for informed patient counseling and clinical decision making. Existing comorbidity-driven risk indices have had varied success in accurately predicting risk in hand surgery. This study provides a novel risk score for reliably predicting reoperations and readmissions in hand surgery. METHODS: Hand surgeries from the National Surgical Quality Improvement Program (NSQIP) 2012 to 2020 database were identified by Current Procedural Terminology (CPT) codes. Independent predictors of 30-day unplanned reoperation and readmission were identified using multivariable logistic regression with backward variable selection on the testing sample (2012-2019). Subsequently, the predictors were weighted according to β-coefficients to generate an integer-based Novel Risk Score (NRS) predictive of reoperation and readmission. The NRS was then validated on 1000 bootstrapped replications of the original sample, and again tested on NSQIP patients who had undergone hand surgery in 2020. The NRS was compared to the modified frailty index (mFI-5) and the modified Charlson Comorbidity Index (mCCI) with receiver operating characteristics (ROC) analysis. RESULTS: 83,409 hand surgeries were identified in the modeling cohort. Reoperations and readmissions occurred 1.1% and 1.3% of the time, respectively. Independent risk factors included male gender, inpatient status, smoking, dialysis dependence, transfusion within 72 hours of surgery, wound classification, ASA Class, diabetes mellitus, CHF, sepsis or septic shock, emergent case, and long initial operative time (all P < 0.05). ROC analysis of the testing (2020) cohort rendered an area under the curve of 0.730, which demonstrates the accuracy of this prediction model. The mFI-5 and mCCI rendered AUCs of 0.580 and 0.585, respectively. CONCLUSION: We present a validated risk stratification tool for unplanned reoperations and readmissions following hand surgery that outperforms the mFI-5 and mCCI. Future studies should determine if implementation of this NRS optimizes safety and reduces reoperation and readmission rates in hand surgery patients.

540 Psychiatric Illness and Substance Abuse: Unaddressed Factors in Burn Injury

Abstract Introduction Patients with psychiatric illness and substance use disorder have high rates of burn injuries. These patients require multidisciplinary care and experience prolonged admissions. Less is known about these patients after discharge due to challenges such as poor healthcare literacy and inequities to healthcare access. This study characterizes this marginalized population’s inpatient burn care and post-discharge outcomes compared to the general burn population. Methods Patients who were admitted to a single burn center from January 1st, 2018 to June 1st, 2022 were included. Patient demographics, history of psychiatric disorders, burn and psychiatric treatment data, and post-discharge outcomes were collected. Results A total of 1,660 patients were included in this study, of which 91 (6%) patients had psychiatric comorbidity and/or substance use disorder. These 91 patients had an average age of 36 years (standard deviation (SD): 12 years). In this cohort, the majority of patients were undomiciled (66%) and male (67%). On admission, 66 (72%) patients reported recent illicit substance use or had positive urine toxicology results. At the time of burn injury, 25 (28%) patients had a pre-existing psychiatric disorder. Patients were treated most for self-inflicted burns, with 36 (40%) patients presenting with burns secondary to self-immolation. In this population, 67 (74%) patients required inpatient psychiatric intervention, of which 31 (46%) were placed on a psychiatric hold. After discharge, 39 (43%) patients returned to the hospital for outpatient follow-up. The readmission rate for patients with psychiatric or substance use comorbidity was greater than 4 times higher than that of the general burn population (31% vs 7%). The most common cause of readmission were subsequent mental health crisis (40%) and inability to perform burn care (32%). Conclusions Burn patients with psychiatric disorders and substance abuse are most often young men who exhibit self-harm. These patients have limited outpatient follow up and access to support outside of the hospital. High readmission rates for subsequent mental health crises and inability to perform basic wound care exemplifies inadequate short-term care for this marginalized population. Applicability of Research to Practice In the short term, patients with psychiatric and substance use disorders may benefit from additional professional support and treatment to address burn care and comorbidities after burn injury.

