Shorter Length Of Stay Research Articles

Regional Anesthesia With Paravertebral Blockade Is Associated With Improved Outcomes in Patients Undergoing Minithoracotomy Cardiac Surgery.

Severe postoperative pain has been shown to affect many patients following minimally invasive cardiac surgeries (MICS). Multimodal pain management with regional anesthesia, particularly by delivery of local anesthetics using a paravertebral catheter (PVC), has been shown to reduce pain in operations involving thoracotomy incisions. However, few studies have reported high-quality safety and efficacy outcomes of PVCs following MICS. Patients who underwent MICS at Vancouver General Hospital between 2016 and 2019 (N = 123) were reviewed for perioperative opioid-narcotic use. Primary outcomes were postoperative opioid use and hospital length of stay (LOS). Statistical analyses were performed using univariate and multivariable regression models to determine independent risk factors. A total of 54 patients received routine systemic analgesia (control), 53 patients received a paravertebral catheter (PVC), and 16 patients received another mode of regional analgesia (non-PVC). The mean hospital LOS was significantly different in patients in the PVC group at 5.8 ± 2.0 days versus 8.3 ± 7.1 days in the control and 6.6 ± 2.3 days in the non-PVC group (P = 0.033). The percentage of patients who did not require postoperative oxycodone was significantly higher in the PVC group (48.1%), compared with the control (24.5%) and non-PVC (37.5%; P = 0.043) groups. The administration of regional anesthesia using PVCs was associated with reduced need for opioids and a shorter LOS. The reduction in postoperative opioids may reduce the risk of potential opioid dependency in this population. Future studies should involve randomized controlled trials with systematic evaluation of pain scores to verify current study results.

LENGTH OF STAY AND DISCHARGE DISPOSITION FOLLOWING ROBOTIC ARM-ASSISTED TOTAL HIP ARTHROPLASTY VERSUS CONVENTIONAL TECHNIQUE AND PREDICTORS OF DELAYED DISCHARGE

In-hospital length of stay (LOS) and discharge disposition following arthroplasty could act as surrogate measures for improvement in patient pathways, and have major cost saving implications for healthcare providers. With the ever-growing adoption of robotic technology in arthroplasty, we wished to evaluate its impact on LOS. The objectives of this study were to compare LOS and discharge disposition following robotic-arm assisted (RO THA) versus conventional technique Total Hip Arthroplasty (CO THA).This large-scale, single institution study included patients of any age undergoing primary THA (N = 1,732) for any cause between May 2019 and January 2023. Data extracted included patient demographics, LOS, need for Post Anaesthesia Care Unit (PACU) admission, anaesthesia type, readmission within 30 days and discharge dispositions. Univariate and multivariate logistic regression models were also employed to identify factors and patient characteristics related to delayed discharge.The median LOS in the RO THA group was 54 hours (34, 78) versus 60 (51, 100) in the CO THA group, p<0.001. Discharge disposition was comparable between the two groups. In the multivariate model, age, need for PACU admission, ASA score > 2, female gender, general anaesthesia and utilisation of the conventional technique were significantly associated with LOS > 2 days.Our study showed that robotic-arm assistance was associated with a shorter LOS in patients undergoing primary THA and no difference in discharge destination. Our results suggest that robotic-arm assistance could be advantageous in partly addressing the upsurge of hip arthroplasty procedures and the concomitant health care burden; however, this needs to be corroborated by long-term cost effectiveness analyses and data from randomised controlled studies.

875-P: Association of Continued Sodium–Glucose Cotransporter-2 Inhibitors from the Ambulatory to Inpatient Setting with In-Hospital Outcomes in Patients with Diabetes Mellitus—A Nationwide Study

Objective: Limited data are available on continuation of outpatient sodium glucose co-transporter-2 inhibitors (SGLT2i) during hospitalization. Design: Nationwide study of admissions of veterans with diabetes where SGLT2i was continued (CONT) in the hospital (N=5,943) compared to those where it was discontinued (DC) (N=30,634). Primary outcome was in-hospital mortality. Secondary outcomes were acute kidney injury (AKI), intensive care unit (ICU) transfer and length of stay (LOS). Propensity-weighted Poisson regression analyses adjusted for age, sex, race, BMI, Elixhauser comorbidity index were performed. Results: Mean (SE) age was 67.2 (0.1) and 67.5 (0.1) years (p=0.03), male 97.0% and 96.6% (p=0.1), white 71.3% and 72.1%, black 20.8% and 20.5% (p=0.52) in CONT vs. DC groups, respectively. After covariate adjustment, CONT had 44% lower mortality rate (IRR 0.56, 95% CI 0.43, 0.74, p=0.0001), no difference in AKI (IRR 0.95, 95% CI 0.89, 1.01, p=0.12), and 41% lower rate of ICU transfer (IRR 0.59, 95% CI 0.53, 0.65, p<0.0001). LOS was 4.5 vs. 4.9 days (IRR 0.93, 95% CI 0.91, 0.95, p<0.0001), in the CONT vs. DC. Similar trends observed after adjusting for additional models. Conclusion: Continued SGLT2i during hospitalization was associated with lower mortality and ICU transfer, no increased AKI, and shorter LOS. Disclosure L.G.Singh: None. S.Ntelis: None. T.Siddiqui: None. S.L.Seliger: Other Relationship; Tricida, Inc., Research Support; Reata Pharmaceuticals, Inc., Palladio Bioscences, Roche Diagnostics. J.D.Sorkin: None. I.Spanakis: Research Support; Dexcom, Inc.

