Surgical Admissions Research Articles

The role of variant anatomy in neurosurgery

Variants of atypical structure and location of anatomical structures always complicate the course of surgical access and admission and are often the causes of surgical errors and complications. This article presents an overview of some features of variant anatomy in areas of interest to neurosurgeons, including those leading to the development of intraoperative problems and postoperative neurological deficits.The main message of the article is not only that neurosurgeons should plan surgery taking into account individual anatomical variability starting with the shape of the skull, but also that in cases of adverse perioperative events, atypical anatomy should be taken into account as an objective risk factor and have a mitigating value in the evaluation of the neurosurgeon’s performance.The aim of this paper is to present and analyse scientific publications on variant anatomy, determining its role in the development of surgical errors and complications in neurosurgery.

Effects of Trauma Center Consolidation on Adult Trauma at a Rural Level 1 Trauma Center.

The aim was to determine the impact of consolidation of two rural level 1 trauma centers on adult trauma patients presenting to the remaining level 1 trauma center. To our knowledge, a study assessing the impact of trauma center consolidation on adult trauma patients had yet to be performed. A single institution, retrospective study was conducted at a rural level 1 trauma center. Adult trauma patients who presented to our center from January 2017 to January 2022 were included. The cohorts spanned 33 months pre- and post-consolidation. Multiple demographic and outcome measures were gathered. Data were analyzed using the student's t-test and Chi-squared testing. There was a 33% increase in overall trauma activations and 9% increase in transfers from outside facilities post-consolidation. The post-consolidation group was significantly older, had higher mean injury severity score, and decreased hospital-free days. The post-consolidation group also saw an increase in ICU admission and surgical intervention. While there were no significant differences in ICU-free days or ventilator days, patients in the post-consolidation group with the highest level of activation who required both surgical intervention and ICU admission experienced decreased mortality. The consolidation of trauma services to a single level 1 trauma center in a rural Appalachian health system led to higher trauma volume and acuity, but most importantly decreased mortality for the most severely injured trauma patients.

Indications for Readmission for Small Bowel Obstruction: A Comparison of Medical vs Surgical Service Admission.

Small bowel obstruction (SBO) impacts the health care system and patient quality of life. Previously, we evaluated differences between medical and surgical admissions in the management of SBO. This study investigates indications for readmission based on original admission to medical (MS) or surgical services (SS). A retrospective chart review was performed for 799 patients aged 18 to 89 admitted between 2012 and 2019 with a diagnosis of SBO. Patient characteristics examined included length of stay (LOS), prior abdominal operations, prior SBO, use of small bowel follow through imaging, operative intervention, mortality, and 30-day readmission. There was no difference in readmission rates in patients originally admitted to MS or SS (13.2% vs 12.7%, P = .86). Patients admitted to SS were more likely to be readmitted for recurrent SBO (39% vs 8.6%, P = .006). Patients admitted to MS were more likely to be readmitted for other reasons (73.9% v. 40.2%, P = .004). In the MS cohort, 30.4% (7 patients) had surgery during their initial admission for SBO, and none of those patients were readmitted for recurrent SBO (rSBO). In the SS cohort, 23% had surgery during their initial admission and 31.6% were readmitted for rSBO (P = .002). Patients admitted to SS were more likely to be readmitted for rSBO and to require surgery. Patients admitted to MS were more likely to be readmitted for other reasons. None of the MS patients who had surgery were readmitted for SBO. 31.6% of SS patients who had surgery were readmitted for SBO.

Socioeconomic Influences on Outcomes Following Congenital Heart Disease Surgery.