A risk score to predict 30-day hospital readmission rate in cirrhotic patients with spontaneous bacterial peritonitis

Background and aimThere is lack of 30-day hospital readmission prediction score in patients with liver cirrhosis and SBP. The aim of this study is to recognize factors capable of predicting 30-day readmission and to develop a readmission risk score in patients with SBP.MethodsThis study prospectively examined the 30-day hospital readmission for patients previously discharged with a diagnosis of SBP. Based on index hospitalization variables, a multivariable logistic regression model was implemented to recognize predictors of patient hospital readmission within 30 days. Consequently, Mousa readmission risk score was established to predict 30-day hospital readmission.ResultsOf 475 patients hospitalized with SBP, 400 patients were included in this study. The 30-day readmission rate was 26.5%, with 16.03% of patients readmitted with SBP. Age ≥ 60, MELD > 15, serum bilirubin > 1.5 mg/dL, creatinine > 1.2 mg/dL, INR > 1.4, albumin < 2.5 g/dL, platelets count ≤ 74 (103/dL) were found to be independent predictors of 30-day readmission. Incorporating these predictors, Mousa readmission score was established to predict 30-day patient readmissions. ROC curve analysis demonstrated that at a cutoff value ≥ 4, Mousa score had optimum discriminative power for predicting the readmission in SBP with sensitivity 90.6% and specificity 92.9%. However, at cutoff value ≥ 6 the sensitivity and specificity were 77.4% and 99.7%, respectively, while a cutoff value ≥ 2 had sensitivity of 99.1% and specificity of 31.6%.ConclusionsThe 30-day readmission rate of SBP was 25.6%. With the suggested simple risk assessment Mousa score, patients at high risk for early readmission can be easily identified so as to possibly prevent poorer outcomes.

Preoperative opioid use disorder has a negative impact on the rate of short-term complications following total and reverse shoulder replacement

BackgroundMore than 2 million Americans and 16 million individuals worldwide are estimated to have an opioid use disorder (OUD). It is imperative that we understand the impact OUD has on patients who require surgical procedures. Preoperative OUD has been associated with increased postoperative complications, lengths of stay, and readmissions in elective procedures. The goal of this study was to elucidate the impact that preoperative OUD has on short-term outcomes following total and reverse shoulder arthroplasty. MethodsPatient information was collected using the National Readmissions Database (2016-2018). Persons who underwent anatomic and reverse shoulder arthroplasty were identified using International Classification of Diseases 10th Revision procedural codes (anatomic: 0RRJ0JZ/0RRK0JZ, reverse: 0RRJ00Z, 0RRK00Z). OUD was defined using the following International Classification of Diseases 10th Revision codes: F11.10, F11.11, F11.20, and F11.21. Patient demographics, comorbidity indices (Charlson and Elixhauser), complications, readmission rates, healthcare costs, and lengths of stay were compared between OUD and non-OUD patients. A univariate analysis was first run with OUD as the independent variable followed by a multivariate analysis to identify if OUD was an independent predictor of adverse outcomes. ResultsOne hundred sixty four thousand and five hundred twenty two total patients were identified (OUD: 1098 vs. non-OUD: 163,424). The OUD patients were younger (64.3 ± 10.0 years vs. 69.4 ± 9.5 years, P < .01), had longer lengths of stay (2.5 ± 2.6 days vs. 1.8 ± 2.0 days, P < .01), and had higher cumulative hospital costs ($83,424.88 ± $53,565.26 vs. $73,099.65 ± $47,548.65, P < .01) on average. Univariate analysis revealed that OUD patients had increased rates of respiratory, intraoperative, hardware, and prosthetic complications, dislocations, infection (surgical site and prosthetic), revision surgeries, and 30-day/90-day readmissions (P < .01). Interestingly, through a multivariate analysis, OUD was predictive for less revision surgeries (odds ratio [confidence interval 95%]: 0.69 [0.48-0.99], P = .045) but trended toward being a predictor for increased rates of 90-day readmissions (odds ratio [confidence interval 95%]: 1.28 [0.96-1.72], P = .09). ConclusionOUD patients were younger on average and had increased lengths of stay, healthcare costs, and risks for developing operative, postoperative, and prosthetic complications compared to non-OUD patients undergoing shoulder replacement. However, OUD was not found to be an independent predictor of adverse outcomes. Together, these findings should encourage surgeons to address substance use disorders with all patients preoperatively in an attempt to mitigate potential complications while not identifying OUD as an exclusive operative contraindication.

Early Discharge, Outpatient Evaluation, and Home Management of Acute Respiratory Failure from COVID-19 in Martinique.