Success of Same-Day Discharge Total Hip and Knee Arthroplasty: Does Location Matter?

BackgroundSame calendar day discharge (SCDD) following total joint arthroplasty is desirable for patients and surgeons alike. The aim of this study was to compare the success rate of SCDD in an ambulatory surgical center (ASC) versus hospital setting. MethodsA retrospective analysis was performed on 510 patients who underwent primary hip and knee total joint arthroplasty over a 2-year period. The final cohort was divided into 2 groups based on location of surgery: ASC (N = 255) or hospital (N = 255). Groups were matched for age, sex, body mass index, American Society of Anesthesiologists score, and Charleston Comorbidity Index. Successes of SCDD, reasons for failure of SCDD, length of stay (LOS), and 90-day readmission and complication rates were recorded. ResultsAll SCDD failures were from the hospital setting (36 [65.6%] total knee arthroplasty [TKA] and 19 [34.5%] total hip arthroplasty [THA]). There were no failures from the ASC. The main causes of failed SCDD in both THA and TKA included failed physical therapy and urinary retention. Regarding THA, the ASC group had a significantly shorter total LOS (6.8 [4.4 to 11.6] versus 12.8 [4.7 to 58.0] hours, P < .001). Similarly, TKA patients had a shorter LOS in the ASC (6.9 [4.6 to 12.9] versus 16.9 [6.1 to 57.0], P < .001). Total 90-day readmission rates were higher in the ASC group (2.75% versus 0%), where all but 1 patient underwent TKA. Similarly, complication rates were higher in the ASC group (8.2% versus 2.75%), where all but 1 patient underwent TKA. ConclusionTJA performed in the ASC, compared to the hospital setting, allowed for reduced LOS and improved success of SCDD.

Conservative and Surgical Modalities in the Management of Pediatric Parapneumonic Effusion and Empyema: A Living Systematic Review and Network Meta-Analysis

The optimal treatment for community-acquired childhood pneumonia complicated by empyema remains unclear. In children with parapneumonic effusion or empyema, do hospital length of stay and other key clinical outcomes differ according to the treatment modality used? A living systematic review of randomized controlled trials (RCTs) was conducted by searching the Cochrane Central Register of Controlled Trials, Embase, Latin American and Caribbean Health Sciences Literature, Ovid MEDLINE, and Web of Science Core Collection databases. Eligible RCTs included patients aged< 18 years and compared two of the following treatment modalities: antibiotics alone, chest tube insertion with or without fibrinolytics, video-assisted thoracoscopic surgery (VATS), and decortication via thoracotomy. A network meta-analysis was performed to evaluate treatment effects on hospital length of stay (LOS), the primary outcome. Eleven trials including a total of 590 patients were selected for the network meta-analysis. Compared with a chest tube alone, a chest tube with fibrinolytics, thoracotomy, and VATS were all associated with shorter LOS, with a mean difference of 5.05days (95%CI, 2.46-7.64), 6.33days (95%CI, 3.17-9.50), and 5.86days (95%CI, 3.38-8.35), respectively. No substantial differences in LOS were observed between the latter three interventions. None of the 11 RCTs compared antibiotics alone vsother types of treatment. Most trials reported peri-procedural complications and the need for reintervention, but the descriptions differed significantly between trials, preventing meta-analysis. In trials reporting health care-associated costs, fibrinolytics had cost advantages compared with VATS. Short- and long-term morbidity and mortality were very low, regardless of the treatment modality. The results of this network meta-analysis showed that a chest tube alone was associated with a longer LOS compared with other treatment modalities. The lower cost associated with a chest tube plus fibrinolytics warrants consideration when choosing between treatment options, given similar LOS and clinical outcomes compared with the other modalities.

