Younger age remains a risk factor for prolonged length of stay after bidirectional cavopulmonary anastomosis

2019 ◽  
Vol 29 (3) ◽  
pp. 369-374 ◽  
Author(s):  
Andrew M. Koth ◽  
Claudia A. Algaze ◽  
Charlotte Sakarovitch ◽  
Jin Long ◽  
Komal Kamra ◽  
...  
Keyword(s):  
Risk Factor ◽  
Length Of Stay ◽  
Demographic Data ◽  
Univariable Analysis ◽  
Prolonged Length ◽  
Atrioventricular Valve Regurgitation ◽  
Younger Age ◽  
Cavopulmonary Anastomosis ◽  
Bidirectional Cavopulmonary Anastomosis ◽  
Operative Recovery

AbstractObjectiveThis study sets out to determine the influence of age at the time of surgery as a risk factor for post-operative length of stay after bidirectional cavopulmonary anastomosis.MethodsAll patients undergoing a Glenn procedure between January 2010 and July 2015 were included in this retrospective cohort study. Demographic data were examined. Standard descriptive statistics was used. A univariable analysis was conducted using the appropriate test based on data distribution. A propensity score for balancing the group difference was included in the multi-variable analysis, which was then completed using predictors from the univariable analysis that achieved significance of p<0.1.ResultsOver the study period, 50 patients met the inclusion criteria. Patients were separated into two cohorts of ⩾4 months (28 patients) and <4 months (22 patients). Other than height and weight, the two cohorts were indistinguishable in their pre-operative saturation, medications, catheterisation haemodynamics, atrioventricular valve regurgitation, and ventricular function. After adjusting group differences, younger age was associated with longer post-operative length of hospitalisation – adjusted mean 15 (±2.53) versus 8 (±2.15) days (p=0.03). In a multi-variable regression analysis, in addition to ventricular dysfunction (β coefficient=8.8, p=0.05), Glenn procedures performed before 4 months were independently associated with longer length of stay (β coefficient=−6.9, p=0.03).ConclusionWe found that Glenn procedures performed after 4 months of age had shorter post-operative length of stay when compared to a younger cohort. These findings suggest that balancing timing of surgery to decrease the inter-stage period should take into consideration differences in post-operative recovery with earlier operations.

Measurement of Dead Space Fraction Upon ICU Admission Predicts Length of Stay and Clinical Outcomes Following Bidirectional Cavopulmonary Anastomosis*

2018 ◽  
Vol 19 (1) ◽  
pp. 23-31 ◽  
Author(s):  
Claire L. Cigarroa ◽  
Sarah J. van den Bosch ◽  
Xiaoqi Tang ◽  
Kimberlee Gauvreau ◽  
Christopher W. Baird ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Clinical Outcomes ◽  
Dead Space ◽  
Icu Admission ◽  
Cavopulmonary Anastomosis ◽  
Bidirectional Cavopulmonary Anastomosis

scholarly journals P067: Factors associated with prolonged length of stay of admitted patients in a tertiary care emergency department

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S101
Author(s):  
K. Johns ◽  
S. Smith ◽  
E. Karreman ◽  
A. Kastelic
Keyword(s):  
Length Of Stay ◽  
Multiple Regression ◽  
Significant Relationship ◽  
Demographic Data ◽  
Healthcare Access ◽  
Tertiary Care ◽  
Outcome Variable ◽  
Prolonged Length ◽  
Patient Demographic Data ◽  
Major Predictor

