Significant Increase In Length Of Stay Research Articles

Canine Outcomes and Length of Stay in a Midwestern Shelter Affected by Breed Specific Legislation

Breed specific legislation (BSL) is intended to restrict or reduce the ownership of selected breeds of dogs within a municipality. These laws frequently aim at “bully breeds” such as the American Pit Bull Terrier and other pure or mixed breeds with similar phenotypic characteristics which are heavily represented in shelters nationwide. This study describes differences in outcomes and length of stay (LOS) for banned dogs versus dogs of other breeds in a managed admission municipal shelter subject to BSL. It was hypothesized that dogs subject to legislation would have fewer live outcomes and a longer LOS when compared to non-legislated dogs. Retrospective outcome data from 1/1/2022 through 12/31/2022 was analyzed. The study population included 764 adult dogs of which 118 were affected by legislation. The legislated and non-legislated groups were found to be demographically equivalent considering age group, sex, previous alteration status, and intake frequency, but legislated dogs had a significantly heavier body weight compared to non-legislated dogs. Initial Pearson Chi-Square testing revealed a statistically significant increase in euthanasia for legislated dogs and adoptions for non-legislated dogs. After controlling for body weight, there was a statistically significant increase in adoption for the non-legislated group, and increased return to owner (RTO) for legislated dogs, however there wasn’t a statistically significant difference in total live outcomes. Mann-Whitney U Testing demonstrated a statistically significant increase in LOS for legislated dogs compared to non-legislated dogs in the full study population, but after controlling for weight their LOS was no longer significantly different. In the body weight controlled group however, LOS was still significantly longer for legislated dogs versus non-legislated dogs with adoption and RTO outcomes. Euthanasia reasons were evaluated for 80 dogs whose first outcome was euthanasia. Pearson Chi Square testing showed legislated dogs in this group were no more likely to be euthanized for aggression than the non-legislated dogs. In this population, dogs subject to BSL were less likely to be adopted but more likely to RTO. It is suspected shelter staff prevented euthanasia of some legislated dogs through heightened efforts to facilitate RTO even though there was not a formal protocol in place to do so. After controlling for body weight, LOS was equivalent between legislated and non-legislated groups, although the legislated dogs did experience increased LOS before live outcomes. Importantly, legislated dogs were not significantly more likely to be euthanized due to aggressive behavior than non-legislated dogs in this population. These findings indicate that dogs targeted by BSL should be considered an at-risk group within the shelter population and shelters should endeavor to develop specific strategies to reduce LOS and provide best outcomes for these dogs. In many jurisdictions, overturning BSL could be a powerful approach to protecting this at-risk population.

Antipsychotic medications associated with increased length of hospital stay in autoimmune encephalitis and multiple sclerosis: A retrospective study

BackgroundAntipsychotic medications (APMs) and selective serotonin reuptake inhibitors (SSRIs) are frequently utilized in patients with neuroinflammatory disorders, such as autoimmune encephalitis and multiple sclerosis (MS). This retrospective study investigates how in-hospital treatment with APMs and SSRIs in patients with these neuroinflammatory diseases are associated with differences in hospital length-of-stay (LOS) and mortality. MethodsWe evaluated all the inpatients in the Stanford University Hospital from 2008 to 2023 diagnosed with either non-infectious encephalitis or MS and subdivided them into those who did or did not receive APMs or SSRIs while hospitalized. We then analyzed whether hospital LOS and mortality differed with these medications. ResultsAmong inpatients with non-infectious encephalitis (n = 114), those who were exposed to APMs had a significantly increased mean LOS (11.8 vs 20.9 days, p < 0.01). For inpatients with MS (n = 1095), treatment with an APM was associated with a significant increase in mean LOS (2.8 vs. 7.1, p < 0.00001). When comparing typical to atypical APMs given to subjects with MS, those who received atypical APMs showed a significant increase in LOS (4.3 vs 10.5, p < 0.01), although typical APMs showed significantly increased risk of mortality (p < 0.05). For inpatients with MS and SSRI use, there was a significant increase in mean hospital LOS (3.5 vs 5.3, p < 0.01), with a significant difference found in those who received fluoxetine or citalopram, but not sertraline or escitalopram. Finally, several healthcare disparities were found, including that Black patients were more likely to receive APMs, and those with MS were more likely to receive typical rather than atypical APMs. Conversely, Black patients with MS were less likely to receive SSRI treatment. ConclusionsThere was a statistically significant increase in LOS associated with APM use in non-infectious encephalitis and MS, as well as with SSRI use in MS. These data reflect the importance of these medications in these neuroinflammatory disorders and suggest that further investigation into their risks and benefits would be warranted.

