261 LENGTH OF HOSPITAL STAY AND THE ASSOCIATION WITH READMISSION AFTER UNCOMPLICATED ESOPHAGECTOMY. SIGNIFICANT HOSPITAL VARIATION IN THE NETHERLANDS.

2020 ◽  
Vol 33 (Supplement_1) ◽  
Author(s):  
D Voeten ◽  
L Werf ◽  
J Sandick ◽  
R Hillegersberg ◽  
M Berge Henegouwen
Keyword(s):  
Esophageal Cancer ◽  
The Netherlands ◽  
Hospital Stay ◽  
Hospital Costs ◽  
Length Of Hospital Stay ◽  
Short Length ◽  
Case Mix ◽  
Readmission Rates ◽  
Admission Rates ◽  
Hospital Variation

Abstract   Prolonged length of hospital stay is a negative outcome of esophageal cancer surgery, not only for the patient; it also leads to increased hospital costs. Within the scope of value-based health care, this study aimed to analyze Dutch hospital performance in terms of length of hospital stay and to investigate its association with readmission rates. Since both parameters are influenced by the occurrence of complications, this study only included patients after an uncomplicated esophagectomy. Methods All patients registered in the Dutch Upper GI Cancer Audit (DUCA) who underwent a potentially curative esophageal cancer resection between 2015 and 2018 were considered for inclusion. Patients were excluded if they had an intraoperative and/or postoperative complication, if they were retransferred to the intensive care unit, or if they had undergone a re-intervention. Length of hospital stay was dichotomized around the national median into “short admissions” and “long admissions”. Hospital variation was evaluated using a case-mix corrected funnel plot based on multivariable logistic regression analyses. Association of length of hospital stay with readmission rates was investigated using the χ2-statistic. Results A total of 1,007 patients was included for analyses. National median length of hospital stay was 9 days, ranging from 6.5–12.5 days among 17 hospitals. The percentage of “short admissions” per hospital ranged from 7.7% to 93.5%. After correction for case-mix variables, 2 hospitals had significantly higher “short admission” rates and 4 hospitals had significantly lower “short admission” rates (figure 1). Overall, 6.2% (hospital variation [0.0%–13.2%]) of patients was readmitted. Hospital readmission rates were not significantly different between hospitals with a short length of hospital stay and those with a long length of hospital stay (5.5% versus 7.6%; p = 0.19). Conclusion Based on these nationwide audit data, length of hospital stay after an uncomplicated esophagectomy varied significantly between hospitals and ranged from 6.5 to 12.5 days among Dutch hospitals. Short length of hospital stay was not associated with a higher readmission rate. The hospital variation indicates that enhanced recovery programs are not implemented at the same level of efficacy among hospitals in the Netherlands. Nationwide improvement might lead to a substantial reduction of hospital costs.

scholarly journals Length of hospital stay after uncomplicated esophagectomy. Hospital variation shows room for nationwide improvement

2020 ◽  
Author(s):  
Daan M. Voeten ◽  
◽  
Leonie R. van der Werf ◽  
Johanna W. van Sandick ◽  
Richard van Hillegersberg ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Substantial Reduction ◽  
Length Of Hospital Stay ◽  
Hospital Performance ◽  
Uneventful Recovery ◽  
Case Mix ◽  
Median Length ◽  
Dutch Hospital ◽  
Readmission Rates ◽  
Hospital Variation

Abstract Background Within the scope of value-based health care, this study aimed to analyze Dutch hospital performance in terms of length of hospital stay after esophageal cancer surgery and its association with 30-day readmission rates. Since both parameters are influenced by the occurrence of complications, this study only included patients with an uneventful recovery after esophagectomy. Methods All patients registered in the Dutch Upper Gastrointestinal Cancer Audit (DUCA) who underwent a potentially curative esophagectomy between 2015 and 2018 were considered for inclusion. Patients were excluded in case of an intraoperative/post-operative complication, readmission to the intensive care unit, or any re-intervention. Length of hospital stay was dichotomized around the national median into ‘short admissions’ and ‘long admissions’. Hospital variation was evaluated using a case-mix-corrected funnel plot based on multivariable logistic regression analyses. Association of length of hospital stay with 30-day readmission rates was investigated using the χ2-statistic. Results A total of 1007 patients was included. National median length of hospital stay was 9 days, ranging from 6.5 to 12.5 days among 17 hospitals. The percentage of ‘short admissions’ per hospital ranged from 7.7 to 93.5%. After correction for case-mix variables, 3 hospitals had significantly higher ‘short admission’ rates and 4 hospitals had significantly lower ‘short admission’ rates. Overall, 6.2% [hospital variation (0.0–13.2%)] of patients were readmitted. Hospital 30-day readmission rates were not significantly different between patients with a short length of hospital stay and those with a long length of hospital stay (5.5% versus 7.6%; p = 0.19). Conclusions Based on these nationwide audit data, median length of hospital stay after an uncomplicated esophagectomy was 9 days ranging from 6.5 to 12.5 days among Dutch hospitals. There was no association between length of hospital stay and readmission rates. Nationwide improvement might lead to a substantial reduction of hospital costs.

