Higher Charlson Comorbidity Index Scores Are Associated With Increased Hospital Length of Stay After Lower Extremity Orthopaedic Trauma

203 Background: Hospitalized patients with cancer often have impaired ADLs related to age, comorbidities, and both cancer and treatment-related morbidity. However, the relationship between ADL impairment and patients’ symptom burden and clinical outcomes has not been well described. Methods: We prospectively enrolled patients with advanced cancer with unplanned hospitalizations at an academic medical center. Upon admission, nurses assessed patients’ ADLs (mobility, feeding, bathing, dressing, and grooming). We used the Edmonton Symptom Assessment Scale (ESAS) and Patient Health Questionnaire-4 to assess physical and psychological symptoms, comparing symptom burden between patients with and without ADL impairment. We used regression models adjusted for age, sex, education, Charlson comorbidity index, months since advanced cancer diagnosis, and cancer type to assess the relationship between any ADL impairment and hospital length of stay, the composite outcome of death or readmission within 90 days of discharge, and survival. Results: Among 932 patients, 40.2% had at least one ADL impairment. Patients with ADL impairment were older (67.2 vs. 60.8 years, p<0.001), had higher Charlson comorbidity index (1.1 vs. 0.7, p<0.001), and higher physical symptom burden (ESAS Physical 35.2 vs. 30.9, p<0.001). Those with ADL impairment were more likely to have moderate to severe constipation (46.7% vs. 36.0%, p<0.01), pain (74.9% vs. 63.1%, p<0.01), drowsiness (76.6% vs. 68.3%, p<0.01), as well as symptoms of depression (38.3% vs. 23.6%, p<0.01) and anxiety (35.9% vs. 22.4%, p<0.01). In adjusted models, ADL impairment was associated with longer hospital length of stay (B=1.30, p<0.01), higher odds of death or readmission within 90 days (odds ratio=2.26, p<0.01), and worse survival (hazard ratio=1.73, p<0.01). Conclusions: Hospitalized patients with advanced cancer who have ADL impairment experience a significantly higher symptom burden and worse health outcomes compared to those without ADL impairment. These findings highlight the need to assess and address ADL impairment among this population to enhance their quality of life and care.

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Early versus Delayed Amputation in the Setting of Severe Lower Extremity Trauma

The American Surgeon ◽

10.1177/000313481508100618 ◽

2015 ◽

Vol 81 (6) ◽

pp. 564-568 ◽

Cited By ~ 5

Author(s):

Zachary F. Williams ◽

Lindsay M. Bools ◽

Ashley Adams ◽

Thomas V. Clancy ◽

William W. Hope

Keyword(s):

Length Of Stay ◽

Lower Extremity ◽

Limb Salvage ◽

Length Of Hospital Stay ◽

Hospital Length ◽

Lower Extremity Amputation ◽

Hospital Length Of Stay ◽

Trauma Patients ◽

Early Group ◽

Extremity Amputation

Leg-threatening injuries present patients and clinicians with the difficult decision to pursue primary amputation or attempt limb salvage. The effects of delayed amputation after failed limb salvage on outcomes, such as prosthetic use and hospital deposition, are unclear. We evaluated the timing of amputations and its effects on outcomes. We retrospectively reviewed all trauma patients undergoing lower extremity amputation from January 1,2000 through December 31, 2010 at a Level 2 trauma center. Patients undergoing early amputation (amputation within 48 hours of admission) were compared with patients undergoing late amputation (amputations >48 hours after admission). Patient demographics, injury specifics, operative characteristics, and outcomes were documented. During the 11-year study period, 43 patients had a lower extremity amputation and 21 had early amputations. The two groups were similar except for a slightly higher Mangled Extremity Severity Score in the early amputation group. Total hospital length of stay significantly differed between groups, with the late amputation group length of stay being nearly twice as long. The late amputation group had significantly more ipsilateral leg complications than the early group (77% vs 15%). There was a trend toward more prosthetic use in the early group (93%vs 57%, P = 0.07). Traumatic lower extremity injuries requiring amputation are rare at our institution (0.3% incidence). Regardless of the amputation timing, most patients were able to obtain a prosthetic. Although the late group had a longer length of hospital stay and more local limb complications, attempted limb salvage still appears to be a viable option for appropriately selected trauma patients.

