Risk Factors For Inpatient Admission Research Articles

Risk factors for inpatient facility admission among home health care patients with diabetes

BackgroundHome health care (HHC) patients with diabetes are at high risk for inpatient admissions. PurposeTo identify variables associated with inpatient admissions among adults age ≥50 with diabetes receiving HHC in the community and in assisted living (AL). MethodsRetrospective HHC data (collected October 2021 to March 2022 in the Southern United States) from the Outcome and Assessment Information Set D were analyzed with logistic regression (n = 5,308 patients). DiscussionThe inpatient admission rate was 29.5%. For community-dwelling patients, multiple hospitalizations, depression, limited cognitive function, decreased activities of daily living (ADL) performance, and unhealed pressure ulcer or injury ≥stage 2 were significantly associated with inpatient admission. For those in AL, multiple prior hospitalizations and decreased ability to perform ADLs were associated with inpatient admission. ConclusionUnderstanding risk factors for inpatient admissions among patients with diabetes can support the identification of at-risk patients and inform interventions.

Making lemonade with lemons: a multicenter effort to improve outpatient sleeve gastrectomy amid the COVID-19 pandemic.

The COVID-19 pandemic impacted healthcare delivery worldwide. Resource limitations prompted a multicenter quality initiative to enhance outpatient sleeve gastrectomy workflow and reduce the inpatient hospital burden. This study aimed to determine the efficacy of this initiative, as well as the safety of outpatient sleeve gastrectomy and potential risk factors for inpatient admission. A retrospective analysis of sleeve gastrectomy patients was conducted from February 2020 to August2021. Inclusion criteria were adult patients discharged on postoperative day 0, 1, or 2. Exclusion criteria were body mass index ≥60 kg/m2 and age ≥65 years. Patients were divided into outpatient and inpatient cohorts. Demographic, operative, and postoperative variables were compared, as well as monthly trends in outpatient versus inpatient admission. Potential risk factors for inpatient admission were assessed, as well as early Clavien-Dindo complications. Analysis included 638 sleeve gastrectomy surgeries (427 outpatient, 211 inpatient). Significant differences between cohorts were age, co-morbidities, surgery date, facility, operative duration, and 30-day emergency department (ED) readmission. Monthly frequency of outpatient sleeve gastrectomy rose as high as 71% regionally. An increased number of 30-day ED readmissions was found for the inpatient cohort (P = .022). Potential risk factors for inpatient admission included age, diabetes, hypertension, obstructive sleep apnea, pre-COVID-19 surgery date, and operative duration. Outpatient sleeve gastrectomy is safe and efficacious. Administrative support for extended postanesthesia care unit recovery was critical to successful protocol implementation for outpatient sleeve gastrectomy within this large multicenter healthcare system, demonstrating potential applicability nationwide.

Risk factors for in-patient admission among adults with intellectual disability and autism: investigation of electronic clinical records.

Adults with intellectual disability or autism are at risk of psychiatric admission which carries personal, social and economic costs. We identified 654 adults with intellectual disability or autism in the electronic clinical records of one mental health trust. We investigated the demographic and clinical factors associated with admission and readmission after discharge. Young male patients with intellectual disability, schizophrenia and previous admissions are most at risk of the former, whereas affective and personality disorders predict the latter. Both community intellectual disability services and mental health crisis care must focus on providing effective support for those patients.

243. Predictors of inpatient admission in the setting of anterior lumbar interbody fusion

BACKGROUND CONTEXT While the anterior lumbar interbody fusion (ALIF) procedure may be amenable to ambulatory surgery, it has been hypothesized that limitations such as the risk of postoperative ileus and vascular complications has hindered transition to the outpatient setting. Identification of independent risk factors predisposing patients to inpatient stays of greater than 24 hours after ALIF may facilitate better postsurgical outcomes, target modifiable risk factors, and assist developing screening tools to transition appropriate patients to the ambulatory surgery center (ASC) setting. PURPOSE The purpose of this study is to identify the most relevant risk factors that predispose patients to ≥ 24-hour admission following ALIF. STUDY DESIGN/SETTING Retrospective PATIENT SAMPLE A total of 135 patients who underwent single or multilevel ALIF. OUTCOME MEASURES Postoperative complications, postoperative fever, blood transfusion, cardiovascular complications, longer inpatient stay METHODS A prospectively maintained surgical registry was reviewed for patients undergoing single or multi-level ALIF between May 2006 and September 2019. Demographics, preoperative diagnosis, perioperative variables, and postoperative complications were evaluated according to their elevation of relative risk (RR) of an inpatient stay ≥ 24 hours. A Poisson regression model evaluated predictors of inpatient stays ≥ 24 hours. A stepwise backward regression model identified risk factors for inpatient admission of greater than or equal to 24 hours. RESULTS A total of 135 patients underwent single or multilevel ALIF. 53% of the cohort was female and 54.8% was ≤50 years of age. Nine (6.7%) patients were discharged in less than 24 hours and 126 remained admitted for ≥24 hours. The average inpatient stay was two days. The most common postoperative complication was a temperature ≥100.4°F (n=5, 3.8%). Other complications included blood transfusions (n=4, 3.0%) and cardiovascular complications (n=3, 2.2%). Bivariate analysis revealed that having a multilevel procedure on L4L5 and either L3L4 or L5S1 (RR=1.07 or 1.09, p=0.003) had the largest RR elevation for an inpatient stay of ≥ 24 hours. Stepwise multivariate analysis of risk factors revealed foraminal stenosis (RR=0.84, P=0.045), degenerative disc disease (RR=1.25, P=0.028), estimated blood loss >50 mL (RR=1.25, P=0.011), and BMI ≥30 kg/m2 (RR=1.16, p=0.030) to be significant predictors for inpatient stays of ≥24 hours. CONCLUSIONS Our study provides an incidence of demographics, perioperative characteristics, and postoperative complications as they pertain to patients undergoing ALIF. This preliminary investigation identified the most relevant risk factors to be considered before appropriately transitioning ALIF procedures to the ASC. Further studies of preoperative characteristics are needed to elucidate ideal ASC ALIF patients. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Predictors of inpatient admission in the setting of anterior lumbar interbody fusion: a Minimally Invasive Spine Study Group (MISSG) investigation.

