Total Number Of Hospital Days Research Articles

Does a history of cannabis use influence onset and course of schizophrenia?

While evidence strongly supports a causal effect of cannabis on psychosis, it is less clear whether the symptom pattern, clinical course, and outcomes differ in cases of schizophrenia with and without a background of cannabis use. Analysis of medical records from a longitudinal follow-up of Swedish conscripts with data on cannabis use in adolescence and subsequent incidence of schizophrenia. One hundred sixty patients with schizophrenia were assessed using the OPCRIT protocol. Cases were validated for diagnosis schizophrenia according to OPCRIT. Patients with a cannabis history (n = 32), compared to those without (n = 128), had an earlier age at onset, a higher number of hospital admissions and a higher total number of hospital days. There was no significant difference in type of onset and clinical symptom profiles between the groups. Our findings indicate that the disease burden of schizophrenia is greater in individuals who use cannabis during adolescence. Strengthening evidence on causality and teasing out long-term effects of pre-illness cannabis use from continued post-illness has clinical implications for improving schizophrenia outcomes.

Intrauterine Growth Restriction-Prediction and Peripartum Data on Hospital Care.

Background and Objectives: We aimed to prospectively obtain data on pregnancies complicated with intrauterine growth restriction (IUGR) in the Prenatal Diagnosis Unit of the Emergency County Hospital of Craiova. We collected the demographic data of mothers, the prenatal ultrasound (US) features, the intrapartum data, and the immediate postnatal data of newborns. We aimed to assess the detection rates of IUGR fetuses (the performance of the US in estimating the actual neonatal birth weight), to describe the prenatal care pattern in our unit, and to establish predictors for the number of total hospitalization days needed postnatally. Materials and Methods: Data were collected from cases diagnosed with IUGR undergoing prenatal care in our hospital. We compared the percentile of estimated fetal weight (EFW) using the Hadlock 4 technique with the percentile of weight at birth. We retrospectively performed a regression analysis to correlate the variables predicting the number of hospitalization days. Results: Data on 111 women were processed during the period of 1 September 2019-1 September 2022. We confirmed the significant differences in US features between early- (Eo) and late-onset (Lo) IUGR cases. The detection rates were higher if the EFW was lower, and Eo-IUGR was associated with a higher number of US scans. We obtained a mathematical formula for estimating the total number of hospitalization days needed postnatally. Conclusion: Early- and late-onset IUGR have different US features prenatally and different postnatal outcomes. If the US EFW percentile is lower, a prenatal diagnosis is more likely to be made, and a closer follow-up is offered in our hospital. The total number of hospitalization days may be predicted using intrapartum and immediate postnatal data in both groups, having the potential to optimize the final financial costs and to organize the neonatal department efficiently.

Correlation of Qualitative Alpha1-microglobulin, Values of Interleukin 6, Cervicometry and Cervical Infection in Pregnant Women with Symptoms of Preterm Birth.

One of the problems in modern obstetrics is how to identify and select pregnant women who are most likely to give premature birth. In the last ten years, due to false-positive test results, i.e., tests with low positive predictive values, there is an increase in unnecessary hospitalization days as well as unnecessary therapy. The probability of preterm birth is 25% in a population of pregnant women with symptoms of preterm birth. The aim was to analyze diagnostic accuracy of tests for the purpose of predicting premature births in< 37th and <34th week of pregnancy.Incidence of preterm births in < 37th week of pregnancy was 28%, while the incidence of preterm births up until 34th week of pregnancy, was < 8%. We included two groups of pregnant women in a prospective study; one group with the symptoms of threatening preterm birth between 22nd and 37th week of pregnancyand the other one of the same gestation period with no symptoms. Each pregnant woman underwent test for placental alphamicroglobulin-1, cervical length screening, cervical sampling for microbiological analysis, blood sampling for IL6 and CRP analysis. There were 16% of preterm births, up until 7 days from hospitalization, and they were all PAMG-1 positive; There is 75% of preterm births if PAMG-1 is positive with cervical length under 25mm. Combining tests, we reached the best predictive accuracy with positive PAMG-1 test, cervical length under 15mm along with the increase of CRP values above 15.96%. Total number of hospitalization days was 29% with preterm births up to 71% with full term births regardless the symptomatology, which justifies further studies towards releasing the pressure from the health care system and from doctors as well in the process of reaching a decision on treatment of pregnant women with the signs of preterm birth.