The role of minimally invasive surgery in resectable distal pancreatic adenocarcinoma

BackgroundIn distal pancreatectomy (DP) for pancreatic ductal adenocarcinoma (PDAC), we hypothesize that minimally invasive DP (MIDP) carries short-term benefits over ODP (ODP) in the absence of postoperative pancreatic fistula (POPF). MethodsNSQIP database was queried to select patients who underwent DP for PDAC with available report on POPF. The population was divided into No-POPF vs. POPF groups. In each group, propensity-score matching was applied to compare 30-day outcomes of ODP vs. MIDP. ResultsThere were 2,824 patients; 2,332 (82%) had No-POPF and 492 (21%) had POPF. In No-POPF patients, 921 pairs were matched between ODP and MIDP. MIDP patients had slightly longer operations (227 vs. 205 minutes; p < 0.001), but lower rates of surgical site complications (1% vs. 2.9%; p = 0.002), postoperative transfusion (7.1% vs. 11.0%; p = 0.003), overall morbidity (21.1% vs. 26.3%; p = 0.009), and one-day shorter median length of stay (LOS) (5 vs. 6 days; p = 0.001).In the POPF group, 172 pairs were matched. There was no difference in morbidity, mortality, reoperation, LOS, and home discharge. Similar conclusions were drawn in the intention-to-treat and per-protocol analyses. ConclusionPOPF is common following DP for PDAC. In the absence of POPF, MIDP is associated with fewer postoperative morbidities and shorter LOS.

OUTC-11. RACE AND AGE ARE ASSOCIATED WITH ICD-10 DIAGNOSES IN THE POST-OPERATIVE PERIOD FOR PEDIATRIC PATIENTS WITH PRIMARY BRAIN TUMORS UNDERGOING NEUROSURGERY

Abstract BACKGROUND Disparities in pediatric cancer care and outcomes are known to exist. This work evaluates the relationship of race, ethnicity, and social determinants of health (SDoH) on the post-operative neurosurgical course of pediatric neuro-oncology patients in a single-institution. METHODS Retrospective data were collected on patients undergoing initial neurosurgery for a primary central nervous system (CNS) tumor between May 2011 and April 2021. Newly attributed ICD-10 codes in the 30-day post-operative period were collected. Descriptive statistics were used to evaluate demographics, geographic region of residence, and insurance type. Logistic regression was performed to estimate the association between covariates and 30-day readmission as well as ICD-10 diagnoses that can complicate the postoperative course including cardiac/respiratory, bleeding, infection, wound, hardware implantation, and neurologic conditions. Linear regression was used to measure association of covariates and length of stay (LOS). RESULTS A total of 836 patients, median age 10.0 years, were included (n=368 females, 44%). Patients were predominantly white (69%) and non-Hispanic/Latino (88%). White (OR [95% CI] 0.55 [0.33,0.90], p=0.02), Native American/Indian (0.25 [0.07,0.89], p=0.03), and multiracial (0.24 [0.08,0.68], p=0.01) patients were significantly less likely to have new ICD-10 codes compared to Black patients. White patients trended toward shorter LOS (p=0.06) compared to Black patients. Younger patients were significantly more likely to have newly reported ICD-10 codes (0.95 [0.92,0.97], p&amp;lt;0.001), increased LOS (r=-0.59 [-0.87,-0.32], p&amp;lt;0.001), and 30-day readmission (0.81 [0.72,0.89], p&amp;lt;0.001). Sex, ethnicity, insurance type, and region had no significant association with outcomes. Income level analyses are ongoing. CONCLUSION Non-black patients were less likely to have new ICD-10 diagnoses reported after surgery for primary CNS tumors. Older age was a protective factor against new post-operative diagnoses, increased LOS, and mortality. More research is necessary to understand the relationship between race, ethnicity, SDoH and post-operative risk including possible mechanisms of interaction across variables.

Post-Acute Care in Inpatient Rehabilitation Facilities Between Traditional Medicare and Medicare Advantage Plans Before and During the COVID-19 Pandemic.

Compare post-acute care (PAC) utilization and outcomes in inpatient rehabilitation facilities (IRF) between beneficiaries covered by Traditional Medicare (TM) and Medicare Advantage (MA) plans during the COVID-19 pandemic relative to the previous year. This multiyear cross-sectional study used Inpatient Rehabilitation Facility-Patient Assessment Instrument (IRF-PAI) data to assess PAC delivery from January 2019 to December2020. Inpatient rehabilitation for stroke, hip fracture, joint replacement, and cardiac and pulmonary conditions among Medicare beneficiaries 65years or older. Patient-level multivariate regression models with difference-in-differences approach were used to compare TM and MA plans in length of stay (LOS), payment per episode, functional improvements, and discharge locations. A total of 271,188 patients were analyzed [women (57.1%), mean (SD) age 77.8 (0.06) years], among whom 138,277 were admitted for stroke, 68,488 hip fracture, 19,020 joint replacement, and 35,334 cardiac and 10,069 pulmonary conditions. Before the pandemic, MA beneficiaries had longer LOS (+0.22days; 95% CI: 0.15-0.29), lower payment per episode (-$361.05; 95% CI:-573.38 to-148.72), more discharges to home with a home health agency (HHA) (48.9% vs 46.6%), and less to a skilled nursing facility (SNF) (15.7% vs 20.2%) than TM beneficiaries. During the pandemic, both plan types had shorter LOS (-0.68day; 95% CI: 0.54-0.84), higher payment (+$798; 95% CI: 558-1036), increased discharges to home with an HHA (52.8% vs 46.6%), and decreased discharges to an SNF (14.5% vs 20.2%) than before. Differences between TM and MA beneficiaries in these outcomes became smaller and less significant. All results were adjusted for beneficiary and facility characteristics. Although the COVID-19 pandemic affected PAC delivery in IRF in the same directions for both TM and MA plans, the timing, time duration, and magnitude of the impacts were different across measures and admission conditions. Differences between the 2 plan types shrank and performance across all dimensions became more comparable over time.

