Risk Factors For Prolonged Length Research Articles

Is there a need for revised guidelines in the treatment of perforated appendicitis in children? A study of risk factors for prolonged hospital stay and postoperative complications

PurposeTo study the need for revised guidelines in the treatment of children with acute perforated appendicitis (APA) by describing the clinical course of children surgically treated for APA in one county in Sweden, with focus on length of hospital stay (LOS) and risk of postoperative complications. The study also aimed to identify variation in practice, comparing a university children's hospital (UCH) to county hospitals (CH). MethodsTwo thousand children, <16 years, who had surgery for acute appendicitis 2014-2018 in four public hospitals (1 UCH and 3 CH), were identified. Patients with perforation of the appendix, n=383(19%) were selected for study and retrospective assessment of patient records. Uni and multivariable logistic regression analyses were done to identify risk factors for prolonged length of stay (PLOS) and complications. ResultsThe median LOS was 5.05 days (0.5-61.9), 6.79 (1.81-61.91) for the UCH (n=186) and 3.65 (0.54-35.65) for CH's (n=197)(p<0.0001). PLOS (=>5 days in hospital) was seen in 147 (79%) at UCH and 53(26.9%) at CH's(p<0.0001). Intra-abdominal abscess within 30 days was identified in 36 (9.4%) and surgical re-intervention was needed in 19 (5%) with no differences between hospitals. The need for readmission within 30 days was higher at CH n=22(11.4%) than at UCH n=4(2.2%), (p=0.0006). Multivariable analyses showed independent predictors of PLOS to be: male gender(OR 2.97 (1.68-5.23)), treatment at UCH(OR 10.24 (6.38-16.44)), CRP >135mg/l(OR per 50 units 1.42 (1.16-1.73)), prehospital delay>2.5 days(OR 1.22 (1.01-1.47)), delayed time to surgery(OR per 10 hours 1.74 (1.26-2.41)) extended surgery time(OR per 2 hours 4.59 (1.43-14.76)) and use of urinary catheter(OR 2.99 (1.42-6.29)). ConclusionGuidelines for treatment of childhood APA, focusing on minimizing antibiotics and facilitating early discharge, would optimize care of the patients but also the economical use of resources. Most children with APA have an uncomplicated course, but factors predicting PLOS have been identified. We found a pronounced variation in practice between the UCH and CH's, without increasing the risk of postoperative complications.

Preoperative risk factors for prolonged length of stay after bullectomy: A single-center retrospective study

ObjectiveProlonged length of stay (LOS) increases the economic burden on patients, therefore, optimizing LOS is a critical clinical challenge for physicians. This study aims to examine the correlation between the postoperative LOS and surgery-related adverse events after bullectomy. We defined prolonged postoperative LOS after bullectomy and analyzed the preoperative risk factors linked to prolonged LOS. MethodsIn this retrospective study, we analyzed patient data from thoracoscopic bullectomy performed at our hospital between January 2018 and December 2023. The receiver operating characteristic (ROC) curve was used to identify the optimal cut-off values defining prolonged LOS after bullectomy. It was then characterized as prolonged LOS. Patients were divided into prolonged and normal LOS groups based on their postoperative duration. Further, univariate and multivariate logistic regression analyses were performed to identify preoperative risk factors associated with prolonged postoperative LOS after bullectomy. ResultsAmong the 152 patients analyzed, binary logistic regression revealed a significant effect of surgery-related adverse events after bullectomy on the LOS (P < 0.001). A postoperative LOS exceeding 3 days was considered prolonged. Among the 152 patients, 38.2 % (58/152) experienced a prolonged LOS out of which 20.4 % (31/152) developed surgery-related adverse events. Multivariate regression analysis revealed that preoperative risk factors associated with prolonged LOS included age ≥60 years (OR = 3.052, 95%CI 1.226–7.586, P = 0.016), current smoking status (OR = 2.754, 95%CI 1.482–6.346, P = 0.025), and ASA grade 3 (OR = 4.783, 95%CI 2.356–9.131, P = 0.003). ConclusionIn summary, the postoperative length of stay beyond 3 days after bullectomy was considered prolonged. The preoperative risk factors associated with prolonged postoperative stays after bullectomy included age (over 60), current smoking, and grade 3 ASA. Therefore, quick identification and intervention in patients with these high-risk factors may promote rapid recovery.

