Total Length Of Stay Research Articles

Outcomes following burn injury in intensive care patients with major psychiatric disorders

AimsPatients with psychiatric comorbidity have been shown to experience high rates of burn injury. Burn epidemiology, etiology, and outcomes have been sparsely documented for patients with major psychiatric disorders. The aim of this study was to analyze the epidemiologic characteristics and outcomes in intensive care burn patients with pre-existing and acute major psychiatric disorders . MethodsA retrospective study was performed including intensive care burn patients admitted between March 2007 and December 2020. Demographic, clinical and epidemiological data were collected and analyzed. Major psychiatric co-morbidities were collected according to ICD-9 and ICD-10 classifications. Patients were stratified according to F-diagnoses. ResultsA total of 1325 patients were included. 16.6 % of all patients had one or more major psychiatric disorders- 9.3 % with anxiety, dissociative, stress-related, somatoform and other nonpsychotic mental disorders, 9.2 % with mood (affective) disorders, 3.5 % with schizophrenia and other non-mood psychotic disorders, and 1.8 % with disorders of adult personality and behavior. Patients with major psychiatric disorders presented with significantly higher burn severity, reflected by higher abbreviated burn severity index (ABSI) scores (5.9 vs. 5.3, p < 0.001) and larger total body surface area (TBSA) affected (15.9 vs. 12.5 %, p = 0.002). Burned TBSA ≥ 30 and inhalation injuries were observed more frequently in patients with MDP, however without statistical significance. They also experienced prolonged hospital length-of-stay (LOS) (25.5 vs. 16.3 days, p < 0.001), prolonged intensive care unit LOS (14.8 vs. 7.7 days, p < 0.001), underwent surgical interventions (3.5 vs. 2.3, p < 0.001) and mechanical ventilation more frequently (34.1 % vs. 16.5 %, p = 0.43) and had significantly longer ventilation durations (73.5 vs. 31.2 h, p = 0.002). Mortality rates were lower compared to patients without major psychiatric disorders (5.9 vs. 8.1, p < 0.001). ConclusionsThe prevalence of major psychiatric disorders in burn patients is considerably high. Patients with psychiatric comorbidities were found to have greater burn severity, prolonged total hospital and ICU LOS, underwent surgical interventions and mechanical ventilation more frequently and had prolonged ventilation duration. Our results highlight the importance of identifying burn patients with major psychiatric disorders who may necessitate additional resources and require extensive inpatient psychiatric care and counseling.

Positive oral contrast material for CT evaluation of non-traumatic abdominal pain in the ED: prospective assessment of diagnostic confidence and throughput metrics.

Evaluate the impact of positive oral contrast material (POCM) for non-traumatic abdominal pain on diagnostic confidence, diagnostic rate, and ED throughput. ED oral contrast guidelines were changed to limit use of POCM. A total of 2,690 abdominopelvic CT exams performed for non-traumatic abdominal pain were prospectively evaluated for diagnostic confidence (5-point scale at 20% increments; 5 = 80-100% confidence) during a 24-month period. Impact on ED metrics including time from CT order to exam, preliminary read, ED length of stay (LOS), and repeat CT scan within 7days was assessed. A subset of cases (n = 729) was evaluated for diagnostic rate. Data were collected at 2 time points, 6 and 24months following the change. A total of 38 reviewers were participated (28 trainees, 10 staff). 1238 exams (46%) were done with POCM, 1452 (54%) were performed without POCM. For examinations with POCM, 80% of exams received a diagnostic confidence score of 5 (mean, 4.78 ± 0.43; 99% ≥ 4), whereas 60% of exams without POCM received a score of 5 (mean, 4.51 ± 0.70; 92% ≥ 4; p < .001). Trainees scored 1,523 exams (57%, 722 + POCM, 801 -POCM) and showed even lower diagnostic confidence in cases without PCOM compared with faculty (mean, 4.43 ± 0.68 vs. 4.59 ± 0.71; p < 0.001). Diagnostic rate in a randomly selected subset of exams (n = 729) was 54.2% in the POCM group versus 56.1% without POCM (p < 0.655). CT order to exam time decreased by 31min, order to preliminary read decreased by 33min, and ED LOS decreased by 30min (approximately 8% of total LOS) in the group without POCM compared to those with POCM (p < 0.001 for all). 205 patients had a repeat scan within 7days, 74 (36%) had IV contrast only, 131 (64%) had both IV and oral contrast on initial exam. Findings were consistent both over a 6-month evaluation period as well as the full 24-month study period. Limiting use of POCM in the ED for non-traumatic abdominal pain improved ED throughput but impaired diagnostic confidence, particularly in trainees; however, it did not significantly impact diagnostic rates nor proportion of repeat CT exams.

Direct cost analysis of rapid MRI in the emergency department evaluation of patients suspected of having acute ischemic stroke*.