Abstract HUP7: Impact of Social Determinants of Health and Academic Hospital Care on Outcomes After Non-Traumatic Subarachnoid Hemorrhage

Background: Growing evidence shows that SDOH and care setting affect ischemic stroke recovery. Impact on non-traumatic SAH is unclear. We studied SDOH and academic hospital influence on SAH outcomes. Methods: We conducted a retrospective study using data from the GWTG Stroke. All analyses were conducted using the Precision Medicine Platform. Hospitals partaking in this study obtained either human research approval for enrolment without patient consent or an IRB exemption. The exposures of interest were the Social Deprivation Index (SDI), the Adjusted Gross Income (AGI), and academic hospital care status. SDI and AGI were divided into three groups each, and care setting was labeled as academic or non-academic. Measured outcomes were: in-hospital death, length of stay (LOS), and discharge disposition (DD). We used regression with interaction terms to assess SDOH and care setting impact. Results: The study included 146,310 SAH patients (mean age 60, female sex 61%). Higher SDI was associated with longer LOS (unadjusted median days 11.1, 12.1 and 12.8) and worse DD (unadjusted risk 42.4%, 44%, 44.7%) (p &lt; 0.001). Lower AGI was associated with increased in-hospital mortality (15.9%, 15.5%, 15.1%) and worse DD (44.2%, 43.9%, 43.1%) (p &lt; 0.001). Academic hospital care demonstrated lower LOS (7.7±10.9 vs. 13.2±14.8, p &lt; 0.001), reduced in-hospital mortality (13.8% vs. 16%, p &lt; 0.001), and better DD (63.3% vs. 53.2%, p &lt; 0.001). Adjusted multivariate analysis confirmed these findings. In comparison to the first, for the third tertile of the SDI, the odds for having a good outcome discharge were 0.87 (95% CI 0.82-0.92, p &lt; 0.001). Additionally, SDI third tertile was associated with a significant increase in LOS (Beta 2.05; p=0.001). Higher AGI was correlated with reduced mortality (OR 0.90; 95% CI 0.83-0.96, p=0.004). Academic care was linked to lower in-hospital mortality (OR 0.89; 95% CI 0.81-0.98, p=0.029) and improved DD (OR 1.09; 95% CI 1.01-1.17, p=0.002). Interaction analysis revealed that academic care and higher AGI lead to synergistic reductions in LOS and better discharge outcomes (p&lt;0.05). Conclusion: This analysis of GWTG-Stroke highlights the significant independent and synergistic influence of SDOH and academic hospital care on outcomes following SAH

Abstract 17956: In Hospital Outcomes of Patients With Acute Coronary Syndrome With Underlying Immune Thrombocytopenia Purpura

Introduction: Acute coronary syndrome (ACS) represents a significant health burden worldwide. Immune thrombocytopenia (ITP), a condition characterized by low platelet due to immune-mediated destruction, has been associated with increased bleeding risk and altered hemostatic balance. This abstract aims to summarize a research study investigating the in-hospital outcomes of patients diagnosed with both ACS and underlying ITP, shedding light on the unique challenges posed by this comorbidity Methods: We queried the National Inpatient Sample (NIS) database from 2016 to 2020. The NIS was searched for hospitalization of adult patients with Acute Coronary Syndrome as a principal diagnosis with and without ITP as a secondary diagnosis using ICD-10 codes. The primary outcome was inpatient mortality .The secondary results were sepsis, acute kidney injury (AKI), Cardiogenic shock (CS), Cardiac arrest (CA), Total hospital charge (THC), pulmonary embolism (PE), and length of stay (LOS). Multivariate logistic and linear regression analysis were used accordingly to adjust for confounders. Results: About 1200515 patients were admitted for ACS, 0.19% (2225) had underlying ITP, Compared with those with ITP, there is statistically significant increase in LOS (8.85 vs 6.26, p&lt;0.004, IRR=1.16,), THC (161275.7 vs 116208.7, p&lt;0.003, IRR=31221.23,) and statistically significant decrease in cardiogenic shock (4.94% vs 5.94%,p&lt;0.039, OR=0.62, 95%CI 0.4-0.98). But there were no statistical significance in Death (13.93% vs 9.8%, p&lt;0.405, OR=1.13, 95%CI 0.84-1.51), sepsis (23.15% vs 18.0%, p&lt;0.728, OR=0.96, 95%CI 0.75-1.22), AKI (35.5% vs 46.52%, p&lt;0.395, OR=1.09, 95%CI 0.89-1.35), PE (2.7% vs 2.49%, p&lt;0.448, OR=0.78, 95%CI 0.41-1.47), and All_CA (13.03% vs 9.87%, p&lt;0.375, OR=1.29, 95%CI 0.73-2.3). Conclusions: These findings suggest that while ACS patients with underlying ITP may have certain differences in LOS, healthcare charges, and cardiogenic shock rates, they do not appear to be at significantly increased risk for mortality or other major complications. Additionally, the lower incidence of cardiogenic shock in the ITP group may indicate potential protective effects or differences in underlying pathophysiology, warranting further investigation

Risk Factors for Extubation Failure After Pediatric Cardiac Surgery and Impact on Outcomes: A Multicenter Analysis.

