Total Readmission Rate Research Articles

Robotic cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: is there a benefit?

Open cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is a therapeutic option for the management of malignancies with peritoneal carcinomatosis and of peritoneal origin. Robotic surgery shows promise as a minimally invasive approach for select patients. We aimed to evaluate the differences in outcomes between robotic versus open CRS/HIPEC and hypothesized less morbidity and faster recovery in the robotic approach group. We conducted a retrospective cohort study from our HIPEC database including all tumor origins. We included patients aged 18-89years who underwent CRS/HIPEC for curative intent at a single institution between January 1, 2017, and December 31, 2023. Patients were stratified by open versus robotic-assisted surgery. Mann-Whitney U and Fisher Exact tests were used to compare differences in patient characteristics and outcomes. A total of 111 patients underwent CRS/HIPEC for curative intent, with 95 (85.6%) cases performed open and 16 (14.4%) robotically. The groups were demographically similar, except patients undergoing robotic CRS/HIPEC had a significantly higher median income ($83,845 vs. $70,519, p < 0.001). Rate of comorbidities and cancer type, including appendiceal, colorectal, and ovarian, were the same. The peritoneal carcinomatosis index and completion of cytoreduction score were similar between groups. Robotic approach was associated with statistically significant lower estimated blood loss (113 vs. 400mL, p < 0.001) and postoperative transfusions (6.3% vs. 23.2%, p = 0.036). Total complications, readmission rates, and 30-day mortality were similar among groups, but the robotic group had a significantly shorter length of stay (5.5 vs. 9 d., p < 0.001). Robotic CRS/HIPEC holds promise to decrease intraoperative blood loss, blood transfusions, and hospital stay while providing similar immediate postoperative outcomes in select patients. These results should be validated in the setting of a prospective trial and effects on long-term oncologic outcomes should be investigated.

Readmission Outcomes in Kidney Transplant Recipients With and Without Delayed Graft Function

Delayed graft function (DGF) is a common post-transplant event associated with increased resource utilization. As a center with experience in DGF, we aimed to assess differences in readmissions and post-transplant outcomes between patients with and without DGF. This was a retrospective review of deceased donor kidney transplant recipients at Mayo Clinic Arizona between 2015 and 2020. Recipients with at least one early readmission following kidney transplantation were included in the study. Two groups were identified: (1) recipients with DGF who required early readmission and (2) recipients without DGF who required early readmission. Among recipients with DGF, 43.9% (n = 405) required early readmission compared to 29.1% (n = 179) without DGF (P < .0001). There were no differences in the initial hospital length of stay (P = .08), and most recipients in both groups only required a single readmission (61.7% vs 72.1%, P = .02). Recipients with DGF were more likely to have ≥2 readmissions (P = .02) and a higher total readmission rate (P = .006). Recipients with DGF who required readmission also required more outpatient clinic visits (P = .003). When comparing recipients with and without DGF who required readmission, there were no differences in patient (P = .22) or death-censored (P = .72) graft survival. When comparing patients with and without DGF requiring one versus ≥2 readmissions, there were no differences in patient survival (P = .15), however patients with DGF and ≥2 readmissions had lower death-censored graft survival (P = .001). Recipients with DGF are at increased risk of readmission. Transplant center-level changes to reduce readmissions and infections could have an important impact on DGF outcomes.

Effect of continuous nursing on rehabilitation of older patients with joint replacement after discharge.

Joint replacement is a common treatment for older patients with high incidences of hip joint diseases. However, postoperative recovery is slow and complications are common, which reduces surgical effectiveness. Therefore, patients require long-term, high-quality, and effective nursing interventions to promote rehabilitation. Continuity of care has been used successfully in other diseases; however, little research has been conducted on older patients who have undergone hip replacement. To explore the clinical effect of continuous nursing on rehabilitation after discharge of older individuals who have undergone joint replacement. A retrospective analysis was performed on the clinical data of 113 elderly patients. Patients receiving routine nursing were included in the convention group (n = 60), and those receiving continuous nursing, according to various methods, were included in the continuation group (n = 53). Harris score, short form 36 (SF-36) score, complication rate, and readmission rate were compared between the convention and continuation groups. After discharge, Harris and SF-36 scores of the continuation group were higher than those of the convention group. The Harris and SF-36 scores of the two groups showed an increasing trend with time, and there was an interaction effect between group and time (Harris score: F intergroup effect = 376.500, F time effect = 20.090, F interaction effect = 4.824; SF-36 score: F intergroup effect = 236.200, F time effect = 16.710, F interaction effect = 5.584; all P < 0.05). Furthermore, the total complication and readmission rates in the continuation group were lower (P < 0.05). Continuous nursing could significantly improve hip function and quality of life in older patients after joint replacement and reduce the incidence of complications and readmission rates.

Improvement in inpatient discharge planning for patients with alcohol use disorder with the implementation of a team-based multidisciplinary workflow.

