Significant Difference In Length Of Stay Research Articles

Exploring the impact of built environment design on oncology inpatient rooms: a single-based study of King Abdullah University Hospital

ABSTRACT The recognized impact of healthcare facility design on patient well-being prompted this investigation into the influence of design variables on patient satisfaction and length of stay (LOS) within a single-center oncology unit. A survey-based methodology was employed at King Abdullah University Hospital (KAUH) to gather data from 88 participants. The study focused on inpatient rooms on the 10th floor, comparing single and shared accommodations. Statistical analysis revealed a significant difference in LOS between the two room types, with patients in single rooms experiencing shorter stays and higher satisfaction. Privacy (PR) received the highest mean score in participant evaluations, followed by social support (SS) and physical support (PS) features. Visual appearance (VA) received the lowest mean score. The correlation analysis showed a significant negative correlation between privacy, visual appearance, and LOS (p < 0.01), indicating that greater privacy and better views (implicated by the visual appearance score) are associated with shorter LOS. Correlations between physical support, social support, and LOS were weak and not statistically significant. These findings underscore the importance of room configuration in shaping the patient experience within oncology units and highlight the pivotal role of design in influencing patient outcomes. They also stress the need for human-centric considerations in healthcare facility design. This knowledge can guide healthcare professionals, architects, and policymakers in optimizing spaces for oncology patients, illustrating how the interplay between the built environment and patient experiences can potentially reshape patient care.

The Landscape of Resource Utilization After Resuscitation of 22-, 23-, and 24-Weeks’ Gestation Infants

ObjectiveTo compare estimated healthcare resources needed to care for 22 through 24 weeks’ gestation infants. Study designThis multicenter, retrospective cohort study included 1,505 live in-born and out-born infants 22 through 24 weeks’ gestational age at delivery from six pediatric tertiary care hospitals from 2011 through 2020. Median neonatal intensive care unit (NICU) length of stay (LOS) for each gestational age was used as a proxy for hospital resource utilization, and the number of comorbidities and medical technology use for each infant were used as estimates of future medical care needs. Data were analyzed using Kruskal-Wallis with Nemenyi’s post hoc test and Fisher’s exact test. ResultsOf the identified newborns, 22-week infants had shorter median LOS than their 23- and 24-week counterparts due to low survival rates. There was no significant difference in LOS for surviving 22-week infants compared with surviving 23-week infants. Surviving 22-week infants had similar proportions of comorbidities and medical technology use as 23-week infants. ConclusionsCompared with 23- and 24-week infants, 22-week infants did not use a disproportionate amount of hospital resources. 22-week infants should not be excluded from resuscitation based on concern for increased hospital care and medical technology requirements. As overall resuscitation efforts and survival rates increase for 22-week infants, future research will be needed to assess the evolution of these results.

Delayed Closure of Guillotine Lower Extremity Amputation in Obese Patients is Associated with Increased Mortality

OBJECTIVEStaged surgery with open guillotine amputation (OGA) prior to a definitive major lower extremity amputation (LEA) has been shown to be effective for sepsis control and improving wound healing. Studies have evaluated postoperative complications including infection, return to the operating room for re-amputation, and amputation failure following OGA. However, the role of timing to close OGA for predictive outcomes remains poorly understood. We aim to assess outcomes of major LEA related to the time of OGA closure. METHODSData from patients who underwent major LEA from 2015 to 2021 was collected retrospectively. The study included all patients undergoing below-, through-, or above-knee amputations. Next, patients who had OGA prior to a definitive amputation were selected. Patients who died before amputation closure were excluded. Post-amputation outcomes such as surgical site infection (SSI), postoperative sepsis, postoperative ambulation, hospital length of stay (LOS), and 30-day, 1-year, and 5-year mortality were reviewed. The study cohort was stratified by demographics and comorbidities. Receiver operating characteristic (ROC) curve analysis was performed to determine the time of closure (TOC) cut-off value. Univariate and multivariate analysis was performed to assess outcomes. Statistical significance was set at p < 0.05. RESULTOf 688 patients who underwent major LEA, 322 underwent staged amputation with OGA before the formalization procedure and were included. The TOC ranged from 1-47 days with a median of 4 days (interquartile range (IQR) from 3 to 7). The optimal TOC point of 8 days (ranging from 2 - 42 days) in obese patients (199/322) for predicting mortality showed the largest area under the curve (AUC) (0.709) with 64.71% sensitivity and 78.3% specificity. Patients who are obese and grouped in TOC less than 8 days had no 30-day mortality, significantly lower 1-year mortality, better survival, and a lower rate of deep venous thrombosis (DVT) complication. There was no significant difference in LOS, postoperative SSI, sepsis, and ambulation between the two subgroups of obese patients. Multivariable analysis showed that gender, CKD, and postoperative ambulation independently predict overall mortality in obese patients. CONCLUSIONTOC cutoff in obese patients showed statistically significant results in predicting mortality. Our findings indicated better survival in obese patients with a lower TOC (less than 8 days). This emphasizes the importance of earlier closure of OGA in obese patients.