A worldwide pandemic of viral infection due to SARS-CoV-2 (and its resultant disease, COVID-19) has been ongoing since 2019. Martinique was affected by a major wave in summer 2021, with saturation of the health system forcing the implementation of home care management. We conducted a retrospective, observational study that included patients treated in the KOVIDHOM 972 program. We included adult patients with SARS-CoV2 hypoxemic pneumonia and requiring 4 L per minute or less of oxygen. In total, 418 were discharged to home with oxygen therapy after hospitalization for SARS-CoV-2 hypoxemic acute pneumonia, and 416 were analyzed. Half (50.2%) were women. Mean age was 58.8 ± 13.0 years. Time from onset of symptoms to hospitalization was 9.1 ± 3.5 days, and average length of stay was 10.5 ± 7.4 days. Maximum oxygen flow during hospitalization was 6.9 ± 4.5 L/min in patients who did not require intensive care. Average oxygen flow at discharge was 1.8 ± 07 L/min. At 30 days after discharge, the readmission rate was 0.5% (95% CI: 0-1.18), and the death rate was 0.5% (95% CI 0-1.18). Our study shows a very low rate of readmission or death in COVID-19 patients discharged to home with oxygen therapy. These results highlight the possibility of safe home care in carefully selected patients. Such programs could be useful in pandemic or wide-scale emergency situations.

Does a Lower Target of Postpartum Blood Pressure Reduce Readmission Rates in Patients With Hypertensive Disorders of Pregnancy? [ID: 1377089

INTRODUCTION: The classification of normal blood pressure in the general population, as determined by multiple organizations including the American Heart Association, American College of Cardiology, and National Institutes of Health, has been evolving. In the pregnant and postpartum population, the threshold of normal blood pressure is higher. Postpartum hypertension has been estimated to affect 20% of women and plays a large role in maternal readmissions. In those with hypertensive disorders of pregnancy, the target postpartum blood pressure should be reevaluated in light of the lower thresholds of the general population. METHODS: This study included pregnant patients with singleton fetuses and a diagnosis of chronic hypertension, gestational hypertension, preeclampsia, and eclampsia who delivered at Luminis Health Anne Arundel Medical Center from January 2019 to 2022. The primary outcome was hospital readmission for a hypertensive diagnosis or related sequelae within the first 30 days of delivery. This study was approved by IRB ID 1735193-1. RESULTS: Out of 1,433 patients with hypertensive disorders of pregnancy, 55 patients (3.8%) were readmitted because of hypertensive disorders or related complications. Patients with a maximum blood pressure after delivery of greater than or equal to 150/100 mm Hg were significantly more likely to be readmitted (odds ratio 1.99 [1.06, 3.75]). The maximum blood pressure on the day of discharge and oral antihypertensive initiation were not significantly associated with readmission. CONCLUSION: For postpartum patients with mild hypertension, a target blood pressure of below 150/100 mm Hg should be considered. Next steps include examining the effect of magnesium sulfate, furosemide, and discharge medication compliance in this population.

B-44 | 30-Day Readmission Rates of Transcatheter Aortic Valve Replacement in Underlying Obstructive vs Restrictive Pulmonary Diseases

Our objective is to compare the 30-day readmission rates for patients undergoing transcatheter aortic valve replacement (TAVR) with underlying obstructive and restrictive pulmonary diseases. We conducted a retrospective cohort analysis using National Readmission Databases 2016-2018 with ICD-10 codes. Primary outcome was readmission rates for patients hospitalized for TAVR with and without underlying chronic pulmonary diseases (CPD). 30-day readmission rate was higher for TAVR patients with CPD as compared to patients without CPD (14.7% vs 11.6%) (Table 1). Mortality rate is also higher in TAVR index admissions with CPD as compared to without CPD (19% vs 13.8%) and also for TAVR 30-day readmissions (4.1% vs 3.6%). Table 2 summarizes the most common principal diagnosis for 30-day readmissions for TAVR Patients with chronic pulmonary disease (CPD). TAVR patients with restrictive pulmonary disease have higher 30-day readmission rate than obstructive pulmonary disease (18.8% vs 14.5%). Among the obstructive pulmonary disease, TAVR patients with underlying bronchiectasis have highest 30-day readmission rate (17.8%) while among restrictive pulmonary disease, TAVR patients with underlying hypersensitivity pneumonitis have the highest 30-day readmission rate (22.3%). TAVR patients with underlying CPD have higher readmission rates, mortality rates, mean length of stay, and mean total charges as compared to patients without CPD. TAVR patients with underlying restrictive pulmonary disease have higher readmission rates than obstructive pulmonary disease.

New insights into the molecular mechanisms of SGLT2 inhibitors on ventricular remodeling.

