PHP2: THE ASSOCIATION OF PRACTICE GUIDELINES AND OTHER FACTORS WITH HOSPITAL LENGTH OF STAY (LOS) AND MORTALITY IN PATIENTS WITH COMMUNITY-ACQUIRED PNEUMONIA (CAP), HEART FAILURE (HF) AND SEDATED INTENSIVE CARE PATIENTS

Objective We evaluated the effect of chronic use of statins based on C-reactive protein (CRP) levels and hospital length of stay (LOS) in patients admitted with community-acquired pneumonia (CAP). Methods We conducted a retrospective study over 12 months at a teaching hospital in Lebanon comparing patients with CAP taking chronic statins with patients not taking statins. Included patients with CAP were older than age 18 years and had two CRP level measures during hospitalization. CURB-65 criteria were used to assess the severity of pneumonia. A decrease in CRP levels on days 1 and 3, LOS, and normalization of fever were used to assess the response to antibiotics. Results Sixty-one patients were taking statins and 90 patients were not taking statins. Patients on statins had significantly more comorbid conditions; both groups had comparable CURB-65 scores. In both groups, no statistically significant difference was seen for the decrease in CRP level on days 1 and 3 and LOS. No difference in days to normalization of fever was detected in either group. Conclusion No association was found between the chronic use of statins and CRP levels, LOS, or days to fever normalization in patients with CAP.

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Abstract 17143: Shorter Length of Stay is Associated With Significantly Lower 30-day All-cause Readmission and 30-day All-cause Mortality in Older Medicare Beneficiaries Hospitalized for Heart Failure

Circulation ◽

10.1161/circ.132.suppl_3.17143 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Cherinne Arundel ◽

Ali Ahmed ◽

Rahul Khosla ◽

Charles Faselis ◽

Charity Morgan ◽

...

Keyword(s):

Heart Failure ◽

Length Of Stay ◽

Prospective Payment System ◽

Early Discharge ◽

Continuous Variable ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Medicare Beneficiaries ◽

Post Discharge ◽

All Cause Mortality

Background: A shorter hospital length of stay, encouraged by Prospective Payment System Act, may result in suboptimal care and early discharge. Heart failure (HF) is the leading cause for 30-day all-cause readmission. However, it is unknown whether hospitalized HF patients with a shorter length of stay may have higher 30-day all-cause readmission, the reduction of which is a goal of the Affordable Care Act. Methods: The 8049 Medicare beneficiaries hospitalized for HF and discharged alive from 106 U.S. hospitals (1998-2001) had a median length of stay of 5 days (interquartile, 4-8 days), of which 4272 (53%) had length of stay ≤ 5 days. Using propensity scores for length of stay 1-5 days, we assembled a matched cohort of 2788 pairs of patients with length of stay 1-5 and ≥6 days, balanced on 32 baseline characteristics. Results: 30-day all-cause readmission occurred in 19% and 23% of matched patients with length of stay 1-5 and ≥6 days, respectively (HR, 0.79; 95% CI, 0.70-0.89; Figure, left panel). When the length of stay of the 8049 pre-match patients was used as a continuous variable and adjusted for the same 32 variables, each day longer hospital stay was associated with a 2% higher risk of 30-day all-cause readmission (HR, 1.02; 95% CI, 1.01-1.03; p<0.001). Among matched patients, HR for 30-day HF readmission associated with length of stay 1-5 days was 0.84 (95% CI, 0.69-1.01; p=0.063). 30-day all-cause mortality occurred in 4.6% and 6.2% of matched patients with length of stay 1-5 and ≥6 days, respectively (HR, 0.73; 95% CI, 0.58-0.91; Figure, right panel). These associations persisted throughout 12 months post-discharge. Conclusions: Among hospitalized patients with HF, length of stay 1-5 days (vs. longer) was associated with significantly lower 30-day all-cause readmissions and all-cause mortality that persisted throughout first year post-discharge.

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Can practice guidelines safely reduce hospital length of stay? Results from a multicenter interventional study

The American Journal of Medicine ◽

10.1016/s0002-9343(98)00129-6 ◽

1998 ◽

Vol 105 (1) ◽

pp. 33-40 ◽

Cited By ~ 83

Author(s):

Scott Weingarten ◽

MaryS Riedinger ◽

Meenu Sandhu ◽

Constance Bowers ◽

A.Gray Ellrodt ◽

...

Keyword(s):

Length Of Stay ◽

Practice Guidelines ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Interventional Study

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Hospital Length of Stay Among Patients Receiving Intermittent Versus Prolonged Piperacillin/Tazobactam Infusion in the Intensive Care Units

Journal of Intensive Care Medicine ◽

10.1177/0885066617708756 ◽

2017 ◽

Vol 33 (2) ◽

pp. 134-141 ◽

Cited By ~ 2

Author(s):

Jeannie D. Chan ◽

Timothy H. Dellit ◽

John B. Lynch

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Length Of Stay ◽

Randomized Trials ◽

Average Duration ◽

Intermittent Infusion ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Inclusion Criteria ◽

Prolonged Infusion

Objectives: We sought to evaluate clinical outcomes of intensive care unit (ICU) patients following a hospital-wide initiative of prolonged piperacillin/tazobactam (PIP/TAZ) infusion. Methods: Retrospective observational study of patients >18 years old who was hospitalized in the ICU receiving PIP/TAZ for >72 hours during the preimplementation (June 1, 2010 to May 31, 2011) and postimplementation (July 7, 2011 to June 30, 2014) periods. Results: There were 124 and 429 patients who met inclusion criteria with average age of 54.3 and 56.9 years, and average duration of PIP/TAZ therapy was 6.1 ± 2.8 days and 5.9 ± 3.4 days in the pre- and postimplementation period, respectively. Intensive care unit and hospital length of stay (LOS) following initiation of PIP/TAZ were 8.0 ± 8.4 days versus 6.4 ± 6.8 days and 26.3 ± 22.8 days versus 20.4 ± 16.1 days among patients in the pre- and postimplementation periods, respectively. Compared to patients who received intermittent PIP/TAZ infusion, the adjusted difference in ICU and hospital LOS was 0.6 ± 0.8 days (95% confidence interval [CI]: −0.9 to 2.1 days) and 5.6 ± 2.1 days (95% CI: 1.4 - 9.7 days) shorter among patients who received prolonged PIP/TAZ infusion. At hospital discharge, 19 (15.3%) intermittent infusion and 74 (17.2%) prolonged infusion recipients had died. In comparison to intermittent infusion recipients, the adjusted odds ratio for mortality was 1.17 (95% CI: 0.65-2.1) with prolonged infusion. Conclusion: Our study demonstrated a reduction in hospital LOS with prolonged PIP/TAZ infusion among critically ill patients. Randomized trials are needed to further validate these findings.

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