Independent Patient Risk Factors Associated With Increased Length of Hospital Stay, Unplanned Return to Operating Room, and 30-Day Readmission Rates After Posterior Cervical Fusion for Cervical Spondylotic Myelopathy

Abstract INTRODUCTION The aim of this study was to determine risk factors associated with readmissions, reoperation, and extended length of stay (LOS) following posterior cervical fusion (PCF) for spondylotic myelopathy. METHODS The National Surgical Quality Improvement Program from 2011 to 2016 was queried for all patients undergoing PCF with a diagnosis of spondylotic myelopathy. The inclusion criteria for this project were defined by the CPT code 22600 for PCF. Patients with a history of trauma, malignancy, and those with nonelective surgery were excluded. Patients without ICD9 (721.1) or ICD10 (M47.12) codes for myelopathy were also excluded. For analysis, patients were classified into 2 cohorts: patients who were readmitted, and those who were not readmitted. Patient demographics, comorbidities, intraoperative variables, and number of levels involved in surgery were collected. RESULTS A total of 893 patients with PCF for spondylotic myelopathy were identified, of which 816 (91.4%) were not readmitted and 77 (8.6%) were readmitted.The readmitted cohort was significantly older (No Readmission: 62.6 +/–10.8 vs Readmission: 65.5 +/– 10.8, P = .029). The readmitted population had a significantly higher proportion of dyspnea on exertion (No Readmission: 8.1% vs Readmission: 15.6%, P = .026) and COPD (No Readmission: 6.9% vs Readmission: 14.3%, P = .018). There were no differences in operative time (P = .762) or multilevel surgeries (P = .453) between the 2 cohorts. LOS was similar between readmitted and nonreadmitted patients (P = .640). Upon logistic regression controlling for demographics, comorbidities, surgery level, and operative time, multiple risk factors predicted extended LOS, including female gender, black race, noninsulin-dependent diabetes, chronic steroid use, and length of surgery. BMI and CHF predicted an unplanned return to the operating room. Age [OR: 1.03,95% CI (1.004-1.06), P = .025] was the single predictor of readmission. CONCLUSION Our study suggests that while there are a host of risk factors for both reoperation and extended LOS, increased age is likely the most significant risk factor for readmission following PCF.

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Postoperative Venous Thromboembolism in Children Is Increased in Setting of Cancer or Infection

Blood ◽

10.1182/blood.v128.22.2391.2391 ◽

2016 ◽

Vol 128 (22) ◽

pp. 2391-2391

Author(s):

Harold J. Leraas ◽

Jina Kim ◽

Zhifei Sun ◽

Uttara P. Nag ◽

Brian D. Ezekian ◽

...

Keyword(s):

Risk Factors ◽

Multivariate Analysis ◽

Venous Thromboembolism ◽

Pediatric Patients ◽

Conflicts Of Interest ◽

Significant Risk ◽

The United States ◽

Improvement Program ◽

Thrombotic Risk ◽

Factors Associated

Abstract Background: Venous thromboembolism (VTE) is an uncommon but clinically significant postoperative complication in children. Incidence of VTE in pediatric patients ranges from 34-58 per 10,000 hospitalized children1. Due to rarity of these events, there is limited information about the factors predisposing children to VTE after surgery. We queried a national surgical database to identify risks and outcomes associated with VTE in pediatric surgical patients. Methods: The National Surgical Quality Improvement Program-Pediatric (NSQIP) is a prospectively collected database that records pediatric surgical information, surgical approaches, and 30 day patient outcomes. The database was queried for the years 2012-2013 to identify pediatric patients (age < 18) who had received surgical intervention and were diagnosed with postoperative VTE. Because of their separate coding in NSQIP, we defined VTE as including venous thromboembolism, or pulmonary embolism (PE) diagnosed radiographically within 30 days of operation. To reduce non-random differences between patients we used propensity scores based on age, sex, race, BMI, and ASA classification to match patients in a 1:2 ratio using the nearest neighbor method. Using univariate and multivariate analysis, we identified preoperative risk factors associated with VTE. Results: In total, 130 patients were identified who developed VTE postoperatively (VTE n=122, PE n=7, BOTH PE + VTE n= 1) from this database of 114,395 patients. There were 104 patients with VTE that also had complete entries and were subsequently analyzed in this study. Surgical specialties treating patients in this analysis included cardiothoracic surgery, general surgery, neurosurgery, orthopedic surgery, otolaryngology, plastic surgery, and urology. Eighty-one unique operative CPT codes were identified for patients with VTE. Patients who developed VTE had increased operative time, anesthesia time, and total length of stay (all p < 0.001). Multivariate analysis demonstrated that pneumonia (odds ratio [OR] 1.73, 95% confidence interval [CI] 1.3 - 2.29), Central Line Associated Bloodstream Infection (CLABSI) (OR 1.69, 95% CI 1.18 - 2.42), sepsis (OR 1.47, 95% CI 1.18 - 1.82), septic shock (OR 1.36, 95% CI 1.06 - 1.75), and current solid or hematologic malignancy or active treatment of malignancy (OR 1.30, 95% CI 1.08 - 1.58) were all statistically significant risk factors associated with development of VTE (all p < 0.05). Conclusions: Postoperative VTE risk is significantly increased in children with malignancy or severe infections. Further research is needed to understand the mechanism between malignancy, systemic inflammation, and VTE risk in children. These findings may help to identify patients in need of prophylactic treatment in order to reduce postoperative thrombotic risk in pediatric patients. References: 1. Raffini L, Huang YS, Witmer C, Feudtner C. Dramatic increase in venous thromboembolism in children's hospitals in the United States from 2001 to 2007. Pediatrics. 2009;124(4):1001-1008. Disclosures No relevant conflicts of interest to declare.