Associations between social determinants of health (SDOH) and adverse outcomes for children with congenital heart disease (CHD) are starting to be recognized; however, such links remain understudied. We examined the relationship between community-level material deprivation on mortality, readmission, and length of stay (LOS) for children undergoing surgery for CHD. We performed a retrospective cohort study of patients who underwent cardiac surgery at our institution from 2015 to 2018. A community-level deprivation index (DI), a marker of community material deprivation, was generated to contextualize the lived experience of children with CHD. Generalized mixed-effects models were used to assess links between the DI and outcomes of mortality, readmission, and LOS following cardiac surgery. The DI and components were scaled to provide mean differences for a one standard deviation (SD) increase in deprivation. We identified 1,187 unique patients with surgical admissions. The median LOS was 11days, with an overall mortality rate of 4.6% and readmission rate of 7.6%. The DI ranged from 0.08 to 0.85 with a mean of 0.37 (SD 0.12). The DI was associated with increased LOS for patients with more complex heart disease (STAT 3, 4, and 5), which persisted after adjusting for factors that could prolong LOS (all p < 0.05). The DI approached but did not meet a significant association with mortality (p = 0.0528); it was not associated with readmission (p = 0.36). Community-level deprivation is associated with increased LOS for patients undergoing cardiac surgery. Future work to identify the specific health-related social needs contributing to LOS and identify targets for intervention is needed.

Emergency department utilisation and treatment for trauma-related presentations of adolescents aged 16–18: a retrospective cross-sectional study

BackgroundA recent study conducted at our tertiary hospital emergency department (ED) reviewed ED consultations and found that adolescents aged 16–18 years present significantly more often for trauma and psychiatric problems than adults over 18 years. Accidental injuries are one of the greatest health risks for children and adolescents. In view of the increased vulnerability of the adolescent population, this study aimed to further analyse trauma-related presentations in adolescents.MethodsWe conducted a single-centre, retrospective, cross-sectional study of all adolescent trauma patients aged 16 to 18 years presenting to the adult ED at the University Hospital (Inselspital) in Bern, Switzerland, from January 2013 to July 2017. We analysed presentation data as well as inpatient treatment and cost-related data. Data of female and male patients were compared by univariable analysis. A comparison group was formed consisting of 200 randomly chosen patients aged 19–25 years old with the same presentation characteristics. Predictive factors for surgical treatment were obtained by multivariable analysis.ResultsThe study population included a total of 1,626 adolescent patients aged 16–18 years. The predominant causes for ED presentation were consistent within case and comparison groups for sex and age and were sports accidents, falls and violence. Male patients were more likely to need surgical treatment (OR 1.8 [95% CI: 1.2–2.5], p = 0.001) and consequently inpatient treatment (OR 1.5 [95% CI: 1.1–2.1], p = 0.01), associated with higher costs (median 792 Swiss francs [IQR: 491-1,598]). Other independent risk factors for surgical treatment were violence-related visits (OR 2.1 [95% CI: 1.3–3.5, p = 0.004]) and trauma to the upper extremities (OR 2.02 [95% CI: 1.5–2.8], p < 0.001). Night shift (OR 0.56 [95% CI: 0.37–0.86], 0.008) and walk-in consultations (OR 0.3 [95% CI: 0.2; 0.4, < 0.001] were preventive factors for surgical treatment.ConclusionsMale adolescents account for the majority of emergency visits and appear to be at higher risk for accidents as well as for surgical treatment and/or inpatient admission due to sports accidents or injuries from violence. We suggest that further preventive measures and recommendations should be implemented and that these should focus on sport activities and injuries from violence.

Early and long-term outcomes following cardiac surgery for patients with heterotaxy syndrome