Impact of economic inequality on Kaposi sarcoma of the lung: A retrospective cohort.

e18920 Background: Kaposi Sarcoma of the lung is a rare entity; it is unclear if a below-average household income has an impact on outcomes. Methods: This is a retrospective cohort study of patients with Kaposi Sarcoma of the lung that were admitted to acute care from 2016 to 2020. Data is derived from the National Inpatient Sample (NIS). We compared outcomes in 2 cohorts: those with household income &lt; $50,000 versus those with &gt; $50,000. The primary endpoint was differences in all-cause in-patient mortality. Secondary endpoints included differences in length of stay (LoS) and admission cost. Results: A total of 460 patients met inclusion criteria; 40% had income &lt; $50K, and 60% &gt; $50K (p &lt; 0.001). There was a trend to male predominance (100% of &lt; $50K, 95% &gt; $50K; p 0.147) with a mean age of 39 (35 for &lt; 50K, 41 for &gt; 50K; p 0.015). Black patients were the most afflicted group (46%; 71% of &lt; $50K, 29% &gt; $50K; p &lt; 0.001), followed by White patients (33%, 20% of &lt; $50K, 43% of &gt; $50K; p &lt; 0.001). Additionally, patients with household income &lt; $50K (40%; p &lt; 0.001) and hospitals located in the South (43%, 48% of &lt; $50K, 40% of &gt; %50K; p &lt; 0.001) and West (32%, 11% of &lt; $50K, 46% of &gt; 50K; p &lt; 0.001) represented the largest group. Majority of patients were under Medicaid insurance coverage, however there was no relationship between Medicaid coverage and mortality (p = 0.709, CI 0.16-3.42). There was no difference in distribution based on primary payer, hospital bed size, hospital teaching status, and hospital ownership (p &gt; 0.05). No differences in mortality were noted among groups (p 0.845). No differences in LoS were seen (p 0.560), but younger patients were more likely to have shorter LoS (p 0.033). Ultimately, no differences in hospitalization costs were noted (p 0.426). Furthermore, from the 460 patients with Kaposi lung sarcoma, 5 were post-transplant patients, and 130 were patients with HIV; in this sub-group of analysis, were no differences between ages. The mean age in patients with lung transplants was 39.5, and the HIV group was 40 years. The black population was the most affected, with an income below $50 000. Conclusions: Income did not impact mortality in patients admitted for Kaposi sarcoma of the lung. Black patients and patients with income &lt; $50,000 represented the largest group. Nevertheless, more research is needed for better stratification and to elucidate many factors that play a role in the mortality of patients with Kaposi sarcoma of the lung.

Disparities in outcomes among hospitalized unhoused patients with cancer in the US.

6502 Background: Cancer is the 2nd leading cause of death among death among unhoused adults in the US. Use of aggressive medical interventions and costs during hospitalizations remains unstudied in the unhoused population. Methods: All hospitalized adults age ≥18 with a principal cancer diagnosis were identified in the 2016-2020 National Inpatient Sample (NIS). Logistic regression tested associations between unhoused status and: cost of care, mortality, and receipt of invasive procedures/systemic therapy. Adjusted analysis accounted for patient demographics, socioeconomic status, comorbidities, and effect modification of housing status by length of stay (LOS). Results: A total of 9,030 unhoused and 2,758,693 housed adults with cancer were included in the study. There were significant ( p&lt;0.01) differences in age &lt;65 years (77% unhoused vs 41% housed), male sex (75% vs 53%), race (Black, 25% vs 13%; White, 58% vs 71%), and insurance type (Private, 6% vs 27%; Medicaid, 53% vs 11%). There were also differences by primary cancer diagnosis, with higher rates of lung (17% vs 14%) and liver (8% vs 3%) cancers. Unhoused persons received less chemotherapy inpatient (5% vs 7%) and fewer overall procedures (48% vs 58%), while experiencing longer LOS (median 6 vs 4 days). On adjusted analyses, unhoused adults were had lower odds of receiving invasive procedures (aOR [95%CI], 0.34 [0.27-0.42]) or systemic therapy (0.41 [0.20-0.85]); and were less likely to have a higher-than-median cost of stay 0.47 [0.39-0.57]). Additionally, unhoused adults were 35% and 20% less likely to have a higher-than-median cost of stay or die while hospitalized (95% CI 0.59 – 0.71 and 0.67 – 0.96, respectively). When accounting for the possibility of housing status being modified by LOS, unhoused persons remained significantly less likely than housed persons to receive inpatient procedures (aOR 0.38, 0.47, and 0.60 for short, medium, and long LOS, respectively; p&lt;0.001 for each) or have high cost of stay (adjusted OR 0.55, 0.71, 0.70, p&lt;.001 for each), though the differences by housing status were attenuated with longer length of stay. Conclusions: In this first nationwide analysis of hospitalizations among unhoused adults with cancer, unhoused patients remained significantly less likely to receive invasive procedures or systemic therapy. These disparities in inpatient management despite the higher prevalence of more aggressive cancers and comorbidities among the unhoused highlight missed opportunities to improve cancer care.