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Determinants of surgical morbidity in gastric cancer: experience of a single center and literature review

Journal of Gastric Surgery ◽

10.36159/jgs.v2i4.71 ◽

2020 ◽

Vol 2 (4) ◽

pp. Press

Author(s):

Houyem Mansouri ◽

Ines Zemni ◽

Mohamed Ali Ayadi ◽

Ines Ben Safta ◽

Tarek Ben Dhiab ◽

...

Keyword(s):

Risk Factors ◽

Gastric Cancer ◽

Operative Time ◽

Multiple Logistic Regression Analysis ◽

Significant Risk ◽

Surgical Margin ◽

Length Of Hospital Stay ◽

Extent Of Resection ◽

Surgical Morbidity ◽

Cancer Experience

Background This study aimed to evaluate the severity of intraoperative and post operative complications of gastric cancer surgery and to investigate the predictive factors correlated to surgical morbidity. Methods We included 145 patients operated for gastric cancer. We investigated the risk factors associated with complications, length of hospital stay, operative time, and intraoperative blood transfusion (BT). Significant risk factors were analyzed by multiple logistic regression analysis. Results Postoperative complications occurred in 32 patients (22.1 %) and the rate of major complications was 7.6%. The rate of anastomotic fistula was 6.9% and was correlated to diabetes, tumor size, operative time, surgical margin, and extended lymphadenectomy. The mean risk factors for postoperative morbidity were the presence of comorbidities and ASA score (p = 0.021), intraoperative BT (p = 0.045) and prolonged operative time (p = 0.055). Conclusion surgical morbidity of gastric cancer is correlated to the extent of resection as well as the clinical and histological characteristics.

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Impact of Preoperative Anemia on Outcomes in Adults Undergoing Elective Posterior Cervical Fusion

Global Spine Journal ◽

10.1177/2192568217705654 ◽

2017 ◽

Vol 7 (8) ◽

pp. 787-793 ◽

Cited By ~ 10

Author(s):

Kevin Phan ◽

Alexander E. Dunn ◽

Jun S. Kim ◽

John Di Capua ◽

Sulaiman Somani ◽

...

Keyword(s):

Length Of Hospital Stay ◽

International Normalized Ratio ◽

Postoperative Outcomes ◽

Unplanned Readmission ◽

Complication Rates ◽

Cervical Fusion ◽

Improvement Program ◽

Preoperative Anemia ◽

Posterior Cervical Fusion ◽

American Society

Study Design: Retrospective analysis of prospectively collected data. Objectives: Few studies have investigated the role of preoperative anemia on postoperative outcomes of posterior cervical fusion. This study looked to investigate the potential relationship between preoperative anemia and postoperative outcomes following posterior cervical spine fusion. Methods: Data from patients undergoing elective posterior cervical fusions between 2005 and 2012 was collected from the American College of Surgeons National Surgical Quality Improvement Program database using inclusion/exclusion criteria. Multivariate analyses were used to identify the predictive power of anemia for postoperative outcomes. Results: A total of 473 adult patients undergoing elective posterior cervical fusions were identified with 106 (22.4%) diagnosed with anemia preoperatively. Anemic patients had higher rates of diabetes ( P = .0001), American Society of Anesthesiologists scores ≥3 ( P < .0001), and higher dependent functional status prior to surgery ( P < .0001). Intraoperatively, anemic patients also had higher rates of neuromuscular injuries ( P = .0303), stroke ( P = .013), bleeding disorders ( P = .0056), lower albumin ( P < .0001), lower hematocrit ( P < .0001), and higher international normalized ratio ( P = .002). Postoperatively, anemic patients had higher rates of complications ( P < .0001), death ( P = .008), blood transfusion ( P = .001), reoperation ( P = .012), unplanned readmission ( P = .022), and extended length of stay (>5 days; P < .0001). Conclusions: Preoperative anemia is linked to a number of postoperative complications, which can increase length of hospital stay and increase the likelihood of reoperation. Identifying preoperative anemia may play a role in optimizing and minimizing the complication rates and severity of comorbidities following posterior cervical fusion.