Correlation of Qualitative Alpha1-microglobulin, Values of Interleukin 6, Cervicometry and Cervical Infection in Pregnant Women with Symptoms of Preterm Birth

Background: One of the problems in modern obstetrics is how to identify and select pregnant women who are most likely to give premature birth. In the last ten years, due to false-positive test results, i.e., tests with low positive predictive values, there is an increase in unnecessary hospitalization days as well as unnecessary therapy. The probability of preterm birth is 25% in a population of pregnant women with symptoms of preterm birth. Objective: The aim was to analyze diagnostic accuracy of tests for the purpose of predicting premature births in&lt; 37th and &lt;34th week of pregnancy. Incidence of preterm births in &lt; 37th week of pregnancy was 28%, while the incidence of preterm births up until 34th week of pregnancy, was &lt; 8%. Methods: We included two groups of pregnant women in a prospective study; one group with the symptoms of threatening preterm birth between 22nd and 37th week of pregnancy and the other one of the same gestation period with no symptoms. Results: Each pregnant woman underwent test for placental alpha microglobulin-1, cervical length screening, cervical sampling for microbiological analysis, blood sampling for IL6 and CRP analysis. There were 16% of preterm births, up until 7 days from hospitalization, and they were all PAMG-1 positive; There is 75% of preterm births if PAMG-1 is positive with cervical length under 25mm. Combining tests, we reached the best predictive accuracy with positive PAMG-1 test, cervical length under 15mm along with the increase of CRP values above 15.96%. Conclusion: Total number of hospitalization days was 29% with preterm births up to 71% with full term births regardless the symptomatology, which justifies further studies towards releasing the pressure from the health care system and from doctors as well in the process of reaching a decision on treatment of pregnant women with the signs of preterm birth.

HEALTHCARE UTILIZATION IN OLDER ADULTS (≥70 YEARS) UNDERGOING CELLULAR THERAPY FOR HEMATOLOGIC MALIGNANCIES

Abstract Increasingly, older adults are receiving hematopoietic cell transplant (HCT) and chimeric antigen receptor T-cell therapy (CAR-T), intensive therapies for treatment of hematologic cancers which typically require prolonged hospital admissions. Older adults are at high risk of increased healthcare utilization and complications of prolonged hospitalization [Mudge, J Am Geriatr Soc, 2019]. We identified patients age ≥70 years who received HCT or CAR-T in a primary outpatient transplant program at Vanderbilt University Medical Center between 1/1/19 and 12/31/20. Healthcare utilization, including all visits and admissions, was captured from the start of conditioning chemotherapy through early post-therapy. Thirty-eight patients met inclusion criteria; 26 (68%) received autologous HCT (autoHCT), 7 (18%) allogenic HCT (alloHCT), and 5 (13%) CAR-T. Twenty-four patients (63%) had high HCT-Comorbidity Index (HCT-CI). Eighteen (69%) autoHCT, 6 (86%) alloHCT, and no CAR-T patients had at least one unplanned admission. The median number of total hospital days (LOS) was 7.5 (2-14), 8 (4-62), and 9 (7-9) days, respectively. One-year mortality was 12% (3) in autoHCT, 43% (3) in alloHCT, and 0% in CAR-T. Low performance status and high HCT-CI did not correlate with LOS (p=0.58 and p=0.16, respectively) or number of outpatient visits (p=1, p=0.19). In conclusion, most patients who received auto- or alloHCT in a planned primary outpatient setting experienced at least one unplanned admission. LOS duration varied widely with shorter LOS among autoHCT patients. Further research is needed to identify factors among older adults (≥70 years) at risk of increased healthcare utilization during HCT or CAR-T.

Effect of comprehensive geriatric assessment for frail elderly patients operated for colorectal cancer—the colorectal cancer frailty study: study protocol for a randomized, controlled, multicentre trial

BackgroundColorectal cancer (CRC) is the third most common cancer worldwide, with a median age of 72–75 years at diagnosis. Curative treatment usually involves surgery; if left untreated, symptoms may require emergency surgery. Therefore, most patients will be accepted for surgery, despite of high age or comorbidity. It is known that elderly patients suffer higher risks after surgery than younger patients, in terms of complications and mortality. Assessing frailty and offering frail elderly patients individualized treatment according to the comprehensive geriatric assessment (CGA) and care concept has been shown to improve the outcome for frail elderly patients in other clinical contexts.MethodsThis randomized controlled multicentre trial aims to investigate if CGA and care prior to curatively intended surgery for CRC in frail elderly patients will improve postoperative outcome. All patients ≥ 70 years with surgically curable CRC will be screened for frailty using the Clinical Frailty Scale (CFS-9). Frail patients will be offered inclusion. Randomization is stratified for colon or rectal cancer. Patients in the intervention group are, in addition to standard protocol, treated according to CGA and care. This consists of individualized assessments and interventions, established by a multiprofessional team. Patients in the control group are treated according to best known practice as stipulated by Swedish colorectal cancer treatment guidelines, within an enhanced recovery after surgery (ERAS) setting. The primary outcome is 90-day mortality. Secondary outcomes are the length of hospital stay and total number of hospital days within 3 months, discharge destination, 30-day readmission, ADL, safe medication assessment, CFS-9 score, complications, Health-Related Quality of Life (HRQoL) at 2-month follow-up in comparison to baseline measurements, health economical calculations including cost-effectiveness analysis based on costs of hospital care and primary care, mortality and HRQoL at baseline, 2- and 12-month follow-up and all-cause 1-year mortality.DiscussionThe trial is the first of its size and extent to investigate intervention with CGA and care prior to surgery for CRC in frail elderly patients. If this addition proves to be favourable, it could have implications on future care of frail elderly patients with CRC.Trial registrationClinicalTrials.gov NCT04358328. Registered on 4 February 2020