Abbreviated "rapid MRI" protocols have become more common for the evaluation of acute ischemic stroke (AIS). Prior research has not evaluated the effect of rapid MRIs on cost or hospital length of stay in AIS patients. We retrospectively identified AIS patients who presented within 6h of acute neurologic symptom onset to an emergency department (ED) and activated a "brain attack" code. We included sequential patients from January 2012 to September 2015, before rapid MRI was available, who had CT perfusion (CTP) and compared them to patients from October 2015 to May 2018 who had a rapid MRI. We used inverse-probability-weighting (IPW) to balance the cohorts. The primary outcomes were direct cost to our healthcare system and total hospital length of stay (LOS). We included 408 brain attack activations (mean ± SD age 62.1 ± 17.6years, 47.8% male): 257 in the CTP cohort and 151 in the MRI cohort. Discharge diagnosis was ischemic stroke in 193/408 (47.3%). After patient matching, we found significant reductions for the MRI cohort in total cost (-18.7%, 95% CI -35.0, -2.4, p = 0.02) and hospital LOS (-17.0%, 95% CI -31.2, -2.8, p = 0.02), with no difference in ED LOS (p = 0.74) as compared to the CTP cohort. Although these results are preliminary and hypothesis-generating, we found that the use of a rapid MRI protocol in emergency department brain attacks was associated with a 18.7% reduction in total direct cost and 17% reduction in hospital length of stay.

Comparative cost analysis of liquid embolization systems for brain arteriovenous malformation using a real-world US hospital database: TRUFILL® versus OnyxTM.

Liquid embolic systems (LES) such as n-butyl cyanoacrylate-based TRUFILL® and ethylene vinyl-alcohol copolymer-based OnyxTM are widely used for the embolization of brain arteriovenous malformations (bAVMs). The purpose of this study was to compare hospital cost and length of stay (LOS) among unruptured bAVM patients undergoing embolization procedures with TRUFILL versus Onyx LES. Adult patients with unruptured bAVMs undergoing endovascular embolization with TRUFILL or Onyx LES between January 1, 2010 and June 30, 2020 were identified from the Premier Healthcare Database. Baseline covariates among the two groups were balanced using propensity score matching. Outcomes including total procedure cost, supply cost, and LOS were examined. A Generalized Estimating Equation model was used to assess outcomes in the matched cohorts. A total of 1072 patients were included in the study; 140 embolized with TRUFILL (mean age 47.06 [15.72] years, 45.70% male) and 932 embolized with Onyx (mean age 46.80 [16.65] years, 52.30% male). In the post-match cohort, the total procedure costs were lower for the TRUFILL (n = 130) versus Onyx (n = 333) group, though not significantly ($36,798 vs. $40,988; odds ratio [OR] = 0.90, 95% confidence interval [CI]: 0.73-1.10; p = 0.30). However, supply cost was significantly lower for hospitalizations with TRUFILL compared to Onyx use ($13,281 vs. $16,371, OR = 0.81, 95% CI: 0.68, 0.98; p = 0.026). Hospital LOS was similar in these two groups (TRUFILL: 4.05 vs. Onyx: 4.06 days; OR = 1.00, 95% CI: 0.70, 1.42; p = 0.99). In a large, multi-center, real-world sample of patients undergoing bAVM embolization, TRUFILL use was associated with significantly lower supply cost compared to Onyx use.

0572 Sleep Quality Prior to Admission May Be Linked to Length of Stay in Older Intensive Care Unit Survivors

Abstract Introduction Older adults who are admitted to an intensive care unit (ICU) often experience daytime sleepiness and inactivity during hospitalization, yet it remains unclear how pre-hospital sleep may influence hospital outcomes. The aim of this study was to explore trends between pre-hospital self-reported nighttime sleep duration, post-ICU daytime sleep duration, and hospital length of stay (LOS) among older ICU survivors. Methods Thirty older ICU survivors who were functionally independent prior to hospitalization and were mechanically ventilated while in ICU were enrolled in the present pilot study. Actigraphy was used to estimate post-ICU daytime total sleep time (TST) for a daytime period (06:00-22:00) within 24-48 hours post-ICU discharge. The Pittsburgh Sleep Quality Index was used to estimate self-reported nighttime sleep duration prior to hospital admission, and participants were grouped into three categories: short sleep (5.5-7.5 hours), moderate sleep (7.5-9 hours), and long sleep (9-10.5 hours). Total hospital LOS in days was obtained via chart review. Descriptive statistics were used to explore trends between pre-hospital sleep duration, post-ICU daytime sleep duration, and hospital LOS. Results Of the 30 enrolled participants, 29 completed the post-ICU actigraphy observation period; one participant was transferred back to ICU for surgical complications. The mean post-ICU daytime TST among participants who reported short pre-hospital sleep was 6.54 hours, while the means for those who reported moderate and long pre-hospital sleep durations were 7.83 and 8.39 hours, respectively. Participants who reported short pre-hospital sleep had a mean hospital LOS of 14.1 days, while participants who reported moderate and long pre-hospital sleep durations had a mean LOS of 29.1 days and 29.2 days, respectively. Conclusion Older ICU survivors who reported shorter sleep at home prior to hospital admission tended to also sleep less during the daytime hours immediately following transition out of ICU, compared to those who reported longer sleep at home. In addition, older ICU survivors who reported shorter sleep at home tended to have shorter LOS, compared to those who reported longer sleep at home. Potential interventions may focus on increasing daytime activity in older ICU survivors who endorse frequent daytime sleepiness and long nighttime sleep at home. Support (If Any)

Multiple regression model to analyze the total LOS for patients undergoing laparoscopic appendectomy