Alcohol use disorder (AUD) is a major economic and healthcare burden in the United States. While there is evidence-based medication-assisted treatment (MAT) for AUD, few physicians implement these therapies on a regular basis. To determine the impact of a pharmacy-guided AUD discharge planning workflow on the rate of MAT prescriptions and inpatient readmissions. This was a single-centered pre-and-post intervention study over a 6-month period, with a 90-day pre-intervention period and a 90-day post-intervention period. The study included all patients over the age of 18 years admitted to a medicine or surgery floor bed who presented with alcohol withdrawal at any point during their hospital course. The intervention involved a pharmacy workflow, in which a list of patients admitted with alcohol withdrawal was automatically generated and referred to pharmacists, who then provided recommendations to the primary physician regarding prescriptions for naltrexone, acamprosate, and/or gabapentin. The patients were then contacted within 30 days after discharge for post-hospitalization follow-up. Our outcome measures were change in prescription rate of MATs, change in total and alcohol-related 90-day readmission rates, and change in total and alcohol-related 90-day emergency department (ED) visit rates. The pre-intervention period consisted of 49 patients and the post-intervention period consisted of 41 patients. Our workflow demonstrated a 195% increase in the prescription rate of MATs at discharge (p < 0.001), 61% reduction in 90-day total readmission rate (p < 0.05), 40% reduction in 90-day total ED visit rate (p = 0.09), 92% reduction in 90-day alcohol-related readmission rate (p < 0.05), and 88% reduction in 90-day alcohol-related ED visit rate (p < 0.05). Our intervention demonstrated that a pharmacy-based AUD discharge planning workflow has the potential to reduce inpatient readmissions and ED visits for patients with AUD, thus demonstrating improved patient outcomes with the potential to reduce healthcare costs.

Impact of Surgeon Type on Total Ankle Arthroplasty Readmission, Complication, and Infection Rates

Introduction/Purpose: Total ankle arthroplasty (TAA) remains an attractive surgical option to address end-stage ankle pathology in appropriately selected patients. When successful, TAA can yield high patient satisfaction and marked improvements in patient- reported outcomes. However, surgical complications can lead to significant clinical impairment. TAA can be performed by both orthopedic surgeons and non-orthopedic surgeons – however, no prior study has compared TAA outcomes based on surgeon type. Methods: Utilizing Medicare claims from 2016 to 2019, we retrospectively identified patients ≥65 years of age who underwent TAA based on CPT coding. Patients on Medicare HMO, under age 65, and dual-eligible patients were excluded. Within this dataset, provider type was identified, allowing for comparisons between orthopedic and nonorthopedic surgeons. We compared groups based on readmission, all-complication, and infection rates within 1-year of TAA using logistic regressions controlling for age, sex, race, and comorbidity. To help mitigate bias, we also performed a propensity matched model with the same variables. Data were reported as percentage point (PPT) differences (95% CI) between groups, with a positive number indicating higher rate of complications among patients treated by nonorthopedic surgeons. Results: During our timeframe, 8,244 Medicare patients underwent TAA – 6,928 performed by orthopedic surgeons and 1,316 performed by non-orthopedic surgeons. There were no differences between groups based on age, sex, or race. Readmission rates were similar between groups (p=0.058). TAA performed by non-orthopedic surgeons had higher all-complication rates (43.4% vs. 36.7%, p&lt; 0.001) and infection rates (8.9% vs. 4.7%, p&lt; 0.001) compared to nonorthopedic surgeons. These differences in all- complication risk in non-orthopedic surgeons were further seen in logistic regression analyses (5.8 ppt (95% CI: 2.3, 9.4), p&lt; 0.001) and propensity matched analyses (5.6 ppt (95% CI: 2.1, 9.2), p&lt; 0.001). Group-differences were also revealed in infection risk through logistic regression analyses (3.9 ppt (95% CI: 2.0, 5.9), p&lt; 0.001) and propensity matched analyses (3.8 ppt (95% CI: 1.8, 5.8), p&lt; 0.001). Conclusion: TAA performed by non-orthopedic surgeons had greater all-complication and infection rates as compared to TAA done by orthopedic surgeons. Analyses of complications between orthopedic surgeons and non-orthopedic surgeons performing total ankle arthroplasty

Trends and Predictors of Readmission among Coronary Artery Disease Patients in a Community Heart Hospital in Nepal