The association between frailty, hypogonadism, and postoperative outcomes among men undergoing radical cystectomy

IntroductionHypogonadism is associated with frailty, lower health-related quality of life, decreased muscle mass, and premature mortality, which may predispose patients to poor postoperative outcomes. We aimed to determine the prevalence of hypogonadism in men undergoing radical cystectomy (RC) and whether hypogonadism and frailty are associated with adverse postoperative outcomes. Materials and methodsThe IBM MarketScan database was used to identify men who underwent RC between 2012 and 2021. Frailty was determined using published Hospital Frailty Risk Score ranges. Patients were considered to have hypogonadism if diagnosed within 5 years prior to RC. Length of stay (LOS), complications, emergency department (ED) visits and inpatient readmissions were compared. Sub-group analysis of men with hypogonadism was performed to determine the effect of testosterone replacement therapy (TRT) on clinical outcomes. ResultsAmong 3,727 men who underwent RC, 226 (6.1%) had a diagnosis of hypogonadism. Overall, 565 (15.2%) men were low-risk frailty, 2,214 (59.4%) intermediate-risk frailty, and 948 (25.4%) were high-risk frailty, and men with hypogonadism were significantly more frail compared to men without hypogonadism (P = 0.027). There was no significant difference in LOS, complications, or rate of ED visits and inpatient readmissions between cohorts (P > 0.05). However, high-risk frailty was associated with an increased risk of 90-day ED visit (HR 1.19, 95%CI 1.00–1.41, P = 0.049) and 90-day readmission (HR 1.60, 95%CI 1.29–1.97, P < 0.001) after RC. Among men with hypogonadism, 58 (25.7%) were on TRT. There was no significant difference in frailty, LOS, complications, or 90-day ED visits or 90-day inpatient readmissions between patient with hypogonadism prescribed TRT and those without TRT. ConclusionsThese findings suggest that hypogonadism and preoperative frailty may be important to evaluate prior to undergoing RC.

COST-EFFECTIVENESS ANALYSIS OF TREATMENT IN GASTROESOPHAGEAL REFLUX DISEASE INPATIENT PATIENTS IN BANDUNG, INDONESIA

Objective: This study aimed to analyze the cost-effectiveness of the GERD treatment management strategy for class II inpatient patients at a police hospital in Bandung, Indonesia.&#x0D; Methods: This study was retrospective, using medical record data collection techniques for 103 patients of the Social Security Administrator for Health (Badan Penyelenggara Jaminan Sosial, BPJS), from January 2017 to July 2019. The pharmacoeconomic method was Cost-Effectiveness Analysis. The medicines being compared were omeprazole injection and pantoprazole injection. The outcome parameter was the length of stay (LOS). The perspective was a hospital with a direct cost component. This study uses a 5% discounting rate due to differences in years.&#x0D; Results: The results showed that the patient majority was female (76%) and the largest age group was&gt;40 y (53%). There was a significant difference in LOS and total cost between omeprazole and pantoprazole (p-value&lt;0.050) using the Mann-Whitney test. The cost-effectiveness ratio showed that omeprazole has a higher value than pantoprazole.&#x0D; Conclusion: Therapy using pantoprazole was more cost-effective than omeprazole.

Low-Dose Short-Term Scheduled Ketorolac Reduces Opioid Use and Pain in Orthopaedic Polytrauma Patients: A Randomized Clinical Trial.

