Relation of Telemetry Use and Mortality Risk, Hospital Length of Stay, and Readmission Rates in Patients With Respiratory Illness

2017 ◽  
Vol 120 (8) ◽  
pp. 1416-1420
Author(s):  
Nancy Dawson ◽  
M. Caroline Burton ◽  
Bryan Hull ◽  
Gregory Beliles ◽  
Ingrid Pritchard ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Mortality Risk ◽  
Respiratory Illness ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Readmission Rates

Opioid Abuse or Dependence Increases 30-day Readmission Rates after Major Operating Room Procedures

2018 ◽  
Vol 128 (5) ◽  
pp. 880-890 ◽  
Author(s):  
Atul Gupta ◽  
Junaid Nizamuddin ◽  
Dalia Elmofty ◽  
Sarah L. Nizamuddin ◽  
Avery Tung ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Operating Room ◽  
Healthcare Utilization ◽  
Cohort Analysis ◽  
Hospital Costs ◽  
Hospital Length ◽  
Opioid Abuse ◽  
Hospital Length Of Stay ◽  
Opioid Overdose ◽  
Readmission Rates

Abstract Background Although opioids remain the standard therapy for the treatment of postoperative pain, the prevalence of opioid misuse is rising. The extent to which opioid abuse or dependence affects readmission rates and healthcare utilization is not fully understood. It was hypothesized that surgical patients with a history of opioid abuse or dependence would have higher readmission rates and healthcare utilization. Methods A retrospective cohort analysis was performed of patients undergoing major operating room procedures in 2013 and 2014 using the National Readmission Database. Patients with opioid abuse or dependence were identified using International Classification of Diseases codes. The primary outcome was 30-day hospital readmission rate. Secondary outcomes included hospital length of stay and estimated hospital costs. Results Among the 16,016,842 patients who had a major operating room procedure whose death status was known, 94,903 (0.6%) had diagnoses of opioid abuse or dependence. After adjustment for potential confounders, patients with opioid abuse or dependence had higher 30-day readmission rates (11.1% vs. 9.1%; odds ratio 1.26; 95% CI, 1.22 to 1.30), longer mean hospital length of stay at initial admission (6 vs. 4 days; P < 0.0001), and higher estimated hospital costs during initial admission ($18,528 vs. $16,617; P < 0.0001). Length of stay was also higher at readmission (6 days vs. 5 days; P < 0.0001). Readmissions for infection (27.0% vs. 18.9%; P < 0.0001), opioid overdose (1.0% vs. 0.1%; P < 0.0001), and acute pain (1.0% vs. 0.5%; P < 0.0001) were more common in patients with opioid abuse or dependence. Conclusions Opioid abuse and dependence are associated with increased readmission rates and healthcare utilization after surgery.

scholarly journals Validation of population-specific Mini-Nutritional Assessment with its long-term mortality-predicting ability: results of a population-based longitudinal 4-year study in Taiwan

2010 ◽  
Vol 104 (1) ◽  
pp. 93-99 ◽  
Author(s):  
Alan C. Tsai ◽  
Shu-Fang Yang ◽  
Jiun-Yi Wang
Keyword(s):  
Life Satisfaction ◽  
Length Of Stay ◽  
Nutritional Status ◽  
Mortality Risk ◽  
Nutritional Assessment ◽  
Mini Nutritional Assessment ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Nutritional Screening ◽  
Screening Assessment

Nutrition is a key element in geriatric health, and nutritional screening/assessment is a key component of comprehensive geriatric evaluation. The study aimed to validate the Mini Nutritional Assessment Taiwan version-1 (MNA-T1) which adopted population-specific anthropometric cut-points, and version-2 (MNA-T2) which replaced BMI with mid-arm and calf circumferences in the scale for predicting the nutritional status of elderly Taiwanese. Using data of a population-representative longitudinal study of 2802 Taiwanese aged 65 years or older, the study graded the nutritional status of each subject with the original and both modified versions at baseline, analysed their hospital length of stay, the Activities of Daily Living (ADL), the Center for Epidemiologic Studies Depression Scale (CES-D) and life-satisfaction scores at baseline and end of 4 years, and tracked their survival during the period. Results showed that both modified versions had superior predictive abilities compared with the original MNA, and their graded scores correlated better with hospital length of stay, and ADL, CES-D and life-satisfaction scores. Both modified versions were effective in predicting follow-up mortality risk. The relative mortality risk was about 7 times for those rated malnourished and 2·5 times for those rated at risk of malnutrition compared with those who were rated normal at baseline by the two modified versions. These results suggest that both of the modified versions are effective in predicting the nutrition and health statuses of Taiwanese elderly and would serve to validate the predictive ability of the two modified versions. The MNA-T2, which requires no BMI, can make routine nutritional screening/assessment an easier task.

