Risk Factors For Length Of Stay Research Articles

Fast-track revision hip arthroplasty: a multicenter cohort study on 1,345 elective aseptic major component revision hip arthroplasties.

Background and purposeData on application of fast-track/enhanced recovery protocols in revision hip arthroplasty (R-THA) surgery is scarce. We report length of stay (LOS), risk of LOS > 5 days, and readmission ≤ 90 days after revision hip arthroplasty in centers with a well-established fast-track protocol in both primary and revision procedures.Patients and methodsThis is an observational cohort study from the Centre for Fast-track Hip and Knee Replacement and the Danish Hip Arthroplasty Register. Consecutive elective aseptic major component revision hip arthroplasties from 6 dedicated fast-track centers from 2010 to 2018 were included.Results1,345 R-THAs were analyzed, including 23% total revisions, 52% acetabular component revisions, and 25% femoral component revisions. Mean age was 70 years (SD 12) and 61% were female. Median LOS was 3 days (interquartile range [IQR] 2–6), decreasing from median 6 (IQR 3–10) days in 2010 to 2 (IQR 1–4) days in 2018. The 90-day readmission rate was 20%, but showed a fluctuating and increasing trend from 13% in 2010 to 28% in 2018. Risk factors for LOS > 5 days and readmission were use of walking aid, preoperative hemoglobin ≤ 13 g/dL, pharmacological treated psychiatric disorder, age ≥ 80 years, age 70–79 years (only LOS > 5 days), cardiac disease (only LOS > 5 days), pulmonary disease (only readmission), BMI ≥ 35 (only LOS > 5 days) and ≥ 1 previous revision (only LOS > 5 days).InterpretationLOS decreased to median 2 days at the end of the study period, but the 90 days readmission risk remained high (> 20%). Several risk factors for postoperative complications were identified, suggesting that at-risk patients should be treated using an extended fast-track/enhanced recovery protocol focusing on preoperative optimization and postoperative monitoring as well as surgical techniques to reduce hip dislocations.

Fast-track revision knee arthroplasty.

BackgroundLimited data exist on fast-track protocols in relation to revision knee arthroplasty. Hence, the aim of this study was to report length of stay (LOS), risk of LOS > 5 days and readmission ≤ 90 days after revision knee arthroplasty in centers with a well-established fast-track protocol in both primary and revision surgery. MethodsAn observational cohort study from the Centre for Fast-track Hip and Knee Replacement and the Danish Knee Arthroplasty Register. We included elective aseptic major component revision knee arthroplasties consecutively from 6 dedicated fast-track centers from 2010 to 2018. Results1439 revision knee arthroplasties were analyzed, including 900 total revisions, 171 large partial revisions (revision of either femoral or tibia component) and 368 revisions of unicompartmental knee arthroplasty (UKA) to total knee arthroplasty (TKA). Mean age was 65 years (SD 10.9) and 66% were females. Mean LOS was 3.7 days (SD 3.9) in the study period, but decreased to 2.4 days (SD 1.3) in 2018. Risk factors for LOS > 5 days was ≥ 1 previous revision, use of walking aid, BMI > 35, ages < 50, 70–79 and ≥ 80 years, whereas revision of UKA to TKA and large partial revision were negatively associated. The 90-day readmission and mortality risk was 9.1% and 0.5%. Cardiac disease and use of walking aid were associated with increased risk of readmission ≤ 90 days. ConclusionElective aseptic major component revision knee arthroplasty using similar fast-track protocols as in primary TKA is safe with short and decreasing LOS.

Sugammadex is associated with shorter hospital length of stay after open lobectomy for lung cancer: a retrospective observational study

BackgroundSugammadex is associated with few postoperative complications. Postoperative pulmonary complications (PPC) are related to prolonged hospitalizations. Present study explored whether the use of sugammadex could reduce PPCs and thereby reduce hospital length of stay (LOS) after lung surgery.MethodsWe reviewed the medical records of patients who underwent elective open lobectomy for lung cancer from January 2010 to December 2015. Patients were divided into the sugammadex group and pyridostigmine group.The primary outcome was hospital LOS and secondary outcomes were postoperative complications and overall survival at 1 year. The cohort was subdivided into patients with and without prolonged LOS to explore the effects of sugammadex on outcomes in each group. Risk factors for LOS were determined via multivariate analyses. After propensity score matching, 127 patients were assigned to each group.ResultsMedian hospital LOS was shorter (10.0 vs. 12.0 days) and the incidence of postoperative atelectasis was lower (18.1 vs. 29.9%) in the sugammadex group. However, no significant difference in overall survival between the groups was seen over 1 year (hazard ratio, 0.967; 95% confidence interval, 0.363 to 2.577). Sugammadex was a predictor related to LOS (exponential coefficient 0.88; 95% CI 0.82–0.95).ConclusionsOur data suggest that sugammadex is a preferable agent for neuromuscular blockade (NMB) reversal than cholinesterase inhibitors in this patient population.Trial registrationThis study registered in the Clinical Research Information Service of the Korea National Institute of Health (approval number: KCT0004735, Date of registration: 21 January 2020, Retrospectively registered).