BackgroundThe rapid growth in the complexity of services and stringent quality requirements present a challenge to all healthcare facilities, especially from an economic perspective. The goal is to implement different strategies that allows to enhance and obtain health processes closer to standards. The Length Of Stay (LOS) is a very useful parameter for the management of services within the hospital and is an index evaluated for the management of costs. In fact, a patient's LOS can be affected by a number of factors, including their particular condition, medical history, or medical needs. To reduce and better manage the LOS it is necessary to be able to predict this value.MethodsIn this study, a predictive model was built for the total LOS of patients undergoing laparoscopic appendectomy, one of the most common emergency procedures. Demographic and clinical data of the 357 patients admitted at “San Giovanni di Dio e Ruggi d’Aragona” University Hospital of Salerno (Italy) had used as independent variable of the multiple linear regression model.ResultsThe obtained model had an R2 value of 0.570 and, among the independent variables, the significant variables that most influence the total LOS were Age, Pre-operative LOS, Presence of Complication and Complicated diagnosis.ConclusionThis work designed an effective and automated strategy for improving the prediction of LOS, that can be useful for enhancing the preoperative pathways. In this way it is possible to characterize the demand and to be able to estimate a priori the occupation of the beds and other related hospital resources.

How do we reduce acyclovir overuse? Impact of FilmArray meningitis/encephalitis panel tests for pediatric patients

BackgroundFew Japanese hospitals can perform in-house cerebrospinal fluid (CSF) polymerase chain reaction (PCR) to screen for herpes simplex virus, leading to patients being administered acyclovir (ACV) for several days. The FilmArray Meningitis/Encephalitis Panel (ME Panel) is a multiplex PCR test that can identify 14 major pathogens within 1 h. We aimed to investigate the efficacy of the ME Panel in children admitted with central nervous system infections in Japan. MethodsWe conducted a single-center, quasi-experimental study. The ME panel was introduced in April 2020. We outsourced the CSF samples to a laboratory during the pre-intervention period (April 2016 to March 2020) and performed the ME panel at our hospital during the post-intervention period (April 2020 to December 2021). Duration and dose of ACV and antibiotic use, length of stay (LOS) in the pediatric intensive care unit (PICU), and total LOS after testing were compared using the Mann-Whitney U test. ResultsThe number of cases in the pre- and post-intervention periods was 67 and 22 cases, respectively. The median duration of ACV decreased significantly from 6 days to 0 day (p < 0.001), and the median dose of ACV use decreased significantly from 14 vials to 0 vial (p < 0.001). No significant differences were noted in the total duration and dose of antibiotic use, LOS in PICU, and the total LOS after testing. ConclusionThe introduction of ME panel may contribute to appropriate ACV use; however, there was no significant change in the duration and dose of antibiotic use or LOS.

Handgrip strength is associated with length of stay and functional outcomes at 1-year follow up in fragility hip fracture patients

Background/Purpose Fragility hip fracture (FHF) is the most prevalent fragility fracture, causing deterioration in ambulatory ability and disability. Early detection of patients who are at risk of prolonged hospitalization and functional decline after FHF is crucial as this facilitates post-operative management and healthcare resources allocation. Handgrip strength (HGS) is an easily-administered and cost-effective tool to assess whole body strength. The objectives of this study were to examine the relationship between pre-operative HGS, length of stay (LOS) and functional outcomes at 1-year follow up in patients with FHF in Hong Kong. Methods Patients aged 65 years old or above who were admitted to a local acute hospital from April 2017 to March 2020 due to FHF that were treated operatively, and subsequently attended the multidisciplinary fragility fracture clinic at 1-year follow up were evaluated. HGS measured at pre-operative physiotherapy initial assessment, post-fracture total LOS, Modified Functional Ambulation Classification (MFAC) and Elderly Mobility Scale (EMS) at 1-year follow up were retrieved for analysis. Correlation between HGS and LOS was analyzed using Pearson's correlation coefficient. Correlations between HGS and MFAC, and HGS and EMS were analyzed using Spearman's rank correlation coefficient. Results One hundred and nineteen patients (mean age = 80.8 ± 7.3 years) (33 males, 86 females) were evaluated. Statistical significant negative correlation between HGS and LOS was found ( r = -0.245, p = 0.007), implying that the lower the HGS, the longer the period of hospitalization. HGS also showed statistical significant positive correlation with MFAC ( r = 0.358, p &lt; 0.001) and EMS ( r = 0.507, p &lt; 0.001), suggesting that the greater the HGS, the better the functional outcomes after 1 year. In short, pre-operative HGS measured by physiotherapists was shown to be associated with LOS and functional outcomes at 1-year follow up. Conclusion HGS is significantly associated with patient's LOS, MFAC and EMS after FHF. HGS is an easily-administered and cost-effective tool to facilitate frontline practitioners to determine and stratify patients’ rehabilitation potential and subsequently establish customized rehabilitation and discharge plan, such as intensive training, caregiver education and potential prediction of discharge destination. Key Messages HGS is significantly associated with patient's LOS, MFAC and EMS after FHF. HGS is an easily-administered and cost-effective tool to facilitate frontline practitioners to determine and stratify patients’ rehabilitation potential and subsequently establish customized rehabilitation and discharge plan.

Effects of an opioid stewardship program on opioid consumption and related outcomes after multilevel lumbar spine fusion: a pre- and postimplementation analysis of 268 patients.