ObjectiveHeterotaxy syndrome is a complex multisystem abnormality historically associated with high morbidity and mortality. We sought to evaluate the early and long-term outcomes after cardiac surgery in heterotaxy syndrome. MethodsThis is a single-center retrospective review of patients with heterotaxy syndrome undergoing single-ventricle palliation or primary or staged biventricular repair from 1998 to 2018. Patients were stratified by single ventricle versus biventricular physiology, and the severity of atrioventricular valve regurgitation. Demographics, anatomic characteristics, and early and late outcomes, including the length of stay, mortality, and surgical or catheter reinterventions, were analyzed. ResultsAmong 250 patients, 150 (60%) underwent biventricular repair. In-hospital mortality was 7.6% (n = 19). Median follow-up was 5.2 (range, 0-16) years. Among survivors to discharge, mortality was 19% (n = 44) and reintervention was 52% (n = 120). Patients with moderate/severe atrioventricular valve regurgitation were older (32 vs 16 months, P = .02), were more likely to experience adverse events during their index surgical admission (72% vs 46%, P < .001), and had longer in-hospital length of stay (20 vs 12 days, P = .009). Among patients with moderate to severe atrioventricular valve regurgitation, single-ventricle palliation is associated with a greater risk of unplanned reintervention compared with patients undergoing biventricular repair (hazard ratio, 2.13; CI, 1.10-4.12; P = .025). ConclusionsThere was no significant difference in early or late outcomes in single-ventricle versus biventricular repair strategies in heterotaxy. In the subgroup of patients with moderate/severe atrioventricular valve regurgitation, patients who underwent single-ventricle palliation were 2.5 times more likely to need a late reintervention compared with those undergoing biventricular repair.

Ileo-ileal knot causing acute gangrenous small bowel obstruction: a case report

BackgroundIleo-ileal knotting is a very rare cause of small bowel obstruction, and only a few reports have been published. Small bowel obstruction (SBO) is one of the most common emergency surgical conditions that require urgent evaluation and treatment and is one of the leading causes of emergency surgical admission. There are many causes of SBO that are known in general surgical practice, and these causes are different in the developing and developed worlds.Clinical presentationIn this article, we present a case of acute gangrenous SBO secondary to ileo-ileal knotting in a 37-year-old Ethiopian female patient after she presented with severe abdominal cramp, vomiting, and abdominal distension of 4 hours duration. The patient was operated on intraoperatively; she had gangrenous small bowel obstruction caused by ileo-ileal knotting. Later, the patient was discharged and improved after 12 days of hospital stay.ConclusionIleo-ileal knotting should always be considered in the differential diagnosis of acute small-bowel obstruction. The diagnostic difficulty and the need for urgent treatment of this condition to yield optimal results are discussed.

RECONSTRUCTION OF ORBITAL FLOOR FRACTURES USING SILICONE BLOCK IMPLANT

Abstract&#x0D; Introduction &amp; Objectives : It has long been a controversial-both the materials for orbital floor reconstruction and the timing of surgery. Silicone block implant is affordable and readily available especially in developing countries. Due to its complications and the development of other materials, silicone block implant has rarely been used. This study aims to evaluate the outcomes of timing of surgery and the use of silicone block implant in orbital floor fractures reconstruction.&#x0D; Methods : We conducted a retrospective review of patients who had orbital floor fractures and undergone reconstruction surgery using silicone block implant in Cipto Mangunkusumo Hospital from January 2017 to December 2021. These patients then divided into three groups based on their surgery interval time. Outpatient notes, Computed Tomography (CT) reports, surgical admission notes, records and complications were recorded. Patients with follow-up less than three months were excluded.&#x0D; Results : Thirty-one patients were included (23 males, 8 females) with age 18-60 years old being dominant. Thirty (96.8%) patients had unilateral fractures, 23 patients (74.2%) came with impure fractures, and fractures mostly caused by traffic accidents (83.9%). Subconjunctival bleeding and eyelid abnormalities were found as the majority of ocular involvement. Symptoms with the greatest improvement were different between three groups based on surgery interval time. Besides, only one extruded implant was found.&#x0D; Conclusion : Silicone block implant provides good outcomes with minimal complications even after late surgical repair of orbital floor fractures.

What is an enhanced recovery patient?