Introduction: Patients of Coronary artery disease after index hospitalization gets readmitted to the same or different hospital for cardiac or noncardiac causes. To study trends of readmission pattern and different factors determining readmission . Methodlogy: The study is retrospective hospital based study for one year. Result: Out of 749 admitted patient with coronary artery disease, 143(19%) patients were readmitted. Mean age was 63.3 ± 13.4. There were 88(61.5%) male and 55(38.5%) female. Readmission rate for 30 days was 2.9%, 6 month 7.3% and 1 year 11.2 %. Forty (38%) of readmitted patients had been admitted more than one time. Common presentations were chest pain 60(42%), shortness of breath 42(29.4%), fever 11(7.7%), epigastric pain 9(6.3%), hemiparesis 8(5.6%), dizziness 4(2.8%), hematemesis 2(1.4%), hempoptysis 2(1.4%), black stool 1(0.7%), palpitation 1(0.7%) and loose stool 1(0.7%). Top factors were enlisted were presence of wall motion abnormalities 96(67.1%), anemia 83(58%), diagnostic invasive procedure in past 80 (55.9%), hypertension 76(52.4%), low systolic function 75 (52.4%) , angina 60(43%), diabetes 59(41.3%), heart failure 50(35%) , revascularization( PCI) 50 (35%), infarction 39(27.3 ), COPD 32(22.4%), infections 29(20.3%),acute kidney injury 25 (17.5), hypothyroidism 16(11.2), dyslipidemia 15(10.5), CKD 14(9.8), CVA 13(9.1), APD 12 (8.4), arrhythmia 10 (7%) h/o CABG,10(7%) and UGI bleeding 10 (7%). Conclusion: Readmission forms nineteen percentage of total admissions and readmission rate calculated within 30 days of admission as 2.9%.

HPB P53 Readmission rate after laparoscopic cholecystectomy in a tertiary HPB Unit

Abstract Background Laparoscopic cholecystectomy comprises a large portion of benign biliary surgery, and is increasingly performed safely as a daycase. The aim of our study was to determine the rate of unplanned readmission to hospital or unscheduled contact with medical services following discharge after laparoscopic cholecystectomy, along with the reasons for seeking medical advice. Methods Patients were identified retrospectively from our HPB Unit's operative database. All patients were included (daycases and inpatients) who underwent laparoscopic cholecystectomy in our unit in the calendar year 2019. Patients were excluded if they also had a CBD Exploration, or if their operation was converted to an open procedure. All patients' records were reviewed in detail on the Northern Ireland Electronic Care Record to capture readmissions, A&amp;E attendances and contact with Out of Hours GP service within 30 days of discharge from hospital following operation. Results 273 patients were admitted for planned cholecystectomy under 7 Consultant Surgeons. 257 had their operation completed laparoscopically (5.86% conversion rate). The overall daycase rate was 66%. 39 patients (15%) sought unplanned medical advice within 30 days of discharge. 15 patients (5.8%) contacted Out of Hours. A further 9 patients (3.5%) went to A&amp;E. Most of these had pain or wound problems. There were 15 (5.8%) readmissions to hospital: 3 within 48 hours; with abdominal wall haematoma, constipation and pneumonia. The remainder (day 4-29) had mostly pain, vomiting or umbilical wound infection. Median length of stay was 3 days. Conclusions Our early readmission rate was low and in line with local guidance of &amp;lt;10%. Most patients seeking unplanned advice had pain or wound problems. Further work looking at counselling patients regarding postoperative pain and wound care may reduce the total readmission rate and unscheduled contact after discharge. Readmission was not dependent on the age or size of the patient, or on whether the operation was carried out as a daycase or inpatient.

Comparison of Long-term Follow-Up of n-HA PA66 Cage and PEEK Cage of Lumbar Interbody Fusion in Multi-level Degenerative Lumbar Diseases: A Stepwise Propensity Score Matching Analysis.

Previous studies have confirmed that the nanohydroxyapatite/polyamide-66 (n-HA/PA66) cage is an ideal alternative material for degenerative lumbar disease (DLD) comparable to the polyether ether ketone (PEEK) cage due to its similar radiographic fusion, subsidence rate, and clinical results. However, these studies were restricted to one-level surgery. The aim of this study was to analyze the long-term clinical and radiologic outcomes between n-HA PA66 cage and PEEK cage for patients with multi-level degenerative lumbar diseases (DLDs). We retrospectively reviewed all patients who underwent multi-level transforaminal lumbar interbody fusion (TLIF) from June 2010 to December 2016 with a minimum 6-year follow-up. Matched-pair analysis was performed using a 1-to-1 closest neighbor approach to match patients who received an n-HA PA66 cage with those who received a PEEK cage. Clinical outcomes and radiographic evaluations were compared between the two groups. The independent student's t-test and χ2 -test were applied to compare the differences between groups. At the end of the propensity score matching (PSM) analysis, 48 patients from n-HA/PA66 group were matched to 48 patients in the PEEK group. No significant difference was observed in cage subsidence and bony fusion except for adjacent segment degeneration (ASD). The occurrence of ASD was 14.58% (7/48) in the n-HA/PA 66 group, which was significantly less than that in the PEEK group (33.33% [16/48]) (p = 0.031). Although the intervertebral space height (IH), segmental angle (SA) and lumbar lordosis (LL) significantly increased after surgery in both groups, there was no significant difference at any time point after surgery (p > 0.05). The visual analogue scale (VAS) and Oswestry disability index (ODI) scores significantly improved in both groups at 3m postoperative, 1y postoperative and at final follow-up. However, there were no significant differences in the VAS and ODI score at any time point (p > 0.05). The total complications and re-admission rate were not different between the two groups. Overall, our data suggest that the outcomes of n-HA/PA66 cage group are comparable to those of the PEEK cage group, with a similar high fusion rate and low cage subsidence rate as PEEK cages, except its lower rate of ASD occurrence.