Opioid stewardship programs combine clinical, regulatory, and educational interventions to minimize inappropriate opioid use and prescribing for orthopedic and spine surgery. Most evaluations of stewardship programs quantify effects on prescriber behavior, whereas patient-relevant outcomes have been relatively neglected. The authors evaluated the impact of an opioid stewardship program on perioperative opioid consumption, prescribing, and related clinical outcomes after multilevel lumbar fusion. The study was based on a retrospective, quasi-experimental, pretest-posttest design in 268 adult patients who underwent multilevel lumbar fusion in 2016 (preimplementation, n = 141) or 2019 (postimplementation, n = 127). The primary outcome was in-hospital opioid consumption (morphine equivalent dose [MED], mg). Secondary outcomes included numeric rating scale pain scores (0-10), length of stay (LOS), incidence of opioid-induced side effects (gastrointestinal, nausea/vomiting, respiratory, sedation, cognitive), and preoperative and discharge prescribing. Outcomes were measured continuously during the hospital admission. Differences in outcomes between the epochs were assessed in bivariable (Wilcoxon signed-rank or Fisher's exact tests) and multivariable (Wald's chi-square test) analyses. In bivariable analyses, there were significant decreases in preoperative opioid use (46% vs 28% of patients, p = 0.002), preoperative opioid prescribing (MED 30 mg [IQR 20-60 mg] vs 20 mg [IQR 11-39 mg], p = 0.003), in-hospital opioid consumption (MED 329 mg [IQR 188-575 mg] vs 199 mg [100-372 mg], p < 0.001), the incidence of any opioid-related side effect (62% vs 50%, p = 0.03), and discharge opioid prescribing (MED 90 mg [IQR 60-135 mg] vs 60 mg [IQR 45-80 mg], p < 0.0001) between 2016 and 2019. There were no significant differences in postanesthesia care unit pain scores (4 [IQR 3-6] vs 5 [IQR 3-6], p = 0.33), nursing floor pain scores (4 [IQR 3-5] vs 4 [IQR 3-5], p = 0.93), or total LOS (118 hours [IQR 81-173 hours] vs 103 hours [IQR 81-132 hours], p = 0.21). On multivariable analysis, the opioid stewardship program was significantly associated with decreased discharge prescribing (Wald's chi square = 9.45, effect size -52.4, 95% confidence interval [CI] -86 to -19.0, p = 0.002). The number of lumbar levels fused had the strongest effect on total opioid consumption during the hospital stay (Wald's chi square = 16.53, effect size = 539, 95% CI 279.1 to 799, p < 0.001), followed by preoperative opioid use (Wald's chi square = 44.04, effect size = 5, 95% CI 4 to 7, p < 0.001). A significant decrease in perioperative opioid prescribing, consumption, and opioid-related side effects was found after implementation of an opioid stewardship program. These gains were achieved without adverse effects on pain scores or LOS. These results suggest the major impact of opioid stewardship programs for spine surgery may be on changing prescriber behavior.

Abstract 89: Temporary Pacing And Clinical Outcomes In The Tavr Patient

Introduction: Transvenous pacemaker (TVP) use during transcatheter aortic valve replacement (TAVR) is routinely utilized to rapid pace the ventricle to assist in valve deployment and treat conduction abnormalities. This study aimed to evaluate the outcomes of patients who had their TVP left in place post procedure as compared to those patients where the TVP was removed in the operating room. Methods: A retrospective analysis of medical records for TAVR patients from 2018-2020 at the University of Illinois Hospital was conducted. These patients were placed into two groups: Those with TVP left in place and those without TVP. Patients with a pacemaker prior to procedure were excluded (11). Primary outcomes included composite MACE (all-cause mortality, MI, or CVA) at 6 months and 12 months. Secondary aims included length of stay (LOS) and ICU length of stay (ILOS). Results: A total of 138 patients were included for analysis. Of this population, 78% (109) were male, 54% (71) non-white, and mean age of 75+/- 12 years old. TVP was left in post procedure for 41 patients (29%). When comparing patients with TVP in place post procedure and those without, there was no difference in 6-month composite MACE (4.9% vs 13.4%, p=0.14). This was redemonstrated at 12 months (9.8% vs 22.6% p=0.076). There was no significant difference in LOS (2.88 vs 2.82 p=0.92). ILOS was significantly longer for those with TVP in place vs. those without (0.63 vs 0.08 days, p=0.006). Conclusion: Our results indicate that a TVP left in place is not significantly associated with composite MACE. Though presence of a TVP is associated with longer ICU stay it is not associated with longer total LOS. We noted that those with TVP in place post procedure did have lower percentage of composite MACE however the reasons for this trend are unclear. The prognostic implication of TVP left in place post TAVR remains to be determined. Further evaluation into the relationship of TVP and clinical outcomes should be investigated to better understand the clinical significance of this practice.

Association of Body Mass Index With the Use of Health Care Resources in Low-Risk Nulliparous Pregnancies After 39 Weeks of Gestation.