Extubation failure (EF) after pediatric cardiac surgery is associated with increased morbidity and mortality. We sought to describe the risk factors associated with early (< 48 hr) and late (48 hr ≤ 168 hr) EF after pediatric cardiac surgery and the clinical implications of these two types of EF. Retrospective cohort study using prospectively collected clinical data for the Pediatric Cardiac Critical Care Consortium (PC4) Registry. Pediatric patients undergoing Society of Thoracic Surgeons benchmark operation or heart transplant between 2013 and 2018 available in the PC4 Registry were included. We analyzed demographics and risk factors associated with EFs (primary outcome) including by type of surgery. We identified potentially modifiable risk factors. Clinical outcomes of mortality and length of stay (LOS) were reported. Overall 18,278 extubations were analyzed. Unplanned extubations were excluded from the analysis. The rate of early EF was 5.2% (948) and late EF was 2.5% (461). Cardiopulmonary bypass time, ventilator duration, airway anomaly, genetic abnormalities, pleural effusion, and diaphragm paralysis contributed to both early and late EF. Extubation during day remote from shift change and nasotracheal route of initial intubation was associated with decreased risk of early EF. Extubation in the operating room was associated with an increased risk of early EF but with decreased risk of late EF. Across all operations except arterial switch, EF portrayed an increased burden of LOS and mortality. Both early and late EF are associated with significant increase in LOS and mortality. Study provides potential benchmarking data by type of surgery. Modifiable risk factors such as route of intubation, time of extubation as well as treatment of potential contributors such as diaphragm paralysis or pleural effusion can serve as focus areas for reducing EFs.

Predicting length of stay for acute medical admissions in New Zealand: the MALICE score.

Predicting length of stay (LoS) in hospital can help guide patient placement, facilitate rapid discharge and aid identification of patients at risk of prolonged stay, in whom early multidisciplinary intervention is warranted. We aimed to pilot the applicability of a modified decision aid (MALICE score) for predicting LoS for acute medical admissions at a New Zealand hospital. A prospective pilot study of 220 acute general medical admissions was performed. Clinical records were reviewed and MALICE scores were calculated for each patient and compared with LoS data using the Kruskal-Wallis H test. A statistically significant increase in LoS was seen with rising MALICE scores (H value 26.85, P < 0.001). MALICE scoring could be employed to guide patient placement and identify patients at risk of prolonged stays, though further study of bedside feasibility and applicability is required.

The impact of psychiatric comorbidities on emergency general surgical patients’ outcomes

BackgroundPsychiatric disorders are increasingly prevalent. Studies have demonstrated that the presence of comorbid psychiatric conditions (CPC) is associated with a number of worsening outcomes in hospitalised patients in general. The relationship between a wide range of psychiatric comorbidities and acute surgical presentations has not been studied to date. Study designThe Hospital In-Patient Enquiry (HIPE) system and prospectively maintained eHandover were used to identify all surgical emergency admissions to Mayo University Hospital, Ireland. Patient demographics, comorbidities, primary diagnoses, length of stay (LoS), and procedures undergone were recorded over a 12-months period. Subgroup analyses examining LoS variation in surgical presentation types were performed. Results1028 admissions occurred over this one year period, amongst 995 patients, the presence of psychiatric comorbidities increased the mean LoS by 1.9 days (p = 0.002). Comorbid depression, dementia, and intellectual disability conferred a significant increase in LoS by 2.4 days, 2.8 days and 6.7 days respectively. Subgroup analysis revealed greater LoS in patients with CPC diagnosed with non-specific abdominal pain (1.4 days, p = 0.019), skin and soft tissue infections (2.5 days, p = 0.040), bowel obstruction (4.3 days, p = 0.047), and medical disorders (18.6 days, p = 0.010). No significant difference was observed in mortality and readmission rates. ConclusionPsychiatric comorbidities significantly impact length of hospital stay and discharge planning in surgical inpatients. Greater awareness of this can facilitate better care delivery for this population to reduce the LoS and subsequent economic burden on the healthcare system.

Implementation of a Multidisciplinary Preoperative Protocol for Geriatric Hip Fractures Improves Time to Surgery at a Level III Trauma Center.