Ventricular remodeling is a pathological process of ventricular response to continuous stimuli such as pressure overload, ischemia or ischemia-reperfusion, which can lead to the change of cardiac structure and function structure, which is central to the pathophysiology of heart failure (HF) and is an established prognostic factor in patients with HF. Sodium glucose cotransporter 2 inhibitors (SGLT2i) get a new hypoglycemic drug that inhibit sodium glucose coconspirator on renal tubular epithelial cells. Recently, clinical trials increasingly and animal experiments increasingly have shown that SGLT2 inhibitors have been largely applied in the fields of cardiovascular diseases, forinstance heart failure, myocardial ischemia-reperfusion injury, myocardial infarction, atrial fibrillation, metabolic diseases such as obesity, diabetes cardiomyopathy and other diseases play a cardiovascular protective role in addition to hypoglycemic. These diseases are association with ventricular remodeling. Inhibiting ventricular remodeling can improve the readmission rate and mortality of patients with heart failure. So far, clinical trials and animal experiments demonstrate that the protective effect of SGLT2 inhibitors in the cardiovascular field is bound to inhibit ventricular remodeling. Therefore, this review briefly investigates the molecular mechanisms of SGLT2 inhibitors on ameliorating ventricular remodeling, and further explore the mechanisms of cardiovascular protection of SGLT2 inhibitors, in order to establish strategies for ventricular remodeling to prevent the progress of heart failure.

A Quality Improvement Project to Assess the Unplanned 30-Day Readmission Rate of Oncology Patients (FR206D)

A Quality Improvement Project to Assess the Unplanned 30-Day Readmission Rate of Oncology Patients (FR206D)

Association of Hospital Readmission Rates With Discharge Disposition for Patients With Psychotic Disorders.

We explored how readmissions may result from patients' lack of access to aftercare services, failure to adhere to psychotropic medication plans, and inability to understand and follow hospital discharge recommendations. We also investigated whether insurance status, demographics, and socioeconomic status are associated with hospital readmissions. This study is important because readmissions contribute to increased personal and hospital expenses and decreased community tenure (the ability to maintain stability between hospital admissions). Addressing hospital readmissions will promote optimal discharge practices beginning on day one of hospital admission. The study examined the differences in hospital readmission rates for patients with a primary psychotic disorder diagnosis. Discharge data were drawn in 2017 from the Nationwide Readmissions Database. Inclusion criteria included patients aged 0-89 years who were readmitted to a hospital between less than 24 hr and up to 30 days from discharge. Exclusion criteria were principal medical diagnoses, unplanned 30-day readmissions, and discharges against medical advice. The sampling frame included 269,906 weighted number of patients diagnosed with a psychotic disorder treated at one of 2,355 U.S. community hospitals. The sample size was 148,529 unweighted numbers of patients discharged. In a logistic regression model, weighted variables were calculated and used to determine an association between the discharge dispositions and readmissions. After controlling for hospital characteristics and patient demographics, we found that the odds for readmission for routine and short-term hospital discharge dispositions decreased for home health care discharges, which indicated that home health care can prevent readmissions. The finding was statistically significant when controlling for payer type and patient age and gender. The findings support home health care as an effective option for patients with severe psychosis. Home health care reduces readmissions and is recommended, when appropriate, as an aftercare service following inpatient hospitalization and may enhance the quality of patient care. Improving healthcare quality involves optimizing, streamlining, and promoting standardized processes in discharge planning and direct transitions to aftercare services.

The cardiovascular promotion of college taekwondo based on fractional differential equation

Abstract The application of fractional partial differential equations (FPDEs) in college taekwondo has attracted more and more attention. Different FPDEs models have been applied to more and more fields, including: Materials, mechanics, and biological systems, and found that FPDEs have more advantages than integer order equation models in studying some materials with memory processes, genetic properties, and heterogeneous materials. The progress of FPDEs in university taekwondo has aroused people's interest in studying numerical algorithms. At present, the management of cardiovascular disease is mainly focused on rescue, drug treatment and revascularization at the onset of the disease, while less attention is paid to the prevention and prognosis management after treatment, leading to the increase of repeated diseases, readmission rate and mortality of patients. With the upsurge of heart rehabilitation dominated by exercise prescriptions, scientific aerobic exercise has gained more and more benefits. After 24 weeks of taekwondo intervention training, the author found that taekwondo exercise had a positive impact on its heart rate variability parameters (mean heart rate, RMSSD, LFnorm, HFnorm, HF), suggesting that taekwondo exercise may improve myocardial blood supply by regulating autonomic nerves. In addition, the Mate analysis of the effect of heart rehabilitation based on taekwondo on patients with coronary heart disease shows that taekwondo has a significant role in improving the aerobic endurance and mental health of patients with coronary heart disease.