Introduction: Extended length of stay (LOS) in emergency departments (EDs) and overcrowding are a problems for the Canadian healthcare system, which can lead to the creation of a healthcare access block, a reduced health outcome for acute care patients, and decreased satisfaction with the health care system. The goal of this study is to identify and assess specific factors that predict length of stay in EDs for those patients who fall in the highest LOS category. Methods: A total of 130 patient charts from EDs in Regina were reviewed. Charts included in this study were from the 90th-100th percentile of time-users, who were registered during February 2016, and were admitted to hospital from the ED. Patient demographic data and ED visit data were collected. T-tests and multiple regression analyses were conducted to identify any significant predictors of our outcome variable, LOS. Results: None of the demographic variables showed a significant relationship with LOS (age: p=.36; sex: p=.92, CTAS: p=.48), nor did most of the included ED visit data such as door to doctor time (p=.34) and time for imaging studies (X-ray: p=.56; ultrasound: p=.50; CT p=.45). However, the time between the request for consult until the decision to admit did show a significant relationship with LOS (p&lt;.01).Potential confounding variables analyzed were social work consult requests (p=.14), number of emergency visits on day of registration (p=.62), and hour of registration (00-12 or 12-24-p&lt;.01). After adjustment for time of registration, using hierarchical multiple regression, time from consult request to admit decision maintained a significant predictor (p&lt;.01) of LOS. Conclusion: After adjusting for the influence of confounding factors, “consult request to admit decision” was by far the strongest predictor of LOS of all included variables in our study. The results of this study were limited to some extent by inconsistencies in the documentation of some of the analyzed metrics. Establishing standardized documentation could reduce this issue in future studies of this nature. Future areas of interest include establishing a standard reference for our variables, a further analysis into why consult requests are a major predictor, and how to alleviate this in the future.

Cold ischemia time is an important risk factor for post-liver transplant prolonged length of stay

2018 ◽  
Vol 24 (6) ◽  
pp. 762-768 ◽  
Author(s):  
Evelyn T. Pan ◽  
Dor Yoeli ◽  
N. Thao N. Galvan ◽  
Michael L. Kueht ◽  
Ronald T. Cotton ◽  
...  
Keyword(s):  
Risk Factor ◽  
Length Of Stay ◽  
Liver Transplant ◽  
Important Risk Factor ◽  
Cold Ischemia Time ◽  
Cold Ischemia ◽  
Ischemia Time ◽  
Prolonged Length

Risk Factors For Unfavorable Outcomes After Bidirectional Cavopulmonary Anastomosis

2017 ◽  
Vol 8 (5) ◽  
pp. 575-583 ◽  
Author(s):  
Nataliya R. Nichay ◽  
Yuriy N. Gorbatykh ◽  
Igor A. Kornilov ◽  
Ilya A. Soynov ◽  
Yuriy Y. Kulyabin ◽  
...  
Keyword(s):  
Risk Factors ◽  
Proportional Hazards ◽  
Cox Regression ◽  
Fontan Procedure ◽  
Unfavorable Outcome ◽  
Atrioventricular Valve Regurgitation ◽  
Cavopulmonary Anastomosis ◽  
Mean Pressure ◽  
Bidirectional Cavopulmonary Anastomosis ◽  
Anomalous Pulmonary Venous Connection

Background: Bidirectional cavopulmonary anastomosis (BCPA) is an important preliminary step toward the Fontan procedure; thus, understanding of risk factors for morbidity and mortality after BCPA may ultimately promote improved rates of success with Fontan completion and general survival. This study evaluated survival and predictors of unfavorable outcomes in patients after BCPA. Methods: Clinical data of 157 patients who underwent BCPA from 2003 to 2015 at a single center were retrospectively analyzed. Results: Three-year and nine-year survival after BCPA were 87.1% ± 2.8% and 85.8% ± 2.9%, respectively. Freedom from unfavorable outcomes (mortality, BCPA takedown, nonsuitability for Fontan procedure) was 83.8% ± 3.1% at three years and 73.5% ± 4.8% at nine years. Multivariate proportional hazards regression analysis revealed that total anomalous pulmonary venous connection (TAPVC; hazard ratio [HR]: 3.74, 95% confidence interval [CI]: 1.35-10.36; P = .01) and increased mean pressure in BCPA circuit (HR: 1.17, 95% CI: 1.02-1.34; P = .03) were independent risk factors for unfavorable outcomes. Postoperative mean pressure in BCPA circuit in patients with poor outcomes was median 16 mm Hg (interquartile range [IQR]: 14-18 mm Hg) versus median 14 mm Hg (IQR: 12-15.5 mm Hg) in patients with favorable outcomes ( P < .01). Preoperative (HR: 1.87, 95% CI: 1.20-2.91; P < .01) and postoperative atrioventricular valve regurgitation (AVVR; HR: 2.22, 95% CI: 1.24-3.94; P < .01) were also associated with unfavorable outcome in univariate Cox regression. Conclusions: Elevated mean pressure in the BCPA circuit is the main predictor of unfavorable outcome; therefore, thorough preoperative examination and careful patient selection are critical points for successful intermediate-stage and later Fontan completion. Total anomalous pulmonary venous connection and insufficient correction of AVVR worsen the prognosis in this patient group.