Hip fractures are common among the elderly, and delays in time to surgery (TTS) and length of stay (LOS) are known to increase mortality risk in these patients. Preoperative multidisciplinary protocols for hip fracture management are effective at larger trauma hospitals. The purpose of this study is to evaluate the effect of a similar multidisciplinary preoperative protocol for geriatric hip fracture patients at our Level III trauma center. In this single-center retrospective study, patients aged 65 and older who were admitted from March 2016 to December 2018 (pre-protocol group, Cohort #1, n = 247) and from August 2021 to September 2022 (post-protocol group, Cohort #2, n = 169) were included. Demographic information, TTS, and LOS were obtained and compared using Student's t-test and Chi-square testing. There was a significant decrease in TTS in Cohort #2 compared to Cohort #1 (P < .001). There was a significant increase in LOS in Cohort #2 compared to Cohort #1 (P < .05), but when comparing a subset of Cohort #2 (Subgroup 2B, patients admitted from May to September 2022 when the effects of COVID-19 were likely dissipated) to Cohort #1, there was no significant difference in LOS (P = .13). For patients admitted to skilled nursing facilities (SNF), LOS in Cohort #2 was significantly longer than in Cohort #1 (P = .001). In general, Level III hospitals have fewer perioperative resources compared to larger Level I hospitals. Despite this fact, this multidisciplinary preoperative protocol effectively reduced TTS which improves mortality risk in elderly patients. LOS is a multifactorial variable, and we believe the COVID-19 pandemic was a significant confounder that reduced available SNF beds in our area which prolonged the average LOS in Cohort #2. A multidisciplinary preoperative protocol for geriatric hip fracture management can improve efficiency of getting patients to surgery at Level III trauma centers.

Does concomitant gout in septic arthritis affect surgical outcomes?

BackgroundWe aim to review and describe the proportion of patients with co-existing gout amongst patients with surgical treated septic arthritis, characterize their clinical presentation, outcomes and complications compared to patients with native joint septic arthritis. MethodsSixty-one patients with surgically treated primary joint septic arthritis were identified from the period of January 2011 to December 2016. There were 13 (21.3%) patients with co-existing septic arthritis and crystal proven gout. Pertinent details such as demographics, comorbidities, clinical features on presentation, infection markers, number of surgeries, length of stay (LOS) in general and individual LOS in supportive care units, limb amputations, readmissions and mortality were reviewed. Multiple linear and logistic regression models were used to control for confounders during analysis. ResultsThe average age of patients was 60.8 years (range: 23–87 years). The patients with gout are associated with comorbidities such as being hypertensive, hyperlipidemia and renal impaired. They tend to present with ankle joint involvement (46.2% vs 8.3%; p = 0.004) while septic arthritis patients without gout tend to present with knee joint involvement (75% vs 46.2%; p = 0.046). In terms of complications, up to two thirds of them require supportive care in the High Dependency Unit and/or Intensive Care Unit during treatment (61.5% vs 29.2%; p = 0.031) and having gout with septic arthritis independently predicted a significant increase in LOS by an additional 12.6 days on average (95% CI: 2.11 – 23.03; p = 0.019). They are also more likely to end up with limb amputation (23.1% vs 0%; p = 0.008) on univariate analysis. ConclusionGout accompanying septic arthritis in the same joint is potentially associated with major systemic and joint related sequela, complications in terms of prolonged hospital stay, need for complex care and risk for limb amputation. Our findings further indicate the value and need for well-designed prospective controlled cohort studies to explore the relationship between gout and septic arthritis

National recurrence of pancreatitis and readmissions after biliary pancreatitis.

National and international guidelines support early cholecystectomy after mild gallstone pancreatitis but a recent nationwide study suggested these recommendations are not universally followed. Our study sought to quantify the national utilization of same hospitalization cholecystectomy versus non-operative management (NOM) and its association with pancreatitis recurrence, readmissions, and costs after mild gallstone pancreatitis (GP). Adult patients admitted with mild GP were identified from the Nationwide Readmission Database 2010-2015. Primary outcomes included the rate of cholecystectomy during the index admission as well as pancreatitis recurrence and readmission at 30 and 180days (30d, 180d) comparing NOM to same hospitalization cholecystectomy. Mortality upon readmission, total length of stay (LOS), and total costs (combined index-readmission hospital costs) were also explored. Cox proportional hazards regression and generalized linear models controlled for patient/hospital confounders. Among the 65,067 patients identified, 30% underwent cholecystectomy. The NOM cohort was older (58 vs. 50years), had more comorbidities (Charlson index &gt; 2, 23.5% vs. 11.5%), fewer female patients (56.7% vs. 67%) and less discharge-to-home (84.9% vs. 94.4%) (all p &lt; 0.001). NOM was associated with increase in recurrence and unplanned readmissions at 30d [Hazard Ratio 3.53 (95% CI 2.92-4.27), 2.41 (2.11-2.74), respectively], and 180d [4.27 (3.65-4.98), 2.78 (2.54-3.04), respectively], as well as increased mortality during 180d readmission 1.88 (1.06-3.35). This approach was also associated with significant increase in LOS [predicted mean difference 2.79days (95% CI 2.46-3.12)] and total costs [$2507.89 ($1714.4-$3301.4)]. In the USA, most patients presenting with mild GP do not undergo same hospitalization cholecystectomy. This strategy results in higher recurrent pancreatitis, mortality during readmission, and an additional $4.85M/year in hospital costs nationwide. These data support same hospitalization cholecystectomy as the gold standard for mild GP.