Outpatient Vyxeos Induction without Planned Admission for Select Patients with Secondary Acute Myeloid Leukemia (sAML): A Multicenter Analysis of Safety and Healthcare Resource Utilization

INTRODUCTION: With the FDA approval of CPX-351 (Vyxeos; Jazz Pharmaceuticals, Inc.; Palo Alto, CA), the prospect of inducing select patients with acute myeloid leukemia (AML) with a regimen that does not require continuous intravenous in the outpatient (OP) setting became a reality. With the recognition that an OP-induction strategy has the potential benefits of reduced healthcare resource utilization (HRU),1,2 improved quality of life3 and decreased risk of nosocomial infections, some centers have opted to administer Vyxeos in the OP setting and to admit patients only if complications which necessitate inpatient (IP) management occur. The safety and decreased HRU of this approach during consolidation has been demonstrated4 in the study population treated on the pivotal phase III trial (NCT01696084).5 We present the first real-world experience of OP AML induction with Vyxeos without planned hospital admission. METHODS: We performed a retrospective analysis of all patients at two institutions treated with OP-Vyxeos without planned admission (OP-Vyxeos) between August, 2017 and June, 2022. Patients were deemed safe for OP induction if they met the criteria outlined in Table 1 at diagnosis or could be stabilized in the hospital and discharged when these criteria were met. Primary and secondary objectives were to evaluate the safety and HRU, respectively, of this approach. The primary endpoint was 30-day mortality. Secondary endpoints included 60-day mortality, rate of adverse effects (AEs), number of hospitalizations, number of hospital days, number of intensive care (ICU) days, and number of days receiving intravenous (IV) antibiotics. When possible, primary and secondary endpoints were compared to patients who received Vyxeos induction in the inpatient setting (IP-Vyxeos) on the phase III trial.5,6 RESULTS: 49 patients received OP-Vyxeos between August, 2017 and June, 2022 and all were evaluable for the primary endpoint. Baseline characteristics of the patients are presented in Table 2. The mean age of OP-Vyxeos patients was less than IP-Vyxeos patients (61.2 years vs. 67.7 years) and a higher proportion of OP-Vyxeos patients were <60 years old (31% vs 0%). Baseline white blood cell count was similar between the two groups but a lower proportion of OP-Vyxeos patients had a platelet count £ 50 x109/L (32% vs. 62%). Clinical efficacy and safety outcomes are presented in Table 3. Complete response (CR) rate for Vyxeos was similar between the OP- and IP-Vyxeos groups (47% vs. 37%), as was time to neutrophil recovery (33.3 vs. 35 days). There were one early death (£ 30 days) in the OP-Vyxeos group (2%) compared to 9 (5.9%) in the IP-Vyxeos group. Sixty-day mortality was similar between the two groups (9% vs. 13.7%). Febrile neutropenia (FN) with or without documented infection and bleeding (any grade) were the most common AEs in both groups, however, the rates varied significantly between OP- and IP-groups (FN: 86% vs. 68%; bleeding: 18% vs. 74.5). FN was by far the most common AE in the OP-Vyxeos group and was the admission diagnosis for 79% (48/61) of admissions. HRU-metrics are presented in Table 4. The majority of OP-Vyxeos patients required hospitalization (90%); however, despite an increased mean number of hospitalizations (1.4 vs. 1.0), the median total number of hospital days in the OP group was decreased (23 vs. 28). Three patients (6%) never required hospitalization during OP-Vyxeos induction. The median days spent OP prior to first admission was 7.6 and 11% (5/44) of patients remained OP for >14 days prior to first hospitalization. The median number of days as OP in the 60 days following treatment initiation was 37 days. CONCLUSIONS: Outpatient Vyxeos induction without planned admission for select patients was safe and resulted in decreased healthcare resource utilization in our multicenter cohort of patients. There was one early deaths in the OP-Vyxeos group. Despite an increased mean number of hospitalizations, patients who received OP-Vyxeos had a decreased number of total hospital days. Limitations of this analysis include that this is a small, single-center, retrospective analysis. In the future, we hope to validate our criteria for OP-induction in a larger, multi-institution patient cohort. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Safety and Feasibility of Outpatient High-Dose Cytarabine Consolidation in AML Patients