To compare health care medical resource utilization in low-risk nulliparous pregnancies according to body mass index (BMI, calculated as weight in kilograms divided by height in meters squared) categories. This is a secondary analysis of a multicenter randomized controlled trial of induction of labor between 39 0/7 39 and 4/7 weeks of gestation compared with expectant management in low-risk nulliparous pregnant people, defined as those without standard obstetric indications for delivery at 39 weeks. Body mass index at randomization was categorized into four groups (lower than 25, 25-29, 30-39, and 40 or higher). The primary outcome of this analysis was time spent in the labor and delivery department from admission to delivery. Secondary outcomes included length of stay (LOS) postdelivery, total hospital LOS, and antepartum, intrapartum, and postpartum resource utilization, which were defined a priori. Multivariable generalized linear modeling and logistic regressions were performed, and 99% CIs were calculated. A total of 6,058 pregnant people were included in the analysis; 640 (10.6%) had BMIs of lower than 25, 2,222 (36.7%) had BMIs between 25 and 29, 2,577 (42.5%) had BMIs of 30-39, and 619 (10.2%) had BMIs of 40 or higher. Time spent in the labor and delivery department increased from 15.1±9.2 hours for people with BMIs of lower than 25 to 23.5±13.6 hours for people with BMIs of 40 or higher, and every 5-unit increase in BMI was associated with an average 9.8% increase in time spent in the labor and delivery department (adjusted estimate per 5-unit increase in BMI 1.10, 99% CI 1.08-1.11). Increasing BMI was not associated with an increase in antepartum resource utilization, except for blood tests and urinalysis. However, increasing BMI was associated with higher odds of intrapartum resource utilization, longer total hospital LOS, and postpartum resource utilization. For example, every 5-unit increase in BMI was associated with an increase of 26.1% in the odds of antibiotic administration, 57.6% in placement of intrauterine pressure catheter, 5.1% in total inpatient LOS, 31.0 in postpartum emergency department visit, and 23.9% in postpartum hospital admission. Among low-risk nulliparous people, higher BMI was associated with longer time from admission to delivery, total hospital LOS, and more frequent utilization of intrapartum and postpartum resources. ClinicalTrials.gov, NCT01990612.

Malnutrition Is Associated With Greater Lengths Of Stay And Rates Of Readmission Following Cardiac Transplant Or Left Ventricular Assist Device Placement

Introduction In a consensus statement, the Academy of Nutrition and Dietetics (AND) and the American Society for Parenteral and Enteral Nutrition (ASPEN) introduced the malnutrition clinical characteristics (MCC). The MCC encompasses a standardized set of characteristics that clinicians can assess to support a diagnosis of malnutrition. Studies utilizing this tool in patients undergoing orthotopic heart transplant (OHT) or placement of a left ventricular assist device (LVAD) are limited. Hypothesis Malnutrition as identified using a modified MCC is associated with greater lengths of stay and rates of readmission following OHT or LVAD placement. Methods A single-center retrospective review of 240 completed nutrition assessments using a modified MCC in patients who underwent OHT (n= 70) or LVAD placement (n=170) between January 2016 and February 2020 was performed. Four MCC characteristics were assessed: weight loss, decreased energy intake, body fat depletion and muscle mass loss. A diagnosis of malnutrition was determined for patients who met two or more of the characteristics (MCC ≥ 2, n= 153). Patients who met less than two of the characteristics did not meet criteria for diagnosis of malnutrition (MCC < 2, n = 87). Comparisons were made between groups using Mann-Whitney U and Chi-Square tests where appropriate. All tests were two-tailed and a p-value of <0.05 was considered statistically significant. Primary outcome was hospital length of stay (LOS). Secondary outcomes included total ICU LOS, post-operative ICU LOS and 30-day readmission. Results No significant difference in age, gender, ethnicity or baseline comorbidities was observed between groups. BMI was significantly lower among patients with an MCC ≥ 2 (26.5, IQR 23.4-31.9) compared to MCC < 2 (29.9, IQR 26.5-34.0, p<0.01). Primary outcome of hospital LOS was significantly greater among patients with an MCC ≥ 2 (p<0.01, table 1). Secondary outcomes of total ICU LOS, post-operative ICU LOS and 30-day readmission were significantly greater among patients with an MCC ≥ 2 compared to MCC < 2 (p<0.01, table 1). Conclusion Malnutrition as identified using a modified MCC was associated with significantly greater hospital and ICU lengths of stay and rates of 30-day readmission following OHT or LVAD placement. In a consensus statement, the Academy of Nutrition and Dietetics (AND) and the American Society for Parenteral and Enteral Nutrition (ASPEN) introduced the malnutrition clinical characteristics (MCC). The MCC encompasses a standardized set of characteristics that clinicians can assess to support a diagnosis of malnutrition. Studies utilizing this tool in patients undergoing orthotopic heart transplant (OHT) or placement of a left ventricular assist device (LVAD) are limited. Malnutrition as identified using a modified MCC is associated with greater lengths of stay and rates of readmission following OHT or LVAD placement. A single-center retrospective review of 240 completed nutrition assessments using a modified MCC in patients who underwent OHT (n= 70) or LVAD placement (n=170) between January 2016 and February 2020 was performed. Four MCC characteristics were assessed: weight loss, decreased energy intake, body fat depletion and muscle mass loss. A diagnosis of malnutrition was determined for patients who met two or more of the characteristics (MCC ≥ 2, n= 153). Patients who met less than two of the characteristics did not meet criteria for diagnosis of malnutrition (MCC < 2, n = 87). Comparisons were made between groups using Mann-Whitney U and Chi-Square tests where appropriate. All tests were two-tailed and a p-value of <0.05 was considered statistically significant. Primary outcome was hospital length of stay (LOS). Secondary outcomes included total ICU LOS, post-operative ICU LOS and 30-day readmission. No significant difference in age, gender, ethnicity or baseline comorbidities was observed between groups. BMI was significantly lower among patients with an MCC ≥ 2 (26.5, IQR 23.4-31.9) compared to MCC < 2 (29.9, IQR 26.5-34.0, p<0.01). Primary outcome of hospital LOS was significantly greater among patients with an MCC ≥ 2 (p<0.01, table 1). Secondary outcomes of total ICU LOS, post-operative ICU LOS and 30-day readmission were significantly greater among patients with an MCC ≥ 2 compared to MCC < 2 (p<0.01, table 1). Malnutrition as identified using a modified MCC was associated with significantly greater hospital and ICU lengths of stay and rates of 30-day readmission following OHT or LVAD placement.