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Reduction in Hospital Length of Stay for Patients Requiring Lower Extremity Amputation

Journal of Vascular Surgery ◽

10.1016/j.jvs.2012.06.037 ◽

2012 ◽

Vol 56 (3) ◽

pp. 890

Author(s):

Joshua Unger ◽

Daniel Geersen ◽

Nancy Payne ◽

Lu-Anne Laws ◽

Mary Jane Stillwagon ◽

...

Keyword(s):

Length Of Stay ◽

Lower Extremity ◽

Hospital Length ◽

Lower Extremity Amputation ◽

Hospital Length Of Stay ◽

Extremity Amputation

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Broadly Applicable Risk Stratification System for Predicting Duration of Hospitalization and Mortality

Anesthesiology ◽

10.1097/aln.0b013e3181f79a8d ◽

2010 ◽

Vol 113 (5) ◽

pp. 1026-1037 ◽

Cited By ~ 64

Author(s):

Daniel I. Sessler ◽

Jeffrey C. Sigl ◽

Paul J. Manberg ◽

Scott D. Kelley ◽

Armin Schubert ◽

...

Keyword(s):

Length Of Stay ◽

Risk Stratification ◽

Hospital Mortality ◽

Risk Adjustment ◽

Charlson Comorbidity Index ◽

Hospital Length Of Stay ◽

Surgical Patients ◽

Administrative Claims ◽

Median Length ◽

Comorbidity Index

Background Hospitals are increasingly required to publicly report outcomes, yet performance is best interpreted in the context of population and procedural risk. We sought to develop a risk-adjustment method using administrative claims data to assess both national-level and hospital-specific performance. Methods A total of 35,179,507 patient stay records from 2001-2006 Medicare Provider Analysis and Review (MEDPAR) files were randomly divided into development and validation sets. Risk stratification indices (RSIs) for length of stay and mortality endpoints were derived from aggregate risk associated with individual diagnostic and procedure codes. Performance of RSIs were tested prospectively on the validation database, as well as a single institution registry of 103,324 adult surgical patients, and compared with the Charlson comorbidity index, which was designed to predict 1-yr mortality. The primary outcome was the C statistic indicating the discriminatory power of alternative risk-adjustment methods for prediction of outcome measures. Results A single risk-stratification model predicted 30-day and 1-yr postdischarge mortality; separate risk-stratification models predicted length of stay and in-hospital mortality. The RSIs performed well on the national dataset (C statistics for median length of stay and 30-day mortality were 0.86 and 0.84). They performed significantly better than the Charlson comorbidity index on the Cleveland Clinic registry for all outcomes. The C statistics for the RSIs and Charlson comorbidity index were 0.89 versus 0.60 for median length of stay, 0.98 versus 0.65 for in-hospital mortality, 0.85 versus 0.76 for 30-day mortality, and 0.83 versus 0.77 for 1-yr mortality. Addition of demographic information only slightly improved performance of the RSI. Conclusion RSI is a broadly applicable and robust system for assessing hospital length of stay and mortality for groups of surgical patients based solely on administrative data.

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Current illicit drug use profile of orthopaedic trauma patients and its effect on hospital length of stay

Injury ◽

10.1016/j.injury.2020.02.077 ◽

2020 ◽

Vol 51 (4) ◽

pp. 887-891

Author(s):

Stephen J. Shymon ◽

D'Ann Arthur ◽

Peyton Keeling ◽

Sara Rashidi ◽

Louis M. Kwong ◽

...

Keyword(s):

Drug Use ◽

Length Of Stay ◽

Illicit Drug ◽

Illicit Drug Use ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Trauma Patients ◽

Orthopaedic Trauma

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Drivers of hospital length of stay in 56,000 orthopaedic trauma patients: The impact of postoperative cardiac events

Journal of Clinical Orthopaedics and Trauma ◽

10.1016/j.jcot.2017.02.003 ◽

2017 ◽

Vol 8 (1) ◽

pp. 45-49 ◽

Cited By ~ 1

Author(s):

Diana G. Douleh ◽

Mahesh Yarlagadda ◽

Michelle S. Shen ◽

Gerard Williams ◽

Idine Mousavi ◽

...

