Outcomes in hospitalisations of women with Turner syndrome compared to women without Turner syndrome

2021 ◽  
pp. 1-8
Author(s):  
Isani Singh ◽  
Lindsey M. Duca ◽  
David Kao ◽  
Kathryn C. Chatfield ◽  
Amber D. Khanna
Keyword(s):  
Length Of Stay ◽  
Turner Syndrome ◽  
Conditional Logistic Regression ◽  
Primary Diagnosis ◽  
Adverse Outcomes ◽  
Prolonged Length ◽  
Logistic Regression Models ◽  
All Cause Mortality ◽  
Comorbidity Index ◽  
Cardiac Diagnosis

Abstract Objective: To evaluate outcomes in patients with Turner Syndrome, especially those with cardiac conditions, compared to those without Turner syndrome. Design: Retrospective cohort study utilising hospitalisation data from 2006 to 2012. Conditional logistic regression models are used to analyse outcomes of interest: all-cause mortality, increased length of stay, and discharge to home. Participants: We identified 2978 women with Turner syndrome, matched to 11,912 controls by primary diagnosis. Results: Patients with Turner syndrome were more likely to experience inpatient mortality (odds ratio 1.44, 95% confidence interval 1.02–2.02, p = 0.04) and increased length of stay (OR 1.31, CI 1.18–1.46, p = 0.03) than primary diagnosis matched controls, after adjusting for age, race, insurance status, and Charlson comorbidity index. Patients with Turner syndrome were 32% less likely to be discharged to home (OR 0.68, CI 0.60–0.78, p < 0.001). When restricting the sample of patients to those admitted with a cardiac diagnosis, the likelihood of mortality (OR 3.10, CI 1.27–7.57, p = 0.01) and prolonged length of stay (OR 1.42, CI 1.03–1.95, p = 0.03) further increased, while the likelihood of discharge to home further decreased (OR 0.55, CI 0.38–0.80, p = 0.001) in Turner syndrome compared to primary diagnosis matched controls. Specifically, patients with congenital heart disease were more likely to have prolonged length of stay (OR: 1.53, CI 1.18–2.00, p = 0.002), but not increased mortality or decreased discharge to home. Conclusions: Hospitalised women with Turner syndrome carry a higher risk of adverse outcomes even when presenting otherwise similarly as controls, an important consideration for those treating them in these settings.

scholarly journals Prolonged Emergency Department Length of Stay as a Predictor of Adverse Outcomes in Patients with Intracranial Hemorrhage

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Erica M. Jones ◽  
Amelia K. Boehme ◽  
Aimee Aysenne ◽  
Tiffany Chang ◽  
Karen C. Albright ◽  
...  
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Adverse Outcome ◽  
Independent Predictor ◽  
Adverse Outcomes ◽  
Stroke Patients ◽  
Significant Independent Predictor ◽  
Prolonged Length ◽  
Stroke Center ◽  
Shift Change

Objectives. Extended time in the emergency department (ED) has been related to adverse outcomes among stroke patients. We examined the associations of ED nursing shift change (SC) and length of stay in the ED with outcomes in patients with intracerebral hemorrhage (ICH). Methods. Data were collected on all spontaneous ICH patients admitted to our stroke center from 7/1/08–6/30/12. Outcomes (frequency of pneumonia, modified Rankin Scale (mRS) score at discharge, NIHSS score at discharge, and mortality rate) were compared based on shift change experience and length of stay (LOS) dichotomized at 5 hours after arrival. Results. Of the 162 patients included, 60 (37.0%) were present in the ED during a SC. The frequency of pneumonia was similar in the two groups. Exposure to an ED SC was not a significant independent predictor of any outcome. LOS in the ED ≥5 hours was a significant independent predictor of discharge mRS 4–6 (OR 3.638, 95% CI 1.531–8.645, and P = 0.0034) and discharge NIHSS (OR 3.049, 95% CI 1.491–6.236, and P = 0.0023) but not death. Conclusions. Our study found no association between nursing SC and adverse outcome in patients with ICH but confirms the prior finding of worsened outcome after prolonged length of stay in the ED.