Hospital length of stay after hip fracture and its association with 4-month mortality – Exploring the role of patient characteristics

2021 ◽  
Author(s):  
Stina Ek ◽  
Anna C Meyer ◽  
Margareta Hedström ◽  
Karin Modig
Keyword(s):  
Hip Fracture ◽  
Length Of Stay ◽  
Mortality Risk ◽  
Cox Regression ◽  
Living Arrangement ◽  
Patient Characteristics ◽  
Hospital Length ◽  
Care Homes ◽  
Hospital Length Of Stay ◽  
Increased Risk

Abstract Background Hospital length of stay (LoS) is believed to be associated with higher mortality in hip fracture patients, however, previous research has shown conflicting results. We aimed to explore the association between LoS and 4-month mortality in different groups of hip fracture patients. Methods The study population in this Swedish register-based cohort study was 47,811 patients ≥65 years old with a first hip fracture during 2012-2016, followed for 4 months after discharge. LoS was categorized by cubic splines and the association between LoS and mortality was analyzed with Cox regression models, adjusted for sociodemographic- and health related factors. Results Mean LoS was 11.2±5.9 days and 12.3% of the patients died within 4 months. Both a shorter and a longer LoS, compared to the reference 9-12 days, was associated with higher mortality (HR [95% CI]); 2-4 days 2.15 (1.98-2.34), 5-8 days 1.58 (1.47-1.69) and 24+ days 1.29 (1.13-1.46). However, in fully-adjusted models, only the association with a long LoS remained; 13-23 days 1.08 (1.00-1.17) and 24+ days 1.42 (1.25-1.61). Stratifying by living arrangement revealed that the increased risk for a short LoS was driven by the group living in care homes. For patients living at home, a short LoS was associated with a lower risk, HR 0.65 (0.47-0.91) and 0.85 (0.74-0.98) for 2-4 and 5-8 days, respectively. Conclusions A long LoS after a hip fracture is associated with increased 4-month mortality risk even after considering patient characteristics. The association between mortality and a short LoS, however, is explained by individuals coming from care homes (with higher mortality risk), being discharged early.

scholarly journals 1951. Extended Infusions of Β-lactam Antibiotics are Feasible and May Improve Mortality in the Pediatric Population

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S59-S60
Author(s):  
Rachael L Schortemeyer ◽  
Tracy N Zembles ◽  
Glenn Bushee ◽  
Evelyn Kuhn ◽  
Michelle L Mitchell
Keyword(s):  
Length Of Stay ◽  
Clinical Outcomes ◽  
Critically Ill ◽  
Interim Analysis ◽  
Pediatric Population ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Readmission Rates ◽  
Drug Concentrations ◽  
All Cause Mortality