Risk factors for prolonged length of hospital stay following elective hip replacement surgery: a retrospective longitudinal observational study

ObjectivesOur aim was to identify which patients are likely to stay in hospital longer following total hip replacement surgery.DesignLongitudinal, observational study used routinely collected data.SettingData were collected from an NHS...

Extremity fractures, attempted suicide, blood transfusion and thromboembolic events are independent risk factors for a prolonged hospital stay in severely injured elderly

MethodsDue to demographic change, the number of polytraumatized geriatric patients (> 64 years) is expected to further increase in the coming years. In addition to the particularities of the accident and the associated injury patterns, prolonged inpatient stays are regularly observed in this group. The aim of the evaluation is to identify further factors that cause prolonged inpatient stays.A study of the data from the TraumaRegister DGU® from 2016–2020 was performed. Inclusion criteria were an age of over 64 years, intensive care treatment in the GAS-region, and an Injury Severity Score (ISS) of at least 16 points. All patients who were above the 80th percentile for the average length of stay or average intensive care stay of the study population were defined as so-called long-stay patients. This resulted in a prolonged inpatient stay of > 25 days and an intensive care stay of > 13 days. Among other, the influence of the cause of the accident, injury patterns according to body regions, the occurrence of complications, and the influence of numerous clinical parameters were examined.ResultsA total of 23,026 patients with a mean age of 76.6 years and a mean ISS of 24 points were included. Mean ICU length of stay was 11 ± 12.9 days (regular length of stay: 3.9 ± 3.1d vs. prolonged length of stay: 12.8 ± 5.7d) and mean inpatient stay was 22.5 ± 18.9 days (regular length of stay: 20.7 ± 15d vs. 35.7 ± 22.3d). A total of n = 6,447 patients met the criteria for a prolonged length of stay. Among these, patients had one more diagnosis on average (4.6 vs. 5.8 diagnoses) and had a higher ISS (21.8 ± 6 pts. vs. 26.9 ± 9.5 pts.)Independent risk factors for prolonged length of stay were intubation duration greater than 6 days (30-fold increased risk), occurrence of sepsis (4x), attempted suicide (3x), presence of extremity injury (2.3x), occurrence of a thromboembolic event (2.7x), and administration of red blood cell concentrates in the resuscitation room (1.9x).ConclusionsThe present analysis identified numerous independent risk factors for significantly prolonged hospitalization of the geriatric polytraumatized patient, which should be given increased attention during treatment. In particular, the need for a smooth transition to psychiatric follow-up treatment or patient-adapted rehabilitative care for geriatric patients with prolonged immobility after extremity injuries is emphasized by these results.

Systemic Outcomes in Adults Undergoing Emergent Repair of Orbital Blowout Fractures

PurposeTo analyze the association between emergent surgery status and systemic adverse outcomes in patients undergoing open orbital floor blowout fracture repair.MethodsThis retrospective cohort analysis utilized the 2005–2018 National Surgery Quality Improvement Program (NSQIP) database. Current Procedural Terminology (CPT) codes were used to identify cases with open treatment of orbital floor blowout fractures (21385, 21386, 21387, 21390, 21395). Demographics, comorbidities, and complication incidences were compared between patients undergoing emergent surgery and those undergoing non-emergent orbital blowout fracture repair using chi-square analyses. The independent effect of preoperative emergent status on adverse outcomes was analyzed using binary logistic regression.Results1,146 (96.0%) non-emergent and 48 (4.0%) emergent orbital blowout fracture repairs were identified from 2005 to 2018. Chi-square analysis indicated patients undergoing emergent repairs had higher incidences of preoperative wound infection (8.3% vs. 2.3%; p = 0.029) and systemic sepsis (8.3% vs. 0.6%; p = 0.001). The emergent cohort had a higher proportion of patients with Hispanic ethnicity (p = 0.011). Unadjusted chi-square analysis indicated the emergent cohort had a higher incidence of prolonged length of stay (50.1% vs. 10.1%; p < 0.001). After adjusting for confounders, logistic regression analysis indicated emergent status was an independent risk factor for prolonged length of stay (OR 13.05; 95% CI 5.26–32.37; p < 0.001).ConclusionEmergent surgery status is an important factor associated with increased odds of prolonged length of stay in patients undergoing open orbital blowout fracture repair.