Propensity-adjusted cost analysis of radial versus femoral access for neuroendovascular procedures

2020 ◽  
pp. neurintsurg-2020-016728
Author(s):  
Joshua S Catapano ◽  
Andrew F Ducruet ◽  
Stefan W Koester ◽  
Tyler S Cole ◽  
Jacob F Baranoski ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Hospital Costs ◽  
Length Of Hospital Stay ◽  
Diagnostic Procedures ◽  
Femoral Access ◽  
Catheter Size ◽  
The Mean ◽  
The Difference ◽  
Procedure Type ◽  
Angiographic Findings

BackgroundTransradial artery (TRA) access for neuroendovascular procedures is associated with fewer complications than transfemoral artery (TFA) access. This study compares hospital costs associated with TRA access to those associated with TFA access for neurointerventions.MethodsElective neuroendovascular procedures at a single center were retrospectively analyzed from October 1, 2018 to May 31, 2019. Hospital costs for each procedure were obtained from the hospital financial department. The primary outcome was the difference in the mean hospital costs after propensity adjustment between patients who underwent TRA compared with TFA access.ResultsOf the 338 elective procedures included, 63 (19%) were performed through TRA versus 275 (81%) through TFA access. Diagnostic procedures were more common in the TRA cohort (51 of 63, 81%) compared with the TFA cohort (197 of 275, 72%), but the difference was not significant (p=0.48). The TRA cohort had a shorter length of hospital stay (mean (SD) 0.3 (0.5) days) compared with the TFA cohort (mean 0.7 (1.3) days; p=0.02) and lower hospital costs (mean $12 968 ($6518) compared with the TFA cohort (mean $17 150 ($10 946); p=0.004). After propensity adjustment for age, sex, symptoms, angiographic findings, procedure type, sheath size, and catheter size, TRA access was associated with a mean hospital cost of $2514 less than that for TFA access (95% CI −$4931 to −$97; p=0.04).ConclusionNeuroendovascular procedures performed through TRA access are associated with lower hospital costs than TFA procedures. The lower cost is likely due to a decreased length of hospital stay for TRA.

scholarly journals A Retrospective Study Evaluating the Effectiveness of an Asthma Clinical Pathway in Pediatric Inpatient Practice

2008 ◽  
Vol 13 (4) ◽  
pp. 233-241
Author(s):  
Elisa Edwards ◽  
Kristie Fox
Keyword(s):  
Drug Therapy ◽  
Hospital Stay ◽  
Clinical Pathway ◽  
Length Of Hospital Stay ◽  
Control Group ◽  
Readmission Rates ◽  
Asthma Education ◽  
Children's Hospital ◽  
Children’S Hospital ◽  
Pediatric Inpatient

OBJECTIVE To determine if the asthma clinical pathway implemented at Wolfson Children's Hospital reduces the length of hospital stay. To determine if pathway use affected the use of asthma education, the use of appropriate discharge medications based on asthma classification, and readmission rates. METHODS A list of patients aged 2 to 18 years discharged from Wolfson Children's Hospital between September 1, 2004 and August 31, 2006 with the diagnosis of asthma was generated. Medical records of eligible patients were reviewed for demographic information, asthma pathway use, duration of hospital stay in days, readmission rates, receipt of asthma education, and medications prescribed upon discharge. Patients placed on the asthma clinical pathway were compared to a control group with asthma who were matched based on age and discharge date. Length of stay was averaged for each group. Asthma education, discharge medications, and readmission rates were compared between the two groups. RESULTS Forty-three patients placed on the asthma clinical pathway were compared to a 43 patients in the control group that were matched for age and discharge date. Use of the asthma clinical pathway reduced hospital stay by 0.372 days (P = .0373). Receipt of asthma education (P = .3864), the use of appropriate drug therapy prescribed upon discharge (P = .1398), and readmission rates (P = .5486) were unaffected by pathway use. CONCLUSIONS The asthma clinical pathway used at Wolfson Children's Hospital reduces length of hospital stay, but has no bearing on receipt of asthma education, use of appropriate drug therapy upon discharge, or readmission rates.

scholarly journals P129 THORACIC VS. ABDOMINAL APPROACHES FOR DIAPHRAGMATIC HERNIA REPAIR: A NATIONWIDE STUDY OF CLINICAL OUTCOMES