Keyword(s):

Length Of Stay ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Trauma Patients ◽

Orthopaedic Trauma ◽

Cardiac Events ◽

The Impact

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Utilization and Outcomes of Local Anesthesia and Peripheral Nerve Block for Hybrid Lower Extremity Revascularization

Journal of Endovascular Therapy ◽

10.1177/1526602819887382 ◽

2019 ◽

Vol 27 (1) ◽

pp. 94-101

Author(s):

Arash Fereydooni ◽

Tess O’Meara ◽

Wanda M. Popescu ◽

Alan Dardik ◽

Cassius Iyad Ochoa Chaar

Keyword(s):

Length Of Stay ◽

Lower Extremity ◽

Peripheral Nerve ◽

Local Anesthesia ◽

Peripheral Nerve Block ◽

Operating Time ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Anesthetic Technique ◽

Lower Extremity Revascularization

Purpose: To investigate the utilization of local anesthesia or peripheral nerve block with monitored anesthesia care (LPMAC) and its impact on the perioperative outcomes of hybrid lower extremity revascularization (LER) compared with general anesthesia (GA). Materials and Methods: A search of the ACS-NSQIP database between 2005 and 2017 identified 9430 patients who underwent hybrid LER for peripheral artery disease. Excluding 449 ineligible cases left 8981 hybrid LER patients for analysis. The patients were dichotomized based on the anesthetic technique: 8631 (96.1%) GA and 350 (3.9%) LPMAC. The GA patients were matched 3:1 based on propensity scores to patients in the LPMAC group based on gender, age, race, functional status, transfer status, chronic obstructive pulmonary disease (COPD), dialysis status, American Society of Anesthesiologists (ASA) class, emergent surgery, preoperative sepsis, indication, and type of open and endovascular procedure. Outcomes including complications, mortality, procedure time, and hospital length of stay were compared between the matched groups (801 GA vs 267 LPMAC). Results: Comparing the unmatched groups, those treated under LPMAC were older (72.7±9 vs 68±8.4 years, p<0.001) and had higher rates of COPD (24.3% vs 17%, p=0.001), dialysis dependence (8.1% vs 4.2%, p=0.002), preoperative sepsis (6.6% vs 4.2%, p=0.029), and ASA class ≥IV (29.1% vs 24.1%, p=0.036) than in the unmatched GA cohort. In the matched comparison, LPMAC was associated with lower overall morbidity (25.5% vs 32.3%, p=0.042) and shorter operating time (202.7±98 vs 217.7±102 minutes, p=0.034) compared with GA. The rate of myocardial infarction was lower (1.1% vs 2.4%) and ventilator use for >48 hours was less frequent (0.4% vs 2.6%) for LPMAC patients, though statistical significance was not reached. There was no difference in mortality or hospital length of stay. Conclusion: LPMAC is an infrequent anesthetic technique for hybrid LER and is primarily used for patients with a high burden of comorbidities. LPMAC is associated with reduced overall morbidity and operating time. Further studies are needed to identify which patients undergoing hybrid LER benefit most from LPMAC.

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Functional impairment on admission and associated symptom burden and health outcomes among hospitalized patients with advanced cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.11554 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. 11554-11554

Author(s):

Daniel E Lage ◽

Areej El-Jawahri ◽

Charn-Xin Fuh ◽

Richard Newcomb ◽

Vicki Jackson ◽

...

Keyword(s):