Risk factors for prolonged length of stay after first single-level lumbar microdiscectomy

ObjectiveThe objective is to identify risk factors that potentially prolong the hospital stay in patients after undergoing first single-level open lumbar microdiscectomy.MethodsA retrospective single-centre study was conducted. Demographic data, medical records, intraoperative course, and imaging studies were analysed. The outcome measure was defined by the number of days stayed after the operation. A prolonged length of stay (LOS) stay was defined as a minimum of one additional day beyond the median hospital stay in our patient collective. Bivariate analysis and multiple stepwise regression were used to identify independent factors related to the prolonged hospital stay.ResultsTwo hundred consecutive patients who underwent first lumbar microdiscectomy between 2018 and 2022 at our clinic were included in this study. Statistical analysis of factors potentially prolonging postoperative hospital stay was done for a total of 24 factors, seven of them were significantly related to prolonged LOS in bivariate analysis. Sex (p = 0.002, median 5 vs. 4 days for females vs. males) and age (rs = 0.35, p ≤ 0.001, N = 200) were identified among the examined demographic factors. Regarding preoperative physical status, preoperative immobility reached statistical significance (p ≤ 0.001, median 5 vs. 4 days). Diabetes mellitus (p = 0.043, median 5 vs. 4 days), anticoagulation and/or antiplatelet agents (p = 0.045, median 5 vs. 4 days), and postoperative narcotic consumption (p ≤ 0.001, median 5 vs. 4 days) as comorbidities were associated with a prolonged hospital stay. Performance of nucleotomy (p = 0.023, median 5 vs. 4 days) was a significant intraoperative factor. After linear stepwise multivariable regression, only preoperative immobility (p ≤ 0.001) was identified as independent risk factors for prolonged length of postoperative hospital stay.ConclusionOur study identified preoperative immobility as a significant predictor of prolonged hospital stay, highlighting its value in preoperative assessments and as a tool to pinpoint at-risk patients. Prospective clinical trials with detailed assessment of mobility, including grading, need to be done to verify our results.

Epidemiology of distal radius fractures: Elucidating mechanisms, comorbidities, and fracture classification using the national trauma data bank

BackgroundAn update on the epidemiology of distal radius fractures in the United States is necessary, particularly as the elderly population grows. Additionally, age and frailty have been associated with complications following surgical fixation of DRFs. Herein, we utilize the National Trauma Data Bank, a robust nationwide resource, to investigate the relationship between demographics, comorbidities, injury and fracture characteristics, and admission details. MethodsPatients with isolated distal radius fractures were identified from the National Trauma Data Bank (2016–2019) according to ICD-10 codes. Univariate and multivariate regressions were conducted to determine independent risk factors for bilateral fractures, displaced fractures, open fractures, as well as length of hospital stay and adverse discharge disposition for patients undergoing inpatient surgical fixation. ResultsThe incidence of DRFs was 3.6/1,000 trauma-related emergency department visits and 10.8/1,000 upper extremity traumas. Trauma mechanism was significantly associated with displaced and open fractures. Age (OR 1.01, 95% CI 1.01–1.01), BMI (OR 1.02, 95% CI 1.01–1.02), smoking (OR 1.34, 95% CI 1.15–1.57), and alcohol level (trace: OR 2.18, 95% CI 1.41–3.29; intoxicated: OR 2.20, 95% CI 1.63–2.95) were significantly associated with open fractures. Machinery (β=2.04, 95% CI 1.00–3.08) and MVT (β=0.39, 95% CI 0.08–0.69) mechanisms were independent risk factors for longer length of stay. mFI-5 was an independent risk factor, in a stepwise fashion, for both length of stay and adverse discharge disposition. ConclusionsHigh-energy mechanisms and risk factors for poor skin quality were significantly associated with open fractures. mFI-5 was an independent risk factor for longer length of stay and non-routine discharges in patients of all ages, despite controlling for other comorbidities, unrelated complications, and mechanism of injury. Trauma mechanism was an independent risk factor for prolonged length of stay only, particularly in patients younger than 65 years of age.