Hypercalcemia as a predictor of adverse treatment outcomes in DLBCL during chemotherapy: A national inpatient database study.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e19571-e19571
Author(s):  
Dennis Danso Kumi ◽  
Trilok Shrivastava ◽  
Maha A.T. Elsebaie ◽  
hisham laswi ◽  
Kriti Ahuja ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Private Insurance ◽  
Tumor Lysis Syndrome ◽  
Kidney Injury ◽  
B Cell Lymphoma ◽  
Adverse Outcomes ◽  
Medical Complications ◽  
Predictors Of Mortality ◽  
Comorbidity Index ◽  
The Mean

e19571 Background: Hypercalcemia occurs in up to 7% of NHL and up to 18% in diffuse large B-cell lymphoma (DLBCL) representing about 60% of cases. Thus far, there are only a few studies that have established the poor prognosis between hypercalcemia and outcomes in DLBCL. We sought to outline specific acute complications that can during admission for chemotherapy in patients with hypercalcemia. Methods: This is a retrospective analysis of hospital admission using the National Inpatient Sample database (2018), including 15,636 adult patients with DLBCL admitted for chemotherapy. We obtained descriptive data, conducted chi-square test, and stratified logistic regression to look for possible chemotherapy related acute medical complications & predictors of mortality in DLBCL with & without hypercalcemia. Study limitations included lack of long term follow up, variations in chemotherapy and possible under-reporting of test subjects. Results: The mean age among DLBCL patients with & without hypercalcemia were 65.41 and 58.52 years respectively and the mean length of stay were 6.56 and 4.98 days respectively. Patient’s race, type of insurance and Charlson’s comorbidity index were found to be significant predictors of mortality in patients with DLBCL admitted for chemotherapy. Among race, Hispanics & Asian or Pacific islanders were found to be at higher risk for mortality, while patients who had private insurance were found to be associated with higher mortality risk (p<0.01). Similarly, Native Americans (aOR 8.72, 1.93-39.34, p<0.01) and patients with Charlson comorbidity index of 4 or more were at higher risk of mortality (aOR 4.34, 2.30-8.18, p<0.01). In regard to acute medical complications, DLBCL patients with hypercalcemia were at higher risk for tumor lysis syndrome (TLS) (aOR 3.86, p<0.01), acute kidney injury (AKI) (aOR 4.28, p<0.01) and hyperuricemia (aOR 9.74, p<0.01). There was no significant association of hypercalcemia in DLBCL with hyperkalemia, fluid overload, ICU admission, mortality, total cost, or length of stay. Conclusions: Hypercalcemia is associated with higher adverse outcomes during chemotherapy treatment in patients with DLBCL including TLS, hyperuricemia, and AKI during chemotherapy admission. This confirms to the overall accession of poor outcomes as published by other studies.[Table: see text]

In-hospital outcomes and prevalence of comorbidities in patients with infective endocarditis with and without heart blocks: Insight from the National Inpatient Sample

2020 ◽  
pp. jim-2020-001501
Author(s):  
Shakeel M Jamal ◽  
Asim Kichloo ◽  
Michael Albosta ◽  
Beth Bailey ◽  
Jagmeet Singh ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Heart Block ◽  
Kidney Injury ◽  
Primary Diagnosis ◽  
Cost Of Care ◽  
Adverse Outcomes ◽  
Cardiac Resynchronization ◽  
National Inpatient Sample

Infective endocarditis (IE) complicated by heart block can have adverse outcomes and usually requires immediate surgical and cardiac interventions. Data on outcomes and trends in patients with IE with concurrent heart block are lacking. Patients with a primary diagnosis of IE with or without heart block were identified by querying the Healthcare Cost and Utilization Project database, specifically the National Inpatient Sample for the years 2013 and 2014, based on International Classification of Diseases Clinical Modification Ninth Revision codes. During 2013 and 2014, a total of 18,733 patients were admitted with a primary diagnosis of IE, including 867 with concurrent heart blocks. Increased in-hospital mortality (13% vs 10.3%), length of stay (19 vs 14 days), and cost of care ($282,573 vs $223,559) were found for patients with IE complicated by heart block. Additionally, these patients were more likely to develop cardiogenic shock (8.9% vs 3.2%), acute kidney injury (40.1% vs 32.6%), and hematologic complications (19.3% vs 15.2%), and require placement of a pacemaker (30.6% vs 0.9%). IE and concurrent heart block resulted in increased requirement for aortic (25.7% vs 6.1%) and mitral (17.3% vs 4.2%) valvular replacements. Conclusion was made that IE with concurrent heart block worsens in-hospital mortality, length of stay, and cost for patients. Our analysis demonstrates an increase in cardiac procedures, specifically aortic and/or mitral valve replacements, and Implantable Cardiovascular Defibrillator/Cardiac Resynchronization Therapy/ Permanent Pacemaker (ICD/CRT/PPM) placement in IE with concurrent heart block. A close telemonitoring system and prompt interventions may represent a significant mitigation strategy to avoid the adverse outcomes observed in this study.