The use of enhanced recovery protocols (ERP) in surgery delivers standardized, repeatable, and measurable care that improves clinical outcomes for patients. These pathways address the surgical care episode, from preoperative surgical readiness, during the surgical admission, until after discharge. Standardized pathways have been well-studied in adults, and emerging data in children show promise. However, data reporting has been targeted toward specific study populations and may be a barrier to broader pathway implementation. In this review, we discuss implementation of pediatric ERPs, examine outcome studies and published inclusion and exclusion criteria, and describe strategies for broader implementation of pediatric ERPs.

Impact of telehealth postoperative care on early outcomes following esophagectomy

ObjectivesTo address the short-term clinical outcomes of patients postesophagectomy who underwent telehealth care following surgery. The primary objective was to compare the frequency of emergency department admission between telehealth and in-person cohorts. Secondary objectives included comparing the frequency of endoscopies and clinic visits, as well as reasons for emergency department admission. MethodsWe conducted a retrospective cohort study to assess the clinical outcomes of patients who underwent esophagectomy between March 2018 and May 2022. Patients attending telehealth (phone or video call) surgical follow-up visits, largely due to the COVID-19 pandemic, were compared with a pre-COVID cohort of patients attending standard in-person care. Demographic data, clinical and disease characteristics, and hospital visit data within 6 months of operation were collected. This included surgical clinic visits, endoscopies, and emergency department admissions. ResultsThere were 168 patients who underwent esophagectomy and had follow-up care between March 2018 and May 2022; 76 telehealth and 92 in-person. Patients attending telehealth appointments had significantly fewer emergency department admissions (0.45 vs 0.79, P = .037) and more endoscopy visits (1.37 vs 0.91, P = .020) compared with patients attending in-person visits. The number of follow-up surgical clinic visits did not differ between the groups. The most frequent reasons for emergency visits for the telehealth cohort included dysphagia, feeding-tube problems, and failure to thrive. For the in-person cohort, feeding-tube complications, inflammation/infection, and failure to thrive were the most common reasons. ConclusionsA program of virtual follow-up, with integrated in person visits and endoscopy as required, is feasible and safe for following patients postesophagectomy.

Achieving equity: patient demographics and outcomes after surgical and non-surgical procedures in South Australia, 2022.

Although modern Australian healthcare systems provide patient-centred care, the ability to predict and prevent suboptimal post-procedural outcomes based on patient demographics at admission may improve health equity. This study aimed to identify patient demographic characteristics that might predict disparities in mortality, readmission, and discharge outcomes after either an operative or non-operative procedural hospital admission. This retrospective cohort study included all surgical and non-surgical procedural admissions at three of the four major metropolitan public hospitals in South Australia in 2022. Multivariable logistic regression, with backwards selection, evaluated association between patient demographic characteristics and outcomes up to 90 days post-procedurally. 40 882 admissions were included. Increased likelihood of all-cause, post-procedure mortality in-hospital, at 30 days, and 90 days, were significantly associated with increased age (P < 0.001), increased comorbidity burden (P < 0.001), an emergency admission (P < 0.001), and male sex (P = 0.046, P = 0.03, P < 0.001, respectively). Identification as ATSI (P < 0.001) and being born in Australia (P = 0.03, P = 0.001, respectively) were associated with an increased likelihood of 30-day hospital readmission and decreased likelihood of discharge directly home, as was increased comorbidity burden (P < 0.001) and emergency admission (P < 0.001). Being married (P < 0.001) and male sex (P = 0.003) were predictive of an increased likelihood of discharging directly home; in contrast to increased age (P < 0.001) which was predictive of decreased likelihood of this occurring. This study characterized several associations between patient demographic factors present on admission and outcomes after surgical and non-surgical procedures, that can be integrated within patient flow pathways through the Australian healthcare system to improve healthcare equity.

Portomesenteric gas in acute mesenteric ischemia - A defoliate tree appearance

Acute mesenteric ischemia (AMI) is an uncommon life-threatening emergency in all acute surgical admissions with reported incidence rates of only 0.09-0.2% and a high mortality rate, ranging 30-90% [1,2]. In elderly people, its incidence is rising up to 10% [3-5].