Length Of Stay ◽

Health Outcomes ◽

Advanced Cancer ◽

Functional Impairment ◽

Symptom Burden ◽

Hospital Length ◽

Hospitalized Patients ◽

Hospital Length Of Stay ◽

Comorbidity Index ◽

The Relationship

11554 Background: Hospitalized patients with cancer often have impaired function, as measured by activities of daily living (ADLs), related to age, comorbidities, and both cancer and treatment-related morbidity. However, the relationship between functional impairment and patients’ symptom burden and clinical outcomes has not been well described. Methods: We prospectively enrolled patients with advanced cancer with unplanned hospitalizations at an academic medical center. Upon admission, nurses assessed patients’ ADLs (mobility, feeding, bathing, dressing, and grooming). We used the Edmonton Symptom Assessment Scale (ESAS) and Patient Health Questionnaire-4 to assess physical and psychological symptoms, comparing symptom burden between patients with and without ADL impairment. We used regression models adjusted for age, sex, education, Charlson comorbidity index, months since advanced cancer diagnosis, and cancer type to assess the relationship between any ADL impairment on admission and hospital length of stay, the composite outcome of death or readmission within 90 days of discharge, and survival. Results: Among 932 patients, 40.2% had at least one ADL impairment. Patients with ADL impairment were older (Mean = 67.2 vs 60.8 years, p < 0.001), had higher Charlson comorbidity index (Mean = 1.1 vs 0.7, p < 0.001), and higher physical symptom burden (ESAS Physical Mean = 35.2 vs 30.9, p < 0.001). Those with ADL impairment were more likely to have moderate to severe constipation (46.7% vs. 36.0%, p < 0.01), pain (74.9% vs. 63.1%, p < 0.01), drowsiness (76.6% vs. 68.3%, p < 0.01), as well as symptoms of depression (38.3% vs. 23.6%, p < 0.01) and anxiety (35.9% vs. 22.4%, p < 0.01). In adjusted models, ADL impairment was associated with longer hospital length of stay (B = 1.30, p < 0.01), higher odds of death or readmission within 90 days (odds ratio = 2.26, p < 0.01), and higher mortality (hazard ratio = 1.73, p < 0.01). Conclusions: Hospitalized patients with advanced cancer who have functional impairment experience a significantly higher symptom burden and worse health outcomes compared to those without functional impairment. These findings highlight the need to assess and address functional impairment among this population to enhance their quality of life and care.

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Higher Patient Complexities are Associated with Increased Length of Stay, Complications, and Readmissions After Total Hip Arthroplasty

Surgical Technology Online ◽

10.52198/21.sti.38.os1412 ◽

2021 ◽

Author(s):

Sai Guntaka ◽

John Tarazi ◽

Zhongming Chen ◽

Rushabh Vakharia ◽

Michael Mont ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Length Of Stay ◽

Hip Arthroplasty ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Medical Complications ◽

Complex Patients ◽

Increasing Trend ◽

Comorbidity Index ◽

Patient Complexity

Introduction: There is an increased incidence of complex patients undergoing total hip arthroplasty (THA), which demands a rigorous preoperative, intraoperative, and postoperative assessment. It is important how increases in patient complexity impact a variety of patient outcomes. Therefore, the purpose of our study is to determine if a higher Elixhauser Comorbidity Index (ECI), a measure of patient complexity, is correlated with: 1) longer hospital length of stay; 2) increased 90-day medical complications; 3) higher 90-day readmissions; and 4) greater two-year implant-related complications following primary THA. Materials and Methods: Patients undergoing primary THA from January 1, 2004 to December 31, 2015 were queried from the Medicare Standard Analytical Files using the International Classification of Disease, ninth revision (ICD-9) procedure code 81.51. The queried patients (387,831) were filtered by ECI scores of 1 to 5. Patients who have ECI scores of 2 to 5 represented the study cohorts and were matched according to age and sex to patients who have the lowest ECI score (ECI of 1). All cohorts were longitudinally followed to assess and compare hospital length of stay, 90-day medical complications, 90-day readmissions, and two-year implant-related complications. We compared odds-ratios (OR), 95% confidence intervals (95% CI), and p-values using logistic regression analyses and Welch’s t-tests. Results: Patients who have ECI scores greater than 1 had higher hospital length of stay (p<0.001), 90-day medical complications (p<0.001), 90-day readmissions (p<0.001), and two-year implant-related complications (p<0.001). Patients who have an ECI score of 2 (1.26, 95% CI: 1.20–1.32), ECI of 3 (1.61, 95% CI: 1.53–1.69), ECI of 4 (2.05, 95% CI: 1.95–2.14), and ECI of 5 (2.32, 95% CI: 2.21–2.43) had an increasing trend for readmissions, with higher ECI scores correlating with greater odds of readmission following primary THA. Two-year implant-related complications also showed a similar increasing trend with greater patient complexity. Patients who had an ECI score of 5 (2.54, 95% CI: 2.39–2.69) had more implant-related complications compared to patients who had an ECI score of 2 (1.39, 95% CI:1.31–1.48). Conclusion: The results of this study illustrate that a higher Elixhauser-Comorbidity Index is an independent risk factor for longer hospital length of stay, higher 90-day medical complications, greater 90-day readmissions, and increased two-year implant-related complications following primary THA. This study is important as it further defines and heightens awareness of adverse events for complex patients undergoing this procedure. Future studies can examine if these events can potentially be mitigated through reductions in ECI scores prior to surgery and increased incentives for the healthcare team.

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