Comparison of Risk-Adjusted Outcomes in Medicare Open versus Laparoscopic Cholecystectomy

2018 ◽  
Vol 84 (1) ◽  
pp. 12-19 ◽  
Author(s):  
Donald E. Fry ◽  
Michael Pine ◽  
Susan M. Nedza ◽  
Agnes M. Reband ◽  
Chun-Jung Huang ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
High Risk ◽  
Length Of Stay ◽  
Adverse Outcome ◽  
Adverse Outcomes ◽  
High Risk Population ◽  
Hospital Level ◽  
Prolonged Length ◽  
Medicare Patients ◽  
Open Versus

More than 90 per cent of cholecystectomies are performed laparoscopically and this has resulted in concern that surgeons will not have sufficient experience to perform open procedures when clinical circumstances require it. We reviewed the open cholecystectomies (OCs) of Medicare patients from 2010 to 2012 in hospitals with 20 or more cases, created risk-adjusted models for adverse outcomes which were evaluated for 90-days after discharge, and compared the hospital-level outcomes with laparoscopic cholecystectomy performed in the same hospitals for the same period of time. Results demonstrated that inpatient deaths, inpatient prolonged length-of-stay outliers, 90-day postdischarge deaths without readmission, and 90-day readmissions were statistically the same with an overall adverse outcome rate of 21.6 per cent in OC versus 20.9 per cent in laparoscopic cholecystectomy. Conversion of laparoscopic to open procedures was not associated with increased adverse outcomes. Laparoscopic cholecystectomy provides patients with many advantages, but when clinical circumstances are necessary, OC continues to be performed with the same overall adverse outcome rates, and the conversion process is not associated with poorer results in this high-risk population of patients.

scholarly journals Impact of obesity on intensive care outcomes in patients with COVID-19 in Sweden—A cohort study

PLoS ONE ◽  
2021 ◽  
Vol 16 (10) ◽  
pp. e0257891
Author(s):  
Lovisa Sjögren ◽  
Erik Stenberg ◽  
Meena Thuccani ◽  
Jari Martikainen ◽  
Christian Rylander ◽  
...  
Keyword(s):  
Intensive Care ◽  
Length Of Stay ◽  
High Body Mass Index ◽  
Severity Of Illness ◽  
Simplified Acute Physiology Score ◽  
Composite Outcome ◽  
Prolonged Length ◽  
Logistic Regression Models ◽  
Risk Of Death ◽  
High Bmi

Background Previous studies have shown that a high body mass index (BMI) is a risk factor for severe COVID-19. The aim of the present study was to assess whether a high BMI affects the risk of death or prolonged length of stay (LOS) in patients with COVID-19 during intensive care in Sweden. Methods and findings In this observational, register-based study, we included patients with COVID-19 from the Swedish Intensive Care Registry admitted to intensive care units (ICUs) in Sweden. Outcomes assessed were death during intensive care and ICU LOS ≥14 days. We used logistic regression models to evaluate the association (odds ratio [OR] and 95% confidence interval [CI]) between BMI and the outcomes. Valid weight and height information could be retrieved in 1,649 patients (1,227 (74.4%) males) with COVID-19. We found a significant association between BMI and the risk of the composite outcome death or LOS ≥14 days in survivors (OR per standard deviation [SD] increase 1.30, 95%CI 1.16–1.44, adjusted for sex, age and comorbidities), and this association remained after further adjustment for severity of illness (simplified acute physiology score; SAPS3) at ICU admission (OR 1.30 per SD, 95%CI 1.17–1.45). Individuals with a BMI ≥ 35 kg/m2 had a doubled risk of the composite outcome. A high BMI was also associated with death during intensive care and a prolonged LOS in survivors assessed as separate outcomes. The main limitations were the restriction to the first wave of the pandemic, and the lack of information on socioeconomic status as well as smoking. Conclusions In this large cohort of Swedish ICU patients with COVID-19, a high BMI was associated with increasing risk of death and prolonged length of stay in the ICU. Based on our findings, we suggest that individuals with obesity should be more closely monitored when hospitalized for COVID-19.