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Risk Factors for Nosocomial Infections in Neonatal Intensive Care Unit

Paediatrica Indonesiana ◽

10.14238/pi34.1-2.1994.48-56 ◽

2018 ◽

Vol 34 (1-2) ◽

pp. 48-56

Author(s):

Ingrid Rita Sitomorang ◽

Herry Garna

Keyword(s):

Risk Factors ◽

Birth Weight ◽

Nasogastric Tube ◽

Nosocomial Infections ◽

Neonatal Intensive Care ◽

Significant Risk ◽

Length Of Hospital Stay ◽

Significant Risk Factor ◽

Factors Associated ◽

G 14

We report our study to determine factors associated with increased nosocomial infections in neonates hospitalized in NJCU, from January until December, 1992. A total number of 116 infants were studied, 68 (58.6%) of them were male, and 101 (87 .1 %) were less than 6 days old. Forty six infants (39.8%) had a birth weight of< 1500 g, 27 (23.3%) between 1500-1999 g, 14 (12.1%) between 2000-2499 g, 27 (23.2%) >2500 g, and 2 (1.7%) were unknown. A total number of64 infants (55.2%) had more than 1 infections, yielding 103 episodes of infection, giving an incidence of 88.8% infection rate. The significant risk factor for nosocomial infections was length of hospital stay. Age, birth weight, gestational age, APGAR scores, use of nasogastric tube or intravenous line, were not statistically significant risk factors. Use of nasogastric tube was associated with increased nosocomial gastroenteritis, compared with use of intravenous lines.

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Prevalence and Risk Factors for Hypovitaminosis D among Healthy Adolescents in Kota Bharu, Kelantan

Journal of the ASEAN Federation of Endocrine Societies ◽

10.15605/jafes.035.02.05 ◽

2020 ◽

Vol 35 (2) ◽

pp. 176-180

Author(s):

Suhaimi Hussain ◽

◽

Maged Elnajeh

Keyword(s):

Risk Factors ◽

Vitamin D ◽

Public Schools ◽

Significant Risk ◽

Hypovitaminosis D ◽

Female Gender ◽

Intact Parathyroid Hormone ◽

Consensus Guideline ◽

Factors Associated ◽

Global Consensus

Objective. We aim to study the prevalence and risk factors of hypovitaminosis D among healthy adolescents in Kota Bharu, Kelantan based on the most recent Paediatric Consensus guideline. Methodology. Ten public schools were selected from Kota Bharu, Kelantan. We analysed their demography (age, gender, ethnicity, income), measured their anthropometry (height, weight, BMI) and finally analysed their vitamin D and intact- Parathyroid hormone levels. Results. The prevalence of hypovitaminosis D was 16.9% among healthy teenagers with mean age of 15.9±1.39 years. Multivariate analysis showed female gender (adjusted OR, 95% CI): 23.7 (5.64, 100.3) and Chinese 0.24 (0.07, 0.84) were the significant predictors for hypovitaminosis D. Conclusion. The prevalence of healthy adolescents with hypovitaminosis D in Kota Bharu, Kelantan was 16.9% using the most recent cut off value of 30 nmol/L from the global consensus 2016. Female and Malay were the significant risk factors associated with hypovitaminosis D. Higher cut off value would result in overestimation of prevalence rate of hypovitaminosis D.