To determine whether scheduled low-dose, short-term ketorolac is associated with reduced length of stay, opioid use, and pain in orthopaedic polytrauma patients. Double-blinded, randomized controlled trial. One Level 1 trauma center. From August 2018 to October 2022, 70 orthopaedic polytrauma patients between 18-75 years-old with a New Injury Severity Score (NISS) > 9 were randomized. 70 participants were enrolled, with 35 randomized to the ketorolac group and 35 to the placebo group. 15 mg of intravenous (IV) ketorolac every 6 hours for up to 5 inpatient days or 2 mL of IV saline in a similar fashion. Length of Stay (LOS), Morphine Milligram Equivalents (MME), Visual Analogue Scale (VAS), and Complications. Study groups were not significantly different with respect to age, BMI, and NISS (p>0.05). Median LOS was 8 days (interquartile range [IQR], 4.5 to 11.5) in the ketorolac group compared to 7 days (IQR, 3 to 10) in the placebo group (p = 0.275). Over the 5-day treatment period, the ketorolac group experienced a 32% reduction in average MME (p = 0.013) and a 12-point reduction in baseline-adjusted mean VAS (p = 0.037) compared to the placebo group. There were no apparent short-term adverse effects in either group. Scheduled low-dose, short-term IV ketorolac was associated with significantly reduced inpatient opioid use and pain in orthopaedic polytrauma patients with no significant difference in LOS and no apparent short-term adverse effects. The results support the use of scheduled low-dose, short-term IV ketorolac for acute pain control among orthopaedic polytrauma patients. Further studies are needed to delineate lasting clinical effects and potential long-term effects, such as fracture healing. Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

HPB P34 A case-controlled study of single-stage versus two-stage approach to managing common bile duct stones

Abstract Background The most common approaches to the treatment of symptomatic common bile duct (CBD) stones are endoscopic retrograde cholangiopancreatography (ERCP) followed by cholecystectomy (two-stage approach) and intra-operative imaging +/- bile duct exploration (BDE) during laparoscopic cholecystectomy (single-stage approach). Intra-operative cholangiogram (IOC) and intra-operative ultrasound (IOUS) are the two common forms of intra-operative imaging. Although IOC is used more frequently, IOUS is safer, non-invasive and can be repeated. The aim of this study was to evaluate outcomes of patients undergoing a single-stage approach with IOUS compared to patients undergoing a two-stage approach. Methods This was a retrospective case-controlled study. Outcomes of patients who had a single-stage approach (group 1) between February 2015 and June 2022 were compared with a cohort of patients (matched for age, sex, and co-morbidities) who had a two-stage approach (group 2). Outcomes included the total number of admissions from diagnosis until cholecystectomy, time from initial presentation to surgery, length of stay (LOS), post-operative and post-ERCP complications (including bile leak, pancreatitis and retained stones), readmission rate and mortality within a year. Results Seventy-four patients were included (65% female, mean age 56 years, median Charlson Comorbidity Index of 2). The median number of admissions was lower in group 1 (1 vs 3 days, p&amp;lt;0.01). The median waiting time till surgery was 4 days in group 1 (vs 128 days, p&amp;lt;0.01). The median LOS for group 1 was 5 days (vs 7 days, p=0.08). Overall complications were lower in group 1 (5% vs 11%, p=0.79). Complications included bile leak (5% vs 0%), pancreatitis (0% vs 8%) and retained stones (0% vs 3%). Readmission rate was 3% vs 16% (p=0.66). Overall mortality was zero. Conclusions Patients who were managed for CBD stones via the single-stage approach had significantly fewer hospital admissions and shorter waiting time to cholecystectomy. There was no significant difference in LOS, rate of complications or readmissions between the two groups. We therefore advocate the use of the single-stage approach using IOUS routinely over ERCP in the management of symptomatic CBD stones.

Oral and intravenous tranexamic acid administration demonstrate no significant difference in objective measures of blood loss in primary total shoulder arthroplasty