Predictive influence of artificial intelligence‐based body composition analysis in trauma patients with pelvic injuries

AbstractBackgroundHigh‐energy trauma patients represent the ultimate challenge to trauma care and are at risk of injury‐related mortality and morbidity—a common cause of loss of productivity. The aim of this study was to implement computed tomography (CT)‐derived, artificial intelligence (AI)‐based body composition analysis (BCA) to identify predictors of morbidity.MethodsRetrospectively, we enrolled 104 patients (38 females and 66 males) who underwent CT imaging for assessment of injuries caused by high‐energy trauma (motor vehicle accidents, falls from significant height, or blast injury). We sought to identify risk factors for prolonged length of stay in hospital and intensive care unit (ICU) and fractures requiring pelvic surgery. Cox and logistic regression analysis were performed using BCA parameters as covariates besides conventional risk factors. Additionally, the effects of pre‐existing conditions, obesity, and sarcopenia were analysed.ResultsIncreased subcutaneous adipose tissue (SAT), determined by BCA, at hospital admittance is a predictor of prolonged hospital stay (P = 0.02) independent of treatment regime and occurrence of related complications, whereas muscle mass does not influence the length of stay. Individuals with sarcopenia and a decreased psoas muscle index (PMI) sustaining high‐energy trauma are at risk of pelvic injuries requiring surgical treatment.ConclusionBCA parameters are easily available from routine CT and significantly predict outcomes in trauma patients with pelvic injuries. Patients with reduced muscle mass are at risk for injuries requiring pelvic surgery, and increased SAT is a risk factor for longer hospital stays. These findings underline the potential of BCA, which may be valuable in identifying trauma patients who require specific support to optimize their physiological reserves and clinical outcome.

Risk Factors for Prolonged Hospital Stay After Femoral Neck Fracture.

The purpose of this study was to investigate the association between pre-operative anemia and prolonged hospital stay among geriatric patients with operative femoral neck fractures. This retrospective cohort study was performed at a level I trauma center and included geriatric patients with femoral neck fractures (OTA/AO 31) and operative treatment with Current Procedural Terminology code 27236. Exclusion criteria were admission to the intensive care unit, evacuation of subdural hematoma, and conditions requiring exploratory laparotomy. A total of 207 individuals, with data collected between January 2015 and August 2019 and age 65 years and older, were included in the analysis. Linear regression was used to evaluate the association between anemia and length of stay adjusting for potential confounders. Anemia was defined using preoperative hematocrit. The primary outcome was prolonged length of stay, defined as 5 or more days. The group was 65% women. The mean age was 80.2 years (range, 64-98 years). The majority (61%) of patients had anemia. American Society of Anesthesiologists classification was associated with preoperative anemia (P=.02). Patients with anemia had a 16% higher risk of prolonged length of stay compared with patients without anemia (81% vs 65%, P=.009). In the linear regression model, preoperative hematocrit was associated with length of stay (P=.032) when adjusted for sex, age, preoperative tranexamic acid, preoperative hemoglobin, postoperative hemoglobin, and postoperative hematocrit. Length of stay was approximately 1 week in this study, with anemia being a statistically significant risk factor for prolonged length of stay. Health care providers and administrators can consider anemia on admission when predicting length of stay. [Orthopedics. 2023;46(4):211-217.].

Identifying Risk Factors for Prolonged Length of Stay in Hospital and Developing Prediction Models for Patients with Cardiac Arrest Receiving Targeted Temperature Management.

Prolonged length of stay (LOS) following targeted temperature management (TTM) administered after cardiac arrest may affect healthcare plans and expenditures. This study identified risk factors for prolonged LOS in patients with cardiac arrest receiving TTM and explored the association between LOS and neurological outcomes after TTM. The retrospective cohort consisted of 571 non-traumatic cardiac arrest patients aged 18 years or older, treated with cardiopulmonary resuscitation (CPR), had a Glasgow Coma Scale score 8, or were unable to comply with commands after the restoration of spontaneous circulation (ROSC), and received TTM less than 12 hours after ROSC. Prolonged LOS was defined as LOS beyond the 75th quartile of the entire cohort. We analyzed and compared relevant variables and neurological outcomes between the patients with and without prolonged LOS and established prediction models for estimating the risk of prolonged LOS. The patients with in-hospital cardiac arrest had a longer LOS than those with out-of-hospital cardiac arrest (p = 0.0001). Duration of CPR (p = 0.02), underlying heart failure (p = 0.001), chronic obstructive pulmonary disease (p = 0.008), chronic kidney disease (p = 0.026), and post-TTM seizures (p = 0.003) were risk factors for prolonged LOS. LOS was associated with survival to hospital discharge, and patients with the lowest and highest Cerebral Performance Category scores at discharge had a shorter LOS. A logistic regression model based on parameters at discharge achieved an area under the curve of 0.840 to 0.896 for prolonged LOS prediction, indicating the favorable performance of this model in predicting LOS in patients receiving TTM. Our study identified clinically relevant risk factors for prolonged LOS following TTM and developed a prediction model that exhibited adequate predictive performance. The findings of this study broaden our understanding regarding factors associated with hospital stay and can be beneficial while making clinical decisions for patients with cardiac arrest who receive TTM.