Ketamine for Primary Analgosedation in Critically Ill Surgery and Trauma Patients Requiring Mechanical Ventilation.

Evaluate effectiveness and safety outcomes associated with the use of ketamine for primary analgosedation in the surgical/trauma ICU setting. Retrospective cohort study. Academic medical center in Minnesota. Patients admitted to the surgical ICU between 2015 and 2019 requiring mechanical ventilation and meeting one of three definitions for ketamine primary analgosedation were included: 1) no concomitant opioid infusion, 2) ketamine monotherapy for greater than or equal to 6 hours with subsequent opioid infusion, or 3) ketamine initiated concomitantly or within 4 hours of opioid and total opioid duration less than 4 hours. None. Use of ketamine, analgesics, and sedatives were evaluated. Pain, sedation, and delirium assessments immediately before and during ketamine infusion were collected and compared with reported goals. Concomitant analgesics, sedatives, and psychotropics were recorded. Reported failures due to ineffectiveness and toxicity were collected. Of 164 included patients, 88% never received a concomitant opioid infusion (primary analgosedation definition 1), 12% met alternative criteria for primary analgosedation (definitions 2 and 3). A majority, 68%, were surgical admissions and mean Acute Physiology and Chronic Health Evaluation III score was 90 (± 30). Median mechanical ventilation duration was 2.5 days (1.1-4.5) and ICU length of stay of 4.9 days (3-8). The median ketamine infusion dose and duration were 0.18 mg/kg/hr (0.1-0.3) and 30 hours (15.1-51.8). Concomitant infusions of propofol and dexmedetomidine were administered in 49% and 29% of patients, respectively. During ketamine infusion, the median percent of total pain scores at goal was 62% (33-96%), while 64% (37-91%) of Richmond Agitation Sedation Scale scores were at goal, and 47% of patients were Confusion Assessment Method-ICU positive during the ketamine infusion. Hallucinations were documented in 14% of patients and ketamine failure occurred in 11% of patients. Ketamine may be an effective primary analgosedation option in intubated surgical ICU patients, but prospective randomized studies are needed to evaluate this strategy.

P1153 Hospital surgical volumes and outcomes in ileocaecal resection for Crohn’s disease in Sweden 2000-2019: A national cohort study

Abstract Background Intestinal resection for Crohn’s disease (CD) is often complex and remains associated with significant postoperative morbidity. In several other types of complex surgery, increased case volumes have been associated with better outcomes. In surgery for CD, such an association has not yet been demonstrated. Methods In this nationwide cohort study, we used the National Patient Register to identify all CD patients who underwent their first (primary) ileocaecal resection in Sweden 2000-2019 at age 15 years or above. Hospitals were grouped into low, middle, and high-volume centres based on the number of intestinal resections for CD the previous calendar year (1-24, 25-36 and ≥37 resections, respectively). Length of hospital stay, severe postoperative complications and deaths during the first 100 days after the date of index surgical admission were compared between groups, and adjusted for sex, age, duration of disease, preoperative corticosteroid therapy, and year of surgery. Rates of surgical reintervention were used as a measure of severe postoperative morbidity. Results In the 20-year study period, 3396 patients underwent primary ileocaecal resection for CD in Sweden; 2371 (69.8%), 527 (15.5%) and 498 (14.7%) in low, middle, and high-volume hospitals, respectively. Median age at surgery was 41, 39 and 34 years, respectively, and the proportion of patients with a diagnostic record of perianal disease was 9, 10 and 16%. Sex, extraintestinal manifestations and preoperative medical therapies and hospital admissions did not differ between hospital types. Laparoscopic surgery was performed in 351 (15%), 126 (24%) and 122 (24%) patients, respectively. Surgical reintervention within 100 days was performed in 117 (4.9%), 19 (3.6%) and 13 (2.6%) patients in the three groups (adjusted odds ratios 0.72 (95% confidence interval 0.43-1.15) for middle-volume and 0.52 (0.28-0.89) for high-volume hospitals, compared to low-volume hospitals, Figure). There were no differences in the length of index admission hospital stay or mortality. Conclusion In primary ileocaecal resection for CD, high-volume hospitals had lower odds of early surgical reintervention, compared to low-volume hospitals. This finding may inform considerations of subspecialisation and centralisation in surgery for Crohn’s disease.