scholarly journals Characteristics, Comorbidities, and Outcomes Among Patients Admitted With COVID-19 in Sheikh Khalifa Medical City: A Retrospective Study

2021 ◽  
Author(s):  
Moustafa Abdelwahab ◽  
Lara Al Qadi ◽  
Mohammad Al Jawabreh ◽  
Hanan Sulaiman ◽  
Mariam Al Blooki
Keyword(s):  
Risk Factor ◽  
Retrospective Study ◽  
Length Of Stay ◽  
Clinical Characteristics ◽  
Demographic Data ◽  
Case Series ◽  
Minimum Length ◽  
Diabetic Patients ◽  
Upper Respiratory Tract ◽  
Medical City

Abstract Background: Many studies were published to describe the clinical characteristics of COVID-19, however there is still lack of knowledge and it’s time to take stock of the war against coronavirus disease 2019 (COVID-19) pandemic before we hit another million in a matter of days. Simply Identifying COVID-19 features will help in mapping the disease and guiding pandemic management. A retrospective review, retrospective study was initiated in SKMC to describe the demographic data, clinical characteristics, and outcomes of COVID-19 cases who were hospitalized during that period.Methods: Confirmed positive COVID-19 sample patients from April 1st 2020 to May 31st 2020 in Sheikh Khalifa Medical City. Clinical characteristics, Demographic data, incubation periods, laboratory findings, and patient outcomes data retrieved from 336 cases in the electronic medical chart (SALAMTAK).Results: The median age was 44 years and 83.9% (n = 282) of the patients were men. The patients with diabetes mellitus being the most common risk factor (25.0%), followed by hypertension (22.9%) and Age ≥60 were (13.4%). Total 36 patients (10.7%) were asymptomatic. The most common symptoms were upper respiratory tract symptoms, manifested as dry cough (70.2%), and followed by fever (54.2%), shortness of breath (43.5%), headache (25.9%) and sore throat (25.3%). Less common symptoms were diarrhea (16.7%) chest pain (14.6%). The maximum length of stay is 32 days. The minimum length of stay in [ICU/HDU] was 1 day and the maximum was 21 days.Conclusion: In this retrospective study, fever and cough were common symptoms. Special attention should be given to patients with risk factors especially patients with one risk factor such as diabetic patients, patients with hypertension and older patients over 60 years as they are the most highly prevalent in this case series. Disease was affecting males and D-dimer was significantly elevated in deceased patients.

scholarly journals Characteristics, Comorbidities, and Outcomes among Patients admitted with COVID-19 in Sheikh Khalifa Medical City: A Retrospective Study

2021 ◽  
Author(s):  
Lara Al Qadi ◽  
Moustafa Abdelwahab ◽  
Mohammad Al Jawabreh ◽  
Hanan Sulaiman ◽  
Mariam Al Blooki
Keyword(s):  
Risk Factor ◽  
Retrospective Study ◽  
Length Of Stay ◽  
Clinical Characteristics ◽  
Demographic Data ◽  
Case Series ◽  
Minimum Length ◽  
Diabetic Patients ◽  
Upper Respiratory Tract ◽  
Medical City