Faktor risiko yang mempengaruhi length of stay pasien kanker solid dengan febrile neutropenia pasca kemoterapi neoadjuvant/terapeutik di Ruang Isolasi RSUP Sanglah, Bali

Background. Febrile neutropenia is a common complication in patient undergoing chemotherapy. Length Of Stay (LOS) is an important marker for disease severity and use of medical resources in febrile neutropenia. This study was done to find the risk factor affecting length of stay in solid cancer patients with febrile neutropenia post neoadjuvant/therapeutic chemotherapy.Method. This is a case control study without matching. Age ≥ 60 years, (Absolute Neutrofil Count) ANC level &lt; 1,5 μL , comorbid, Hb level &lt;10 gr/dl, and albumin &lt; 3 gr/dl, were related to LOS ( ≤ 5 days and &gt; 5 days). Univariate (chi square) and multivariate (logistic regression) were used to analyse the statistic.Results. Forty six patients met inclusion-exclusion criteria were included in this study. ANC level in all patients were &lt; 1,5 μL (100%). Hb level &lt;10 gr/dl is statistically significant (P&lt;0.05), whereas age ≥ 60 years, and comorbid, albumin level &lt; 3 gr/dl were not is statistically significant (P&gt;0.05).Conclusion. Hb level &lt; 10 gr/dl is the risk factor for LOS &gt; 5 days in solid cancer patients with febrile neutropenia post neoadjuvant/therapeutic chemotherapy.

Abstract 165: Total Intravenous Anesthesia as Compared to Volatile Anesthesia is Associated with Reduced Length of Stay After Transcatheter Aortic Valve Replacement: Results From Two-Year Program at Major Academic Medical Center

Background: Transcatheter aortic valve replacement (TAVR) is an alternative to surgical aortic valve replacement in patients with severe, symptomatic aortic stenosis who are at least intermediate risk for surgery. As TAVR has evolved, more emphasis has been placed on reducing hospital length of stay (LOS) following the procedure. Therefore, we sought to identify whether changes in the general anesthetic technique, specifically using total intravenous anesthesia (TIVA) versus volatile anesthesia (VA), would lead to reductions in hospital LOS. Methods: A retrospective review was conducted of 67 consecutive patients at a single institution who underwent TAVR under general anesthesia (GA) with either TIVA or VA between November 2014 and July 2016. Hospital LOS, as well as patient demographics, intraoperative, and postoperative risk factors for prolonged hospital LOS were analyzed. Descriptive statistics were conducted using Fisher’s exact and Student’s t-test. Risk factors for LOS were assessed using unadjusted linear regression. Results: Data were analyzed from 67 TAVR patients with a mean age of 78 ± 9 years. The patient population was 43% female (29/67), 88% Caucasian (59/67), with a mean ± SD aortic valve gradient of 42 ± 17 mmHg with an ejection fraction of 53 ± 13 %. Of the 67 patients, 35 received TIVA (52%) and 32 received VA (48%). The majority of patients in both the TIVA and VA group underwent TAVR with a transfemoral approach (29/35, 83% vs. 24/32, 75%, p=0.55). Patients receiving TIVA had a shorter hospital LOS (3.7 ± 2.6 days vs. 5.9 ± 3.3 days, p=0.003) and shorter ICU LOS (1.5 ± 0.8 days vs. 2.7 ± 2.0 days, p=0.004) as compared to patients receiving VA. For every hour increase in anesthesia time, hospital LOS was increased by 0.92 days (p=0.02). Patients receiving GA with propofol infusion had a reduction in hospital LOS by 1.9 days (p=0.02) and a reduction in ICU LOS by 1 day (p=0.009) as compared to patients who received VA with desflurane. Conclusions: Reducing hospital LOS following TAVR is a complex and multifactorial problem. Our study suggests that anesthetic technique, the particular mix of drugs used for GA, and the time under GA all play a role in determining the hospital LOS. This finding can influence refinements in the techniques used to care for patients undergoing TAVR and may help us continue to reduce hospital LOS following TAVR.