Epidural Analgesia Is Associated With Reduced Inpatient Opioid Consumption and Length of Stay After Wilms Tumor Resection

IntroductionWilms’ tumor (WT) is the most common renal malignancy in children and requires an extensive laparotomy for resection. Epidural analgesia (EA) is commonly used in postoperative pain management, but previous literature suggests it may prolong length of stay (LOS). We hypothesized that EA is associated with prolonged LOS but decreased postoperative opioid use in children undergoing WT resection. Materials and methodsA retrospective chart review was performed for all WT patients who underwent nephrectomy between January 1, 1998, and December 31, 2018, at a tertiary children's hospital. Patients with incomplete records, bilateral WT, caval or cardiac tumor extension, or intubation postoperatively were excluded. Outcomes included postoperative opioid consumption measured in oral morphine equivalents per kilogram, receipt of opioid prescription at discharge, and postoperative LOS. Mann–Whitney and multivariable regression analyses were performed. ResultsOverall, 46/77 children undergoing WT resection received EA. Children with EA used significantly less inpatient opioids than children without EA (median 1.0 vs. 3.3 oral morphine equivalents per kilogram; P < 0.001). Comparing patients with EA to patients without, there was no significant difference in opioid discharge prescriptions (57% vs. 39%; P = 0.13) or postoperative LOS (median 5 d vs. 6 d; P = 0.10). Controlling for age and disease stage, EA was associated with shorter LOS by multivariable regression (coefficient −0.73, 95% confidence interval: −1.4, −0.05; P = 0.04). ConclusionsEA is associated with decreased opioid use in children without an associated increase in postoperative LOS following WT resection. EA should be considered as part of multimodal pain management for children undergoing WT resection.

The Pediatric Emergency Department Nurse and Gastrostomy Tube Replacement: How Safe Is it?

To review the outcomes of a nurse-only guideline for replacement of gastrostomy tubes (g-tubes) in a pediatric emergency department (ED) and compare rates of success, failure, length of stay (LOS), and return visits with that of ED physicians. Nursing g-tube guidelines, created by a nurse educator and nursing council, were instigated on January 31, 2018. Variables examined included LOS, age at visit, return visit within 72 hours, reason for replacement, and any postplacement complications. Data of g-tube placement by nurses and physicians were compared using t test or χ 2 analysis (IBM-SPSS version 20, New Orchard Road, Armonk, NY). The institutional review board determined the study to be exempt from human subjects. The STROBE checklist was used and completed accordingly. Chart abstraction and data were collected from January 1, 2011 through April 13, 2020, and medical records were obtained using International Classification of Diseases, Tenth Revision (ICD-10) codes for g-tubes: Z93.1, K94.23. A total of 110 patients were included in our study. Fifty-eight underwent nursing-only replacements; 52 were replaced by physicians. Nurse replacement success rate was 98.3% with an average stay of 22 minutes. Physician success rate was 100% with an average stay of 86 minutes. The difference between nursing and physician LOS was 64.6 minutes. No patient in either group experienced postreplacement complications. The initiation of nurse-only management of dislodged g-tubes was successful, safe, and had a shorter LOS when compared with physicians in the pediatric ED. Our study determined the implications of nurse-only replacement of g-tubes in a pediatric ED. We found that nurses replacing g-tubes was equally safe and effective as physician counterparts. In addition, we found that it significantly reduced the LOS for patients, which has consequences on patient satisfaction and billing. Nursing staff were trained in g-tube replacement using guidelines created by a nurse educator and nursing council. Patients either had their dislodged g-tubes replaced by the trained nurse or a physician and comparisons on the outcomes were made. Patients were aware of the study and consented to have their medical records accessed to make the data comparisons. With more than 189,000 children in the United States relying on g-tubes, nursing staff will inevitably be involved in the care of patients with such a device. In addition, as pediatric EDs continue to develop longer and longer waiting times, we must learn how to better use our nursing staff for procedures within their scope and minimize LOS. Our research demonstrates the safety, feasibility, and general benefits of having the pediatric nursing staff replace g-tubes in the ED, and it is hoped that this will lead to beneficial policy changes. - Demonstrates the safety and effectiveness of nurse-only g-tube replacement- Reports on the statistically significant difference in LOS between physician and nurse replacement of g-tubes in a pediatric ED- Has the ability to lead to policy change in the pediatric ED that will allow for greater patient satisfaction and decrease patient cost.