Abstract Background: Many studies were published to describe the clinical characteristics of COVID-19, however there is still lack of knowledge and it’s time to take stock of the war against coronavirus disease 2019 (COVID-19) pandemic before we hit another million in a matter of days. Simply Identifying COVID-19 features will help in mapping the disease and guiding pandemic management. A retrospective review, retrospective study was initiated in SKMC to describe the demographic data, clinical characteristics, and outcomes of COVID-19 cases who were hospitalized during that period. Methods: Confirmed positive COVID-19 sample patients from April 1st 2020 to May 31st 2020 in Sheikh Khalifa Medical City. Clinical characteristics, Demographic data, incubation periods, laboratory findings, and patient outcomes data retrieved from 336 cases in the electronic medical chart (SALAMTAK). Results: The median age was 44 years and 83.9% (n = 282) of the patients were men. The patients with diabetes mellitus being the most common risk factor (25.0%), followed by hypertension (22.9%) and Age ≥60 were (13.4%). Total 36 patients (10.7%) were asymptomatic. The most common symptoms were upper respiratory tract symptoms, manifested as dry cough (70.2%), and followed by fever (54.2%), shortness of breath (43.5%), headache (25.9%) and sore throat (25.3%). Less common symptoms were diarrhea (16.7%) chest pain (14.6%). The maximum length of stay is 32 days. The minimum length of stay in [ICU/HDU] was 1 day and the maximum was 21 days. Conclusion: In this retrospective study, fever and cough were common symptoms. Special attention should be given to patients with risk factors especially patients with one risk factor such as diabetic patients, patients with hypertension and older patients over 60 years as they are the most highly prevalent in this case series. Disease was affecting males and D-dimer was significantly elevated in deceased patients.

scholarly journals Prolonged Length of Stay in the Emergency Department and Mortality in Critically Ill Elderly Patients with Infections: A Retrospective Multicenter Study

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Wonjin Choi ◽  
Seon Hee Woo ◽  
Dae Hee Kim ◽  
June Young Lee ◽  
Woon Jeong Lee ◽  
...  
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Elderly Patients ◽  
Hospital Mortality ◽  
Demographic Data ◽  
Multivariable Analysis ◽  
Clinical Findings ◽  
Adverse Outcomes ◽  
Prolonged Length ◽  
History Of

Background. This study aimed at investigating whether the length of stay (LOS) in the emergency department (ED) is associated with mortality in elderly patients with infections admitted to the intensive care unit (ICU). Delayed admission to the ICU may be associated with adverse clinical outcomes in elderly patients with infections. Methods. This was a retrospective study conducted with subjects over 65 years of age admitted to the ICU from 5 EDs. We recorded demographic data, clinical findings, initial laboratory results, and ED LOS. Outcomes were all-cause in-hospital mortality and hospital LOS. A multivariable regression model was applied to identify factors predictive of mortality. Results. A total of 439 patients admitted to the ICU via the ED were included in this study, 132 (30.1%) of whom died in the hospital. The median (IQR) age was 78 (73, 83) years. In multivariable analysis, a history of malignancy (OR: 3.76; 95% CI: 1.88–7.52; p < 0.001 ), high lactate level (OR: 1.13; 95% CI: 1.01–1.27; p = 0.039 ), and ED LOS (OR: 1.01; 95% CI: 1.00–1.02; p = 0.039 ) were independent risk factors for all-cause in-hospital admission. Elderly patients with an ED LOS >12 hours had a longer hospital LOS ( p = 0.018 ), and those with an ED LOS > 24 hours had a longer hospital LOS and higher mortality rate ( p = 0.044 ,   p = 0.008 ). Conclusions. This study shows that prolonged ED LOS is independently associated with all-cause in-hospital mortality in elderly patients with infections requiring ICU admission. ED LOS should be considered in strategies to prevent adverse outcomes in elderly patients with infections who visit the ED.

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