The Multidimensional Prognostic Index predicts in-hospital length of stay in older patients: a multicentre prospective study

Background: Antibiotic use may increase hospital length of stay (LOS) among older patients with advanced cancer who are transitioned to comfort measures. Methods: We studied a cohort of patients with advanced cancer aged ≥65 years who were transitioned to comfort measures during admission from July 1, 2014, through November 30, 2016. We evaluated the association between antibiotic exposure and LOS using a Poisson regression model adjusted for age, gender, cancer type, comorbidities, infection, and intensive care unit admission. Results: Among 461 patients with advanced cancer, median age was 74 years (range: 65-99), 49.0% (n = 226) were female, and 20.6% (n = 95) had liquid tumors. Overall, 82.9% (n = 382) received ≥1 antibiotic and 64.6% (n = 298) had ≥1 infection diagnosis during hospitalization. Infection diagnoses commonly included sepsis (35%, n = 161/461), pneumonia (25%, n = 117/461), and urinary tract infection (14%, n = 66/461). Among those receiving antibiotics, the most common choices included vancomycin (79%, n = 300/382), cephalosporins (63%, n = 241/382), and penicillins (45%, n = 172/382). In a multivariable Poisson regression model, LOS was 34% longer (count ratio = 1.34, [95% confidence interval: 1.20-1.51]) among those exposed versus unexposed to antibiotics. Conclusions: Antibiotic use among patients with advanced cancer who are transitioned to comfort measures is associated with longer LOS. These data illustrate the importance of tradeoffs associated with antibiotic use, such as unintended increased LOS, when striving for goal-concordant care near the end of life.

Download Full-text

Vasoactive-ventilation-renal score: a reliable prognostic index for perioperative outcomes following congenital heart surgery in adults

Cardiology in the Young ◽

10.1017/s1047951120004588 ◽

2020 ◽

pp. 1-7

Author(s):

Diana M. Torpoco Rivera ◽

Richard U. Garcia ◽

Sanjeev Aggarwal

Keyword(s):

Length Of Stay ◽

Heart Surgery ◽

Strong Predictor ◽

Prognostic Index ◽

Congenital Heart Surgery ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Perioperative Outcomes ◽

Study Cohort ◽

Prolonged Length

Abstract Introduction: The number of adults requiring surgeries for CHD is increasing. We sought to evaluate the utility of the vasoactive-ventilation-renal (VVR) score as a predictor of prolonged length of stay in adults following CHD surgery. Methods: This is a retrospective review of 158 adult patients who underwent CHD surgery involving cardiopulmonary bypass. VVR score was calculated upon arrival to ICU and every 6 hours for the first 48 hours post-operatively. Our primary outcome was prolonged length of stay defined as hospital length of stay greater than 75th percentile for the cohort (≥8 days). Results: The study cohort had a median age of 25.6 years (18–60 years), and 83 (52.5%) were male. The groups with and without prolonged length of stay were comparable in age, gender, race, and surgical severity score. VVR score was significantly higher at all time points in the group with prolonged length of stay. The first post-operative day peak VVR score ≥13 had a sensitivity of 81% and specificity of 75% for predicting prolonged length of stay (p = 0.0001). On regression analysis, peak VVR score during the first day was independently associated with prolonged length of stay. Conclusions: Peak VVR score during the first post-operative day was a strong predictor of prolonged length of stay in adults following CHD surgery.

Download Full-text

Secular reverence predicts shorter hospital length of stay among middle-aged and older patients following open-heart surgery

Journal of Behavioral Medicine ◽

10.1007/s10865-011-9334-8 ◽

2011 ◽

Vol 34 (6) ◽

pp. 532-541 ◽

Cited By ~ 16

Author(s):

Amy L. Ai ◽

Paul Wink ◽

Marshall Shearer

Keyword(s):

Length Of Stay ◽

Older Patients ◽

Heart Surgery ◽

Open Heart Surgery ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Open Heart ◽

Middle Aged

Download Full-text

The Six-Item Cognitive Impairment Test Is Associated with Adverse Outcomes in Acutely Hospitalized Older Patients: A Prospective Cohort Study

Dementia and Geriatric Cognitive Disorders Extra ◽

10.1159/000490240 ◽

2018 ◽

Vol 8 (2) ◽

pp. 259-267 ◽

Cited By ~ 3

Author(s):

Jacinta A. Lucke ◽

Roos C. van der Mast ◽

Jelle de Gelder ◽

Noor Heim ◽

Bas de Groot ◽

...