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Renal Failure after Coronary Bypass Surgery and the Associated Risk Factors

The Heart Surgery Forum ◽

10.1532/hsf.1216 ◽

2015 ◽

Vol 18 (1) ◽

pp. 006

Author(s):

Hasan Reyhanoglu ◽

Kaan Ozcan ◽

Murat Erturk ◽

Fatih İslamoglu ◽

İsa Durmaz

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Renal Failure ◽

Coronary Artery ◽

Coronary Artery Bypass ◽

Bypass Surgery ◽

Artery Bypass ◽

Significant Risk ◽

High Morbidity ◽

Factors Associated

Objective: We aimed to evaluate the risk factors associated with acute renal failure in patients who underwent coronary artery bypass surgery. Methods: One hundred and six patients who developed renal failure after coronary artery bypass grafting (CABG) constituted the study group (RF group), while 110 patients who did not develop renal failure served as a control group (C group). In addition, the RF group was divided into two subgroups: patients that were treated with conservative methods without the need for hemodialysis (NH group) and patients that required hemodialysis (HR group). Risk factors associated with renal failure were investigated. Results: Among the 106 patients that developed renal failure (RF), 80 patients were treated with conservative methods without any need for hemodialysis (NH group); while 26 patients required hemodialysis in the postoperative period (HR group). The multivariate analysis showed that diabetes mellitus and the postoperative use of positive inotropes and adrenaline were significant risk factors associated with development of renal failure. In addition, carotid stenosis and postoperative use of adrenaline were found to be significant risk factors associated with hemodialysis-dependent renal failure (P < .05). The mortality in the RF group was determined as 13.2%, while the mortality rate in patients who did not require hemodialysis and those who required hemodialysis was 6.2% and 34%, respectively. Conclusion: Renal failure requiring hemodialysis after CABG often results in high morbidity and mortality. Factors affecting microcirculation and atherosclerosis, like diabetes mellitus, carotid artery stenosis, and postoperative vasopressor use remain the major risk factors for the development of renal failure.

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Does Vancomycin Resistance Increase Mortality? Clinical Outcomes and Predictive Factors for Mortality in Patients with Enterococcus faecium Infections

Antibiotics ◽

10.3390/antibiotics10020105 ◽

2021 ◽

Vol 10 (2) ◽

pp. 105

Author(s):

Jatapat Hemapanpairoa ◽

Dhitiwat Changpradub ◽

Sudaluck Thunyaharn ◽

Wichai Santimaleeworagun

Keyword(s):

Risk Factors ◽

Clinical Outcomes ◽

Proportional Hazards Model ◽

Significant Risk ◽

Vancomycin Resistance ◽

Cox Proportional Hazards Model ◽

Factors Associated ◽

Joint Infections ◽

Bone And Joint Infections ◽

The Impact

The prevalence of enterococcal infection, especially E. faecium, is increasing, and the issue of the impact of vancomycin resistance on clinical outcomes is controversial. This study aimed to investigate the clinical outcomes of infection caused by E. faecium and determine the risk factors associated with mortality. This retrospective study was performed at the Phramongkutklao Hospital during the period from 2014 to 2018. One hundred and forty-five patients with E. faecium infections were enrolled. The 30-day and 90-day mortality rates of patients infected with vancomycin resistant (VR)-E. faecium vs. vancomycin susceptible (VS)-E. faecium were 57.7% vs. 38.7% and 69.2% vs. 47.1%, respectively. The median length of hospitalization was significantly longer in patients with VR-E. faecium infection. In logistic regression analysis, VR-E. faecium, Sequential Organ Failure Assessment (SOFA) scores, and bone and joint infections were significant risk factors associated with both 30-day and 90-day mortality. Moreover, Cox proportional hazards model showed that VR-E. faecium infection (HR 1.91; 95%CI 1.09–3.37), SOFA scores of 6–9 points (HR 2.69; 95%CI 1.15–6.29), SOFA scores ≥ 10 points (HR 3.71; 95%CI 1.70–8.13), and bone and joint infections (HR 0.08; 95%CI 0.01–0.62) were significant risk factors for mortality. In conclusion, the present study confirmed the impact of VR-E. faecium infection on mortality and hospitalization duration. Thus, the appropriate antibiotic regimen for VR-E. faecium infection, especially for severely ill patients, is an effective strategy for improving treatment outcomes.

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Risk Factors Associated With Dengue Fever Outbreak in Taiz Governorate, Yemen, 2018: Case-control Study

10.21203/rs.3.rs-624873/v1 ◽

2021 ◽

Author(s):

Abdulkareem Ali Hussein Nassar ◽

Amr Abdulaziz Torbosh ◽

Yassin Abdulmalik Mahyoub ◽

Mohammed Abdullah Al Amad

Keyword(s):