Endoscopic retrograde cholangiopancreatography outcomes in inflammatory bowel disease patients: a 12-year analysis of a national database

Despite inflammatory bowel disease's (IBD) association with hepatobiliary disorders and the use of endoscopic retrograde cholangiopancreatography (ERCP) for both diagnostic and therapeutic evaluation of these diseases, it remains a poorly studied area within the literature. The purpose of this study is to examine the effect of IBD on the occurrence of adverse events (AE) pertaining to ERCP.This project utilized the National Inpatient Sample (NIS) database, the largest inpatient database in the USA. All patients 18 years or older with and without IBD undergoing ERCP were identified from 2008 to 2019. Post-ERCP AEs were analyzed using multivariate logistic or linear regression controlling for age, race, and existing comorbidities using the Charlson comorbidity index (CCI).There was no difference in post-ERCP pancreatitis (PEP) or mortality. IBD patients were also found to have a lower risk of bleeding and decreased length of stay (LOS) despite adjustment for comorbidities. They also underwent less sphincterotomies when compared to the non-IBD cohort. Subgroup analysis between ulcerative colitis (UC) and Crohn's disease (CD) did not find any significant differences in outcomes.To our knowledge, this is the largest study to date evaluating ERCP outcomes in IBD patients. After adjustment of co-variates, there was no difference in the occurrence of PEP, infections, and perforation. IBD patients were less likely to experience post-ERCP bleeding and mortality and had shorter LOS which may be due to the decreased frequency of sphincterotomy in this population.

Robotic Versus Laparoscopic Hepatectomy: A Single Surgeon Experience of 629 Consecutive Minimally Invasive Liver Resections.

Robotic surgery has the potential to broaden the indications for minimally invasive liver surgery owing to its technical advantages. This paper compares our experience with robotic liver surgery (RLS) with conventional laparoscopic liver surgery (LLS). All consecutive liver resections between October 2011 and October 2022 were selected from our prospective database to be included in this cohort study. Patients who underwent RLS were compared with a LLS group for operative and postoperative outcomes. In total, 629 patients were selected from our database, including 177 patients who underwent a RLS and 452 patients who had LLS. Colorectal liver metastasis was the main indication for surgery in both groups. With the introduction of RLS, the percentage of open resections decreased significantly (32.6% from 2011 to 2020 vs. 11.5% from 2020 onward, P < 0.001). In the robotic group, redo liver surgery was more frequent (24.3% vs. 16.8%, P = 0.031) and the Southampton difficulty score was higher (4 [IQR 4 to 7] vs. 4 [IQR 3 to 6], P = 0.02). Median blood loss was lower (30 vs. 100ml, P < 0.001), and postoperative length of stay (LOS) was shorter in the robotic group (median 3 vs. 4days, P < 0.001). There was no significant difference in postoperative complications. Cost related to the used instruments and LOS was significantly lower in the RLS group (median €1483 vs. €1796, P < 0.001 and €1218 vs. €1624, P < 0.001, respectively), while cost related to operative time was higher (median €2755 vs. €2470, P < 0.001). RLS may allow for a higher percentage of liver resections to be completed in a minimally invasive way with lower blood loss and a shorter LOS.

Communication functions of adult patients admitted to intensive care: A multicentre, binational point prevalence study