Keyword(s):

Cognitive Impairment ◽

Length Of Stay ◽

Hospital Mortality ◽

Older Patients ◽

Adverse Outcome ◽

Independent Predictor ◽

Hospital Length ◽

Adverse Outcomes ◽

Hospital Length Of Stay ◽

Impaired Cognition

Aim: The study aim was to investigate whether cognitive impairment, measured by the Six-Item Cognitive Impairment Test (6-CIT), is an independent predictor of adverse outcomes in acutely hospitalized older patients. Methods: This was a prospective multicenter study including acutely hospitalized patients aged 70 years and older. Multivariable logistic regression was used to investigate whether impaired cognition (6-CIT ≥11 points) was an independent predictor of 90-day adverse outcome, a composite measure of functional decline and mortality. Secondary endpoints were hospital length of stay, new institutionalization, and in-hospital mortality. Results: In total, 196 (15.6%) of 1,252 included patients had a 6-CIT ≥11. Median age was 80 years (interquartile range 74–85). Patients with impaired cognition had higher rates of 90-day adverse outcome (41.7% compared to 30.3% in 1,056 not cognitively impaired patients, p = 0.009). Impaired cognition was a predictor of 90-day adverse outcome with a crude odds ratio (OR) of 1.64 (95% CI 1.13–2.39), but statistical significance was lost when fully corrected for possible confounders (OR 1.44, 95% CI 0.98–2.11). For all secondary outcomes, impaired cognition was an independent predictor. Conclusions: In the acute hospital setting, the 6-CIT is associated with 90-day adverse outcome and is an independent predictor of hospital length of stay, new institutionalization, and in-hospital mortality.

Download Full-text

MP09: Incidence of emergency department induced delirium: a Canadian two years prospective study

CJEM ◽

10.1017/cem.2018.163 ◽

2018 ◽

Vol 20 (S1) ◽

pp. S43-S43

Author(s):

M. Emond ◽

A. Nadeau ◽

V. Boucher ◽

P. Voyer ◽

M. Pelletier ◽

...

Keyword(s):

Emergency Department ◽

Length Of Stay ◽

Prospective Study ◽

Functional Status ◽

Hospital Length ◽

Cognitive Status ◽

Hospital Length Of Stay ◽

Kappa Statistics ◽

Term Care ◽

Modifiable Factors

Introduction: Prevalence and incidence of delirium in older patients admitted to acute and long-term care facilities ranges between 9.6% and 89% but little is known in the context of emergency department (ED) incident delirium. Literature regarding the incidence of delirium in the ED and its potential impacts on hospital length of stay (LOS), functional status and unplanned ED readmissions is scant, its consequences have yet to be clearly identified in order to orient modern acute medical care. Methods: This study is part of the multicenter prospective cohort INDEED study. Three Canadian EDs completed the two years prospective study (March-July 2015 and Feb-May 2016). Patients aged 65 years old, initially free of delirium with an ED stay 8hours were followed up to 24h after ward admission. Patients were assessed 2x/day during their entire ED stay and up to 24 hours on hospital ward by research assistants (RA). The primary outcome of this study was incident delirium in the ED or within 24 h of ward admission. Functional and cognitive status were assessed using validated Older Americans’ Resources and Services and the Telephone Interview for Cognitive Status- modified tools. The Confusion Assessment Method (CAM) was used to detect incident delirium. ED and hospital administrative data were collected. Inter-observer agreement was realized among RA. Results: Incident delirium was not different between sites, nor between phases, nor between times from one site to another. All phases confounded, there is between 7 to 11% of ED related incident delirious episodes. Differences were seen in ED LOS between sites in non-delirious patients, but also between some sites for delirious participants (p<0.05). Only one site had a difference in ED LOS between their delirious and non-delirious patients, respectively of 52.1 and 40.1 hours (p<0.05). There is also a difference between sites in the time between arrival to the ED and the incidence of delirium (p=0.003). Kappa statistics were computed to measure inter-rater reliability of the CAM. Based on an alpha of 5%, 138 patients would allow 80% power for an estimated overall incidence proportion of 15 % with 5% precision.. Other predictive delirium variables, such as cognitive status, environmental factors, functional status, comorbidities, physiological status, and ED and hospital length of stay were similar between sites and phases. Conclusion: The fact that incidence of delirium was the same for all sites, despite the differences of ED LOS and different time periods suggest that many other modifiable and non-modifiable factors along LOS influenced the incidence of ED induced delirium. Emergency physician should concentrate on improving senior-friendly environment for the ED.

Download Full-text