INTRODUCTION: High dose cytarabine (HiDAC) for acute myeloid leukemia (AML) consolidation has historically been given as an inpatient (IP) regimen. Reasons for IP administration may include regimen scheduling/logistics, hydration requirements, patient assessments, and adverse effect management. However, the landscape of oncology treatment is moving towards chemotherapy administered in an outpatient (OP) setting. This may be directed by hospital census, reimbursement challenges, or patient satisfaction. At The Ohio State University, IP-HiDAC was identified as one regimen to transition to the OP setting. We present a detailed description of the process and our institutional experience by which patients receive OP-HiDAC through clinic and ambulatory home infusion. METHODS: To develop a safe process for patients to receive OP-HiDAC, we created a guideline authored by pharmacists, physicians, and a clinical nurse specialist. Exclusion criteria for OP-HiDAC includes serum creatinine >1.5 mg/dL, enrollment on a clinical trial requiring IP administration, and lack of social support. To facilitate standardization, an order-set was developed for all required supportive care prescriptions. Providers are required to have a visit with OP-HiDAC candidates the week prior to chemotherapy initiation to educate and organize the logistics of OP treatment. For OP-HiDAC, cytarabine is given over 2 hours every 10 hours on days (D) 1, 3, and 5 every 28-day cycle. The morning dose is given in the OP clinic and the evening dose is administered at home through an ambulatory infusion pump. Pharmacists and nurses are required to provide education prior to or during the first infusion appointment, including reviews of the home pump disconnect process and medication calendars. Caregivers can choose to disconnect the chemotherapy at home after the evening infusion, or patients can return to the clinic on D2, 4, and 6 for pump disconnect. Caregivers are required to complete a signature, speech, and gait log 1 hour prior to each evening dose. Patients are able to choose whether to self-inject growth factor on D7 (filgrastim, peg-filgrastim, or biosimilars) or return for clinic administration, with insurance approval. RESULTS: A retrospective chart review characterized our experience and healthcare resource utilization (HRU) of HiDAC from June 1, 2020 (OP-HiDAC go-live) through July 2022, see Table 1. During the first month, only 1 patient was treated outpatient each week, with the remainder of patients receiving IP-HiDAC. This process allowed for workflow evaluation from staff, patients, and caregivers. Since making OP-HiDAC the preferred regimen, 41 patients received OP-HIDAC and 37 received IP-HiDAC. Common reasons for IP-HIDAC included lack of caregiver, infection/bleeding concern, and lack of transportation. In the OP-HiDAC and IP-HiDAC groups, the majority of patients were ≤60 years old, 93% and 84%, respectively, and received full dose 3000 mg/m2/dose, 90% and 81%, respectively. In the IP-HiDAC group, 16 patients (43%) had an unplanned hospital admission(s) during treatment, compared to 18 patients (44%) in the OP-HiDAC group. Common reasons for unplanned admissions in both groups were comparable and included febrile neutropenia, sepsis, thrombocytopenia with bleeding (including hematuria and epistaxis), pain, syncope, and dyspnea. One OP-HIDAC patient had suspected neurotoxicity and after a brief admission for monitoring, continued therapy OP without recurrence of symptoms. Another OP-HiDAC patient had a pump malfunction on C2D1 in which the evening dose did not infuse. The caregiver correctly notified triage and was given further instructions, preventing a hospital admission. The median total number of hospital days for unplanned admissions with OP-HiDAC and IP-HiDAC were 3 and 4, respectively, suggesting that OP-HiDAC patients did not require longer hospitalizations for toxicity or complications. CONCLUSIONS: OP-HiDAC through clinic and ambulatory pump home infusion is an exciting alternative to IP-HiDAC, saving inpatient resource utilization by avoiding planned chemotherapy admissions. OP-HiDAC requires significant education for both healthcare teams and patients/caregivers to be successful and ultimately can provide opportunity for increased patient satisfaction with less time spent in a hospital or clinic setting. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Epidemiology and outcomes of surgical site infections among pediatric liver transplant recipients.

Surgical site infections (SSI) are a significant cause of morbidity in liver transplant recipients, and the current data in the pediatric population are limited. The goal of this study was to identify the incidence, classification, risk factors, and outcomes of SSIs among children undergoing liver transplantation (LT). A single-center, retrospective descriptive analysis was performed of patients age ≤18 years undergoing LT between September 2007 and April 2017. SSI identified within the first 30 days were analyzed. Primary endpoints included incidence, classification, risk factors, and outcomes associated with SSIs. We included 86 patients, eight patients (9.3%) developed SSIs. Among segmental grafts (SG) recipients, 7/61 (11.4%) developed SSI. Among whole grafts recipients, 1/25 (4%) developed SSI. SSIs were associated with the presence of biliary complications (35%vs. 3%, p < .01; odds ratios 24, 95% CI: 3.41-487.37, p<.01). There were no differences in long term graft or patient survival associated with SSI. Patients who developed SSI were more likely to undergo reoperation (50%vs. 16.7%, p = .045) and had an increased total number of hospital days in the first 60 days post-transplant (30.5vs. 12.5 days, p = .001). SSIs after pediatric LT was less frequent than what has been previously reported in literature. SSIs were associated with the presence of biliary complications without an increase in mortality. SG had an increased rate of biliary complications without an association to SSIs but, considering its positive impact on organ shortage barriers, should not be a deterrent to the utilization of SGs.

