Adherence to a strict medication protocol can reduce length of stay in hospitalized patients with Parkinson's Disease

Background: Dysphagia is a frequent complication that may increase morbidity and mortality in Parkinson’s disease (PD). Nevertheless, there is limited data on its objective impact on healthcare outcomes. Objective: To investigate the outcomes associated with dysphagia in hospitalized patients with PD and associated healthcare costs and utilization. Methods: We performed a retrospective cohort study using the National Inpatient Sample (NIS) data from 2004 to 2014. A multivariable regression analysis was adjusted for demographic, and comorbidity variables to examine the association between dysphagia and associated outcomes. Logistic and negative binomial regressions were used to estimate odds or incidence rate ratios for binary and continuous outcomes, respectively. Results: We identified 334,395 non-elective hospitalizations of individuals with PD, being 21,288 (6.36%) associated with dysphagia. Patients with dysphagia had significantly higher odds of negative outcomes, including aspiration pneumonia (AOR 7.55, 95%CI 7.29–7.82), sepsis (AOR 1.91, 95%CI 1.82–2.01), and mechanical ventilation (AOR 2.00, 95%CI 1.86–2.15). For hospitalizations with a dysphagia code, the length of stay was 44%(95%CI 1.43–1.45) longer and inpatient costs 46%higher (95%CI 1.44–1.47) compared to those without dysphagia. Mortality was also substantially increased in individuals with PD and dysphagia (AOR 1.37, 95%CI 1.29–1.46). Conclusion: In hospitalized patients with PD, dysphagia was a strong predictor of adverse clinical outcomes, and associated with substantially prolonged length of stay, higher mortality, and care costs. These results highlight the need for interventions focused on early recognition and prevention of dysphagia to avoid complications and lower costs in PD patients.

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A prospective investigation of clinical profile and outcome among hospitalized patients with Parkinson's disease (PD)

Parkinsonism & Related Disorders ◽

10.1016/j.parkreldis.2020.06.341 ◽

2020 ◽

Vol 79 ◽

pp. e94

Author(s):

D. Biswas ◽

S. Banerjee ◽

H. Kumar

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Hospitalized Patients ◽

Clinical Profile ◽

Prospective Investigation

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Parkinson Disease Associated Differences in Elective Orthopedic Surgery Outcomes: A National Readmissions Database Analysis

Journal of Parkinson s Disease ◽

10.3233/jpd-201992 ◽

2020 ◽

Vol 10 (4) ◽

pp. 1577-1586

Author(s):

Michelle Fullard ◽

Dylan Thibault ◽

Hanan Zisling ◽

James A. Crispo ◽

Allison Willis

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Length Of Stay ◽

Index Admission ◽

Inclusion Criteria ◽

Database Analysis ◽

Discharge Disposition ◽

Orthopedic Procedure ◽

Surgery Outcomes ◽

Clinical Conditions

Background: Advances in the treatment of Parkinson’s disease (PD) have allowed for improvements in mortality and quality survival, making the management of comorbid conditions of aging, such as osteoarthritis, crucial. Objective: To determine the extent to which PD impacts hospitalization outcomes after an elective orthopedic procedure. Methods: This retrospective cohort study used data from the National Readmissions Database and included adults ages 40 and above with and without PD. Primary outcomes included length of stay of the index admission, discharge disposition and 30-day readmission. Logistic regression was used to compare the odds of readmission for PD patients compared to non-PD. Clinical conditions associated with readmission were compared between the two groups. Results: A total of 4,781 subjects with PD and 947,475 subjects without PD met inclusion criteria. Length of stay (LOS) during the index admission was longer for PD patients. PD patients were much more likely to be discharged to inpatient post-acute care (49.3% vs 26.2%) while non-PD subjects were more likely to be discharged home with (31.9% [PD] vs 44.8% [non-PD]) or without home health (18.7% [PD] vs 28.9% [non-PD]). A total of 271 PD patients (5.66%) and 28,079 non-PD patients (2.96%) were readmitted within 30 days following surgery. After adjusting for age, sex, socioeconomic status, expected payer, comorbidities, index admission LOS, year and discharge disposition, PD subjects were 31% more likely to be readmitted than non-PD subjects (AOR 1.31, 1.07–1.62). Conclusions: Parkinson’s disease patients were readmitted more often than non-PD patients, although the rate of readmission was still low.

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Matched Cohort Analysis of Elective Lumbar Spinal Fusion in Patients With and Without Parkinson’s Disease: In-hospital Complications, Length of Stay, and Hospital Charges

Global Spine Journal ◽

10.1177/2192568218776653 ◽

2018 ◽

Vol 8 (8) ◽

pp. 842-846 ◽

Cited By ~ 3

Author(s):

Justin E. Kleiner ◽

Alexandre Boulos ◽

Adam E. M. Eltorai ◽

Wesley M. Durand ◽

Alan H. Daniels

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Length Of Stay ◽

Spinal Fusion ◽

Cohort Analysis ◽

Hospital Charges ◽

Matched Cohort ◽

Lumbar Spinal Fusion ◽

Lumbar Spinal

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Service evaluation of an acute Parkinson's therapy pathway between hospital and home

International Journal of Therapy and Rehabilitation ◽

10.12968/ijtr.2019.0047 ◽

2020 ◽

Vol 27 (7) ◽

pp. 1-6

Author(s):

Christopher J Lovegrove ◽

Jonathan Marsden

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Length Of Stay ◽

Intervention Group ◽

Service Evaluation ◽

Hospital Length ◽

Community Services ◽

Hospital Length Of Stay ◽

Hospital Environments ◽

Home Based

Background People with Parkinson's disease report that inpatient hospital environments do not replicate their home setup. A therapy pathway was developed integrating early home-based assessment, therapy sessions with photographs of key home areas, enhanced communication with community services, and staggered discharge. Methods Outcome measures (length of stay and readmissions within 14 days) in people with Parkinson's disease on the therapy pathway (n=5) were compared to those previously receiving standard care (n=5). Results Mean length of stay was 7.2 days shorter in the intervention group and their discharge Lindop Parkinson's mobility scale score was 39.4% higher. No difference was found in the Modified Barthel Index between the groups. Both groups had the same readmission rates. The pathway was accepted by both people with Parkinson's disease and clinicians. Conclusions The pathway reduced hospital length of stay and increased mobility in patients with Parkinson's disease. It was accepted by patients and clinicians and was feasible to integrate into current practice. The pathway warrants further evaluation.

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