Oral anticoagulation in heart failure complicated by atrial fibrillation: a nationwide routine data study

Abstract Background/Introduction Heart failure (HF) is frequently complicated by atrial fibrillation (AF). The co-occurrence of both conditions worsens the overall patient prognosis (1). To reduce the risk of thromboembolic complications, current guidelines highly recommend an oral anticoagulant (OAC) therapy in the majority of patients affected (2). Purpose Aim of this study was to evaluate whether a permanent OAC therapy in patients with HF and AF leads to favourable outcomes. Additional benefits of new oral anticoagulants (NOACs), compared to vitamin K antagonists (VKA), were further assessed. Methods Anonymous routine data of patients who were medically insured at the largest German health insurance provider and had a claims record for hospitalisation with the main diagnosis of HF and AF (2017-2019) were included. Admission due to HF in the previous year, incomplete medication data within 90 days after hospital stay as well as the diagnoses of congenital anomaly, transplantation, asthma, and age under 30 years were exclusion criteria. The endpoints of mortality and readmission rate for all-cause and stroke/intracranial bleeding (ICB) 91-365 days after the index hospitalisation were analysed. For this, information about the medications was taken from the pharmacy database. Kaplan-Meier survival curves and multivariable Cox regression models were used to evaluate the impact of medication on outcome. Adjusted hazard ratios (HRs) and 95% confidence intervals (95% CIs) were calculated. Patient age, sex, and comorbidities were evaluated as independent factors, including all variables of the CHA2DS2-VASc score. Results We included n = 180,316 cases (see figure 1). The median age was 81 years (interquartile range of 76-86) with 55.6% of the patients being female. 96.81% had a CHA2DS2-VASc score of ≥ 2. We found OAC prescription in 80.6% (VKA: 21.7%; direct factor Xa inhibitors (FXaI): 60.0%; direct thrombin inhibitors (DTI): 3.4%). In 8,087 cases, more than one OAC was prescribed. The mortality rate was 19.1%, readmission rate was 29.9% and stroke/ICB occurred in 1.9% during the observed time span. As presented in figure 2, the risk of death was lower with any OAC (HR 0.77, 95% CI 0.75-0.79) but without significant differences in OAC type (VKA: HR 0.73, 95% CI 0.71-0.76; FXaI: HR 0.77, 95% CI 0.75-0.78; DTI: HR 0.71, 95% CI 0.66-0.77). The total readmission rate (HR 0.97, 95% CI 0.94-0.99) and readmission for stroke/ICB (HR 0.71, 95% CI 0.65-0.77) was likewise lower with OAC use. Conclusion(s) Routine data confirm the beneficial outcome of OAC therapy in patients with HF complicated by AF regarding mortality and readmission for all-cause as well as for stroke/ICB. No additional benefits were visible with the use of NOACs.Figure 1.Patient selection criteria.Figure 2.Kaplan-Meier survival (OAC).

Mechanical thrombectomy is associated with shorter length of hospital stay and lower readmission rates compared with conservative therapy for acute submassive pulmonary embolism: a propensity-matched analysis.

To determine if mechanical thrombectomy (MT) for submassive pulmonary embolism (PE) positively impacts length of hospital stay (LOS), intensive care unit stay (ICU LOS), readmission rate, and in-hospital mortality compared with conservative therapy. This was a retrospective review of all patients with submassive PE who either underwent MT or conservative therapy (systemic anticoagulation and/or inferior vena cava filter) between November 2019 and October 2021. Pediatric patients (age <18) and those with low-risk and massive PEs were excluded from the study. Patient characteristics, comorbidities, vitals, laboratory values (cardiac biomarkers, hospital course, readmission rates, and in-hospital mortality) were recorded. A 2:1 propensity score match was performed on the conservative and MT cohorts based on age and the PE severity index (PESI) classification. Fischer's exact test, Pearson's χ2 test, and Student's t-tests were used to compare patient demographics, comorbidities, LOS, ICU LOS, readmission rates, and mortality rates, with statistical significance defined as P < 0.05. Additionally, a subgroup analysis based on PESI scores was assessed. After matching, 123 patients were analyzed in the study, 41 in the MT cohort and 82 in the conservative therapy cohort. There was no significant difference in patient demographics, comorbidities, or PESI classification between the cohorts, except for increased incidence of obesity in the MT cohort (P = 0.013). Patients in the MT cohort had a significantly shorter LOS compared with the conservative therapy cohort (5.37 ± 3.93 vs. 7.76 ± 9.53 days, P = 0.028). However, ICU LOS was not significantly different between the cohorts (2.34 ± 2.25 vs. 3.33 ± 4.49, P = 0.059). There was no significant difference for in-hospital mortality (7.31% vs. 12.2%, P = 0.411). Of those that were discharged from the hospital, there was significantly lower incidence of 30-day readmission in the MT cohort (5.26% vs. 26.4%, P < 0.001). A subgroup analysis did not demonstrate that the PESI score had a significant impact on LOS, ICU LOS, readmission, or in-hospital mortality rates. MT for submassive PE can reduce the total LOS and 30-day readmission rates compared with conservative therapy. However, in-hospital mortality and ICU LOS were not significantly different between the two groups.