Prehabilitation in Patients on the Waiting List for Heart Transplant Improves Postoperative Outcomes

<h3>Purpose</h3> Frailty and poor functional capacity in advanced heart failure patients in the waiting list for heart transplantation (HT) are associated with increased morbidity and mortality. Pilot studies show short-term benefits through an exercise training program (prehabilitation) in HT candidates. We aim to investigate the efficacy of a prehabilitation program on the short and mid-term outcomes after HT <h3>Methods</h3> All patients entering the waiting list in a single centre from July 2017 to July 2021 were offered to join a prehabilitation program consisting in 2 hours/week personalized in-hospital exercise training, nutritional optimization and mindfulness sessions. Patients entering the program and reaching HT were included as Prehab-Group. Contemporaneous patients undergoing HT who did not start (or refused) the program, and those undergoing HT prior to program implementation (2014 to 2017) conformed the control group. Urgent HT and multiorgan transplants were excluded. Endpoints of study were mechanical ventilation time (MVT), intensive care unit (ICU) stay, total length of stay (LOS), postoperative complications, 30 days re-hospitalization and mortality after HT. <h3>Results</h3> 40 patients completed the program, from them 5 improved and came out of the waiting list, 1 patient worsened and received an LVAD and 31 reached HT and were included as Prehab-G. Fifty-one patients were included as controls. Baseline characteristics show no differences between groups except for longer median waiting time in the Prehab-G [191 (108-407) vs. 92 (27-260] days, p=0.003). Controls had longer MVT (37 vs. 20 hours, p=0.03), longer ICU stay [7 (5-14) vs. 5 (3-7) days, p=0.01], and total LOS [(23 (18-38) vs. 18 (16-22), p=0.008] than prehab patients. Prehab patients had lower rate of medical complications (5 vs. 2, p<0.001) and less severity of them (Comprehensive Complication Index 31 (23-41) vs 37 (30-72), p=0.003). There were no differences in surgical complications, in 30 d rehospitalisation or 90 days mortality between groups. All prehab patients except one (93.5%) were discharged home, whereas 16 (31.4%) controls required non-home discharge nursing/rehabilitation facilities (p=0.009). <h3>Conclusion</h3> Prehabilitation in patients listed for HT reduces postoperative complications and shortens mechanical ventilation time, ICU stay and total LOS with a higher rate of home discharge.

Lower Incidence of Postoperative Atrial Arrhythmia After Prophylactic Donor Heart Tricuspid Annuloplasty in Orthotopic Heart Transplantation

<h3>Purpose</h3> Donor heart tricuspid valve annuloplasty (dTVA) may reduce incidence of tricuspid regurgitation after orthotopic heart transplantation (OHT) but data on short-term hemodynamics outcome after prophylactic dTVA is limited. We hypothesized that prophylactic dTVA could benefit post-operative hemodynamics by minimizing right atrial pressure and atrial fibrillation. In our program, we have two primary OHT surgeons, one who routinely uses a DeVega dTVA and one who does not, presenting an opportunity for the study. <h3>Methods</h3> We retrospectively evaluated 52 consecutive OHT recipients between January 2020 and September 2021. They were divided into standard bicaval OHT group (sOHT; n = 28) and bicaval OHT with De Vega dTVA group (dvTVA; n = 24). Incidence of atrial fibrillation, hemodynamics, intensive care unit (ICU) length of stay (LOS), total LOS and echocardiographic measurements were reviewed and analyzed. <h3>Results</h3> Of 52 OHT recipients, mean age was 54.4 ± 11.3 years and 13 (25%) were female. There was no difference between groups in ICU or total LOS, days on inotropic support and in-hospital mortality. Hemodynamically, mean central venous pressure (CVP) at one week, four weeks and three months was not significantly different between groups. Proportion of recipients with significant v wave from CVP tracing wave form in the sOHT group trended higher but without statistically significance compared to dvTVA group and lowered overtime (46.1% vs 26.1%, p = 0.23 at one week, 25.0% vs 20.8%, p = 0.75 at four weeks and 16.6% vs 9.5%, p = 0.67 at three months). However, at mean follow-up of 7.4 months, incidence of atrial arrhythmia including atrial fibrillation and atrial flutter in sOHT group was significantly higher than in dvTVA group (32.1% vs 8.3%, p = 0.046) and most of atrial arrhythmia episodes occurred within one month post-operatively. <h3>Conclusion</h3> We show that OHT recipients with dTVA have lower incidence of atrial arrhythmia and trend to have less significant atrial v waves compared with sOHT patients. Interestingly, over time, the v wave in sOHT recipients normalized, suggesting improvement in RV function. Further study is needed to evaluate long-term outcome with prophylactic dTVA in OHT, incidence of amiodarone use and long term survival.