BackgroundPatient communication is profoundly impacted during the intensive care unit (ICU) stay. While the impacts of altered communication are recognised, there is a paucity of data on the prevalence of communication attempts as well as modes utilised by patients and unit practices to manage communication function. ObjectiveThe objectives of this study were to describe the prevalence and characteristics of observed communication attempts (nonverbal, verbal, and use of the staff call bell) in adult ICU patients and report on unit-level practices on communication management. MethodsA prospective, binational, cross-sectional point-prevalence study was conducted across 44 Australia and New Zealand adult ICUs. Data on communication attempts, modes, ICU-level guidelines, training, and resources were collected in June 2019. ResultsAcross 44 ICUs, 470 of 623 (75%) participants, including ventilated and nonventilated patients, were attempting to communicate on the study day. Of those invasively ventilated via an endotracheal tube for the entire study day, 42 of 172 (24%) were attempting to communicate and 39 of 45 (87%) patients with a tracheostomy were attempting to communicate. Across the cohort, the primary mode of communication was verbal communication, with 395 of 470 (84%) patients using speech; of those 371 of 395 (94%) spoke English and 24 of 395 (6%) spoke a language other than English. Participants attempting to communicate on the study day had a shorter length of stay (LOS), a mean difference of 3.8 days (95% confidence interval: 0.2; 5.1) shorter LOS in the ICU than those not attempting to communicate, and a mean difference 7.9 days (95% confidence interval: 3.1; 12.6) shorter LOS in hospital overall. Unit-level practices and supports were collected. Six of 44 (14%) ICUs had a protocol for communication management, training was available in 11 of 44 (25%) ICUs, and communication resources were available in 37 of 44 (84%) ICUs. ConclusionThree-quarters of patients admitted to the ICU were attempting to communicate on the study day, with multiple methods used to support verbal and nonverbal communication regardless of ventilation status. Guidance and training were absent from the majority of ICUs, indicating a need for development and implementation of policies, training, and resources.

The Risk Assessment and Prediction Tool (RAPT) Score Predicts Discharge Destination, Length of Stay, and Postoperative Mobility After Total Joint Arthroplasty

BackgroundPredicting an arthroplasty patient’s discharge disposition, length of stay (LOS), and physical function is helpful because it allows for preoperative patient optimization, expectation management, and discharge planning. The goal of this study was to evaluate the ability of the Risk Assessment and Prediction Tool (RAPT) score to predict discharge destination, LOS, and postoperative mobility in patients undergoing primary total knee arthroplasty (TKA) and total hip arthroplasty (THA). MethodsPrimary unilateral TKAs (n = 9,064) and THAs (n = 8,649) performed for primary osteoarthritis at our institution from 2018 to 2021 (excluding March to June 2020) were identified using a prospectively maintained institutional registry. We evaluated the associations between preoperative RAPT score and (1) discharge destination, (2) LOS, and postoperative mobility as measured by (3) successful ambulation on the day of surgery and (4) Activity Measure for Post-Acute Care (AM-PAC) “6-Clicks” score. ResultsOn multivariable analyses adjusting for multiple covariates, every one-point increase in RAPT score among TKA patients was associated with a 1.82-fold increased odds of home discharge (P < .001), 0.22 days shorter LOS (P < .001), 1.13-fold increased odds of ambulating on postoperative day 0 (P < .001), and 0.25-point higher Activity Measure for Post-Acute Care score (P < .001). Similar findings were seen among THAs. A RAPT score of 8 or higher was the most sensitive and specific cutoff to predict home discharge. ConclusionAmong nearly 18,000 TKA and THA patients, RAPT score was predictive of discharge disposition, LOS, and postoperative mobility. A RAPT score of 8 or higher was the most sensitive and specific cutoff to predict discharge to home. In contrast to prior studies of the RAPT score which have grouped TKAs and THAs together, this study ran separate analyses for TKAs and THAs and found that THA patients seemed to perform better than TKA patients with equal RAPT scores, suggesting that RAPT may behave differently between TKAs and THAs, particularly in the intermediate risk RAPT range.

O135 Efferent limb stimulation prior to loop ileostomy closure- a meta-analysis

Abstract Introduction Postoperative ileus (POI) remains a common phenomenon following loop ileostomy closure. We aimed to determine whether preoperative physiological stimulation (PPS) of the efferent limb reduced the incidence of POI. Methods A PRISMA-compliant meta-analysis searching PubMed, EMBASE and CENTRAL databases from inception until Oct 2022, was performed. All studies comparing PPS versus no stimulation were included. The primary objective was the incidence of POI whilst secondary objectives included time to resume oral diet, nasogastric tube (NGT) placement postoperatively, time to first passage of flatus/stool, length of stay (LOS) and other complications. Random effects models were used to calculate pooled effect size estimates. Sensitivity analyses were also performed. Results Four studies (3 randomized, 1 prospective) capturing 293 patients (140 PPS, 153 no-stimulation) were included. The PPS group was associated with a lower POI incidence (10.7 vs. 26.8%, OR 0.27, 95%CI=0.09-0.86, p=0.03), quicker time to resume oral diet (MD -1.34 days, p=0.02), shorter LOS (MD -1.43 days, p=0.001) and fewer complications (OR 0.37, p=0.008). However, there was no difference in the requirement for NGT placement (OR 0.50, p=0.12) or time to first passage of flatus/stool (MD -0.71 days, p=0.24). On sensitivity analysis, focusing on randomized data only, the difference observed in POI rates was lost (OR 0.35, p=0.10) whereas the results of the secondary objectives prevailed. Conclusion Efferent limb stimulation prior to surgery appears to result in a quicker time to resume oral diet, shorter LOS but similar POI rates. Further studies are needed to confirm those findings.