IntroductionThe routine use of tranexamic acid (TXA) in shoulder arthroplasty has grown in popularity due to the perceived benefits of reduction in intra-operative blood loss and the related adverse sequelae. Both intravenous (IV) and oral (PO) formulations of TXA exist and there is minimal data regarding the optimal route of administration. This study aimed to assess whether there was a significant difference in efficacy between the administration of PO vs. IV TXA prior to total shoulder arthroplasty. We hypothesized equivalence in preoperative (preop) to postoperative change in hemoglobin (Hg) and hematocrit (Hct) as well as the length of stay (LOS), 90-day readmission, transfusion rates and adverse events between the two routes. Materials and methodsA single-center retrospective chart review was conducted between May 2022 and January 2023. All patients undergoing primary anatomic or reverse total shoulder arthroplasty during this period were included. Patients undergoing revision shoulder arthroplasty or arthroplasty for fracture were excluded. The primary outcome of interest was the change (Δ) in preop to postoperative day 1 Hg and Hct reported as ΔHg and ΔHct. Intraoperative estimated blood loss (EBL), transfusion rates, patient demographics, LOS, and adverse event data were also collected. ResultsTwo hundred and thirty patients who underwent shoulder arthroplasty met the inclusion criteria. A total of 176 patients received preoppreop IV TXA and 54 patients received preop PO TXA. There was no significant difference between groups in the mean ΔHg (1.69 in the IV group and 2.52 in the PO group, P = .11) or ΔHct (5.19 in the IV group and 5.04 in the PO group, P = .42). There was no significant difference in LOS, transfusion rates, or 90-day readmission between groups. There was a significant difference in the mean EBL between the two groups (123.78cc in the IV group and 173.06cc in the PO group, P < .001). Our study was adequately powered at 0.95. ConclusionThere was no statistically significant difference between the IV and PO TXA groups when comparing preop to postoperative day 1 change in Hg and Hct, LOS, transfusion rates, surgical site infections, and 90-day readmission indicating similar efficacy between the two routes of administration. EBL was found to be significantly higher in the PO TXA group, though the clinical significance of this finding is indeterminate. Given these findings, however, PO TXA may be a reliable alternative to IV TXA in primary shoulder arthroplasty.

Better medical care quality in weekday daytime schedule with gastrointestinal hospitalists than conventional care teams

ABSTRACT Objectives This study sought to uncover whether having a gastrointestinal (GI) hospitalist available during weekday daytime hours results in higher-quality medical care compared to care provided by a team of residents. Methods Our hospitalist GI team consisted of two gastroenterologists working weekday daytime hours and two physician assistants. The team of conventional care headed by thirteen professors, comprised twelve residents and eight physician assistants. We conducted a retrospective cohort study in South Korea between March 2 and 9 December 2020. The hospitalist team treated 528 patients, while the conventional care team treated 2,335. We assessed the medical parameters of length of stay (LOS), rates of in-hospital mortality, transfer to the intensive care unit, and readmission rate within 30 days. Furthermore, we gathered feedback from nurses working with both teams. Results The study found that there was no significant difference in LOS between infections (P = 0.422) and other GI diseases like bleeding (P = 0.226). There was no significant difference in the rates of in-hospital mortality (P = 0.865) and transfer to the intensive care unit (P = 0.486) between the two teams. However, the hospitalist team had notably lower readmission rates than the conventional care team (P = 0.002) as well as a lower unscheduled readmission rate (P = 0.046). Furthermore, the survey results indicated that nurses who worked with the hospitalist team had significantly better responses than those who worked with the conventional care team (P < 0.001). Conclusions This study indicates that having GI hospitalists work weekday daytime hours improves patient care, and treatment and reduces readmission rates.

A Retrospective Study of the Association between Respiratory Tract Viral PCR Panel Results and Clinical Outcomes in Children with Cancer and Febrile Neutropenia and Review of the Literature

Abstract Objective The role of respiratory viral pathogens (RVPs) in children with cancer having febrile neutropenic (FEN) episodes has not been well studied. The objectives of this study were to investigate the prevalence and clinical outcomes of RVP in this group. Methods Pediatric patients with cancer and an episode of FEN, presenting between March 2021 and March 2022 were included. All data were retrospectively retrieved from patient files. A throat swab sample was obtained for the detection of 17 RVPs and evaluated by a polymerase chain reaction (PCR) method. Results A total of 110 (male n = 76; 69.1%) patients with a mean ± standard deviation age of 6.68 ± 4.92 years were included. Reproduction in PCR was seen in 76 (69.1%) children. Rhinovirus (31.6%) and respiratory syncytial virus (15.8%) were the most frequently detected viruses. Mixed respiratory viruses (coinfections of ≥2 viruses) were only seen in 13%. The median (range) duration of hospitalization was 11 (2–143) days, and 8.2% of the children were admitted to the pediatric intensive care unit (PICU). The median (range) length of stay (LOS) in the PICU was 8 (1–100) days. Overall mortality rate was 3.6%. There was no significant difference in LOS in the hospital, rate of admission to PICU, LOS in the PICU, and the mortality rate between children with and without growth in PCR (p &gt; 0.05). Conclusion There was high prevalence of RVP in children with cancer and FEN. However, given that having a positive RVP does not affect LOS in the hospital/PICU or disease severity, in this population, there was no association between positive PCR findings and clinical features investigated or outcome.

