The Impact of Resident Holdover Admissions on Length of Hospital Stay and Risk of Transfer to an Intensive Care Unit

2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Deepshikha Charan Ashana ◽  
Vincent K. Chan ◽  
Sitaram Vangala ◽  
Douglas S. Bell
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
The Impact

scholarly journals Statin Use and COVID-19 Infectivity and Severity in South Korea: Two Population-Based Nationwide Cohort Studies (Preprint)

2021 ◽  
Author(s):  
Seung Won Lee ◽  
So Young Kim ◽  
Sung Yong Moon ◽  
In Kyung Yoo ◽  
Eun-Gyong Yoo ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Hospital Stay ◽  
Clinical Outcomes ◽  
Length Of Hospital Stay ◽  
Population Based ◽  
Adjusted Relative Risk ◽  
Invasive Ventilation ◽  
Independent Population ◽  
Statin Use

BACKGROUND Basic studies suggest that statins as add-on therapy may benefit patients with COVID-19; however, real-world evidence of such a beneficial association is lacking. OBJECTIVE We investigated differences in SARS-CoV-2 test positivity and clinical outcomes of COVID-19 (composite endpoint: admission to intensive care unit, invasive ventilation, or death) between statin users and nonusers. METHODS Two independent population-based cohorts were analyzed, and we investigated the differences in SARS-CoV-2 test positivity and severe clinical outcomes of COVID-19, such as admission to the intensive care unit, invasive ventilation, or death, between statin users and nonusers. One group comprised an unmatched cohort of 214,207 patients who underwent SARS-CoV-2 testing from the Global Research Collaboration Project (GRCP)-COVID cohort, and the other group comprised an unmatched cohort of 74,866 patients who underwent SARS-CoV-2 testing from the National Health Insurance Service (NHIS)-COVID cohort. RESULTS The GRCP-COVID cohort with propensity score matching had 29,701 statin users and 29,701 matched nonusers. The SARS-CoV-2 test positivity rate was not associated with statin use (statin users, 2.82% [837/29,701]; nonusers, 2.65% [787/29,701]; adjusted relative risk [aRR] 0.97; 95% CI 0.88-1.07). Among patients with confirmed COVID-19 in the GRCP-COVID cohort, 804 were statin users and 1573 were matched nonusers. Statin users were associated with a decreased likelihood of severe clinical outcomes (statin users, 3.98% [32/804]; nonusers, 5.40% [85/1573]; aRR 0.62; 95% CI 0.41-0.91) and length of hospital stay (statin users, 23.8 days; nonusers, 26.3 days; adjusted mean difference –2.87; 95% CI –5.68 to –0.93) than nonusers. The results of the NHIS-COVID cohort were similar to the primary results of the GRCP-COVID cohort. CONCLUSIONS Our findings indicate that prior statin use is related to a decreased risk of worsening clinical outcomes of COVID-19 and length of hospital stay but not to that of SARS-CoV-2 infection.

scholarly journals Clinical and prognostic significance of emergency MRI findings in neck infections

2021 ◽  
Author(s):  
Jaakko Heikkinen ◽  
Janne Nurminen ◽  
Jarno Velhonoja ◽  
Heikki Irjala ◽  
Tatu Happonen ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Hospital Stay ◽  
Prognostic Significance ◽  
Length Of Hospital Stay ◽  
C Reactive Protein ◽  
Mri Findings ◽  
Neck Infection ◽  
Reactive Protein ◽  
Icu Treatment