Healthcare associated infections in gynecologic oncology: clinical and economic impact

ObjectiveThe purpose of this study was to assess the rate and type of infections in gynecological cancer patients. We also performed an economic analysis to provide an overview of costs...

Factors influencing length of hospital stay among veterans admitted to an inpatient psychiatric unit

It is well established that Veterans are at increased risk for mental health problems and associated hospitalization. While hospitalization is appropriate for acute stabilization, prolonged stays can contribute to reduced quality of life, increased healthcare expenditures, and trauma exposure with associated trauma-related symptoms. To reduce inpatient psychiatric length of stay and to improve patient outcomes, it is imperative that risk factors for prolonged length of stay are elucidated. The purpose of this retrospective chart review was to examine demographic and clinical characteristics and their association with inpatient psychiatric length of stay in a sample of Veterans. Demographic information collected included age and race. Clinical characteristics collected included primary admitting psychiatric diagnosis, number of psychiatric emergencies during hospitalization, utilization of restraint or seclusion, observation status, 30-day readmission status, adherence to psychiatric follow-up appointments post-discharge, and presence of suicidality. A total of 820 Veterans were included in the analysis. Age, primary psychiatric diagnosis, occurrence of a psychiatric emergency, and observation status were significant predictors of length of stay (F = 24.39, p < .001). There were significant differences in the average length of stay between Veterans with substance use disorders and those with psychotic disorders (B = 0.576, p < .001). Likewise, Veterans with neurocognitive disorders also had longer lengths of stay than those without neurocognitive disorders, respectively (B = 0.014, p < .001). In summary, quality of mental health care can be improved by reducing length of stay, but additional understanding related to risk factors is first needed.

The Potential Risk Factors for Prolonged Length of Stay Despite an Enhanced Recovery After Surgery Protocol for Elderly Patients Undergoing Short-Level Lumbar Fusion Surgery.

To identify the risk factors associated with prolonged length of stay (LOS) despite an enhanced recovery after surgery (ERAS) protocol in short-level lumbar fusion surgery. We gathered data for all patients undergoing short-level lumbar fusion surgery from January to November 2021. Given the discharge criteria, a threshold was set according to mean LOS, and two groups were spontaneously formed: LOS shorter than the threshold for discharge (control group, n = 114) and LOS longer or equal to the threshold for discharge (delayed group, n = 72). Preoperative metrics were compared to identify risk factors associated with prolonged LOS. A total consecutive 186 patients with complete medical records were enrolled (77 males and 109 females; mean age 71.08 ± 5.70 years). After dichotomization according to the threshold for discharge, there were 114 patients in control group and 72 in delayed group. Statistical analysis demonstrated that age ≥75 years (P = .002), female sex (P < .001), American Society of Anesthesiologists grade ≥ 3 (P = .035), operation time (P < .001), anesthesia time (P < .001), ambulation time >1day (P = .027), removal of urinary catheter time >1day (P = .019), fusion levels (P < .001), Clavien-Dindo grade > 1 (P <.001) and allogeneic transfusion (P = .009) were significantly related to prolonged LOS. Binary logistic regression revealed that age (odds ratio (OR) 5.149; 95% confidence interval (CI) 2.045-12.966, P = .001), sex (OR 5.185, 95% CI 2.183-12.317, P < .001) and Clavien-Dindo grade > 1(OR 15.936, 95% CI 5.220-48.652, P < .001) were independent risk factors of prolonged LOS. In this retrospective study, we analyzed the potential risk factors associated with delayed LOS despite implementing ERAS, further, binary logistic regression exhibited that age ≥75years old, female sex and Clavien-Dindo grade >1 were independently correlated with prolonged LOS.

Predicting perioperative outcomes of robot-assisted radical cystectomy: Data from the Asian Robot-Assisted Radical Cystectomy Consortium.