Does identifying frailty from ICD-10 coded data on hospital admission improve prediction of adverse outcomes in older surgical patients? A population-based study

2020 ◽  
Author(s):  
Lara A Harvey ◽  
Barbara Toson ◽  
Christina Norris ◽  
Ian A Harris ◽  
Robert C Gandy ◽  
...  
Keyword(s):  
Information Criterion ◽  
International Classification Of Diseases ◽  
Population Based ◽  
Adverse Outcomes ◽  
Unplanned Readmission ◽  
Model Discrimination ◽  
Prolonged Length ◽  
Logistic Regression Models ◽  
Explanatory Variables ◽  
Classification Of Diseases

Abstract Background frailty is a major contributor to poor health outcomes in older people, separate from age, sex and comorbidities. This population-based validation study evaluated the performance of the International Classification of Diseases, 10th revision, coded Hospital Frailty Risk Score (HFRS) in the prediction of adverse outcomes in an older surgical population and compared its performance against the commonly used Charlson Comorbidity Index (CCI). Methods hospitalisation and death data for all individuals aged ≥50 admitted for surgery to New South Wales hospitals (2013–17) were linked. HFRS and CCI scores were calculated using both 2- and 5-year lookback periods. To determine the influence of individual explanatory variables, several logistic regression models were fitted for each outcome of interest (30-day mortality, prolonged length of stay (LOS) and 28-day readmission). Area under the receiving operator curve (AUC) and Akaike information criterion (AIC) were assessed. Results of the 487,197 patients, 6.8% were classified as high HFRS, and 18.3% as high CCI. Although all models performed better than base model (age and sex) for prediction of 30-day mortality, there was little difference between CCI and HFRS in model discrimination (AUC 0.76 versus 0.75), although CCI provided better model fit (AIC 79,020 versus 79,910). All models had poor ability to predict prolonged LOS (AUC range 0.62–0.63) or readmission (AUC range 0.62–0.65). Using a 5-year lookback period did not improve model discrimination over the 2-year period. Conclusions adjusting for HFRS did not improve prediction of 30-mortality over that achieved by the CCI. Neither HFRS nor CCI were useful for predicting prolonged LOS or 28-day unplanned readmission.

Discriminative Ability for Adverse Outcomes After Hip Fracture Surgery: A Comparison of Three Commonly Used Comorbidity-Based Indices

Gerontology ◽  
2021 ◽  
pp. 1-13
Author(s):  
Junfei Guo ◽  
Jun Di ◽  
Xian Gao ◽  
Junpu Zha ◽  
Xiuli Wang ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Risk Adjustment ◽  
Adverse Outcomes ◽  
Discriminative Ability ◽  
Surgical Delay ◽  
Hip Fracture Surgery ◽  
Major Complications ◽  
All Cause Mortality ◽  
Comorbidity Index ◽  
Fracture Surgery