Use of Phenobarbital to Treat Neonatal Abstinence Syndrome From Exposure to Single vs. Multiple Substances.

Drug use in pregnancy is a major public health issue. Intrauterine exposure to opioids alone or in addition to other substances may lead to neonatal abstinence syndrome (NAS). Little consensus exists on optimal therapy, especially for those exposed to multiple drugs. We aim to determine whether the use of opioids alone vs. in combination with phenobarbital will affect short-term neonatal outcomes. This retrospective review of infants admitted to the neonatal intensive care unit (NICU) included newborns ≥35 weeks of gestation exposed to opioids, or multiple substances including opioids, in utero. Treatment with opioids alone, and addition of phenobarbital as initial therapy vs. rescue, was evaluated. Out of 182 newborns, 54 (30%) were exposed to methadone alone vs. 128 (70%) to multiple drugs. Length of stay (LOS) in the hospital was not significantly affected (p = 0.684) by single vs. multiple drug exposure in utero. Treatment of NAS with opioid alone resulted in significantly shorter LOS (27 days), as compared to those treated with opioid and phenobarbital (45 days, p < 0.001). LOS was further prolonged in those treated with phenobarbital as a “rescue” medication in addition to an opioid (49 days, p < 0.0001). There was a significant increase in LOS and duration of opioid treatment for all infants treated with phenobarbital, both in those exposed to opioids alone, and to multiple substances in utero.

Impact of COVID-19 first wave on the in-hospital length of stay of operated proximal femur fracture patients in an industrial hospital in Eastern India.

Objective:The objective of this article is to study the impact of coronavirus disease 2019 (COVID-19) pandemic first wave on the in-hospital length of stay of operated proximal femur fractures.Materials and Methods:A retrospective analysis of data collected through the electronic record system of the hospital, after applying inclusion and exclusion criteria, was done. The data were collected from the pre-pandemic, early part first wave and later part first wave of COVID-19 pandemic to calculate the average preoperative stay (POS) and total length of stay (LOS) of operated proximal femur fracture patients. Also, a sub-analysis of POS and LOS was done as per age (male/female), sex (<60/≥60 years) and fracture subtype (intertrochanteric, neck of femur and subtrochanteric fracture) of the patients to study if any of these had a significant direct impact on the POS and LOS.Results:The LOS and POS were found to be significantly increased during early part of first wave of COVID-19 pandemic in comparison to the pre-pandemic era (13.6 ± 7.7 days vs. 11.1 ± 5.7 days). The later part of the first wave of the pandemic however saw the LOS and POS to return to near pre-pandemic values, although still remaining higher.Conclusion:The study highlights that unpreparedness during the early part of the unprecedented pandemic event leads to a significant increase in LOS of operated patients with its associated implications; however, prompt action by the government, hospital administration and hospital staff the LOS could be reduced to near pre-pandemic values in the later part of the first wave of the pandemic. Analysis of the causes that lead to a significant increase in LOS can help for better future management of similar events in future.

Preexisting opioid use disorder is associated with poor outcomes in hospitalized acute pancreatitis patients.

Although opioids are widely used for pain management in acute pancreatitis, the impact of opioid use disorder (OUD) on outcomes in patients with acute pancreatitis remains unknown. In the current study, we aimed to evaluate the impact of the OUD on outcomes in patients hospitalized with acute pancreatitis and delineate the trends associated with OUD and acute pancreatitis using a nationally representative sample. This is a retrospective cohort study of patients with acute pancreatitis using the combined releases of the year 2005-2014 of the National (Nationwide) Inpatient Sample (NIS) database. Patients over the age of 18 years with a principal diagnosis of acute pancreatitis were divided into cohorts of patients with opioid use disorders and those without. The primary measured outcome was in-hospital mortality and secondary outcomes were healthcare utilization measures, including length of stay (LOS) and hospitalization costs. A total of 2 593 831 hospitalizations of acute pancreatitis were included; of which, 37 849 (1.46%) had a secondary diagnosis of OUD. Total acute pancreatitis-related hospitalizations increased from 237 882 in 2005 to 274 006 in 2014. At the same time prevalence of OUD in acute pancreatitis patients also increased from 1 to 2.1%. Patients with OUD had significantly increased mortality as compared to patients without OUD (aOR: 1.4; P < 0.001). At the same time, acute pancreatitis patients with OUD were associated with 1.3 days longer LOS as compared to other acute pancreatitis patients (P < 0.001]. The mean adjusted difference in total hospitalization costs was $2353 (P < 0.001). OUD is associated with a significant increase in LOS, healthcare utilization cost and in-hospital mortality in patients admitted for acute pancreatitis. Therefore, clinicians should exercise caution in prescribing opioid medications to this high-risk patient population and other modalities such as nonopioid pain medications should be tried as alternatives to opioid analgesics.