Oral anticoagulation in heart failure complicated by atrial fibrillation: A nationwide routine data study

BackgroundThis nationwide routine data analysis evaluates if oral anticoagulant (OAC) use in patients with heart failure (HF) and atrial fibrillation (AF) leads to a lower mortality and reduced readmission rate. Superiority of new oral anticoagulants (NOACs), compared to vitamin K antagonists (VKA), was analyzed for these endpoints. MethodsAnonymous data of patients with a health insurance at the Allgemeine Ortskrankenkasse and a claims record for hospitalization with the main diagnosis of HF and secondary diagnosis of AF (2017–2019) were included. A hospital stay in the previous year was an exclusion criterion. Mortality and readmission for all-cause and stroke/intracranial bleeding (ICB) were analyzed 91–365 days after the index hospitalization. Kaplan-Meier survival curves and multivariable Cox regression models were used to evaluate the impact of medication on outcome. Results180,316 cases were included [81 years (IQR 76–86), 55.6% female, CHA2DS2-VASc score ≥ 2 (96.81%)]. In 80.6%, OACs were prescribed (VKA: 21.7%; direct factor Xa inhibitors (FXaI): 60.0%; direct thrombin inhibitors (DTI): 3.4%; with multiple prescriptions per patient included). Mortality rate was 19.1%, readmission rate was 29.9% and stroke/ICB occurred in 1.9%. Risk of death was lower with any OAC (HR 0.77, 95% CI [0.75–0.79]) but without significant differences in OAC type (VKA: HR 0.73, [0.71–0.76]; FXaI: HR 0.77, [0.75–0.78]; DTI: HR 0.71, [0.66–0.77]). The total readmission rate (HR 0.97, [0.94 to 0.99]) and readmission for stroke/ICB (HR 0.71, [0.65–0.77]) was lower with OAC. ConclusionsNationwide data confirm a reduction in mortality and readmission rate in HF-AF patients taking OACs, without NOAC superiority.

30-and 90-day readmissions in lumbar spine surgery. Differences in prevalence and causes

BackgroundThe morbidity associated with surgical treatment of lumbar degenerative conditions has attracted increasing interest due to the economic impact on society, especially postoperative readmission. Limited studies have assessed this risk in a prospective, single-center consecutive fashion. ObjectiveTo assess the incidence and causes of 30- and 90-day unplanned readmission and revision surgery following surgical treatment for lumbar degenerative spine conditions at a tertiary treatment center. Study designProspective, single-center cohort study. MethodsAll patients undergoing degenerative lumbar spine surgery in a 1-year period from February 1st, 2016, were prospectively included. Patient characteristics, surgical information and information regarding postoperative complications, including readmission (30- and 90-days) and revision surgery were recorded. Readmissions were classified according to whether they were due to the surgical intervention specifically, or a medical complication. ResultsA total of 1399 patients underwent surgery for various lumbar degenerative pathologies in the study period and all were included. Of these, 9.4% (n = 132) were readmitted within 30 days of surgery and in some cases, multiple readmissions occurred (up to 3). The total 90-day readmission rate was 17.6%. Of these, 15% were related to the surgical procedure.The predominant medical related causes were systemic infection (30-day: 14.4%, 90-day: 10.7%), neurological symptoms (30-day: 6.3%, 90-day: 5.0%) and cardiovascular events (30-day: 8.1%, 90-day: 12.9%).The surgical related causes for readmission were pain (30-day: 13.1%, 90-day: 2.9%), wound complications (30-day: 11.3%, 90-day: 5.0% and re-herniation (30-day: 13.1%, 90-day: 2.9%).Age was the only factor with significant influence on readmission. ConclusionThe incidence of medical conditions causing unplanned 30-day readmissions following surgery for lumbar degenerative conditions, is significantly higher compared to readmissions related specifically to the surgical procedure. Examples of medical treatment included antibiotics, analgesics, laxatives, anticoagulants and beta blockers. The difference is even more pronounced for the 90-day readmissions. The predominant medical causes were systemic infections, neurological and cardiovascular events. Predominant causes related to the surgery were pain, wound complications and re-herniations. Readmissions may be reduced by optimizing the medical treatment and the pain management before discharge of the patient.