Implementation of a standardised accept note to improve communication during inter-hospital transfer: a prospective cohort study

ImportanceThe transfer of patients between hospitals (interhospital transfer, IHT), exposes patients to communication errors and gaps in information exchange.ObjectiveTo design and implement a standardised accept note to improve communication during...

A retrospective comparison of 90-day outcomes, length of stay, and readmissions between robotic-assisted and laparoscopic colectomy.

Investigations generally assess 30days of perioperative outcomes with robotic-assisted and laparoscopic colectomy. Outcomes beyond 30days serve as a quality metric of surgical services and an assessment of 90days of outcomes may have greater clinical utility. The purpose of this study was to assess 90days of outcomes, length of stay (LOS), and readmissions among patients who underwent a robotic-assisted versus laparoscopic colectomy using a national database. Patients undergoing either robotic-assisted or laparoscopic colectomy were identified using Current Procedural Terminology (CPT) codes within PearlDiver, a national, inpatient records database from 2010 to 2019. Outcomes were defined using the National Surgical Quality Improvement Program (NSQIP) risk calculator and identified using International Classification of Disease (ICD) diagnosis codes. Categorical variables were compared using chi-square tests, and continuous variables were compared using paired t tests. Covariate-adjusted regression models were also constructed to evaluate these associations while accounting for potential confounders. A total of 82,495 patients were assessed in this study. At 90days, patients of the laparoscopic colectomy cohort experienced a higher rate of complications than patients who underwent robotic-assisted colectomy (9.5 vs. 6.6%, p < 0.001). There were no significant differences in LOS (6 vs. 6.5days, p = 0.08) and readmissions (6.1 vs. 6.7%, p = 0.851) at 90days. Patients undergoing robotic-assisted colectomy have a lower risk for morbidity at 90days. Neither approach is superior for LOS nor 90days of readmissions. Both techniques are effective minimally invasive procedures, yet patients may gain a greater risk benefit from robotic colectomy.

Did COVID-19 impact national trends of hospitalization and outcomes for neutropenic fever in adults with cancer?

e18799 Background: Neutropenic fever (FN) is an oncologic emergency associated with significant morbidity and mortality. Patients on chemotherapy are at a higher risk of COVID-19-related complications. During the initial phase of the pandemic, healthcare systems were overwhelmed, resulting in shortage of resources and rationing of care. We aimed to assess the impact of the COVID-19 on trends of hospitalization and outcomes in adult emergency department (ED) visits for cancer-related FN in the US between 2019 and 2020. Methods: In this retrospective observational study using the National Emergency Department Sample of adults presenting to ED for cancer-related FN as primary diagnosis (using ICD-10-CM codes), we compared the outcomes between patients presenting in 2019 (pre-pandemic) and 2020. The primary outcome was mortality. Secondary outcomes were incidence of shock, discharge disposition, and length of stay (LOS). A propensity score matching was performed to estimate the effect of COVID-19 on outcomes. Results: There were a total of 95,163 visits to the ED for FN in 2019 and 2020. Both groups had similar demographics, with mainly White (68.1% vs 69.3%) patients presenting to large metropolitan areas (57.6% vs 58.6%) and mostly metropolitan teaching hospitals (74.5% vs 77.2%). More patients presenting in 2020 had a higher Elixhauser comorbidity index (66.6% vs 70.2% for comorbidity of ≥3; p = 0.0002). Although the number of patients who got admitted or died in the ED was similar in 2019 and 2020 (88.4% vs 87.8% for admission and 0.1% for death, p = 0.83), higher number died during their hospitalization (3.4% vs 4.4%, p = 0.002), and were likely to develop shock (6.0 vs 7.1%, p = 0.005) in 2020. More patients were discharged home with services (21.9% vs 17.1%, p &lt; 0.001), while fewer patients went to nursing homes (7.9% vs 8.5%, p &lt; 0.001) in 2020. There were no significant differences in LOS or cost of hospitalization. A propensity score matching was performed to estimate the effect of COVID-19 on outcomes showing higher mortality during hospitalization (13.7% vs 4.6%, p = 0.006) and increased LOS (6 days vs 5 days, p = 0.02) for patients with concurrent COVID-19. Conclusions: Overall, mortality related to FN was higher during the pandemic and more so among patients with concurrent COVID-19. While patients developing shock was higher in 2020, this was not attributable to COVID. Fewer patients were discharged to nursing homes, and more patients went home with services during the pandemic highlighting the constraints imposed on resources during the pandemic. [Table: see text]

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.