2021 ◽  
Vol 108 (Supplement_8) ◽  
Author(s):  
Andrea Carolina Quiroga Centeno ◽  
Orlando Navas ◽  
Juan Paulo Serrano ◽  
Sergio Alejandro Gómez Ochoa
Keyword(s):  
Hospital Stay ◽  
Diaphragmatic Hernia ◽  
Hospital Costs ◽  
Length Of Hospital Stay ◽  
Hospital Charges ◽  
Surgical Approaches ◽  
Multivariate Logistic Regression Model ◽  
Abdominal Repair ◽  
Lower Health ◽  
The Impact

Abstract Aim “To compare the outcomes of different surgical approaches for diaphragmatic hernia (DH) repair.” Material and Methods “Adult patients with a principal admitting diagnosis of uncomplicated DH registered in the National Inpatient Sample in the period 2010-2015 were included. Patients with obstruction, gangrene, or congenital hernias were excluded. The primary outcome was in-hospital mortality. Secondary outcomes were the incidence of complications, length of stay, and hospital charges. A multivariate logistic regression model adjusted by age, sex, elective admission, comorbidities, and hospital characteristics was used to analyze the impact of the surgical approach on the evaluated outcomes.” Results “A total of 14910 patients with DH were included (median age 65 years, 74% women). Abdominal approaches were the most commonly performed (78.9% laparoscopy and 13.6% open). Patients that underwent open abdominal and thoracic repairs had a higher risk of complications (sepsis, pneumonia, surgical site infection, prolonged postoperative ileus, and acute myocardial infarction), longer hospital stay, higher total hospital costs, and a significantly higher risk of mortality (OR 2.62. 95% CI 1.59-4.30 and OR 4.60; 95% CI 2.37-8.91, respectively) compared to patients that underwent laparoscopic abdominal repair. Individuals whose DH repair was performed through thoracoscopy had a similar mortality risk to those who underwent laparoscopic abdominal repair (OR 0.87; 95% CI 0.11-6.43).” Conclusions “Nowadays, laparoscopy has become the most used approach for DH repair. In the present cohort, it was associated with better outcomes in terms of complications, length of hospital stay, and mortality, as well as lower health costs. Additional studies assessing hernia characteristics are required to validate this result.”

scholarly journals Variation in length of hospital stay after lung cancer surgery in the Netherlands†

2018 ◽  
Vol 54 (3) ◽  
pp. 560-564 ◽  
Author(s):  
Erik M von Meyenfeldt ◽  
Geertruid M H Marres ◽  
Eric van Thiel ◽  
Ronald A M Damhuis
Keyword(s):  
Lung Cancer ◽  
The Netherlands ◽  
Hospital Stay ◽  
Lung Cancer Surgery ◽  
Length Of Hospital Stay ◽  
Cancer Surgery

scholarly journals Hospital Variation in Cholecystectomies in The Netherlands: A Nationwide Observational Study

2020 ◽  
Vol 37 (6) ◽  
pp. 488-494
Author(s):  
Carmen S.S. Latenstein ◽  
Sarah Z. Wennmacker ◽  
Stef Groenewoud ◽  
Mark W. Noordenbos ◽  
Femke Atsma ◽  
...  
Keyword(s):  
The Netherlands ◽  
Clinical Outcomes ◽  
Gallstone Disease ◽  
Practice Variation ◽  
Emergency Department Visits ◽  
Case Mix ◽  
Hospital Variation ◽  
Improved Outcomes ◽  
Related Group ◽  
Nationwide Observational Study

<b><i>Background:</i></b> Practice variation generally raises concerns about the quality of care. This study determined the longitudinal degree of hospital variation in proportion of patients with gallstone disease undergoing cholecystectomy, while adjusted for case-mix, and the effect on clinical outcomes. <b><i>Methods:</i></b> A nationwide, longitudinal, database study was performed in all hospitals in the Netherlands in 2013–2015. Patients with gallstone disease were collected from the diagnosis-related group database. Hospital variation in case-mix-adjusted cholecystectomy rates was calculated per year. Clinical outcomes after cholecystectomy were compared between hospitals in the lowest/highest 20th percentile of the distribution of adjusted cholecystectomy rates in all 3 subsequent years. <b><i>Results:</i></b> In total, 96,673 patients with gallstones were included. The cholecystectomy rate was 73.6%. In 2013–2015, the case-mix-adjusted performance of cholecystectomies was in hospitals with high rates 1.5–1.6 times higher than in hospitals with low rates. Hospitals with a high adjusted cholecystectomy rate had a higher laparoscopy rate, shorter time to surgery, and less emergency department visits after a cholecystectomy compared to hospitals with a low-adjusted cholecystectomy rate. <b><i>Conclusion:</i></b> Hospital variation in cholecystectomies in the Netherlands is modest, cholecystectomy rates varies by &#x3c;2-fold, and variation is stable over time. Cholecystectomies in hospitals with high adjusted cholecystectomy rates are associated with improved outcomes.