<b><i>Introduction:</i></b> Preoperative risk assessment can predict adverse outcomes following hip fracture surgery, helping with decision-making and management strategies. Several risk adjustment models based on coded comorbidities such as Charlson Comorbidity Index (CCI), modified Elixhauser’s Comorbidity Measure (mECM), and modified frailty index (mFI-5) are currently prevalent for orthopedic patients, but there is no consensus regarding which is optimal. The primary purpose was to identify the risk factors of CCI, mECM, and mFI-5, as well as patient characteristics for predicting (1) 1-month, 3-month, 1-year, and 2-year mortality, (2) perioperative complications, and (3) extended length of stay (LOS) following hip fractured surgery. The secondary aim was to compare the best-performing comorbidity index combined with characteristics identified in terms of their discriminative ability for adverse outcomes. <b><i>Methods:</i></b> We retrospectively reviewed 3,379 consecutive patients presenting with intertrochanteric fractures at our Level I trauma center from 2013 to 2018. After eliminated by exclusion criteria, 2,241 patients undergoing hip fracture surgery by PFNA, with age ≥65 years, were included. Three main multivariate logistic regression models were constructed. Cox proportional hazards models were used to calculate hazard ratios for mortality. A base model included age, BMI, surgical delay, anesthesia type, hemoglobin record at admission, and American Society of Anesthesiologists grade (ASA) also was constructed and assessed. <b><i>Results:</i></b> Base model + mECM outperformed other models for the occurrence of major complications including severe complications, cardiac complications, and pulmonary complications [the area under the receiver operating characteristic curve (AUC), 0.647; 95% CI, 0.616–0.677; AUC, 0.637; 95% CI, 0.610–0.664; AUC, 0.679; 95% CI, 0.642–0.715, respectively], while base model + CCI provided better prediction of minor complications of neurological complications and hematological complications (AUC, 0.659; 95% CI, 0.609, 0.709; AUC, 0.658; 95% CI, 0.635, 0.680). In addition, BMI, surgical delay, anesthesia type, and ASA were found highly relevant to extended LOS. Age-group (with a 10-year interval) was indicated to be mostly associated with all-cause mortality with fully adjusted hazard ratio of 1.35 and 95% CI range 1.20–1.51. <b><i>Conclusions:</i></b> In comparison with mFI-5 and CCI, mECM so far may be the best comorbidity index combined with the base model for predicting major complications following hip fracture. The base model already achieved good discrimination for all-cause mortality and extended LOS, further addition of risk adjustment indices led to only 1% increase in the amount of variation explained.

Factors Associated With Prolonged Length of Stay in Patients Hospitalized With Generalized Convulsive Status Epilepticus in the United States

2021 ◽  
pp. 194187442110005
Author(s):  
Alain Lekoubou ◽  
Kunal Debroy ◽  
Kinfe G. Bishu ◽  
Bruce Ovbiagele
Keyword(s):  
United States ◽  
Status Epilepticus ◽  
Length Of Stay ◽  
The United States ◽  
Primary Diagnosis ◽  
Hospital Length Of Stay ◽  
Convulsive Status Epilepticus ◽  
Multivariable Logistic Regression Model ◽  
Prolonged Length ◽  
Continuous Eeg

Objective: Generalized convulsive status epilepticus (GCSE) is a severe complication of epilepsy, which typically requires extended hospitalization, resulting in substantial resource utilization, hospital expenditures, and patient costs. In this nationwide analysis, we examined hospital length of stay (LOS) patterns for GCSE, and the factors that influence prolonged LOS. Methods: We extracted data for adult patients (age 18 years and above) with a primary discharge diagnosis of GCSE from the National Inpatient Sample (NIS) from 2006-2014, the largest all-payer inpatient care database in the United States. We computed LOS (≤1, 2-6, and ≥7 days), overall, and across pre-specified patient-related, hospital-related, and healthcare system-related variables available in the NIS. We identified factors independently associated with prolonged hospitalization (2 or more days), using a multivariable logistic regression model. Results: Of 57,832 discharged with a primary diagnosis of GCSE, 6,133 (10.7%) had a LOS ≤1 day, 27,327 (7.3%) stayed for 2-6 days, and 24,372 (42.1%) stayed for ≥7 days. After adjusting for confounders, patients who were older, female, Black, and Hispanic, who underwent continuous EEG video monitoring, were Medicare beneficiaries, had medical comorbidities, or were admitted to large/urban hospitals, were all significantly more likely to have prolonged LOS. Conclusion: Over 40% of patients hospitalized for GCSE in the United States spend at least a week in the hospital. Efforts to shorten hospitalization for GCSE may need to primarily focus on patient groups with select sociodemographic and clinical characteristics.