PO-01-019 PRE-OPERATIVE DISCONTINUATION OF NOVEL ORAL ANTICOAGULANTS IN CARDIOVASCULAR SURGERY: HOLD TIME IS ASSOCIATED WITH LENGTH OF STAY

Pre-operative discontinuation of novel oral anticoagulants (NOACs) in cardiovascular surgery (CVS) is necessary to reduce peri-operative bleeding risks. However, there is little data on optimal pre-operative hold times for these agents and their effect on the length of stay (LOS). A retrospective evaluation of the effect of pre-operative NOAC hold times (i.e. ≤2 or ≥3 days) with or without heparin bridging, on LOS (i.e. hospital and ICU). Baseline and follow-up clinical data were collected for consecutive CVS patients treated with NOACs at a single tertiary care centre (2013-2016). After calculations of bivariate associations and between-group differences, multivariate linear regression was used to evaluate the association between NOAC hold times and post-operative complications and LOS. In 107 patients (age= 73.6±7.7 years, 72.9% male, 83.2% Atrial Fibrillation history), NOACs hold times ranged from: ≤2 days (Group 1, n= 17), ≥ 3 days without heparin (Group 2, n= 63), and ≥3 days with heparin (Group 3, n= 27). Mean LOS were respectively 20.0 (25.8), 7.6 (4.12), and 13.6 (8.21) days post-operation (Group 1- Group 2= 12.4 days; p= 0.001). In contrast, length of ICU stays did not differ between groups (3.6, 1.9, 3.1 days in groups 1-3 respectively, p= 0.17). Aside from significantly higher LOS among patients with major bleeding (15.3 vs. 8.2 days, p= 0.01) or a bleeding episode (18.1 vs. 8.3 days, p= 0.01), there were no significant differences in LOS according to baseline comorbidities or other CVS complications. Multivariate linear regression model, adjusted for age, sex, NOACs and procedure type (elective versus emergent), indicated significantly shorter LOS when NOACs were held ≥3 days without heparin (Group 2) compared to ≤2 days pre-op (Group 2: b= -11.70 [-17.94, -5.46], p< 0.001, Adj. R2= 0.19). Despite trending towards lower LOS, group 3 (i.e. ≥3 days with heparin) was not associated with significantly lower LOS (Group 3: b= -5.24 [-12.09, 1.61], p= 0.13). These findings persisted even after additional adjustment for major bleeding (Group 2: b= -10.46 [-16.62, -4.31], p= 0.001, Adj. R2= 0.23) or postoperative bleeding episode (Group 2: b= -9.30 [-15.45, -3.15], p= 0.003, Adj. R2= 0.26). Compared to NOACs held ≤2 days before CVS, holding NOACs for ≥3 days before CVS without heparin bridging was independently associated with shorter LOS, even after adjustment for differences in major bleeding.

Benefits of an Early Mobility Program for Hospitalized Patients With Cancer.

Patients with cancer are often hospitalized with complications from cancer and cancer treatment. Many experience a decline in physical functioning, including loss of mobility, which likely contributes to increased length of stay (LOS) and increased readmissions. We aimed to determine whether a mobility program would improve quality of care and decrease health care utilization. We implemented a mobility aide program on an oncology unit in a large academic medical center for all patients without bedrest orders between October 1, 2018, and February 28, 2021. The program consisted of nursing evaluation using the Activity Measure for Post-Acute Care (AMPAC), an ordinal scale ranging from bed rest to ambulating ≥ 250 feet, to quantify mobility. Plan of care was determined in a multidisciplinary manner with physical therapy (PT), nursing, and a mobility aide, who is a medical assistant with enhanced rehabilitation training. Patients were then mobilized two times per day 7 days a week. Using descriptive statistics and mixed effects logistic regression, we evaluated the programs impact on LOS, readmissions, and changes in mobility during this time period compared with the 6-month interval before implementation. A total of 1,496 hospitalized patients were identified. The odds of hospital readmission within 30 days of discharge was significantly less for those who received the intervention (OR, 0.53; 95% CI, 0.37 to 0.78; P = .001). The odds ratio (OR) of having a final AMPAC score at or above the median was significantly higher for those who received the intervention (OR, 1.60; 95% CI, 1.04 to 2.45; P < .05). There was no significant difference in LOS. Use of this mobility program resulted in a significant decrease in readmissions and maintained or improved patients' mobility. This demonstrates that non-PT professionals can effectively mobilize hospitalized patients with cancer, thereby decreasing the burden on PT and nursing resources. Future work will evaluate the sustainability of the program and evaluate association with health care costs.