OC-030 COMPARISON OF OUTCOMES OF THE EXTENDED-VIEW TOTALLY EXTRAPERITONEAL RIVES-STOPPA (ETEP-RS) AND THE INTRAPERITONEAL ONLAY MESH WITH DEFECT CLOSURE (IPOM-PLUS) FOR W1-W2 MIDLINE INCISIONAL HERNIA REPAIR

Abstract Aim This study aimed to compare the outcomes of the eTEP-RS and IPOM-plus procedures in W1 and W2 midline incisional abdominal wall hernia (IAWH) repairs performed by the same surgeon. Material and Methods Prospectively collected data of laparoscopic abdominal wall repairs performed on 61 patients with eTEP between November 2018 and April 2022 and on 67 patients with IPOM-plus between January 2016 and April 2022 were retrospectively analyzed. A total of 74 out of 128 patients, 30 in the eTEP-RS group and 44 in the IPOM-plus group, who underwent W1-W2 midline incisional hernia repair were included in the study. The mean follow-up was 24 months in the eTEP-RS group and 45 months in the IPOM-plus group. Results There was no statistically significant difference between the groups regarding age, sex, BMI, ASA score, or active smoking. The mean mesh area (MMA) and mesh/defect (M/D) ratio were higher in the eTEP-RS group (p &amp;lt;0.001 and p =0.004). In the eTEP-RS group, the hospital length of stay (LOS) (1.48 days vs. 2.58 days, p &amp;lt;0.001) and pain on the first and 10th postoperative days were significantly lower (p &amp;lt;0.001), while the operative time was significantly longer (p &amp;lt;0.001). There was no significant difference in terms of intraoperative complications (p =0.56), seroma formation (p =0.83), or recurrence (p =0.83). Conclusions The eTEP-RS technique has advantages over the IPOM-plus approach, such as a shorter LOS and less early postoperative pain with W1-W2 midline IAWH repair. However, the eTEP technique has a longer operative time.

Association of open globe injury characteristics with outcome measures in the emergency department.

To evaluate the association of demographic and clinical features of emergency department (ED) patients presenting with open globe injuries (OG) with outcomes such as inpatient admission rate, length of stay (LOS), and total cost. The Nationwide Emergency Department Sample database 2018 and 2019 was used to analyze the association of demographic and clinical features of OG patients with outcome measures. 8404 OG patients were identified. Medicaid patients were associated with higher ED costs and a higher frequency of extended LOS. The 70+ age group was associated with higher inpatient admission. Frail patients were associated with significantly increased likelihood of inpatient admission, higher likelihood of extended LOS and higher total combined ED cost. Falls and being struck were associated with shorter LOS. This study describes the most common demographic and clinical characteristics of OGIs that present to the ED, as well as the association of these characteristics with outcome measures such as inpatient admission rates, LOS, and total cost. The study further identified potential high-risk patients for prolonged length of stay. The findings will better optimize patient care protocols to improve outcomes.

Factors Associated With Hip Fracture Length of Stay Among Older Adults in a Community Hospital Setting

Hip fractures in geriatric populations constitute a heavy burden on the healthcare system. The study goal was to identify patient, hospital, and surgical factors associated with hospital length of stay (LOS) for geriatric patients with hip fractures requiring surgical intervention in a community hospital setting. This was a cross-sectional retrospective chart review of geriatric hip fractures that underwent surgical fixation at a community hospital between 2017 and 2019. The scope of the surgeries was limited to cephalomedullary device fixation or hemiarthroplasty hip fracture surgeries. Sliding hip screw or total hip arthroplasty procedures and patients who died during the index hospitalization were excluded. Median tests were conducted to examine differences between the groups. Unadjusted and adjusted truncated negative binomial regression models were used to examine the factors associated with LOS. Bivariate analyses revealed results that the factors associated with a longer LOS were preoperative anemia (P = 0.029), blood transfusion (P = 0.022), and the number of days between admission and surgery (P = 0.001). The adjusted regression model results suggested that older patients, patients who underwent surgery more than one day after admission, current smokers, malnourished patients, patients with sepsis, and patients with a history of a thromboembolic event had statistically significant (P < 0.05) longer LOS. However, patients who live in institutions (nursing homes or assisted living) had a shorter LOS than those who live at home alone or with family (P < 0.05). Older adult patients who underwent surgery with a cephalomedullary device or hip hemiarthroplasty for a hip fracture and had preoperative anemia, postoperative blood transfusions, and increased days between admission and surgery had a longer LOS. Additional factors positively associated with a longer LOS included current smokers, malnourishment, admission with sepsis, and patients with a history of a thromboembolic event. Of interest, institutionalized patients had a shorter LOS than those living at home alone or with family.