Impact of psychiatric comorbidities on emergency surgical patients’ outcomes

AimsPsychiatric disorders are increasingly prevalent and present as a comorbidity in many hospitalized patients. Studies have demonstrated that the presence of comorbid psychiatric conditions (CPC) is associated with worsened inpatient outcomes. Emergency surgical admissions and the impact of CPC on their outcomes has not been studied in Ireland to date. This study aims to provide a comprehensive analyses of the relationship between a wide range of psychiatric comorbidities and surgical presentations.MethodThe Hospital In-Patient Enquiry (HIPE) and prospectively maintained electronic patient records were used to identify all surgical emergency admissions between 31st August 2019 and 1st September 2020 to Mayo University Hospital, Ireland. Patient demographics, comorbidities, primary diagnoses, length of stay (LoS), discharge destination, and surgical interventions were recorded. Subgroup analyses were performed examining LoS variation in the type of surgical presentation. Physical comorbidities were scored using the Charlson Comorbidity Index (CCI). Statistical calculations were performed using SPSS.ResultA total of 995 admissions were recorded. The presence of CPC increased the overall mean LoS by 1.9 days (p = .002). This trend was observed in both operative and conservative management. Significant increase in LoS was noted in patients with a comorbid depression (2.4 days, p = .003), dementia (2.8 days, p = .019), and intellectual disability (6.7 days, p = .007). Subgroup analysis revealed greater LoS in patients with CPC diagnosed with non-specific abdominal pain (1.4 days, p = .019), skin and soft tissue infections (2.5 days, p = .040), bowel obstruction (4.3 days, p = .047), and medical disorders (18.6 days, p = .010). The odds of nursing home or convalescence as a discharge destination was 2.44 (95% CI: 1.37–4.35, p = 0.002) in patients with CPC and the odds of self-discharge against medical advice in this population was 4.89 (95% CI: 1.43–16.70, p = 0.005). No significant difference was observed in mortality and readmission rates.ConclusionPsychiatric comorbidities significantly impact length of hospital stay and influence discharge planning in surgical inpatients. Greater vigilance is required in providing care for patients with psychiatric comorbidities, particularly those with depression, dementia and intellectual disability. Better optimisation of facilities and a more personalised approach to patients with CPC are required to improve inpatient outcomes and resource allocation.

727. Outcomes of Antibiotic Use in Ischemic Colitis

BackgroundIschemic colitis (IC) is caused by inadequate blood flow to the colon. Most cases resolve with conservative management. Isolated right-sided colitis, peritonitis, shock, and vascular risk factors are predictors of severe disease which can be life-threatening and require surgery. Current guidelines recommend antibiotics for moderate/severe disease. This is based on results from animal models and concern for gut translocation of bacteria; there have been no comparative studies in humans. This study aims to evaluate whether there is benefit to antibiotic use in non-severe IC.MethodsThis is a single-center retrospective cohort study of adult patients hospitalized with IC from 2015-2018. Inclusion in the study required endoscopic, radiologic, operative, or histologic evidence of ischemic colitis. Patients were divided into mild/moderate and severe IC cohorts as per 2014 American College of Gastroenterology Guidelines. Primary outcomes were length of stay (LOS) and any adverse event, which is defined as a composite measure of pre-specified secondary outcomes including mortality, need for surgery, 1-year relapse, and bacteremia.ResultsOf 191 patients enrolled in the study, 130 had mild/moderate IC and 61 had severe IC. In mild/moderate IC groups there was no significant difference in total adverse events, although use of antibiotics was associated with a significant increase in LOS (Table 1). In the severe IC groups there was no significant difference in any primary outcomes, but mortality was lower at 3 and 6 months among patients who did not receive antibiotics.Table 1 ConclusionAntibiotics did not improve outcomes in mild/moderate IC, suggesting that conservative management may be sufficient in this group. Antibiotic use was associated with increased LOS in mild/moderate IC and with increased mortality in severe IC; it is not clear whether these associations are true antibiotic-mediated adverse effects or whether they simply reflect a tendency to use antibiotics more frequently in patients who are more unstable. Future prospective research is needed to establish clear guidelines for antibiotic indications, agent selection, and optimal treatment duration.Disclosures All Authors: No reported disclosures