PC6. A Nationally Validated Risk Assessment Score for Predicting Unplanned Readmissions in Hand Surgery

PURPOSE: To present a validated model that reliably predicts unplanned readmission after upper extremity/hand surgery. METHODS: A total of 83,409 hand surgery patients were identified using the 2012-2019 ACS-NSQIP databases. Thirty-day unplanned readmission was defined as unexpected readmission for a postoperative occurrence related to the principal hand surgery. Independent predictors of 30-day unplanned readmission were identified using multivariable logistic regression with backward variable selection on the testing sample. Subsequently, the predictors were weighted according to β-coefficients to generate an integer-based New Risk Score (NRS) predictive of readmission. The NRS was then tested on the original sample and validated on NSQIP patients who had undergone hand surgery in 2020 (n = 15,247). The NRS was compared to two other widely used risk scores with receiver operating characteristics (ROC) analysis. RESULTS: The rate of 30-day unplanned readmission in the 2020 cohort was 1.1%. Independent risk factors included female gender, emergent case, diabetes, dyspnea, underweight BMI, ASA Class 5, smoking, hypertension, dialysis dependence, wound infection, chronic steroid use, weight loss, transfusion prior to surgery, and SIRS/sepsis (all P < 0.05). ROC analysis of the validation (2020) cohort rendered an area under the curve of 0.754, which demonstrates the accuracy of this prediction model. The mFI-5 and mCCI rendered AUCs of 0.686 and 0.704, respectively. CONCLUSION: We present a validated risk stratification tool for unplanned readmissions following hand surgery. Future studies should determine if implementation of this NRS optimizes safety and reduces readmission rates in hand surgery patients.

Sepsis prevalence and associated hospital admission and mortality after ureteroscopy in employed adults.

To determine 30-day inpatient mortality, intensive care unit (ICU) admissions, inpatient admissions/readmissions, and yearly trends in sepsis prevalence and inpatient mortality after ureteroscopy (URS) in employed adults. We performed a retrospective analysis of the IBM MarketScan Commercial Database to identify employed adults aged 18-64 years who underwent URS between 2015 and 2019. Patients were categorized as having no sepsis (controls), non-severe sepsis, or severe sepsis within 30 days of URS. The main outcomes included inpatient mortality, ICU admissions, inpatient admissions, readmissions, and annual rates of sepsis and associated inpatient mortality. Among 109 496 patients undergoing URS, 5.6% developed sepsis (4.1% non-severe, 1.5% severe). The 30-day inpatient mortality rates were 0.03%, 0.3% and 2.5% for controls, non-severe sepsis and severe sepsis, respectively (P < 0.001). In a multivariable analysis, diagnosis of sepsis regardless of severity (hazard ratio [HR] 17.2, 95% confidence interval [CI] 10.5-28.1; P < 0.001) or severe sepsis (HR 49.5, 95% CI 28.9-84.7; P < 0.001) increased the risk of 30-day inpatient mortality compared to no sepsis (controls). ICU admissions on the day of procedure (1.5%, 19.8% and 52.4%), inpatient admission rates (18.3%, 74.9% and 76.9%) and readmission rates (7.1%, 12.0% and 15.9%) were higher with severe sepsis and non-severe sepsis vs controls (all P < 0.001). During the study period, the prevalence of sepsis after URS increased from 4.7% to 6.6% (P < 0.001), while the associated mortality rate decreased from 0.7% to 0.2% (P < 0.001). Among working adults aged 18-64 years, sepsis after URS increases the risk of 30-day inpatient mortality, ICU and hospital admission, and hospital readmission. Although the prevalence of sepsis after URS is increasing over time, associated mortality rates are declining. Urologists should be aware of the potentially deadly consequences of sepsis after URS in younger patients.