The Impact of Malnutrition and Body Mass Index on Heart Transplant Outcomes

<h3>Purpose</h3> Up to 70% of heart failure patients are malnourished which may affect post heart transplant (HT) outcomes. Studies assessing malnutrition pre-HT using validated tools are limited. This study aimed to assess if nutritional status using a validated tool and body mass index (BMI) impacted post-HT outcomes. <h3>Methods</h3> Single centre retrospective study of consecutive patients undergoing HT July 2015 to June 2021. Pre-HT nutritional status was assessed using the Subjective Global Assessment (SGA) tool and anthropometric data. Outcome measures included Intensive Care Unit (ICU) and total length of stay (LOS) at time of HT; post-HT infection and mortality (to 12-months). Results reported as mean±SD. <h3>Results</h3> 103 patients underwent HT during the study (mean age 50.3±12.2 years, 74% male). SGA at HT completed for 85.4% (n=88) of patients, 28.4% (n=25) were mild or moderately malnourished (SGA B), of these 24% (n=6) were overweight (BMI ≥25kg/m²). Malnourished patients had a longer but not statistically significant ICU LOS (18.5±26.8 days) compared to well-nourished patients (12.3±15.7 days, <i>p</i>=0.22). Total LOS between groups was not significant (malnourished 31.3±22.5 vs well-nourished 41.6±52.0 days; <i>p=0.37).</i> Malnourished patients experienced more post-HT infections compared to well-nourished patients (28% vs 22%, <i>p</i>=0.58). 16 patients died within 12 months post-HT and were more likely to be malnourished (n=7 of 12 SGAs completed, 58%, <i>p</i>=0.03). Obesity (BMI≥30kg/m²) was associated with significantly longer LOS (60.9±69.1 vs 28.8±28.5 days, <i>p</i>=0.002), but not ICU LOS (<i>p</i>=0.22). Overweight (BMI 25-29.9kg/m²) patients had higher rates of infections than healthy weight and obese patients (47.6% vs 23.8% and 28.6%, <i>p</i>=0.68). BMI had no impact on 12-month mortality post-HT (<i>p</i>=0.55). <h3>Conclusion</h3> Malnourished patients had a significant increased risk of 12-month mortality and experienced increased ICU LOS and infection rates post-HT. Obesity (BMI ≥30 kg/m²) was significantly associated with increased total LOS. Findings highlight the presence of potentially modifiable nutrition risk factors in HT patients. Nutrition assessments pre-and post-HT provide an opportunity to identify at risk patients, optimise nutritional status and may improve post-HT outcomes. This study was limited by small sample size. Future larger studies to investigate the impact of malnutrition and BMI on HT outcomes are warranted.

Lactate Is a Reliable Predictor of ICU Length of Stay Following Ultra-radical Ovarian Cancer Surgery.

With a greater proportion of women with advanced ovarian cancer (AOC) successfully undergoing radical cytoreductive surgery, the demand on peri-operative resources - including intensive care (ICU) beds - is also on the rise. Extended post-operative ICU length of stay (LOS) confers increased patient morbidity and mortality. Several variables associated with prolonged ICU LOS following AOC surgery have been identified. We aimed to evaluate the predictive value of serum lactate levels. All patients undergoing ultra-radical surgery for AOC in a large cancer centre over a 34-month period between 2018-2021 were identified via the institution tumour registry. Data were collected retrospectively via electronic care and operating records; biochemistry, radiology, and histopathology databases. In total, 63 patients were identified. Elevated intra-operative serum lactate levels were associated with significantly longer length of ICU post-operative stay. Longer time for hyperlactaemia to normalise following surgery also conferred significantly longer ICU, high dependency and total hospital LOS. Greater blood loss, higher surgical complexity and peritoneal carcinomatosis score, and longer operating time were associated with higher - and persistently elevated - peri-operative lactate levels. Serum lactate in the context of ultra-radical surgery for AOC represents an accessible and inexpensive marker with potential to not only reliably predict LOS, but also to serve as a dynamic prompt for early targeted intervention. Early recognition and correction of hyperlactaemia following AOC may reduce ICU LOS limiting both the resource pressure and patient morbidity/mortality sequelae.

