The Six-Clicks Mobility Measure: A Useful Tool for Predicting Discharge Disposition

Introduction Advanced directives (ADs) provide a framework from which families may understand patient’s wishes. However, end-of-life planning may not be prioritized by everyone. This analysis aimed to determine what populations have ADs and how they affected trauma outcomes. Methods Adult trauma patients recorded in the American College of Surgeons Trauma Quality Improvement Program (TQIP) from 2013-2015 were included. The primary outcome was presence of an AD. Secondary outcomes included mortality, length of stay (LOS), mechanical ventilation, ICU admission/LOS, withdrawal of life-sustaining measures, and discharge disposition. Multivariable logistic regression models were developed for outcomes. Results 44 705 patients were included in the analyses. Advanced directives were present in 1.79% of patients. The average age for patients with ADs was 77.8 ± 10.7. African American (odds ratio (OR) .53, confidence intervals [CI] .36-.79) and Asian (OR .22, CI .05-.91) patients were less likely to have ADs. Conversely, Medicaid (OR 1.70, CI 1.06-2.73) and Medicare (OR 1.65, CI 1.25-2.17) patients were more likely to have ADs as compared to those with private insurance. The presence of ADs was associated with increased hospital mortality (OR 2.84, CI 2.19-3.70), increased transition to comfort measures (OR 2.87, CI 2.08-3.95), and shorter LOS (CO −.74, CI −1.26-.22). Patients with ADs had an increased odds of hospice care (OR 4.24, CI 3.18-5.64). Conclusion Advanced directives at admission are uncommon, particularly among African Americans and Asians. The presence of ADs was associated with increased mortality, use of mechanical ventilation, admission to the ICU, withdrawal of life-sustaining measures, and hospice. Future research should target expansion of ADs among minority populations to alleviate disparities in end-of-life treatment.

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Are the First and Second Hip in Staged Bilateral Total Hip Arthroplasty Equal? A Hospital Adverse Event and Perioperative Risk Comparison

The Journal of Hip Surgery ◽

10.1055/s-0041-1729868 ◽

2021 ◽

Author(s):

Jesus M. Villa ◽

Tejbir S. Pannu ◽

Carlos A. Higuera ◽

Juan C. Suarez ◽

Preetesh D. Patel ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Adverse Events ◽

Hip Arthroplasty ◽

Retrospective Chart Review ◽

Consecutive Series ◽

Level Of Evidence ◽

Exact Test ◽

Total Hip ◽

Discharge Disposition ◽

The Mean

AbstractHospital adverse events remain a significant issue; even “minor events” may lead to increased costs. However, to the best of our knowledge, no previous investigation has compared perioperative events between the first and second hip in staged bilateral total hip arthroplasty (THA). In the current study, we perform such a comparison. A retrospective chart review was performed on a consecutive series of 172 patients (344 hips) who underwent staged bilateral THAs performed by two surgeons at a single institution (2010–2016). Based on chronological order of the staged arthroplasties, two groups were set apart: first-staged THA and second-staged THA. Baseline-demographics, length of stay (LOS), discharge disposition, hospital adverse events, and hospital transfusions were compared between groups. Statistical analyses were performed using independent t-tests, Fisher's exact test, and/or Pearson's chi-squared test. The mean time between staged surgeries was 465 days. There were no significant differences in baseline demographics between first-staged THA and second-staged THA groups (patients were their own controls). The mean LOS was significantly longer in the first-staged THA group than in the second (2.2 vs. 1.8 days; p < 0.001). Discharge (proportion) to a facility other than home was noticeably higher in the first-staged THA group, although not statistically significant (11.0 vs. 7.6%; p = 0.354). The rate of hospital adverse events in the first-staged THA group was almost twice that of the second (37.2 vs. 20.3%; p = 0.001). There were no significant differences in transfusion rates. However, these were consistently better in the second-staged THA group. When compared with the first THA, our findings suggest overall shorter LOS and fewer hospital adverse events following the second. Level of Evidence Level III.

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Body mass index and clinical outcomes in patients with intracerebral haemorrhage: results from the China Stroke Center Alliance

Stroke and Vascular Neurology ◽

10.1136/svn-2020-000534 ◽

2021 ◽

pp. svn-2020-000534

Author(s):

Zhentang Cao ◽

Xinmin Liu ◽

Zixiao Li ◽

Hongqiu Gu ◽

Yingyu Jiang ◽

...