Going Virtual: Effect of Implementing Video Visits On Readmission Rates in Gi Surgical Oncology Patients

DeLong, Jonathan C MD; Ngongoni, Rejoice MD; Khan, Saud MBBS, MHA; Ohkuma, Rika MD; Timmerhuis, Hester Christine; Dua, Monica M MD, FACS; Visser, Brendan Christopher MD, FACS Author Information

Temporal changes in incidence, treatment strategies and 1-year re-admission rates in patients with atrial fibrillation/flutter under 65 years of age: A Danish nationwide study

AimTo examine temporal changes in incidence rates of atrial fibrillation/flutter (AF), treatment strategies, and AF readmission rates in patients <65 years. MethodsUsing Danish nationwide registries, we identified patients <65 years with a first-time AF diagnosis from 2000 to 2018. The cohort was categorized according to calendar periods; 2000–2002, 2003–2006, 2007–2010, 2011–2014, and 2015–2018. In this retrospective cohort study the incidence rate (IR) of AF per 100,000 person years (PY), catheter ablation, electrical cardioversion, use of pharmacotherapy, and AF readmission, were investigated in the first year following AF diagnosis. ResultsWe identified 60,917 patients; 8150 (13.4%) in 2000–2002, 11,898 (19.5%) in 2003–2006, 13,560 (22.3%) in 2007–2010, 14,167 (23.3%) in 2011–2014, and 13,142 (21.6%) in 2015–2018. Apart from 2015 to 2018, a stepwise increase in the crude IR of AF was observed across calendar periods; 2000–2002: 78.7 (95% CI 77.0;80.4), 2003–2006: 86.3 (84.7;87.8), 2007–2010: 97.9 (96.3;99.6), 2011–2014: 102.3 (100.7;104.0), 2015–2018: 93.6 (92.0;95.2). Over the studied time-periods, we found a stepwise increase in the cumulative incidence of catheter ablation (1.2% to 7.6%) electrical cardioversion (2.0% to 8.7%) and treatment with oral anticoagulant therapy (OAC) (28.5% to 47.8%) within the first year of diagnosis. No temporal differences in incidence of 1-year AF readmission were identified (AF-readmissions: 2000–2002: 32.7%, 2003–2006: 31.1%, 2007–2010: 32.2%, 2011–2014: 32.1% and 2015–2018: 31.7%). ConclusionThe incidence rate of AF in patients <65 years increased from 2000 to 2018, as did the use of catheter ablation, electrical cardioversion and OAC in the first year following AF diagnosis. 1-year AF readmission incidence remained stable around 32% over the study period.

Correlation between traditional Chinese medicine and reduced risk of readmission in rheumatoid arthritis patients with hypoproteinemia:a retrospective cohort study

This study aimed to explore the correlation between traditional Chinese medicine(TCM) and reduced risk of readmission in patients having rheumatoid arthritis with hypoproteinemia(RA-H). A retrospective cohort study was conducted on 2 437 rheumatoid arthritis patients in the information system database of the First Affiliated Hospital of Anhui University of Chinese Medicine from 2014 to 2021, and 476 of them were found to have hypoproteinemia. The patients were divided into TCM users and non-TCM users by propensity score matching. Exposure was defined as the use of oral Chinese patent medicine or herbal decoction for ≥1 month. Cox regression analysis was performed to explore the risk factors of clinical indicators of rheumatoid arthritis. Additionally, the use of TCM during hospitalization was analyzed, and analysis of association rules was conducted to investigate the correlation between TCM, improvement of indicators and readmission of patients. Kaplan-Meier survival curve was plotted to compare the readmission rate of TCM users and non-TCM users. It was found the readmission rate of RA-H patients was significantly higher than that of RA patients. By propensity score matching, 232 RA-H patients were divided into TCM group(116 cases) and non-TCM group(116 cases). Compared with the conditions in the non-TCM group, the readmission rate of the TCM group was lowered(P&lt;0.01), and the readmission rate of middle-aged and elderly patients was higher than that of young patients(P&lt;0.01). Old age was a risk factor for readmission of RA-H patients, while TCM, albumin(ALB) and total protein(TP) were the protective factors. During hospitalization, the TCMs used for RA-H patients were mainly divided into types of activating blood and resolving stasis, relaxing sinew and dredging collaterals, clearing heat and detoxifying, and invigorating spleen and resolving dampness. The improvement of rheumatoid factor(RF), immunoglobulin G(IgG), erythrocyte sedimentation rate(ESR), C-reactive protein(CRP) and ALB was closely related to TCM. On the basis of western medicine treatment, the application of TCM could reduce the readmission rate of RA-H patients, and longer use of TCM indicated lower readmission rate.

30-day Readmission Rates In Patients With Premature Heart Failure With Preserved Ejection Fraction

30-day Readmission Rates In Patients With Premature Heart Failure With Preserved Ejection Fraction