Prevalence, characteristics, and longer-term outcomes of patients with persistent critical illness attributable to COVID-19 in Scotland: a national cohort study

BackgroundPatients with COVID-19 can require critical care for prolonged periods. Patients with persistent critical Illness can have complex recovery trajectories, but this has not been studied for patients with COVID-19. We examined the prevalence, risk factors, and long-term outcomes of critically ill patients with COVID-19 and persistent critical illness. MethodsThis was a national cohort study of all adults admitted to Scottish critical care units with COVID-19 from March 1, 2020 to September 4, 20. Persistent critical illness was defined as a critical care length of stay (LOS) of ≥10 days. Outcomes included 1-yr mortality and hospital readmission after critical care discharge. Fine and Gray competing risk analysis was used to identify factors associated with persistent critical Illness with death as a competing risk. ResultsA total of 2236 patients with COVID-19 were admitted to critical care; 1045 patients were identified as developing persistent critical Illness, comprising 46.7% of the cohort but using 80.6% of bed-days. Patients with persistent critical illness used more organ support, had longer post-critical care LOS, and longer total hospital LOS. Persistent critical illness was not significantly associated with long-term mortality or hospital readmission. Risk factors associated with increased hazard of persistent critical illness included age, illness severity, organ support on admission, and fewer comorbidities. ConclusionsAlmost half of all patients with COVID-19 admitted to critical care developed persistent critical illness, with high resource use in critical care and beyond. However, persistent critical illness was not associated with significantly worse long-term outcomes compared with patients who were critically ill for shorter periods.

526 Keep it up! Inpatient Weight Changes in Burn Patients with &amp;gt;20%TBSA

IntroductionBurn patients with >20%TBSA suffer from a hypermetabolic state causing loss of muscle mass as well as a compromised immune system and delayed wound healing. Weight loss is most severe in patients with >20%TBSA with an initial gain of weight due to fluid resuscitation. These findings led the American Burn Association to propose new quality measures for burn-injury admissions, including weight loss from admission to discharge. We aim to assess how our institution’s outcomes adhere to the proposed measures and if our findings correlate with previously described results.MethodsA retrospective review was conducted for adult patients admitted to our institution with burn injuries of >20%TBSA since 2016. Three groups were established based on %TBSA: 20-29% (Group 1), 30-39% (Group 2), and >40% (Group 3). We assessed weight changes from admission to discharge and performed a multivariate analysis to account for age, sex, number of surgical procedures, and hospital length-of-stay (LOS).ResultsData from 40 patients suffering burn injuries of >20%TBSA showed 11 patients with %TBSA of 20-29%, 10 patients with %TBSA of 30-39%, and 19 patients with %TBSA of >40%. When comparing groups 1 and 2, we saw significantly more weight loss in group 2 over the course of admission without a significant change in total hospital LOS. The average %weight loss for group 1 was 1.46%, 8.36% for group 2, and 10.56% for group 3. No patients in group 1 had a weight loss >15%. For group 2, patients with weight loss >15% had a significantly longer LOS and underwent significantly more surgical procedures during their admission. For group 3, most patients that experienced weight loss >20% did not have a longer LOS but did require more surgical procedures during their course of admission.ConclusionsAnalysis of the data demonstrates that patients with >20%TBSA do suffer significant weight changes, likely due to extreme metabolic disturbances. Our data suggests that an increased length of stay is not a significant driver for weight loss changes between patients with %TBSA of 20-29 and 30-39, suggesting other pathophysiologic mechanisms in play. Our data supports the idea that patients with %TBSA>40 are a unique subset of patients, requiring specialized nutritional protocols and metabolic analysis.

Regression Models to Study the Total LOS Related to Valvuloplasty.

Background: Valvular heart diseases are diseases that affect the valves by altering the normal circulation of blood within the heart. In recent years, the use of valvuloplasty has become recurrent due to the increase in calcific valve disease, which usually occurs in the elderly, and mitral valve regurgitation. For this reason, it is critical to be able to best manage the patient undergoing this surgery. To accomplish this, the length of stay (LOS) is used as a quality indicator. Methods: A multiple linear regression model and four other regression algorithms were used to study the total LOS function of a set of independent variables related to the clinical and demographic characteristics of patients. The study was conducted at the University Hospital “San Giovanni di Dio e Ruggi d’Aragona” of Salerno (Italy) in the years 2010–2020. Results: Overall, the MLR model proved to be the best, with an R2 value of 0.720. Among the independent variables, age, pre-operative LOS, congestive heart failure, and peripheral vascular disease were those that mainly influenced the output value. Conclusions: LOS proves, once again, to be a strategic indicator for hospital resource management, and simple linear regression models have shown excellent results to analyze it.

Abstract 148: Preoperative determinants of length of stay in people with type 2 diabetes mellitus undergoing an elective CABG: An observational single centre study

Background: 22-48% of the CABG performed are attributed to diabetic patients suffering from CAD. There is a paucity of Indian studies on the influence of preoperative HbA1c on postoperative CABG outcome, in T2DM patients. Some discord exists among studies looking at the above associations.Aims and Objectives: Aim of the study was to find any association between HbA1c and total length of stay (LoS) in hospital and other perioperative outcomes in Indian diabetic patients following CABG.Results: It was retrospective study including 229 patients within six month. The mean duration of T2DM was 8.4 years and mean HbA1c was 8.2. There was statistically significant difference (p <0.05) found between the groups divided based on total LoS (≤10 and >10 days) with HbA1c, duration of T2DM, haemoglobin and insulin requirement on the day of surgery. Age, mean insulin requirement preoperatively, DM duration, Hb, hypothyroidism and other macrovascular complications as preoperative parameters showed a significant correlation with total LoS. On linear regression, age, other macrovascular complications and preoperative insulin requirement were found to be predictors for LoS.Conclusion: This retrospective study revealed that preoperative HbA1c would be associated with prolonged hospital stay following CABG surgery, paving way for further prospective studies.