Inter-hospital variation in length of hospital stay after ST-elevation myocardial infarction: results from the Belgian STEMI registry

2013 ◽  
Vol 68 (3) ◽  
pp. 235-239 ◽  
Author(s):  
Marc J. Claeys ◽  
Peter R. Sinnaeve ◽  
Carl Convens ◽  
Philippe Dubois ◽  
Jean Boland ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
St Elevation Myocardial Infarction ◽  
Hospital Variation ◽  
St Elevation

scholarly journals Operative Outcomes of Minimally Invasive Esophagectomy versus Open Esophagectomy for Resectable Esophageal Cancer

2021 ◽  
Vol 10 (04) ◽  
pp. 230-235
Author(s):  
Ramachandra Chowdappa ◽  
Anvesh Dharanikota ◽  
Ravi Arjunan ◽  
Syed Althaf ◽  
Chennagiri S. Premalata ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Postoperative Complications ◽  
Hospital Stay ◽  
Minimally Invasive Esophagectomy ◽  
Intraoperative Complications ◽  
Length Of Hospital Stay ◽  
Pulmonary Complications ◽  
Invasive Esophagectomy ◽  
Open Esophagectomy ◽  
Operative Duration

Abstract Background There is a recent rise in the incidence of esophageal carcinoma in India. Surgical resection with or without neoadjuvant chemoradiation is the current treatment modality of choice. Postoperative complications, especially pulmonary complications, affect many patients who undergo open esophagectomy for esophageal cancer. Minimally invasive esophagectomy (MIE) could reduce the pulmonary complications and reduce the postoperative stay. Methodology We performed a retrospective analysis of prospectively collected data of 114 patients with esophageal cancer in the department of surgical oncology at a tertiary cancer center in South India between January 2019 and March 2020. We included patients with resectable cancer of middle or lower third of the esophagus, and gastroesophageal junction tumors (Siewert I). MIE was performed in 27 patients and 78 patients underwent open esophagectomy (OE). The primary outcome measured was postoperative complications of Clavien–Dindo grade II or higher within 30 days. Other outcomes measured include overall mortality within 30 days, intraoperative complications, operative duration and the length of hospital stay. Results A postoperative complication rate of 18.5% was noted in the MIE group, compared with 41% in the OE group (p = 0.034). Pulmonary complications were noted in 7.4% in the MIE group compared to 25.6% in the OE group (p = 0.044). Postoperative mortality rates, intraoperative complications, and other nonpulmonary postoperative complications were almost similar with MIE as with open esophagectomy. Although the median operative time was more in the MIE group (260 minutes vs. 180 minutes; p < 0.0001), the median length of hospital stay was shorter in patients undergoing MIE (9 days vs. 12 days; p = 0.0001). Conclusions We found that MIE resulted in lower incidence of postoperative complications, especially pulmonary complications. Although, MIE was associated with prolonged operative duration, it resulted in shorter hospital stay.

scholarly journals Risk Factors of Anastomotic Leakage After Esophagectomy With Intrathoracic Anastomosis

2021 ◽  
Vol 8 ◽  
Author(s):  
Huan Li ◽  
Shimin Zhuang ◽  
Honghong Yan ◽  
Wenxiao Wei ◽  
Quanguan Su
Keyword(s):  
Risk Factors ◽  
Esophageal Cancer ◽  
Hospital Stay ◽  
Anastomotic Leakage ◽  
Old Age ◽  
Multivariate Logistic Regression Analysis ◽  
Rank Correlation ◽  
Length Of Hospital Stay ◽  
Cancer Center ◽  
Intrathoracic Anastomosis

Purpose: Anastomotic leakage is one of the most common complications of esophagectomy, it serves as one of the main causes of postoperative death of esophageal cancer. It is of clinical significance to try to discover the risk factors that cause anastomotic leakage.Methods: This retrospective study was conducted on 1,257 consecutive esophageal cancer patients who underwent esophagectomy with intrathoracic anastomosis from January 2010 to December 2015 at a high volume cancer center. Multivariate Logistic Regression analysis, Spearman rank correlation analysis, Mann-Whitney U test and Kruskal-Wallis test were performed to identify the risk factors to the occurrence of anastomotic leakage and the length of hospital stay.Results: Intrathoracic anastomotic leakage occurred in 98 patients (7.8%). Older patients were more likely to develop anastomotic leakage. Patients with diabetes had a higher leakage rate. Intrathoracic anastomotic leakage, old age as well as comorbidities were associated with longer hospital stay.Conclusion: Our study suggested that old age and diabetes were risk factors to intrathoracic anastomotic leakage. In-hospital stay would be lengthened by intrathoracic anastomotic leakage, old age and comorbidities.

Sign in / Sign up

Export Citation Format

Share Document