To report the perioperative outcomes of robot-assisted radical cystectomy and elucidate their risk factors. A review of the Asian Robot-Assisted Radical Cystectomy Consortium database from 2007 to 2020 was performed. The perioperative outcomes studied included complication rates, time to solid food intake, estimated blood loss, length of hospital stay, and 30-day readmission rates. Of 568 patients, the overall complication rate was 49.2%, comprising major complications in 15.6%. Preoperative hydronephrosis was associated with an increased risk of major complications (odds ratio 3.27, 95% confidence interval 1.48-7.26, P = 0.004) while neoadjuvant chemotherapy was protective (odds ratio 0.46, 95% confidence interval 0.25-0.84, P = 0.012). The median time to solid food intake was 4 days (interquartile range 3-7) and smoking was a risk factor (odds ratio 4.28, 95% confidence interval 2.36-7.79, P < 0.001) for prolonged time to solid food intake. Median length of hospital stay was 13 days (interquartile range 9-19), and diabetes mellitus (odds ratio 1.66, 95% confidence interval 1.08-2.56, P = 0.021), neoadjuvant chemotherapy (odds ratio 2.21, 95% confidence interval 1.46-3.33, P < 0.001), and orthotopic bladder substitute creation (odds ratio 2.82, 95% confidence interval 1.90-4.18, P < 0.001) were independent risk factors for prolonged length of hospital stay. The 30-day readmission rate was 23.4% and higher in those with bilateral hydronephrosis (odds ratio 4.58, 95% confidence interval 1.97-10.65, P < 0.001) and orthotopic bladder substitute creation (odds ratio 1.87, 95% confidence interval 1.16-3.02, P = 0.010). There are preoperative conditions which are significant risk factors for adverse perioperative outcomes in robot-assisted radical cystectomy. Most are potentially modifiable and can direct strategies to reduce surgical morbidity related to this major oncological procedure.

Black and Hispanic Patients Do Not Stay Longer After Primary Total Knee Arthroplasty: Results From an Urban Center Serving a Predominantly Minority Cohort.

Previous reports identified minority race/ethnicity to be an independent risk factor for prolonged length of stay (LOS); however, these cohorts consisted of predominantly White patients. This study sought to evaluate minority status as an independent risk factor for prolonged LOS after primary total knee arthroplasty (TKA) in a predominantly Hispanic and Black cohort. This was a retrospective study using an institutional database of patients who underwent primary TKA between the years 2016 and 2019. Demographic and socioeconomic data, smoking, body mass index (BMI), medical comorbidities, discharge disposition, and 30-day readmission rates were collected. Patients were first categorized into racial/ethnic groups (Hispanic, Black, or White). An univariate analysis was performed comparing patient characteristics between racial/ethnic groups using the Wilcoxon rank sum, chi-squared, and Fisher exact tests. We then categorized patients into two groups-normal LOS (discharged on postoperative day 1 to 2) and prolonged LOS (discharged after postoperative day 2). An univariate analysis was again performed comparing patient characteristics between LOS groups using Wilcoxon rank sum, chi-squared, and Fisher exact tests. After identifying risk factors markedly associated with LOS, a multivariate logistic regression analysis was performed to identify independent risk factors for prolonged LOS. A total of 3,093 patients were included-47.9% Hispanic and 38.3% Black. Mean LOS was 2.9 ± 1.6 days. An univariate analysis found race/ethnicity, age, low socioeconomic status (SES), discharge disposition, insurance type, weekday of surgery, BMI >40, smoking, increased American Society of Anesthesiologists (ASA)/Charlson Comorbidity Index (CCI) and several medical comorbidities to be associated with prolonged LOS (P < 0.05). A multivariate logistic regression analysis found Black and Hispanic patients were less likely to have prolonged LOS after adjusting for associated risk factors. White race/ethnicity, nonhome discharge, low SES, weekday of surgery, smoking, BMI >40, and increased ASA and CCI were identified as independent risk factors for prolonged LOS (P < 0.05). The overall 30-day readmission rate was 3.6%, with no notable difference between racial/ethnic and LOS groups (P = 0.98 and P = 0.78). In contrast to previous reports, our study found that after adjusting for associated risk factors, minority patients do not have prolonged LOS after primary TKA in an urban, socioeconomically disadvantaged, predominantly minority patient cohort. White race/ethnicity, nonhome discharge, low SES, weekday of surgery, smoking, BMI >40, increased CCI, and ASA were all found to be independent risk factors for prolonged LOS. These findings highlight the need to further investigate the role of race/ethnicity on LOS after primary TKA using large-scale, randomized controlled trials with equally represented patient cohorts.