Effect of Perioperative Oral Vitamin C Supplementation on In-Hospital Postoperative Medication Costs for Cardiac Surgery Patients: A Prospective, Single-Centre, Randomised Clinical Trial.

Due to its antioxidant properties, vitamin C might be a promising and effective strategy for preventing postoperative atrial fibrillation (POAF) after cardiac surgery. This study was aimed at evaluating whether vitamin C supplementation is effective in reducing the cost of in-hospital postoperative medication used for patients undergoing coronary artery bypass (CABG) or valve surgery (±CABG). The primary goal of this study was to evaluate the impact of perioperative vitamin C supplementation in patients undergoing cardiac surgery on in-hospital postoperative medication costs, while secondary endpoints were the effects on length of stay (LOS) in both the intensive care unit (ICU) and the hospital, and the incidence of POAF. From November 2018 to January 2021, 253 patients planned for CABG or valve surgery (±CABG) in AZ Maria Middelares, Ghent, Belgium, and who met the inclusion criteria (≥18 years of age, all having cardiac sinus rhythm, and who provided written informed consent) were randomised into a placebo group or vitamin C group. The medication was administered orally (1g twice daily), starting from 5 days preoperatively until 10 days postoperatively. The medication used, LOS in the hospital/ICU, and development of clinically relevant POAF in the ICU were registered. Mean medication costs were €264.6±98.1 for patients in the vitamin C group and €294.9±267.3 for patients in the placebo group. When stratifying according to the type of surgery (CABG or valve surgery [±CABG]), these costs did not significantly differ. There was no significant difference in LOS or the incidence of clinically relevant POAF. Our data did not identify any short-term financial impact on postoperative medication costs after oral perioperative vitamin C supplementation (1g twice daily) for patients undergoing a CABG procedure or valve surgery (±CABG). No effect was found on the LOS or the incidence of clinically relevant POAF. Potential effects in the longer term, after intravenous administration of vitamin C or in other types of (cardiac) surgery, are still to be investigated. NCT03592680.

MP07-03 OBESITY IMPACTS ROBOTIC SACROCOLPOPEXY OUTCOMES

You have accessJournal of UrologyCME1 Apr 2023MP07-03 OBESITY IMPACTS ROBOTIC SACROCOLPOPEXY OUTCOMES Jessie Chen, Paige Kuhlmann, Alana Christie, Ramy Goueli, Philippe Zimmern, and Maude Carmel Jessie ChenJessie Chen More articles by this author , Paige KuhlmannPaige Kuhlmann More articles by this author , Alana ChristieAlana Christie More articles by this author , Ramy GoueliRamy Goueli More articles by this author , Philippe ZimmernPhilippe Zimmern More articles by this author , and Maude CarmelMaude Carmel More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003222.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Obesity is a known risk factor for pelvic organ prolapse (POP) and its prevalence has been increasing worldwide. Many obese women with POP seek treatment, and robotic sacrocolpopexy (RSC) is a gold standard for apical POP. We sought to investigate the impact of obesity on complication rates and clinical outcomes in women undergoing RSC at our institution. METHODS: IRB approval was obtained for this study. We reviewed the charts of all women who underwent RSC at our institution between December 2013 and September 2022 and compared women without obesity, those with class 1 obesity (BMI ≥30 and <35), and those with class 2 obesity or greater (BMI≥35). Patient characteristics included age, ASA score, and surgery performed. Outcomes assessed included operating time, estimated blood loss (EBL), length of stay (LOS), intra-operative complications, and readmission rates. Additional clinical characteristics evaluated included history of prolapse surgery, pre-operative POP-Q stage, and follow up time. Outcomes evaluated were POP recurrence beyond the hymen, sensation of bulge, further surgery for POP, and overall failure rate (composite of the last three outcomes mentioned). RESULTS: 166 non-obese and 60 obese women were included in our study. 39 patients had BMI ≥30 and <35; 21 had BMI ≥35. Obese patients were significantly younger than non-obese patients (p<0.0001). Patients with BMI≥35 were more likely to undergo a simultaneous SUI procedure (p=0.042). There were no significant differences in ASA score, type of RSC, or likelihood of having a concomitant rectopexy or other major procedure. There were no significant differences in LOS, intra-operative complications, EBL, operating time, or readmission rates between groups. There were no significant differences in length of follow up. Among patients with ≥6 months of follow up, none experienced recurrence of apical prolapse. Those with BMI≥35 were more likely to experience failure in the anterior or posterior compartment (p=0.0029) and need for additional surgery for POP (p=0.033). CONCLUSIONS: Obesity was not associated with higher EBL, operating time, intra-operative complications, or readmission rates. However, BMI≥35 was associated with higher failure rates and need for further surgery for POP. Source of Funding: Internal funding © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e85 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jessie Chen More articles by this author Paige Kuhlmann More articles by this author Alana Christie More articles by this author Ramy Goueli More articles by this author Philippe Zimmern More articles by this author Maude Carmel More articles by this author Expand All Advertisement PDF downloadLoading ...