Causes for 30-day readmissions and accuracy of the LACE index in regional Victoria, Australia.

Clinicians and funders continue to search for ways to reduce costs without sacrificing quality of care. Ongoing research should focus on innovative care models that identify patients at high-risk for hospitalisation and thereby reduce healthcare costs. This study examined readmission rates, comorbidity profiles and the performance of the LACEi (Length of stay, Acuity of admission, Charlson Comorbidity Index, ED admissions in the previous 6 months index) to predict the risk of 30-day readmissions in a regional population. Furthermore, we tested a novel clinician-orientated classification for the causes of 30-day readmissions. Using a nested case-control design, data were extracted from administrative health records using 30-day readmission status as the outcome. We defined cases as discharges within 30 days before readmission and controls without a discharge within 30 days before admission between 1 July 2020 and 30 June 2022. The study was conducted at South West Healthcare in Victoria, Australia. All adult medical patients were discharged alive from the facility. We excluded planned readmissions, surgical and obstetric admissions, dialysis, transfers to alternative facilities and discharges against medical advice. Thirty-day readmission rate, comorbidity profile for all admissions, LACEi for all admissions, the performance of the LACEi in our setting and the causes leading to readmission using a clinician-orientated classification tool. Comorbidity burden, male sex and age > 65 years were associated with increased readmission risk but not length of stay. The LACEi demonstrated modest predictive ability to identify high-risk patients for readmissions (area under the receiver operating characteristic curve = 0.59). Additional variables were needed to increase accuracy. The novel classification identified 42% of readmissions as potentially avoidable. Our study identified comorbidity burden, male sex and age ≥ 65 years as critical indicators for readmission risk. Although the LACEi showed moderate predictive ability, additional variables were needed for increased accuracy. Over 40% of readmissions were potentially avoidable, and nearly two thirds occurred within 14 days of discharge from the hospital.

Genetic kidney disease has a higher likelihood and cost of inpatient admissions compared to other aetiologies

PurposeThere is increasing recognition of monogenic aetiologies for kidney disease. We sought to identify whether genetic kidney disease (GKD) has distinct hospitalization patterns compared to other forms of chronic kidney disease (CKD). MethodsHealth service utilization analysis was undertaken in a CKD cohort study across public hospital services in Queensland, Australia. CKD due to clinically coded potential monogenic causes was compared to all other causes in terms of annual frequency, cost, and type of hospital admission. ResultsWe analyzed 7 years of hospital admissions data (809,188 admissions) among 29,046 patients. Compared to non-genetic CKD, GKD was associated with a higher likelihood and cost of admissions. GKD had consistently more admissions (mean excess annual number of admissions increasing from 5.2 in year 1 to 13.4 in year 7) and more costly admissions (mean excess annual cost increasing from $5,265 in year 1 to $12,993 in year 7). This gap in hospitalization likelihood and cost increased over time for both surgical and medical admission episodes, but not for all (immunological, cancer) causes of admissions. ConclusionUnderstanding the nature and extent of differences in healthcare needs between GKD and other CKD will enable better secondary prevention and inform resource allocation decisions to reduce healthcare system pressures attributable to knowable causes.

Impact of the COVID-19 pandemic on the complete rehabilitation journey of hip fracture patients in Italy: From surgical admission to rehabilitation facility discharge.