Abstract 14045: The Incidence and Associated Risk Factors of New-onset Atrial Fibrillation in the Medical Intensive Care Unit

Introduction: New-onset AF (NOAF) in the medical ICU is associated with worse patient outcomes. The research on NOAF in this setting compared to that in the post-cardiothoracic and non-cardiac surgery patients is not as robust. For example, a 2019 literature review found that the reported incidence of NOAF in the medical ICU ranges between 1.7% and 43.9%. This retrospective single-center observational study examines the incidence and associated risk factors of this relatively understudied population. Methods: The total study population is comprised of 2682 consecutive patients with medical ICU stays in 2018. Post-operative patients as well as patients with preexisting AF were excluded. ICD-10 codes were used in conjunction with i2b2 to identify patients. Manual chart review confirmed those with NOAF during a 2018 ICU stay. These patients were compared with a control group comprised of 106 randomly-selected patients from the study population. Demographics and diagnoses were collected, along with length of stay (LOS), mortality at discharge and mortality after one year. Results: 90 patients of the 2682 patient cohort (3.4%) developed NOAF during their ICU stay. Patients with NOAF were more likely to be older (67.7 vs. 56.5 years), have hypertension (75.6% vs. 62.3%) and have peripheral vascular disease (41.1% vs. 26.4%) compared to the control group. More importantly, NOAF was associated with an increased LOS of 16.5 days relative to 9.6 days in the control group. No significant difference was found in mortality between the two groups. The results of this preliminary analysis are summarized in Table 1 . Conclusions: We found the incidence of NOAF in patients admitted to the medical ICU was 3.4%, and NOAF was associated with a significant increase in LOS. Upon completion of data extraction and multivariate analysis for the entire study population, we hope that this study will contribute to our understanding of the significance of NOAF in critically ill patients.

Length of Stay in Patients With Central Line-Associated Bloodstream Infection at a Tertiary Hospital in the Kingdom of Saudi Arabia.

ObjectiveTo examine the impact of central line-associated bloodstream infection (CLABSI) on hospital length of stay (LOS) and to identify the factors associated with prolonged LOS.MethodsThe research setting was King Saud University Medical City (KSUMC) in Riyadh, Kingdom of Saudi Arabia. A retrospective cohort design was applied with a sample of adult CLABSI patients. Patients developed CLABSI following central line insertion at KSUMC between March 2016 and February 2018.ResultsThe CLABSI-related prolongation of LOS was 13.13 ± 9.53 days for a total of 283 patients. This figure rose for patients with any CLABSI-related sequela, and the result was statistically significant (p<0.033). It was also significantly higher in patients with delayed central line removal (p<0.001). A patient’s setting (i.e., in the intensive care unit prior to or following infection) was not a factor associated with prolonged LOS. Nevertheless, the requirement for inotropes after the infection was linked to prolonged LOS in a statistically significant way (p<0.048).ConclusionsFor ill patients who need hemodynamic support following infection, CLABSI can significantly increase hospital LOS. Delayed decisions or slow central line removal are associated with significant increases in LOS.

Epidural Analgesia Is Associated with Prolonged Length of Stay After Open HPB Surgery in Over 27,000 Patients

BackgroundThe impact of epidural analgesia (EA) on postoperative morbidity and length of stay (LOS) after HPB surgery remains to be determined. These specific outcomes have been highlighted by the implementation of multiple enhanced recovery pathways (ERAS). The authors hypothesized that EA in the current environment may be associated with LOS and other outcomes. MethodsThe American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) databases from 2014 to 2017 for patients undergoing open hepatopancreaticobiliary (HPB) surgery were included in a retrospective cohort analysis with propensity score matching (PSM) comparing EA with control. ResultsTwenty-seven thousand two hundred eighteen patients underwent open HPB surgery, of which 6048 (22%) received EA. There was an increase use of EA over time (from 19.3 to 25.5%, p = 0.001). On PSM, EA was associated with more than half of a day increase in LOS for both pancreatic (p < 0.001) and hepatic surgery (p < 0.001). Furthermore, for pancreatic surgery, there was an increase in urinary tract infection (2.5% vs. 3.3%, p = 0.018), time to drain removal (7.8 vs. 8.7 days, p < 0.001), and discharge to rehabilitation (2.9% vs. 4.3%, p = 0.029). For hepatic surgery, there was an increase in blood transfusion requirements (17% vs. 20%, p = 0.019). There were no differences in overall morbidity and mortality. ConclusionIn this cohort of over 27,000 patients with granular surgical details, there was a significant increase in LOS associated with EA after HPB surgery, along with increased procedure-specific UTI and blood transfusion. With the ever-increasing need for standardized and efficient patient care pathways that reduce LOS, alternative analgesic adjuncts may be considered to optimize patient outcomes.