Revision ureteroneocystostomy in pediatric renal transplant patients for symptomatic vesicoureteral reflux and its effect on recurrent hospitalizations

Nearly 13,000 pediatric renal transplantations have been performed since 1987 with improving overall mortality and morbidity; however, graft infection remains a significant post-transplant concern. Recurrent urinary tract infections in pediatric patients with vesicoureteral reflux into their renal transplant can result in graft dysfunction, increased hospital cost, and impaired social and cognitive development due to time spent hospitalized. To evaluate the effect of revision ureteroneocystostomy on pediatric renal transplant patients with symptomatic vesicoureteral reflux in reducing hospitalizations and recurrent urinary tract infections. We retrospectively reviewed pediatric patients from 2002 through 2021 who underwent renal transplantation and required revision ureteroneocystostomy due to symptomatic vesicoureteral reflux. We analyzed the differences in days hospitalized, days hospitalized due to urinary tract infection, and treated urinary tract infections prior to and after revision ureteroneocystostomy. Ten patients requiring revision ureteroneocystostomy secondary to symptomatic vesicoureteral reflux were identified. There was no difference in the observation time between transplant to revision, and revision to last follow up (2.3 years (IQR 1.3-6.5) vs 1.7 years (IQR 1-6.7), p=0.4446). Overall, there was a significant decrease in the total number of hospitalization days (21.5 days (IQR 3-43) vs 5.5 days (IQR 0-9), p=0.006), total number of hospitalization days related to urinary tract infection (14.5 days (IQR 3-28) vs 0 days (IQR 0-3), p=0.008) and treated urinary tract infections (3.5 (IQR 3-6) vs 1 (IQR 0-2), p=0.019) following revision ureteroneocystostomy. The rate of hospitalization days for urinary tract infection was also significantly decreased following revision ureteroneocystostomy (7.15 per/year (IQR 0.4-11.75) vs 0 per/year (IQR 0-0.8), p=0.008). Symptomatic vesicoureteral reflux in pediatric transplant patients is difficult to manage and some patients will ultimately require surgery. There have been previous studies on the success of revision ureteroneocystostomy in treating reflux but no data on the reduction in hospitalizations associated with recurrent infections following the procedure. Limitations of this study are the small cohort size, retrospective nature, multi-surgeon study, and inherent selection bias due to evaluation of only surgical patients. Revision ureteroneocystostomy can limit the negative consequences of recurrent graft infections with reduction in hospitalization days and improved hospitalization rates due to urinary tract infections. The reduction in hospitalizations can greatly improve the cost of care along with quality of life for transplant patients and should be strongly considered in children with symptomatic vesicoureteral reflux who have failed conservative therapy.

Physical Activity and Fall Prevention in Geriatric Inpatients in an Acute Care Unit (AGIR Study): Protocol for a Usability Study

BackgroundFalls are one of the world’s top 10 risks associated with disability in people older than 60 years. They also represent more than two-thirds of adverse events in hospitals, mainly affecting patients older than 65 years. Physical activity is a central intervention in fall prevention for older people. Whatever the details of the prevention strategy that is adopted (ie, how a mono- or multifactorial intervention is evaluated, the category of person the intervention targets, and where it is used), it is important to ensure that the proposed intervention is feasible and usable for the patient and the health care team.ObjectiveThe primary objective is to study the usability of carrying out a physical activity intervention, including 3 types of exercises, in older patients hospitalized in a geriatric acute care unit and categorized according to 3 fall risk levels: low, moderate, and high. The secondary objectives are to determine the difficulty of the physical exercise for patients with different fall risk levels, to study the health care team’s perceptions of the intervention’s feasibility, and to study the benefits for patients.MethodsThis is an open-label, unicenter, nonrandomized, usability prospective clinical trial. The intervention tested is a daily physical activity program. It consists of 3 types of physical exercise: staying out of bed for at least 3 hours, performing balance exercises while standing for 2 minutes, and the Five Times Sit to Stand transfer exercise. These exercises are carried out under the supervision of the health care team. Fall risk in the patients is classified with the Brief Geriatric Assessment tool. The exercise program starts on the second day of hospitalization after inclusion in the study. Patient assessment continues until the last day of hospitalization or the 20th day of hospitalization, whichever is earlier. For each fall-risk group and each type of exercise, the intervention will be defined as usable if at least 80% of the participants complete 75% or more of the exercises (ie, the ratio between the number of days when the patient completes a type of exercise and the total number of hospitalization days). The perceived feasibility by the health care team is measured with 2 scales, measuring perceived difficulty and time spent with the patient. The intervention benefit is evaluated using the performance of the Five Times Sit to Stand test before and after the intervention.ResultsThe first patient was recruited on March 16, 2015. The study enrolled 266 patients, including 75 with low fall risk, 105 with moderate risk, and 85 with high risk.ConclusionsWe have not yet analyzed the results, but our observations suggest that the usability of each type of exercise for a given patient will depend on their fall risk level.Trial RegistrationClinicalTrials.gov NCT02393014; https://clinicaltrials.gov/ct2/show/NCT02393014International Registered Report Identifier (IRRID)DERR1-10.2196/32288

The Pandemic’s Impact on Patients with Bipolar Affective Disorder in a Non-COVID Medical Unit