The COVID-19 pandemic led to a significant reorganization of health services, potentially affecting the quality of care for major public health concerns such as proximal femoral fractures. This study aimed to investigate potential changes in the timing of various steps in the patient journey after a hip fracture during the pandemic in Piedmont, a region in Northern Italy. A retrospective study was conducted on the discharge records of patients aged 65 or older who were admitted for hip surgery following a femur fracture in 2019 and 2020. The study examined four-time steps: duration from hospital admission to surgery, length of hospital stay, interval between hospital discharge and admission to the rehabilitation facility, and duration of stay at the rehabilitation facility. To mitigate biases linked to sex and age factors, groups well-balanced across 2019 and 2020 were created using propensity score estimation. The dataset consisted of two cohorts of 583 patients each for the years 2019 and 2020. The average duration from admission to surgery was approximately 1.9 days in both years, with 75% of patients undergoing surgery within 2 days of hospital admission. The average hospital stay reduced from 13.49 days in 2019 to 11.34 days in 2020. The gap between hospital discharge and admission to rehabilitation was approximately 10-12 days, and the average duration of stay at the rehabilitation facility was about 31.6 days. The study indicates that healthcare systems can exhibit resilience and adaptability, even during a global pandemic, to ensure high-quality and safe standards of care. However, further long-term studies are needed to fully understand the pandemic's impact on primary health outcomes following hip replacement surgery and subsequent rehabilitation. The potential role of telemedicine in reducing the time between steps also warrants further investigation.

Intensive Care Unit Outcomes and Mortality in Elderly Oncology Patients

Introduction: Rising life expectancy has increased elderly admissions to intensive care units. With age, comorbidity risks rise. Intensive care units’ hospital mortality for elderly patients stands at 24% to 40%. Oncology patients often require intensive care units care, stemming from cancer-related conditions, treatment complications, or other health issues. However, intensive care units’ mortality remains higher among cancer patients. Materials and Method: Ethics committee-approved retrospective analysis covered oncology patients aged 65+ in intensive care units from Jan 2020 to Dec 2021. We categorized patients into two age groups, reviewing demographic data, admissions’ reasons, cancer types, recent treatments, APACHE II and SOFA scores, ventilator use, renal replacement therapy need, intensive care units /hospital durations, mortality rates, primary diseases, and comorbidities. Results: Among 706 intensive care units’ patients, 25% were over 65 with similar mortality across age groups. Lung/colon tumors and acute leukemias were common. Hematological cancer had higher APACHE II scores but similar mortality. Vasoactive drugs and mechanical ventilation significantly affected intensive care units and hospital mortality. Mortality increased in patients without vasoactive drugs/ventilation during hospitalization. Recent surgery correlated with lower hospital mortality in cancer patients. Mechanical ventilation and vasoactive drugs doubled mortality risk. Surgical admissions showed lower mortality. Renal replacement therapy correlated with higher mortality. No significant survival difference existed between cancer types. Conclusion: In conclusion, treatments impact elderly oncology patients’ survival in intensive care units /hospitals. Intensive care units’ care’s effectiveness in older groups, especially those 75+, suggests potential benefits. Non-surgical admissions and life support contribute to higher mortality. Further studies on pre- intensive care unit treatment and admission timing are essential. Keywords: Neoplasms; Critical Care; Aged.

Primary indication for admissions to a multi-specialty paediatric intensive care unit in Sri Lanka