The safety and effectiveness of enhanced recovery after surgery (ERAS) in older patients undergoing orthopedic surgery: a systematic review and meta-analysis.

To systematically review and analyze the safety and effectiveness of ERAS in older patients undergoing orthopedic surgeries. We searched PubMed, EMBASE, CINAHL, MEDLINE (Ovid), Web of Science, the Cochrane Library, and other databases to identify all randomized controlled studies and cohorts. We used the Cochrane Risk of Bias Assessment Tool and the Newcastle‒Ottawa Scale to assess the study quality. A meta-analysis was performed using the inverse variance weighting method. This study included 15 studies involving a total of 2591 older patients undergoing orthopedic surgeries with 1480 in the ERAS group. The ERAS group had a lower incidence of postoperative complications than the control group (RR 0.52; 95% CI 0.42-0.65). Length of stay was 3.37days lower in the ERAS group than in the control group (P < 0.01). And the ERAS protocol reduced the patient's postoperative VAS score (P < 0.01). Meanwhile, there was a lack of evidence of significant differences between the ERAS group and the control group in total bleeding and 30-day readmission rate. The implementation of the ERAS program in older patients undergoing orthopedic surgeries is safe and effective. However, there is still a lack of standardization of protocols across institutions and centers for orthopedic surgery for older patients. Identifying ERAS components that are beneficial to older patients and developing ERAS protocols that are appropriate for older adults may further improve outcomes.

Success of Same-Day Discharge Total Hip and Knee Arthroplasty: Does Location Matter?

BackgroundSame calendar day discharge (SCDD) following total joint arthroplasty is desirable for patients and surgeons alike. The aim of this study was to compare the success rate of SCDD in an ambulatory surgical center (ASC) versus hospital setting. MethodsA retrospective analysis was performed on 510 patients who underwent primary hip and knee total joint arthroplasty over a 2-year period. The final cohort was divided into 2 groups based on location of surgery: ASC (N = 255) or hospital (N = 255). Groups were matched for age, sex, body mass index, American Society of Anesthesiologists score, and Charleston Comorbidity Index. Successes of SCDD, reasons for failure of SCDD, length of stay (LOS), and 90-day readmission and complication rates were recorded. ResultsAll SCDD failures were from the hospital setting (36 [65.6%] total knee arthroplasty [TKA] and 19 [34.5%] total hip arthroplasty [THA]). There were no failures from the ASC. The main causes of failed SCDD in both THA and TKA included failed physical therapy and urinary retention. Regarding THA, the ASC group had a significantly shorter total LOS (6.8 [4.4 to 11.6] versus 12.8 [4.7 to 58.0] hours, P < .001). Similarly, TKA patients had a shorter LOS in the ASC (6.9 [4.6 to 12.9] versus 16.9 [6.1 to 57.0], P < .001). Total 90-day readmission rates were higher in the ASC group (2.75% versus 0%), where all but 1 patient underwent TKA. Similarly, complication rates were higher in the ASC group (8.2% versus 2.75%), where all but 1 patient underwent TKA. ConclusionTJA performed in the ASC, compared to the hospital setting, allowed for reduced LOS and improved success of SCDD.

The impact of unplanned 30-day readmission as a quality indicator in pediatric surgery.

Hospital readmission is one of the indicators used to assess quality of service provided in healthcare. Based on accumulated knowledge, risk management teams assess data related to readmissions to find curative solutions for underlying factors. The current article's aim is investigating readmission routes within the workplace in paediatric surgery service during the first 30 days post discharge from Mater Dei Hospital (MDH). A retrospective study of children's hospital readmissions between October 2017 and November 2019 was performed, strictly before COVID-19 pandemic. Demographics and clinical records including age, gender, pre-existing comorbidities, diagnosis during primary admission and readmission, procedure carried out, ASA grade, length of stay, and outcomes were collected. All children re-admitted under a single paediatric surgical department within 30 days from initial admission to tertiary referral hospital were included. Patients undergoing emergency visitation without subsequent admissions were excluded. Readmissions were classified into cohorts: elective and emergency, depending on the nature of primary admission. Contributing factors and outcomes were compared. 935 surgical admissions (221 elective and 714 emergencies) were registered at MDH over the given period, with an average hospital stay of 3.62 days. Total readmission rate was 1.7% (n = 16). 25% (n = 4) of readmissions were post elective, 75% (n = 12) post emergency admission, with an average stay of 4.37 days and no mortalities. 43.7% (n = 7) were re-admissions post-surgical intervention. Further surgical interventions were necessary in 25% (n = 4) of readmitted patients, the remainder (n = 12) treated conservatively. Published reports concerning paediatric surgical readmission rates are limited, challenging healthcare systems. Most readmissions area voidable; therefore, healthcare workers must provide adequate strategies tailored to their resources, efficient multidisciplinary approaches with improved communication to decrease morbidity and prevent readmissions.