IntroductionBipolar disorder or manic-depressive illness is a mental disorder which consists of abnormal and long-lasting changes in a person’s mood, energy, and ability to function. The ongoing COVID-19 pandemic restrictions precipitate the condition of those with bipolar affective disorder.ObjectivesWe searched for significant differences before and during the pandemic by analyzing socio-demographic data.MethodsWe carried out a research activity at the I Psychiatry Clinic of the Clinical Hospital of Neuropsychiatry Craiova. We formed two groups of hospitalized patients during 2019 and during 2020, when the pandemic broke out. The inclusion criterion was the presence of bipolar affective disorder as a primary diagnosis.ResultsThe number of cases and the total number of hospitalization days was higher during the pandemic, 101 cases versus 94 cases, 1667 days versus 1184 days. We identified a predominance of females during the pandemic, whereas in the previous year the distribution by sex was approximately equal. Regarding environment, the number of patients from urban and rural areas was approximately equal in 2019, while during the pandemic those in urban areas predominated, possibly due to easier access to psychiatric services. The ages of patients maintained a Gaussian distribution with a concentration of cases between 35-55 years.ConclusionsWhile other psychiatric disorders were less present in the clinic during the pandemic, the number of bipolar affective disorder cases increased. Bipolar affective disorder is a major challenge due to the wide range of symptoms which cross with comorbidities that increase the likelihood of a SARS-CoV-2 infection.DisclosureNo significant relationships.

Impact of Home-Based Pediatric Palliative Care on Hospital and Emergency Department Utilization at a Single Institution.

Background: There is limited data on home-based pediatric palliative care (PPC) demographics and utilization outcomes. Objective: Describe who receives home-based PPC and compare emergency department visits, hospital admissions, and hospital days admitted in the one year before and after initiation of home-based PPC. Design: Exploratory retrospective medical chart review. Settings/Subjects: Patients, from birth to their 21st birthday, who received home-based PPC during January 1, 2015 to July 31, 2016 at a single site. Measurements: Demographics and hospital utilization were extracted from the medical chart. Results:N = 154. Comparing one year before and after initiation of home-based PPC, the median number of hospitalizations decreased from 2 to 1 (p < 0.001), and the median total number of hospital days admitted decreased from 16 to 4 days (p < 0.001). Conclusions: Children enrolled in a home-based PPC program experienced a significant decrease in the number of hospital admissions and hospital days admitted.

Mortality and Resource Use Among Individuals With Chronic Kidney Disease or Cancer in Alberta, Canada, 2004-2015

Although the public is aware that cancer is associated with excess mortality and adverse outcomes, the clinical consequences of chronic kidney disease (CKD) are not well understood. To compare the clinical consequences of incident severe CKD and the first diagnosis with a malignant tumor, focusing on the 10 leading causes of cancer in men and women residing in Canada. This population-based cohort study enrolled individuals aged 19 years and older with severe CKD or certain types of cancer between 2004 and 2015 in Alberta, Canada. Data were analyzed in November 2021. Individuals were categorized as having severe CKD (based on estimated glomerular filtration rate <30 mL/min/1.73 m2 or nephrotic albuminuria without dialysis or kidney transplantation) or nonmetastatic or metastatic cancer (defined by a diagnosis of lung, breast, colorectal, prostate, bladder, thyroid, kidney or renal pelvis, uterus, pancreas, or oral cancer). All-cause mortality, number of hospitalizations, total number of hospital days, and placement into long-term care were calculated after diagnosis. Of 200 494 individuals in the cohort (104 559 women [52.2%]; median [IQR] age, 66.8 [55.9-77.7] years), 51 159 (25.5%) had incident severe CKD, 115 504 (57.6%) had nonmetastatic cancer, and 33 831 (16.9%) had metastatic cancer. Kaplan-Meier 1-year survival was 83.3% (95% CI, 83.0%-83.6%) for patients with CKD, 91.2% (95% CI, 91.0%-91.4%) for patients with nonmetastatic cancer, and 52.8% (95% CI, 52.2%-53.3%) for patients with metastatic cancer. Kaplan-Meier 5-year survival was 54.6% (95% CI, 54.2%-55.1%) for patients with CKD, 76.6% (95% CI, 76.3%-76.8%) for patients with nonmetastatic cancer, and 33.9% (95% CI, 33.3%-34.4%) for patients with metastatic cancer. Compared with nonmetastatic cancer, the age-, sex-, and comorbidity-adjusted relative rate of death was similar for CKD (adjusted relative rate, 1.00; 95% CI, 0.97-1.03; P = .92) during the first year of follow-up and was higher for CKD at years 1 to 5 (adjusted relative rate 1.23; 95% CI, 1.19-1.26). During the first year of follow-up, for patients with CKD, adjusted rates of placement in long-term care (adjusted relative rate, 0.88; 95% CI, 0.82-0.94) and hospitalization (adjusted relative rate, 0.65; 95% CI, 0.64-0.66) were lower than rates for patients with nonmetastatic cancer; however, those rates were higher for the CKD group than for the nonmetastatic cancer group during years 1 to 5 (long-term care placement, adjusted relative rate, 1.36; 95% CI, 1.29-1.43; hospitalization, adjusted relative rate, 1.55; 95% CI, 1.52-1.58). As expected, adjusted rates of long-term care placement and hospitalization were higher for patients with metastatic cancer than for the other 2 groups. In this study, mortality, hospitalization, and likelihood of placement into long-term care were similar for CKD and nonmetastatic cancer. These data highlight the importance of CKD as a public health problem.