Epidural Analgesia Is Associated With Prolonged Length Of Stay After Open Hpb Surgery In Over 27,000 Patients

The impact of epidural analgesia (EA) on postoperative morbidity and length of stay (LOS) after HPB surgery remains to be determined. These specific outcomes have been highlighted by the implementation of multiple enhanced recovery pathways (ERAS). The authors hypothesized that EA in the current environment may be associated with LOS and other outcomes. The American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) databases from 2014 to 2017 for patients undergoing open hepatopancreaticobiliary (HPB) surgery were included in a retrospective cohort analysis with propensity score matching (PSM) comparing EA with control. Twenty-seven thousand two hundred eighteen patients underwent open HPB surgery, of which 6048 (22%) received EA. There was an increase use of EA over time (from 19.3 to 25.5%, p = 0.001). On PSM, EA was associated with more than half of a day increase in LOS for both pancreatic (p < 0.001) and hepatic surgery (p < 0.001). Furthermore, for pancreatic surgery, there was an increase in urinary tract infection (2.5% vs. 3.3%, p = 0.018), time to drain removal (7.8 vs. 8.7 days, p < 0.001), and discharge to rehabilitation (2.9% vs. 4.3%, p = 0.029). For hepatic surgery, there was an increase in blood transfusion requirements (17% vs. 20%, p = 0.019). There were no differences in overall morbidity and mortality. In this cohort of over 27,000 patients with granular surgical details, there was a significant increase in LOS associated with EA after HPB surgery, along with increased procedure-specific UTI and blood transfusion. With the ever-increasing need for standardized and efficient patient care pathways that reduce LOS, alternative analgesic adjuncts may be considered to optimize patient outcomes.

Trends in Post-Heart Transplant Biopsies for Graft Rejection versus Non-Rejection

Purpose With alternatives to surveillance endomyocardial biopsies (EMBs) post-orthotopic heart transplant (OHT) now available (such as gene expression profiling), we evaluated the current utilization of EMBs for hospitalized patients post-OHT. Both surveillance EMBs (in patients without complications) and in the setting of graft complications were evaluated. Methods The 2004-2014 National Inpatient Sample database was used to assess trends of inpatient EMB (ICD-9 code 37.25) in OHT patients (ICD-9 V42.1, excluding the transplant procedure itself). ICD-9 996.83 was used to identify OHT complications including rejection. Annual trends in in-hospital mortality, length of stay (LOS), and cost of care were determined. Results There was no significant change in the number of EMBs performed over the study period (p=0.44). Of 37,955 EMBs, 2283 (6%) were in the setting of OHT complications. EMBs in OHT complications did not showed a significant increase in LOS (p=0.06), but had a significant increase in cost over time (P=0.001) (Fig 1). However, LOS on average was 5 days longer (p<0.001) and $88,816 higher cost compared to hospitalizations in non-complication EMB (p<0.001). In-patient mortality decreased over time for both groups (p<0.001), with higher odds of inpatient mortality with OHT complications (odds ratio 1.87; 95%CI, 1.70-2.05). Conclusion The vast majority of in-hospital EMBs were not related to OHT complications. Nevertheless, EMB hospitalizations with OHT complications including rejection showed significantly greater LOS and cost compared to those without complications. Furthermore, cost has increased over the study period. With alternatives to surveillance endomyocardial biopsies (EMBs) post-orthotopic heart transplant (OHT) now available (such as gene expression profiling), we evaluated the current utilization of EMBs for hospitalized patients post-OHT. Both surveillance EMBs (in patients without complications) and in the setting of graft complications were evaluated. The 2004-2014 National Inpatient Sample database was used to assess trends of inpatient EMB (ICD-9 code 37.25) in OHT patients (ICD-9 V42.1, excluding the transplant procedure itself). ICD-9 996.83 was used to identify OHT complications including rejection. Annual trends in in-hospital mortality, length of stay (LOS), and cost of care were determined. There was no significant change in the number of EMBs performed over the study period (p=0.44). Of 37,955 EMBs, 2283 (6%) were in the setting of OHT complications. EMBs in OHT complications did not showed a significant increase in LOS (p=0.06), but had a significant increase in cost over time (P=0.001) (Fig 1). However, LOS on average was 5 days longer (p<0.001) and $88,816 higher cost compared to hospitalizations in non-complication EMB (p<0.001). In-patient mortality decreased over time for both groups (p<0.001), with higher odds of inpatient mortality with OHT complications (odds ratio 1.87; 95%CI, 1.70-2.05). The vast majority of in-hospital EMBs were not related to OHT complications. Nevertheless, EMB hospitalizations with OHT complications including rejection showed significantly greater LOS and cost compared to those without complications. Furthermore, cost has increased over the study period.