Application of a specialist nurse-led multidisciplinary team model in the perioperative care of patients undergoing simultaneous pancreas and kidney transplantation: randomized controlled trial.

Simultaneous pancreas and kidney transplantation (SPKT) is an effective treatment option for individuals who suffer from both diabetes mellitus and renal failure. However, experiments exploring nurse-led multidisciplinary team management during the perioperative management of patients undergoing SPKT are currently limited. This study aims to explore the clinical performance of a transplant nurse-led multidisciplinary team (MDT) in the perioperative management of SPKT patients. A total of 218 patients who underwent SPKT were randomly assigned to either a control group (n=116) receiving conventional care or an intervention group (n=102) managed through a transplant nurse-led MDT approach. The incidence of postoperative complications, hospital stay, total hospitalization cost, readmission rate, and postoperative nursing quality were compared between these 2 groups. The intervention and control groups showed no significant differences in age, gender, and body mass index. Compared with the control group, the intervention group had a significantly lower incidence of postoperative pulmonary infection and gastrointestinal (GI) bleeding (27.6% vs. 14.7% and 31.0% vs. 15.7%, respectively, both P<0.05). Compared to the control group, the intervention group had significantly lower hospitalization costs, length of hospital stay, and readmission rate 30 days after discharge (32.98±9.10 vs. 36.78±15.36, 26.47±13.4 vs. 31.03±11.61 and 31.4% vs. 50.0%, respectively, all P<0.05). Additionally, the intervention group had significantly better quality of postoperative nursing care than the control group (11.61±0.69 vs. 9.64±1.42, P<0.01), the availability of infection control and prevention measures (11.74±0.61 vs. 10.53±1.11, P<0.01), the effectiveness of health education (11.73±0.61 vs. 10.41±1.06, P<0.01), the effectiveness of rehabilitation training (11.77±0.54 vs. 10.37±0.96, P<0.01), and the patient satisfaction with nursing care (11.83±0.42 vs. 10.81±1.08, P<0.01). The nurse-led MDT model for transplant patients can reduce complications, shorten hospital stays, and save costs. It also provides clear guidelines for nurses, improving care quality and aiding patient recovery. Chinese Clinical Trial Registry ChiCTR1900026543.

Specimen extraction through natural orifices with Cai tubes in gastrointestinal surgery: a single-institute series of 234 cases

Objective: To investigate the feasibility of Cai tube-assisted natural orifice specimen extraction surgery (NOSES) in gastrointestinal surgery. Methods: This was a descriptive case-series study. Inclusion criteria: (1) colorectal or gastric cancer diagnosed by preoperative pathological examination or redundant sigmoid or transverse colon detected by barium enema; (2) indications for laparoscopic surgery; (3) body mass index <30 kg/m2 (transanal surgery) and 35 kg/m2 (transvaginal surgery); (4) no vaginal stenosis or adhesions in female patients undergoing transvaginal specimen extraction; and (5) patients with redundant colon aged 18-70 years and a history of intractable constipation for more than 10 years. Exclusion criteria: (1) colorectal cancer with intestinal perforation or obstruction, or gastric cancer with gastric perforation, gastric hemorrhage, or pyloric obstruction; (2) simultaneous resection of lung, bone, or liver metastases ; (3) history of major abdominal surgery or intestinal adhesions; and (4) incomplete clinical data. From January 2014 to October 2022, 209 patients with gastrointestinal tumors and 25 with redundant colons who met the above criteria were treated by NOSES utilizing a Cai tube (China invention patent number:ZL201410168748.2) in the Department of Gastrointestinal Surgery, Zhongshan Hospital, Xiamen University. The procedures included eversion and pull-out NOSES radical resection in 14 patients with middle and low rectal cancer, NOSES radical left hemicolectomy in 171 patients with left-sided colorectal cancer, NOSES radical right hemicolectomy in 12 patients with right-sided colon cancer, NOSES systematic mesogastric resection in 12 patients with gastric cancer, and NOSES subtotal colectomy in 25 patients with redundant colons. All specimens were collected by using an in-house-made anal cannula (Cai tube) with no auxiliary incisions. The primary outcomes included 1-year recurrence-free survival (RFS) and postoperative complications. Results: Among 234 patients, 116 were male and 118 were female. The mean age was (56.6±10.9) years. NOSES was successfully completed in all patients without conversion to open surgery or procedure-related death. The negative rate of circumferential resection margin was 98.8% (169/171) with both two positive cases having left-sided colorectal cancer. Postoperative complications occurred in 37 patients (15.8%), including 11 cases (4.7%) of anastomotic leakage, 3 cases(1.3%) of anastomotic bleeding, 2 cases (0.9%) of intraperitoneal bleeding, 4 cases (1.7%) of abdominal infection, and 8 cases (3.4%) of pulmonary infection. Reoperations were required in 7 patients (3.0%), all of whom consented to creation of an ileostomy after anastomotic leakage. The total readmission rate within 30 days after surgery was 0.9% (2/234). After a follow-up of (18.3±3.6) months, the 1-year RFS was 94.7%. Five of 209 patients (2.4%) with gastrointestinal tumors had local recurrence, all of which was anastomotic recurrence. Sixteen patients (7.7%) developed distant metastases, including liver metastases(n=8), lung metastases(n=6), and bone metastases (n=2). Conclusion: NOSES assisted by Cai tube is feasible and safe in radical resection of gastrointestinal tumors and subtotal colectomy for redundant colon.