Zoonoses as Important Causes of Hospital Admissions: A 15-Year Study in Portugal

Introduction: Zoonoses represent 75% of emerging diseases. These diseases pose a permanent threat to human health and well-being and have the potential to become increasingly frequent due to habitat degradation; land-use changes; and increased global mobility of humans, animals, and animal products. The objective of this study was to investigate the impact ten zoonoses (brucellosis, cysticercosis, echinococcosis, leishmaniasis, leptospirosis, Lyme disease, rabies, toxoplasmosis, trichinellosis, and West Nile fever) had on human hospitalizations between 2002 and 2016 in Portuguese National Health Service hospitals. Material and Methods: A retrospective nationwide study was conducted using hospitalization records gathered by Administração Central do Sistema de Saúde from all Portuguese public hospitals. Results: Between 2002 and 2016, zoonoses caused 181,741 hospitalizations, a total number of hospitalization days of 2,033,125, and 10,611 deaths. The ten studied zoonoses caused 5,183 hospitalizations, 71,548 hospitalization days, and 176 deaths. All, except Lyme disease, showed a trend of decreasing numbers of hospitalizations. Discussion and Conclusion: The impact of each zoonosis in hospitalized patients regarding their age, sex, the severity of disease, and region can be attributed to the specific characteristics of each disease, regarding means of infection, pathogenicity, and geographic distribution. Hospitalizations caused by zoonoses have declined since the beginning of the century in Portugal. They still represent, however, relevant impacts on Public Health. The promotion of trans professional cooperation guided by One Health principles will further aid in the control of these important diseases.

Abstract 10599: The Effects of Gestational Age and Size on Management Strategies and Outcomes in Neonatal Tetralogy of Fallot

Introduction: Data suggests there are benefits to both staged (SR) and complete repair (CR) for neonatal Tetralogy of Fallot (nTOF), though data is lacking on whether high-risk groups would benefit from one strategy over another. In a large state with variable practice patterns, we studied the impact of gestational age (GA) and weight by GA (birth weight z-score: BWz) at birth on surgical strategy and outcomes in nTOF, hypothesizing that GA and BWz would influence these outcomes. Methods: Population-based cohort study (2011-2017) of infants with nTOF (defined as catheter or surgical intervention prior to 44 weeks corrected GA) was performed. BWz was categorized as appropriate, small or large for GA. Surgical strategy and timing were compared by GA ( &lt; 36 weeks preterm (n= 96), 37-38 weeks early term (n= 97), &gt; 38 weeks full term (n= 152)) and BWz. Multivariable (MV) models were constructed to evaluate composite outcome of mortality or significant morbidity (BPD, IVH, NEC, PVL etc.) at 1 year and total number of hospital days in first year of life. Results: There were 345 patients included (SR= 194; CR= 151). Surgical strategy did not differ by GA or BWz. Within CR group, full term and early term neonates underwent surgery 20 (95%CI: -27.1, -14.1; p&lt;0.001) and 15 days (95%CI: -22.1, -8.2; p&lt;0.001) sooner than preterm neonates. BWz was not associated with surgical timing. A stratified analysis trended toward lower survival probability among preterm neonates undergoing CR vs. SR (p= 0.1). In a MV model including GA, BWz, surgical approach and DOL surgery, only GA was associated with the composite outcome. The odds of a poor outcome was 0.45 (95%CI:0.24,0.86) times lower in full term vs. preterm neonates, p= 0.02. The adjusted total burden of hospital days in the first year was 32 (95%CI: -47.7,-16.9; p&lt;0.001) and 22 (95%CI: -36.5,-7.7; p= 0.003) days less in early term and full term compared to preterm neonates. Conclusions: In nTOF, GA and BWz were not associated with surgical strategy though premature neonates were more likely to wait longer for their initial intervention. One-year outcomes appear to be strongly influenced by GA and not surgical strategy; however, there was a trend to suggest that SR may result in better survival probability among premature neonates.

Comparison between the Transperitoneal and Retroperitoneal Approach Methods for Severe Retroperitoneal Abscess

Purpose: Retroperitoneal (RP) abscess is a rare condition with poor prognosis, unclear etiology, characteristics, and treatment. This study compared transperitoneal and RP approach methods in the treatment of RP abscess. Methods: There were 45 patients with RP abscess diagnosed at Inha University Hospital from January 2014 to August 2018, of which 22 patients with 2 RP zones and systemic inflammatory response syndrome were included. Characteristics, etiology, laboratory and radiological findings, surgical technique, complications, and total number of hospital days were examined. Patients were assigned to either the transperitoneal (TP) or RP approach group. Results: There were 22 patients with RP abscess who were treated with surgical drainage using either the TP (&lt;i&gt;n&lt;/i&gt; = 13) or RP (&lt;i&gt;n&lt;/i&gt; = 9) approach. There was no difference in characteristics between the 2 groups. The number of reinterventions in the RP group (&lt;i&gt;n&lt;/i&gt; = 6) was more than in the TP group (&lt;i&gt;n&lt;/i&gt; = 4; &lt;i&gt;p&lt;/i&gt; = 0.02). Mortality in the TP group (&lt;i&gt;n&lt;/i&gt; = 5) was higher than in the RP group (&lt;i&gt;n&lt;/i&gt; = 1; p &lt; 0.01). The total mean number of hospital days in the RP group (mean: 76, range: 29-180 days) was more than in the TP group (mean: 58, range: 18-280 days, &lt;i&gt;p&lt;/i&gt; = 0.03). Conclusion: RP abscess requires rapid drainage using the TP or RP approach. Reintervention events and number of hospital days in the RP group was greater than the TP group; however, mortality in the RP group was lower than in the TP group.