While the anterior lumbar interbody fusion (ALIF) procedure may be amenable to ambulatory surgery, it has been hypothesized that limitations such as the risk of postoperative ileus and vascular complications have hindered transition of this procedure to the outpatient setting. Identification of independent risk factors predisposing patients to inpatient stays of ≥ 24 hours after ALIF may facilitate better postsurgical outcomes, target modifiable risk factors, and assist in the development of screening tools to transition appropriate patients to the ambulatory surgery center (ASC) setting for this procedure. The purpose of this study was to identify the most relevant risk factors that predispose patients to ≥ 24-hour admission following ALIF. A prospectively maintained surgical registry was reviewed for patients undergoing single ALIF between May 2006 and December 2019. Demographics, preoperative diagnosis, perioperative variables, and postoperative complications were evaluated according to their relative risk (RR) elevation for an inpatient stay of ≥ 24 hours. A Poisson regression model was used to evaluate predictors of inpatient stays of ≥ 24 hours. Risk factors for inpatient admission of ≥ 24 hours were identified with a stepwise backward regression model. A total of 111 patients underwent single-level ALIF (50.9% female and 52.6% male, ≤ 50 years old). Eleven (9.5%) patients were discharged in < 24 hours and 116 remained admitted for ≥ 24 hours. The average inpatient stay was > 2 days (53.7 hours). The most common postoperative complications were fever (body temperature ≥ 100.4°F; n = 4, 3.5%) and blood transfusions (n = 4, 3.5%). Bivariate analysis revealed a preoperative diagnosis of retrolisthesis or lateral listhesis to elevate the RR for an inpatient stay of ≥ 24 hours (RR 1.11, p = 0.001, both diagnoses). Stepwise multivariate analysis demonstrated significant predictors for inpatient stays of ≥ 24 hours to be an operation on L4-5, coexisting degenerative disc disease (DDD) with foraminal stenosis, and herniated nucleus pulposus (RR 1.11, 95% CI 1.03-1.20, p = 0.009, all covariates). This study provides data regarding the incidence of demographic and perioperative characteristics and postoperative complications as they pertain to patients undergoing single-level ALIF. This preliminary investigation identified the most relevant risk factors to be considered before appropriately transitioning ALIF procedures to the ASC. Further studies of preoperative characteristics are needed to elucidate ideal ASC ALIF patients.

66: PREDICTORS of inpatient admission after robot-assisted and laparoscopic myomectomy

To identify risk factors for inpatient admission after laparoscopic and robot-assisted myomectomy to improve preoperative counseling and postoperative care. Retrospective cohort study including patients undergoing minimally invasive myomectomy from January 2014 to December 2016 at an urban university hospital center by fellowship trained minimally invasive gynecologic surgeons (N = 249). All pre-operative and operative characteristics were collected. Similarly, all intraoperative and postoperative complications were gathered for analysis. T-test was used to compare characteristics of cases with overnight stay versus cases with same day discharge. Logistic regression analysis was performed to ascertain further clinical predictors of overnight stay. Two hundred forty-nine patients underwent minimally invasive myomectomies. One hundred twenty (48%) were admitted for at least one overnight stay while 129 (52%) were discharged the same day. Overnight stay compared to same day discharge was associated significantly with older age (38 vs. 35 years, P < 0.001), lower pre-op hematocrit (36% vs. 38%, P = 0.007), and prior surgical procedure including prior cesarean section (12% vs. 2%, P = 0.005) or myomectomy (12% vs. 5%, P = 0.049), single site procedures (30% vs. 10.1%, P < 0.001), prolonged operative time (185 vs. 139 minutes, P < 0.001), and intraoperative or post-operative complication including blood loss >1,000 mL (7.5% vs. 0%, P = 0.001). Logistic regression analysis found that 5% decrease in Hematocrit, single site operation, 30 minute increase in operative time are significant predictors of any inpatient admission after myomectomy. Perioperative factors such as preoperative hematocrit, and modality of minimally invasive surgery as well as intraoperative factors such as prolonged operative time are predictive of overnight hospital stay. That information could be used for better patient optimization preoperatively and improved counseling.

Risk Factors for Inpatient Hospital Admission in Pediatric Burn Patients.

PurposeOur objective was to determine the risk factors for inpatient admission of pediatric burn patients.Materials & methodsThis cross-sectional study uses data from the Healthcare Cost and Utilization Project Kids' Inpatient Database (HCUP KID) for the years of 2003, 2006, 2009, and 2012 to estimate the risk factors for inpatient admission for pediatric patients who sustained a burn injury. Patients who sustained a burn between the ages of 1 and 18 years were included.ResultsA total of 43,453 patients met inclusion criteria. Of those, 42.3% were Caucasian, 20.1% were African American, and 19.3% were Hispanic. Males comprised 63.5% of the studied population. The month of July was associated with a 31.8% increased chance (p=.011) of being admitted to hospital for a pediatric burn. It was found that patients being admitted had a 32.2% increased chance (p=.002) of a fluid and electrolyte abnormality and a 61.0% increased chance (p=.027) of drug abuse. ConclusionsPediatric burn patients are more likely to be admitted to the hospital having a fluid and electrolyte abnormality, having a drug abuse status, and/or during the month of July.