Effects of sacubitril-valsartan on heart failure patients with mid-range ejection fractions: A systematic review and meta-analysis.

Aim: The effect of sacubitril-valsartan (ARNI) in heart failure (HF) patients with mid-range ejection fractions (HFmrEF) remains unclear. This study aimed to investigate the effects of ARNI in HFmrEF patients. Methods: From inception to 15 February 2022, articles were searched via PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure, Whip, and Wanfang databases. Left ventricular functions, indicators related to HF, quality of life score, 6-Minute Walk Test, total effective rate, mortality, readmission rate, and adverse events were the outcomes. Relative risk (RR), weighted mean difference (WMD), and 95% confidence interval (CI) were used to evaluate the outcomes. The heterogeneity test was conducted for each indicator and measured by I2 statistics. Subgroup analysis was performed regarding the type of study and duration of treatment. Results: Sixteen studies involving 1,937 patients were included in this study. Our results showed ARNI was likely to improve left ventricular function by increasing the left ventricular ejection fraction (LVEF) (WMD: 2.36, 95%CI: 1.09-3.62), stroke volume (WMD: 16.800, 95%CI: 11.385-22.215), and left ventricular short-axis shortening rate (WMD: 2.05, 95%CI: 0.25-3.86), decreasing left ventricular end-diastolic dimension (WMD: -2.48, 95%CI: -3.83 to -1.13), left atrial diameter (WMD: -2.23, 95%CI: -2.83 to -1.63), C-reactive protein level (WMD: -1.40, 95%CI: -2.62 to -0.18), and N-terminal-pro B-type natriuretic peptide level (WMD: -494.92, 95%CI: -641.34 to -348.50). ARNI has a higher total effective rate (RR: 1.15, 95%CI: 1.08-1.21), Kansas City cardiomyopathy questionnaire (WMD: 4.13, 95%CI: 3.46-4.81), and 6-Minute Walk Test (WMD: 51.35, 95%CI: 26.99-75.71) compared with angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB). In addition, ARNI decreased the readmission rate (RR: 0.54, 95%CI: 0.43-0.68) (all p < 0.05). Nevertheless, there were no significant differences in the adverse outcomes. Conclusion: This meta-analysis suggests ARNI may be an effective strategy with which to improve the left ventricular function, and quality of life, and reduce the readmission rate in HFmrEF patients. However, long-term clinical studies with large samples are still needed to further explore the efficacy and safety of ARNI compared with ACEI or ARB in the HFmrEF population.

Readmission Rates of Patients Discharged on Antipsychotic Polypharmacy Compared to Antipsychotic Monotherapy.

Antipsychotic medications are used to treat many psychiatric conditions and are paramount for relapse prevention in patients with mental illnesses. Antipsychotic monotherapy (APM) is a commonly recommended approach, however there is no clear consensus on the use of antipsychotic polypharmacy (APP). A single-center retrospective review was conducted comparing readmission rates of behavioral health patients discharged on APP or APM between August 1st 2019 and July 31st 2021. The primary outcome was the one-year psychiatric readmission rate. Secondary outcomes included further readmission time frame stratification, olanzapine equivalent doses, and use of anticholinergic medications. The total readmission rate was 24.5% (24/98) in the APP group compared to 19.1% (107/560) in the APM group (p = 0.22). Patients discharged on APM were not found to have a statistically significant increase in readmission rate compared to patients discharged on APP. Further research is needed to assess the risks and benefits of APP.

MP04-01 IMPACT OF 5-ALPHA REDUCTASE INHIBITORS ON FUNCTIONAL OUTCOMES OF GREENLIGHT PHOTOVAPORIZATION OF THE PROSTATE (PVP): AN ANALYSIS OF 3500 MEN IN THE GLOBAL GREENLIGHT GROUP (GGG) DATABASE

MP04-01 IMPACT OF 5-ALPHA REDUCTASE INHIBITORS ON FUNCTIONAL OUTCOMES OF GREENLIGHT PHOTOVAPORIZATION OF THE PROSTATE (PVP): AN ANALYSIS OF 3500 MEN IN THE GLOBAL GREENLIGHT GROUP (GGG) DATABASE