Lung Transplantation as Acute ‘Rescue’ Therapy

<h3>Purpose</h3> Lung transplantation (LT) is an effective treatment of end-stage lung disease. Despite recommendations for optimal referral for LT, some patients still present in distress seeking emergent rescue LT. Traditionally, these patients have been considered too ill to benefit from LT. Clinical outcomes for this population remain uncertain. Here, we compare outcomes between emergently transplanted patients with standard LT recipients. <h3>Methods</h3> A retrospective review of all LT recipients at our center between January 1, 2015 and December 31, 2019 was performed. 204 patients underwent standard evaluation and ten patients were referred for and underwent rescue LT. The rescue cohort consisted of patients not previously known to the transplant team but were urgently evaluated and listed for LT, after presenting in respiratory distress (oxygen needs ≥ 60% FiO₂ or need for mechanical ventilation +/- ECMO support). <h3>Results</h3> Mean LAS at LT was 81.99 in the rescue group (RG) and 39.19 in the standard group (SG) (student's t test: p<0.0001). One year survival in the RG was 90% and 88.23% in the SG (Kaplan-Meier p=0.89). Median ICU length of stay (LOS) of the RG and SG were 14 and 5 days respectively (Mann-Whitney U test p=0.4). The median index LOS was 31 days in the RG and 19 days in the SG (Mann-Whitney U test p=0.50). The total number of hospital days in the first post-LT year was a median of 46.5 days in the RG and 40 in the SG (Mann-Whitney U test p=0.50). Of surviving recipients, 55.6% of RG and 14.1% of SG patients required dialysis (HD) at hospital discharge (χ ²=10.97; p=0.006). Of surviving recipients, 33.3% of the RG and 7.2% in the SG were receiving HD at one year (χ ²=7.54; p=0.03). 44.4% of the RG were discharged to home vs. 83.3% of the SG (χ ²=6.28; p=0.03). <h3>Conclusion</h3> Compared to patients referred in accordance with published guidelines, the RG experienced no worse 1 year post-LT survival but did have increased index ICU stays, HD needs, and need for post-hospitalization inpatient care. Given these observances, our results support continuing to offer LT as a rescue therapy.

14. One-Year Outcomes From a Multi-Center Randomized Controlled Trial (RCT) of Refeeding in Anorexia Nervosa: The Study of Refeeding to Optimize Inpatient Gains (STRONG)

We recently reported the short-term results of this RCT, demonstrating that higher calorie refeeding (HCR) restored medical stability earlier with no increase in safety events, and significant savings associated with shorter length of stay as compared to lower calorie refeeding (LCR) in hospitalized adolescents and young adults with anorexia nervosa (AN). Here we report the one-year outcomes including rates of clinical remission, rehospitalization rate, number of readmissions, and total number of hospital days following the initial admission.

The utilization of specialized healthcare services among frail older adults in the Helsinki Birth Cohort Study

Background The association between frailty and specialized healthcare utilization is not well studied. We, therefore, examined the utilization of specialized healthcare services among frail Finnish older adults. Methods A sub-sample of 1060 participants of the Helsinki Birth Cohort Study were followed prospectively for specialized healthcare utilization from nationwide registers between the years 2013 and 2017. The participants’ frailty status was assessed according to Fried’s criteria at a mean age of 71.0 (2.7 SD) years between the years 2011 and 2013. A negative binomial regression model was used to examine the association between frailty and the total number of visits, emergency visits, outpatient appointments separating the first outpatient appointments and the follow-up appointments, inpatient care including elective and non-elective hospital admissions and the total number of hospital days. We also calculated average length of stay (ALOS) and used the Kruskal–Wallis test to examine the differences between the groups. Results After adjusting for covariates, frailty was significantly associated with the number of specialized healthcare visits (IRR 1.50, 95% CI = 1.04–2.15) and all subgroups of visits apart from follow-up outpatient appointments. Frailty was particularly strongly associated with the number of hospital days (IRR 5.24, 95% CI = 2.35–11.7) and notably with emergency visits (IRR = 2.26, 95% CI = 1.45–3.51) and hospital admissions (IRR 2.23, 95% CI = 1.39–3.56). Frail older adults had also higher ALOS compared to non-frail participants (p = .009). Conclusions Frailty increases the use of most specialized healthcare services. Preventative interventions against frailty are needed to decrease the burden on specialized healthcare systems. KEY MESSAGE Frailty is associated with the utilization of most specialized healthcare services, the most expensive part of the healthcare in most high-income countries. The association of frailty with inpatient care is particularly strong. Preventative interventions against frailty are needed to decrease the burden on specialized healthcare systems.