NCOG-05. RISK FACTORS FOR PROLONGED LENGTH OF STAY AND POSTOPERATIVE COMPLICATIONS IN PATIENTS WITH INTRAMEDULLARY SPINAL CORD TUMORS

Abstract INTRODUCTION Primary spine tumors are rare neoplasms that affect about 0.62 per 100,000 individuals in the US. Intramedullary spinal cord tumors (IMSCTs) are the rarest of all primary tumors involving the spine and can cause pain, imbalance, urinary dysfunction and neurological deficits. These types of tumors oftentimes necessitate surgical treatment, yet there is a lack of data on length of stay and complication rates following treatment. Given that treatment candidacy, quality of life, and outcomes are tied so closely to these metrics, it is important to illustrate the risk factors for prolonged length of stay and their association with post-op complications with the ultimate goal of improving patient selection and preoperative optimization. METHODS The National Surgical Quality Improvement Program (NSQIP) database was queried for all patients undergoing surgery for treatment of intramedullary spinal cord tumors between 2005 and 2017. Univariate and multivariate analysis were performed to assess patient risk factor influencing prolonged length of stay and post-op complications. RESULTS A total of 638 patients were included in the analysis. Pre-operative American Society of Anesthesiology (ASA) physical status classification of 3 and above ( OR 1.89; p=0.0005), dependent functional status ( OR 2.76; p=0.0035) and transfer from facilities other than home ( OR 8.12; p&amp;lt; 0.0001) were independent predictors of prolonged length of stay ( &amp;gt;5 days). The most commonly reported complications were pneumonia (5.7%), urinary tract infection (9.4%), septic shock (3.8%), superficial incisional infection (5.7%), organ or space infection (5.7%), pulmonary embolism (11.3%), DVT requiring therapy (15.1%) and wound dehiscence (5.7%). CONCLUSION Our study demonstrated the significant influence of clinical variables on prolonged hospitalization of IMSCT patients. This should be factored into clinical and surgical decision making and when counseling patients of their expected outcomes.

Risk factors for prolonged length of stay in patients undergoing surgery for intramedullary spinal cord tumors

Primary spine tumors are rare neoplasms that affect about 0.62 per 100,000 individuals in the US. Intramedullary spinal cord tumors (IMSCTs) are the rarest of all primary tumors involving the spine and can cause pain, imbalance, urinary dysfunction and neurological deficits. These types of tumors oftentimes necessitate surgical treatment, yet there is a lack of data on hospital length of stay and complication rates following treatment. Given that treatment candidacy, quality of life, and outcomes are tied so closely to potential for prolonged length of stay and postoperative complications, it is important to better understand the factors that increase the risk of these outcomes in patients with IMSCTs. MethodsThe National Surgical Quality Improvement Program (NSQIP) database was queried for all patients undergoing surgery for treatment of intramedullary spinal cord tumors between 2005 and 2017. Univariate and multivariate analysis were performed to assess patient risk factors influencing prolonged length of stay and post-op complications. ResultsA total of 638 patients were included in the analysis. Pre-operative American Society of Anesthesiology (ASA) physical status classification of 3 and above (OR 1.89; p = 0.0005), dependent functional status (OR 2.76; p = 0.0035) and transfer from facilities other than home (OR 8.12; p <0.0001) were independent predictors of prolonged length of stay (>5 days). The most commonly reported complications were pneumonia (5.7%), urinary tract infection (9.4%), septic shock (3.8%), superficial incisional infection (5.7%), organ or space infection (5.7%), pulmonary embolism (11.3%), DVT requiring therapy (15.1%) and wound dehiscence (5.7%). ConclusionOur study demonstrated the significant influence of clinical variables on prolonged hospitalization of IMSCT patients. This should be factored into clinical and surgical decision making and when counseling patients of their expected outcomes.