Risk Factors ◽

Dengue Fever ◽

Case Control Study ◽

Significant Risk ◽

Case Fatality ◽

Case Control ◽

Case Definition ◽

P Value ◽

Factors Associated ◽

Control Study

Abstract Background: Dengue Fever (DF) is a significant health problem in Yemen especially in the coastal areas. On November 6, 2018, Taiz governorates surveillance officer notified the Ministry of Public Health and Population on an increase in the number of suspected DF in Al Qahirah and Al Mudhaffar districts, Taiz governorate. On November 7, 2018, Field Epidemiology Training Program sent a team to perform an investigation. The aims were to confirm and describe the outbreak by person, place and time in Taiz governorate, and identify its risk factors.Methodology: Descriptive and case-control study (1:2 ratio) were conducted. WHO case definition was used to identify cases in Al Qahirah or Al Mudhaffar districts during August-November 2018. Control was selected from the same districts who did not suffer from DF. Predesigned questionnaire was used to collect data related to sociodemographic, behavioral and environmental characteristics. Bivariate and multivariate backward stepwise analyses were used. The adjusted odds ratios (aOR) and 95% confidence intervals (95%CI) were calculated. A P value < 0.05 was considered as the cut point for statistically significant. Epi info version 7.2 was used.Results: A total of 50 DF cases were found. Almost 52% were males and 76% were <30 years of age. The overall attack rate was 1/10,000 of the population. Case fatality rate was 4%. In multivariate analysis, not working (aOR = 26.6, 95% CI: 6.8–104.7), not using mosquito repellent (aOR = 13.9, 95% CI:1.4–136.8), wearing short sleeves/pants (aOR = 27.3, 95% CI: 4.8–156.8), poor sanitation (aOR = 5.4, 95% CI: 1.4–20.3), presence of outdoor trees (aOR = 13.2, 95% CI: 2.8–63.0) and houses without window nets (aOR = 15.7, 95% CI: 3.9–63.4) were statistically significant risk factors associated with DF outbreak. Eleven 11 (58%) of blood samples were positive for DF IgM.Conclusions: DF outbreak in Al Qahirah and Al Mudhaffar districts, Taiz governorate was confirmed. This study provides evidence-based information regarding the identified risk factors that contributed to the occurrence of this outbreak. Raising community awareness on the importance of personal protection measures and improving the sanitation services are strongly recommended.

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A Model to Predict Central-Line–Associated Bloodstream Infection Among Patients With Peripherally Inserted Central Catheters: The MPC Score

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2017.167 ◽

2017 ◽

Vol 38 (10) ◽

pp. 1155-1166 ◽

Cited By ~ 27

Author(s):

Erica Herc ◽

Payal Patel ◽

Laraine L. Washer ◽

Anna Conlon ◽

Scott A. Flanders ◽

...

Keyword(s):

Risk Factors ◽

Risk Model ◽

Significant Risk ◽

Hospital Medicine ◽

Central Line ◽

Cox Proportional Hazards Model ◽

Operating Characteristics ◽

Peripherally Inserted Central Catheters ◽

Factors Associated ◽

Central Catheters

BACKGROUNDPeripherally inserted central catheters (PICCs) are associated with central-line–associated bloodstream infections (CLABSIs). However, no tools to predict risk of PICC-CLABSI have been developed.OBJECTIVETo operationalize or prioritize CLABSI risk factors when making decisions regarding the use of PICCs using a risk model to estimate an individual’s risk of PICC-CLABSI prior to device placement.METHODSUsing data from the Michigan Hospital Medicine Safety consortium, patients that experienced PICC-CLABSI between January 2013 and October 2016 were identified. A Cox proportional hazards model with robust sandwich standard error estimates was then used to identify factors associated with PICC-CLABSI. Based on regression coefficients, points were assigned to each predictor and summed for each patient to create the Michigan PICC-CLABSI (MPC) score. The predictive performance of the score was assessed using time-dependent area-under-the-curve (AUC) values.RESULTSOf 23,088 patients that received PICCs during the study period, 249 patients (1.1%) developed a CLABSI. Significant risk factors associated with PICC-CLABSI included hematological cancer (3 points), CLABSI within 3 months of PICC insertion (2 points), multilumen PICC (2 points), solid cancers with ongoing chemotherapy (2 points), receipt of total parenteral nutrition (TPN) through the PICC (1 point), and presence of another central venous catheter (CVC) at the time of PICC placement (1 point). The MPC score was significantly associated with risk of CLABSI (P<.0001). For every point increase, the hazard ratio of CLABSI increased by 1.63 (95% confidence interval, 1.56–1.71). The area under the receiver-operating-characteristics curve was 0.67 to 0.77 for PICC dwell times of 6 to 40 days, which indicates good model calibration.CONCLUSIONThe MPC score offers a novel way to inform decisions regarding PICC use, surveillance of high-risk cohorts, and utility of blood cultures when PICC-CLABSI is suspected. Future studies validating the score are necessary.Infect Control Hosp Epidemiol2017;38:1155–1166

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