Does Ending a Posterior Construct Proximally at C2 Versus C3 Impact Patient Reported Outcomes in Degenerative Cervical Myelopathy Patients up to 24months After the Surgery?

Retrospective cohort study. The primary objective was to evaluate the impact of the upper instrumented level (UIV) being at C2 vs C3 in posterior cervical construct on patient reported outcomes (PROs) up to 24months after surgery for cervical degenerative myelopathy (DCM). Secondary objectives were to compare operative time, intra-operative blood loss (IOBL), length of stay (LOS), adverse events (AEs) and re-operation. Patients who underwent a posterior cervical instrumented fusion (3 and + levels) with a C2 or C3 UIV, with 24months follow-up were analyzed. PROs (NDI, EQ5D, SF-12 PCS/MCS, NRS arm/neck pain) were compared using ANCOVA. Operative duration, IOBL, AEs, and re-operation were compared. Subgroup analysis was performed on patient presenting with pre-operative malalignment (cervical sagittal vertical axis ≥40mm and/or T1slope- cervical lordosis >15°). 173 patients were included, of which 41 (24%) had a C2 UIV and 132 (76%) a C3 UIV. There was no statistically significant difference between the groups for the changes in PROs up to 24months. Subgroup analysis of patients with pre-operative malalignment showed a trend towards greater improvement in the NDI at 12months with a C2 UIV (P = .054). Operative time, IOBL and peri-operative AEs were more in C2 group (P < .05). There was no significant difference in LOS and re-operation (P > .05). In this observational study, up to 24months after surgery for posterior cervical fusion in DCM greater than 3 levels, PROs appear to evolve similarly.

Impact of a hospital policy to redistribute admission flow across clinical services for capacity relief during COVID-19 surges.

Increased hospital admissions due to COVID-19 place a disproportionate strain on inpatient general medicine service (GMS) capacity compared to other services. To study the impact on capacity and safety of a hospital-wide policy to redistribute admissions from GMS to non-GMS based on admitting diagnosis during surge periods. Retrospective case-controlled study at a large teaching hospital. The intervention included adult patients admitted to general care wards during two surge periods (January-February 2021 and 2022) whose admission diagnosis was impacted by the policy. The control cohort included admissions during a matched number of days preceding the intervention. Capacity measures included average daily admissions and hospital census occupied on GMS. Safety measures included length of stay (LOS) and adverse outcomes (death, rapid response, floor-to-intensive care unit transfer, and 30-day readmission). In the control cohort, there were 365 encounters with 299 (81.9%) GMS admissions and 66 (18.1%) non-GMS versus the intervention with 384 encounters, including 94 (24.5%) GMS admissions and 290 (75.5%) non-GMS (p < .001). The average GMS census decreased from 17.9 and 21.5 during control periods to 5.5 and 8.5 during intervention periods. An interrupted time series analysis confirmed a decrease in GMS daily admissions (p < .001) and average daily hospital census (p = .014; p < .001). There were no significant differences in LOS (5.9 vs. 5.9 days, p = .059) or adverse outcomes (53, 14.5% vs. 63, 16.4%; p = .482). Admission redistribution based on diagnosis is a safe lever to reduce capacity strain on GMS during COVID-19 surges.