Prognostic importance of anaemia in patients with acute pulmonary embolism

2011 ◽  
Vol 106 (08) ◽  
pp. 289-295 ◽  
Author(s):  
Jacques Donzé ◽  
José Labarère ◽  
Marie Méan ◽  
David Jiménez ◽  
Drahomir Aujesky
Keyword(s):  
Pulmonary Embolism ◽  
Length Of Stay ◽  
Acute Pulmonary Embolism ◽  
Geometric Mean ◽  
Length Of Hospital Stay ◽  
Primary Diagnosis ◽  
Adverse Outcomes ◽  
Random Intercept ◽  
Short Term Mortality ◽  
Time Of Presentation

SummaryAlthough associated with adverse outcomes in other cardiopulmonary diseases, limited evidence exists on the prognostic value of anaemia in patients with acute pulmonary embolism (PE). We sought to examine the associations between anaemia and mortality and length of hospital stay in patients with PE. We evaluated 14,276 patients with a primary diagnosis of PE from 186 hospitals in Pennsylvania, USA. We used random-intercept logistic regression to assess the association between anaemia at the time of presentation and 30-day mortality and discretetime logistic hazard models to assess the association between anaemia and time to hospital discharge, adjusting for patient (age, gender, race, insurance type, clinical and laboratory variables) and hospital (region, size, teaching status) factors. Anaemia was present in 38.7% of patients at admission. Patients with anaemia had a higher 30-day mortality (13.7% vs. 6.3%; p <0.001) and a longer length of stay (geometric mean, 6.9 vs. 6.6 days; p <0.001) compared to patients without anaemia. In multivariable analyses, anaemia remained associated with an increased odds of death (OR 1.82, 95% CI: 1.60–2.06) and a decreased odds of discharge (OR 0.85, 95% CI: 0.82–0.89). Anaemia is very common in patients presenting with PE and is independently associated with an increased short-term mortality and length of stay.

Abstract 335: Association of Amyloidosis With In-hospital & 30-day Outcomes Among Patients Hospitalized With Heart Failure

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Nikita Patil ◽  
Sameer Arora ◽  
Paula D Strassle ◽  
Arman Qamar ◽  
Muthiah Vaduganathan ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Regression Models ◽  
Cardiac Amyloidosis ◽  
Primary Diagnosis ◽  
Inpatient Mortality ◽  
Logistic Regression Models ◽  
Comorbidity Index ◽  
Over Time ◽  
National Readmission Database

Objectives: Cardiac amyloidosis is an underdiagnosed cause of heart failure (HF). We investigated the prevalence and impact of amyloidosis in HF. Methods: All hospitalizations for primary diagnosis of HF between January 1, 2010, and August 31, 2015 were identified in the National Readmission Database (NRD). Of these, hospitalizations with amyloidosis were matched in a 3:1 fashion to hospitalizations without amyloidosis using the year of admission, discharge quarter, age, sex, and Charlson comorbidity index. Primary outcomes of interest were inpatient mortality and 30-day readmission. Multivariable logistic regression models were used to estimate the association of HF with amyloidosis with adverse clinical outcomes. Results: Overall, 2,846 (0.2%) hospitalizations had HF with amyloidosis. Hospitalizations for HF with amyloidosis had a higher prevalence of renal disease (56% vs. 45%), atrial fibrillation (48% vs 42%) and malignancy (20% vs 4%) as compared with HF without amyloidosis. In adjusted analyses, HF with amyloidosis had higher odds of in-hospital mortality (6% vs. 3%; OR 1.60, 95% CI 1.28, 2.00), 30-day readmission (OR 1.18, 95% CI 1.06, 1.32), and longer length of stay (CIE 1.73, 95% CI 1.44, 2.03). Among the HF with amyloidosis group, there were similar incidences of CV and non-CV-related readmissions (48% and 52%, respectively), but HF was the most common primary readmission diagnosis, constituting 35% of all readmissions. The incidence of inpatient mortality and 30-day readmission did not change significantly over time during the study period for either HF hospitalizations with or without amyloidosis. Conclusion: In decompensated HF, presence of amyloidosis was associated with higher risk of inpatient mortality and 30-day readmission.

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