It is critical to analyse the pattern of admissions made to a multi-specialty ICU (Intensive Care Unit) facility in order to enhance the standard of care, update resources, and to train the PICU (Paediatric Intensive Care Unit) personnel. Policymakers, funders, healthcare practitioners and administrators must be aware of the epidemiology and patterns of ICU admissions improve existing health services and plan for future delivery of intensive care.Objectives was to describe the primary indication for admissions to a multi-specialty Paediatric Intensive Care Unit of Teaching Hospital, Karapitiya, Sri Lanka. Children from birth to 16 years of age treated in the PICU from 1st April 2022 to 31st March, 2023 were retrospectively analysed. Information was collected on age, sex, home town, mode of admission, primary specialty indication, length of stay, main system involved, requirement of mechanical ventilation and survival.A total of 341 children were admitted and were included in the study. 60.5 % of the study population were males. Transfers within hospitals (62.1%) outnumbered transfers outside hospitals (37.9%).The average PICU stay was 5.8 days. Respiratory illnesses accounted for 54.4% of medical admissions and was the most common reason for intensive medical care. Other indications included neurological problems (21.3%) and multiorgan sepsis (8.4%). Leading cause of surgical specialty admissions was post-operative care (80.8%). Overall survival rate was 87.9% and mortality rate was 12.1%.Respiratory and neurological problems and multi-organ sepsis were the most common reasons for medical admission to the PICU. Leading cause of surgical specialty admissions was post-operative care. Overall survival rate was 87.9%.

Lessons to enhance integrated care by assessing between-hospital variation in mortality, readmissions and prolonged length-of-stay for cardiovascular diagnoses: results of a cardiovascular population analysis.

Background: Unwarranted between-hospital variation is a persistent healthcare quality issue that can threaten healthcare equity. Despite the benefits of studying multiple patient outcomes together, research on between-hospital variation has often focused on single outcomes or disease-specific study populations. In this study we examined three important patient outcomes: (1) in-hospital mortality as a pinnacle measure of patient safety; (2) 30-day readmissions as an accountability measure for hospitals; and (3) prolonged length-of-stay, i.e. a length-of-stay above the All-Patient-Refined Diagnoses-Related-Group (APR-DRG)-specific 90th percentile (pLOS) because of its correlations with complications and costs of care. By tapping into the potential of administrative discharge datasets, that today are primarily used for financial purposes, we aimed to quantify between-hospital variation, allowing for priority setting for future quality improvement policies. As the level of between-hospital variation is unknown for cardiology patients, we set out to study a nationwide cardiology sample.&#x0D; Who is it for: This study is highly relevant for both clinicians and policymakers on hospital and governmental level.&#x0D; Methods: In this observational study, we used hierarchical mixed-effects logistic regression models to estimate hospital- and APR-DRG-specific risk-standardised rates. Between-hospital variation was assessed based on the estimated variance components. We studied 521,162 hospital admissions for cardiovascular pathologies, divided into 28 APR-DRGs, in 99 (98%) Belgian acute-care hospitals between 2016 and 2018.&#x0D; Findings: Our analysis revealed notable between-hospital variation in mortality, readmission and prolonged length-of-stay for cardiovascular hospital admissions in Belgium, in particular for medical diagnoses. Seven medical diagnoses were found to have significant between-hospital variation across the three studied outcomes, among which heart failure, angina pectoris and hypertension. Lowering of mortality rates in upper-quartile hospitals to the median could potentially annually save 633 cardiovascular deaths or 26.4% of deaths occurring in these hospitals. Moreover, an overall prevention of 322 (11.8%) readmissions and 1578 (33.3%) long patient stays could be secured in those bottom-performing hospitals. The largest absolute gain could be made for heart failure patients with 122 deaths, 62 readmissions and 277 pLOS potentially avoided.&#x0D; Interpretation: Our results are suggestive of larger inequalities in cardiovascular quality of care for medical than for surgical admissions. We would recommend future policies to target these diagnoses. Further investments and implementation of clinical guidelines and standardisation as well as systematic collation and benchmarking of outcomes and variation on national and international levels have proven valuable to ensure future focus on the right priorities. As we will demonstrate during this presentation, administrative data are useful for this longitudinal follow-up, as they require no additional workload, are readily available and reliable when applying adequate statistical modelling. Our findings have demonstrated that reducing variation in patient outcomes could be highly beneficial, at least for the cardiovascular patient population. The methods presented are easily transferrable to other disease groups besides cardiology, allowing for quality priority setting across the healthcare spectrum. &#x0D;