Concurrent diagnosis of anxiety increases postoperative length of stay among patients receiving esophagectomy for esophageal cancer

Psychiatric comorbidities disproportionately affect patients with cancer. While identified risk factors for prolonged length of stay (LOS) after esophagectomy are primarily medical comorbidities, the impact of psychiatric comorbidities on perioperative outcomes is unclear. We hypothesized that psychiatric comorbidities would prolong LOS in patients with esophageal cancer. The 2016 National Inpatient Sample (NIS) was used to identify patients with esophageal cancer receiving esophagectomy. Concurrent psychiatric illness was categorized using Clinical Classifications Software Refined for ICD-10, creating 34 psychiatric diagnosis groups (PDGs). Only PDGs with >1% prevalence in the cohort were included in the analysis. The outcome of interest was hospital LOS. Bivariable testing was performed to determine the association of PDGs and demographic factors on LOS using rank sum test. Multivariable regression analysis was performed using backward selection from bivariable testing (α≤0.05). We identified 1,730 patients who underwent esophagectomy for esophageal cancer in the 2016 NIS. The median LOS was 8 days (IQR 5-12). In bivariable testing, a concurrent diagnosis of anxiety was the only PDG associated with LOS (9 days (IQR 6-14) with anxiety diagnosis vs 8 days (IQR 5-12) with no anxiety diagnosis, p=0.022). Multivariable modeling showed an independent association between anxiety diagnosis and increased LOS (OR 4.82 (1.25-25.23), p=0.022). Anxiety was not associated with increased hospital cost or in-hospital mortality. This analysis demonstrates an independent effect of anxiety prolonging postoperative LOS after esophagectomy in the United States. These findings may influence perioperative care, patient expectations, and resource allocation. This article is protected by copyright. All rights reserved.

Evaluation of Risk Factors for Prolonged Stay in Post Anaesthesia Care Unit (PACU) in a Tertiary Care Hospital of Saudia Arabia

Background Delayed discharges and transfers from PACU result in congestion and bottleneck at various stages along perioperative care. We did this retrospective cross-sectional study to evaluate the incidence and risk factors for prolonged length of stay (LOS) in PACU. This study was conducted at Security Forces Hospital, Riyadh, Kingdom of Saudi Arabia. Materials and methods We included patients who stayed postoperatively in PACU for more than 2 hours. We collected the data of patients having surgical procedures in main operation room from April 2019 to February 2020. We collected preoperative, operative and postoperative variables of all included patients. The reasons for prolonged LOS in PACU were recorded as documented in patient notes. Results There was a total of 206 prolonged stays in PACU of our hospital. Perioperative cardiovascular and respiratory adverse events accounted for most of cases of prolonged PACU stays followed by surgical reasons like bleeding and extended surgery. Conclusion The main reasons for prolonged stay in PACU were cardiovascular and respiratory adverse events in perioperative period.

Postoperative delirium after cardiac surgery of elderly patients as an independent risk factor for prolonged length of stay in intensive care unit and in hospital

BackgroundPostoperative delirium (POD) is a relevant and underdiagnosed complication after cardiac surgery that is associated with increased intensive care unit (ICU) and hospital length of stay (LOS). The aim of this subgroup study was to compare the frequency of tested POD versus the coded International Statistical Classification of Diseases and Related Health Problems (ICD) diagnosis of POD and to evaluate the influence of POD on LOS in ICU and hospital.Methods254 elective cardiac surgery patients (mean age, 70.5 ± 6.4 years) at the University Hospital Bonn between September 2018 and October 2019 were evaluated. The endpoint tested POD was considered positive, if one of the tests Confusion Assessment Method for ICU (CAM-ICU) or Confusion Assessment Method (CAM), 4 'A's Test (4AT) or Delirium Observation Scale (DOS) was positive on one day.ResultsPOD occurred in 127 patients (50.0%). LOS in ICU and hospital were significantly different based on presence (ICU 165.0 ± 362.7 h; Hospital 26.5 ± 26.1 days) or absence (ICU 64.5 ± 79.4 h; Hospital 14.6 ± 6.7 days) of POD (p < 0.001). The multiple linear regression showed POD as an independent predictor for a prolonged LOS in ICU (48%; 95%CI 31–67%) and in hospital (64%; 95%CI 27–110%) (p < 0.001). The frequency of POD in the study participants that was coded with the ICD F05.0 and F05.8 by hospital staff was considerably lower than tests revealed by the study personnel.ConclusionApproximately 50% of elderly patients who underwent cardiac surgery developed POD, which is associated with an increased ICU and hospital LOS. Furthermore, POD is highly underdiagnosed in clinical routine.