Keyword(s):

Body Mass Index ◽

Hospital Mortality ◽

Body Mass ◽

Intracerebral Haemorrhage ◽

Final Analysis ◽

Normal Weight ◽

Discharge Disposition ◽

Increased Risk ◽

Significant Difference ◽

Stroke Center

Background and aimObesity paradox has aroused increasing concern in recent years. However, impact of obesity on outcomes in intracerebral haemorrhage (ICH) remains unclear. This study aimed to evaluate association of body mass index (BMI) with in-hospital mortality, complications and discharge disposition in ICH.MethodsData were from 85 705 ICH enrolled in the China Stroke Center Alliance study. Patients were divided into four groups: underweight, normal weight, overweight and obese according to Asian-Pacific criteria. The primary outcome was in-hospital mortality. The secondary outcomes included non-routine discharge disposition and in-hospital complications. Discharge to graded II or III hospital, community hospital or rehabilitation facilities was considered non-routine disposition. Multivariable logistic regression analysed association of BMI with outcomes.Results82 789 patients with ICH were included in the final analysis. Underweight (OR=2.057, 95% CI 1.193 to 3.550) patients had higher odds of in-hospital mortality than those with normal weight after adjusting for covariates, but no significant difference was observed for patients who were overweight or obese. No significant association was found between BMI and non-disposition. Underweight was associated with increased odds of several complications, including pneumonia (OR 1.343, 95% CI 1.138 to 1.584), poor swallow function (OR 1.351, 95% CI 1.122 to 1.628) and urinary tract infection (OR 1.532, 95% CI 1.064 to 2.204). Moreover, obese patients had higher odds of haematoma expansion (OR 1.326, 95% CI 1.168 to 1.504), deep vein thrombosis (OR 1.506, 95% CI 1.165 to 1.947) and gastrointestinal bleeding (OR 1.257, 95% CI 1.027 to 1.539).ConclusionsIn patients with ICH, being underweight was associated with increased in-hospital mortality. Being underweight and obese can both increased risk of in-hospital complications compared with having normal weight.

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In Reply to the Letter to the Editor Regarding “Predictors of Nonroutine Discharge Disposition Among Parasagittal/Parafalcine Meningioma Patients”

World Neurosurgery ◽

10.1016/j.wneu.2020.08.132 ◽

2021 ◽

Vol 146 ◽

pp. 429

Author(s):

Adrian E. Jimenez ◽

Adham M. Khalafallah ◽

Debraj Mukherjee

Keyword(s):

Discharge Disposition ◽

Letter To The Editor

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Trending Racial and Socioeconomic Inequality in the Surgical Management and Outcome of Traumatic Cervical Spinal Cord Injury With Fracture In the USA From 1998 to 2009

Neurosurgery ◽

10.1093/neuros/nyz310_160 ◽

2019 ◽

Vol 66 (Supplement_1) ◽

Author(s):

Alexander Dru ◽

Dan Neal ◽

W Christopher Fox ◽

Brian Lim Hoh ◽

Daniel J Hoh

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Socioeconomic Status ◽

Hospital Mortality ◽

Cervical Spinal Cord ◽

Cervical Spinal Cord Injury ◽

Lower Odds ◽

Discharge Disposition ◽

Treatment Type ◽

Cord Injury

Abstract INTRODUCTION Advances in treatment of traumatic cervical spinal cord injury with fracture (TCSCIF) have led to significant improvements in clinical outcomes; however, progress in healthcare is seldom ubiquitous across demographic groups. We explored if disparities in treatment and outcome after TCSCIF exist across race and socioeconomic status. METHODS We queried the Nationwide Inpatient Sample database from 1998 to 2009 for TCSCIF hospitalizations. Multivariate analysis was used to identify the correlation between socioeconomic status and race to treatment type and outcome. RESULTS There were 21 985 admissions for TCSCIF. In all 66.9% had a favorable discharge disposition. In-hospital mortality rate was 12.5%. In all 43.7% underwent surgery. Overall, surgery was associated with lower in-hospital mortality (OR 0.30, 95% CI 0.27-0.34, P < .01) and better discharge disposition (OR 0.68, 95% CI 0.62-0.74, P < .01) vs nonsurgical or no intervention. Controlling for race and socioeconomic status demonstrated higher status (HS) non-Caucasians had lower odds of receiving surgery than HS Caucasians (OR 0.89, 95% CI 0.81-0.97, P = .01). LSES non-Caucasians had lower odds of receiving surgery than HS Caucasians (OR 0.83, 95% CI 0.73-0.94, P < .01). HS non-Caucasians had lower odds of receiving surgery than LSES Caucasians (OR 0.87, 95% CI 0.77-0.99, P = .03). LSES non-Caucasians had lower odds of receiving surgery than LSES Caucasians (OR 0.82, 95% CI 0.71-0.94, P = .01). For favorable discharge status HS non-Caucasians, LSES non-Caucasians, and LSES Caucasians all had lower odds of favorable discharge compared to HS Caucasians (OR 0.83, 95% CI 0.73-0.95, P = .01/OR 0.69, 95% CI 0.59-0.81, P < .01/OR 0.75, 95% CI 0.66-0.85, P < .01), respectively. CONCLUSION In our multivariate model that controlled for race and socioeconomic status in the setting of TCSCIF, race (but not socioeconomic status) was a factor in receiving surgery and both race and LSES impacted favorable discharge.

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