Abstract Background Infections due to multi-drug-resistant organisms (MDRO) are associated with poor clinical outcomes. Due to limited treatment options for MDROs, it is essential to improve the delivery of available antibiotics. Optimal efficacy of β-lactam antibiotics can be achieved when free drug concentrations exceed the minimum inhibitory concentration of the organism for at least 50% of the dosing interval. This is more feasible when extending the duration of infusion. Adult literature supporting the use of extended infusion β-lactams (EIBL) is robust; however, pediatric data are limited. Furthermore, extended infusions (EI) may be more difficult to achieve in pediatric patients due to limited intravenous line access. The purpose of this study was to determine the feasibility of EIBLs as the standard of care and compare clinical outcomes between standard infusions (SI) and extended infusions (EI). Methods This retrospective chart analysis included hospitalized patients less than 18 years old between October 1, 2017 and March 31, 2019 who received at least 72 hours of cefepime, piperacillin/tazobactam, or meropenem. Patients weighing less than 3.5 kg or requiring continuous renal replacement therapy were excluded. EI were defined as antibiotic delivery over 3–4 hours, while SI were delivered over 30 minutes. The percent of patients completing therapy utilizing EI was measured. Clinical outcomes compared hospital length of stay; time to blood culture clearance, defervescence, inflammatory marker normalization; 30-day readmission rates; and 30-day all-cause mortality between the SI and EI groups. Results A total of 560 patients were included in the interim analysis. Over 90% of patients were able to complete therapy utilizing EI (Figure 1). The EI group had lower readmission rates, but the interim analysis has not yet controlled for planned admissions. A sub-analysis of critically ill patients requiring vasopressors identified a lower mortality rate (5.1% vs. 23.1%, P = 0.023) and decreased the length of stay (554 vs. 1,055 hours, P = 0.035) in the EI compared with SI group (Table 1). Conclusion EIBLs are feasible in the pediatric population and may lead to improved outcomes including decreased all-cause mortality and hospital length of stay, especially in critically ill children. Disclosures All Authors: No reported Disclosures.

THE EFFECTS OF PERIOPERATIVE DEXAMETHASONE ON GLYCEMIC CONTROL AND POSTOPERATIVE OUTCOMES

2020 ◽  
Vol 26 (2) ◽  
pp. 218-225 ◽  
Author(s):  
Rebecca A. Herbst ◽  
Onala T. Telford ◽  
John Hunting ◽  
W. Michael Bullock ◽  
Erin Manning ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Length Of Stay ◽  
Confidence Interval ◽  
Orthopedic Surgery ◽  
Geometric Mean ◽  
Hospital Length ◽  
Hazard Ratio ◽  
Hospital Length Of Stay ◽  
Geometric Mean Ratio ◽  
Readmission Rates

Objective: Perioperative glucocorticoids are commonly given to reduce pain and nausea in patients undergoing surgery. However, the glycemic effects of steroids and the potential effects on morbidity and mortality have not been systematically evaluated. This study investigated the association between perioperative dexamethasone and postoperative blood glucose, hospital length of stay (LOS), readmission rates, and 90-day survival. Methods: Data from 4,800 consecutive orthopedic surgery patients who underwent surgery between 2000 and 2016 within a single health system were analyzed retrospectively. Results: Patients with and without diabetes mellitus (DM) who were given a single dose of dexamethasone had higher rates of hyperglycemia during the first 24 hours after surgery as compared to those who did not receive dexamethasone (hazard ratio [HR] was 1.81, and 95% confidence interval [CI] was [1.46, 2.24] for the DM cohort; HR 2.34, 95% CI [1.66, 3.29] for the nonDM cohort). LOS was nearly 1 day shorter in patients who received dexamethasone (geometric mean ratio [GMR] 0.79, 95% CI [0.75, 0.83] for patients with DM; GMR 0.75, 95% CI [0.72, 0.79] for patients without DM), and there was no difference in 90-day readmission rates. In patients without DM, dexamethasone was associated with a higher 90-day overall survival (99.07% versus 96.90%; P = .004). Conclusion: In patients with and without DM who undergo orthopedic surgery, perioperative dexamethasone was associated with a transiently higher risk of hyperglycemia. However, dexamethasone treatment was associated with a shorter LOS in patients with and without DM, and a higher overall 90-day survival rate in patients without DM, compared to patients who did not receive dexamethasone. Abbreviations: BMI = body mass index; CAD = coronary artery disease; CI = confidence interval; DM = diabetes mellitus; GMR = geometric mean ratio; HR = hazard ratio; IV = intravenous; LOS = length of stay; POD = postoperative day

scholarly journals Impact of a COPD comprehensive case management program on hospital length of stay and readmission rates

2017 ◽  
Vol Volume 12 ◽  
pp. 961-971 ◽  
Author(s):  
Abdulmajeed Alshabanat ◽  
Michael Otterstatter ◽  
Don Sin ◽  
Jeremy Road ◽  
Carmen Rempel ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Case Management ◽  
Hospital Length ◽  
Management Program ◽  
Hospital Length Of Stay ◽  
Readmission Rates ◽  
Case Management Program
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