Abstract Objectives Due to its superior soft-tissue contrast and ability to delineate abscesses, MRI has high diagnostic accuracy in neck infections. Whether MRI findings can predict the clinical course in these patients is unknown. The purpose of this study was to determine the clinical and prognostic significance of various MRI findings in emergency patients with acute neck infections. Materials and methods We retrospectively reviewed the 3-T MRI findings of 371 patients with acute neck infections from a 5-year period in a single tertiary emergency radiology department. We correlated various MRI findings, including retropharyngeal (RPE) and mediastinal edema (ME) and abscess diameter, to clinical findings and outcomes, such as the need for intensive care unit (ICU) treatment and length of hospital stay (LOS). Results A total of 201 out of 371 patients (54%) with neck infections showed evidence of RPE, and 81 out of 314 patients (26%) had ME. Both RPE (OR = 9.5, p < 0.001) and ME (OR = 5.3, p < 0.001) were more prevalent among the patients who required ICU treatment than among those who did not. In a multivariate analysis, C-reactive protein (CRP) levels, RPE, and maximal abscess diameter were independent predictors of the need for ICU treatment, and CRP, ME, and maximal abscess diameter were independent predictors of LOS. Conclusion In patients with an acute neck infection that requires emergency imaging, RPE, ME, and abscess diameter, as shown by MRI, are significant predictors of a more severe illness. Key Points • Two hundred one out of 371 patients (54%) with neck infection showed evidence of retropharyngeal edema (RPE), and 81 out of 314 patients (26%) had mediastinal edema (ME). • Maximal abscess diameter, RPE, and C-reactive protein (CRP) were independent predictors of the need for intensive care unit (ICU) treatment, and maximal abscess diameter, ME, and CRP were independent predictors of length of hospital stay. • Prognostic significance of MRI findings was evident also while controlling for CRP values.

scholarly journals COVID in women in Brazil: length of stay and outcomes of first hospitalizations

Rev Rene ◽  
2021 ◽  
Vol 22 ◽  
pp. e61049
Author(s):  
Erica de Brito Pitilin ◽  
Maicon Henrique Lentsck ◽  
Vanessa Aparecida Gasparin ◽  
Larissa Pereira Falavina ◽  
Vander Monteiro da Conceição ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Length Of Stay ◽  
Hospital Stay ◽  
Ecological Study ◽  
Length Of Hospital Stay ◽  
Secondary Diagnosis ◽  
Chi Square ◽  
Hospital Stays ◽  
Underlying Diseases

Objective: to analyze the length of hospital stay and outcomes of the first hospitalizations due to COVID-19 of women at the beginning of the pandemic. Methods: ecological study with data on COVID-19 hospitalizations of women. Data classification was done by states, regions, age, length of hospital stay, main and secondary diagnosis (underlying diseases), and outcome. Kruskal-Wallis, Mann-Whitney, and chi-square tests were used for the analysis. Results: the Southeast region had the highest number of hospitalizations (0.6%). Of the total number of hospitalizations, 14.6% required an intensive care unit. The length of hospital stay of women over 50 years was significant for Brazil (p<0.001). There was an association between length of hospital stay and levels 2 and 3 of comorbidity. Deaths in women over 50 years old were significant in Brazil, Northeast, and Southeast (p<0.001). Conclusion: women over 50 years old with comorbidities are associated with longer hospital stays and deaths.

scholarly journals BACTERIAL AND SENSITIVITY PATTERN OF PATHOGENS CAUSING VENTILATOR-ASSOCIATED PNEUMONIA IN INTENSIVE CARE UNIT

2022 ◽  
Vol 32 (1) ◽  
pp. 22
Author(s):  
Marsheila Harvy Mustikaningtyas ◽  
Bambang Pujo Semedi ◽  
Kuntaman Kuntaman
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Hospital Stay ◽  
High Mortality ◽  
Length Of Hospital Stay ◽  
Resistant Bacteria ◽  
Ventilator Associated Pneumonia ◽  
E Coli ◽  
Sensitivity Pattern ◽  
Sensitivity Rate

Highlight:1. Antimicrobial resistance bacteria isolated from VAP patients are often associated with high mortality and length of hospital stay. 2. Mortality in VAP patients was 33.3% and the VAP group had a longer hospital stay compared to the non-VAP group. 3. The three most predominant bacteria that were found were A. baumannii, P. aeruginosa, K. pneumoniae. Cefoperazone-sulbactam, meropenem and amikacin were more than 70% sensitive against these bacteria.Abstract:Background: Ventilator-Associated Pneumonia (VAP) is the most common nosocomial infection in Intensive Care Unit (ICU). Antimicrobial resistant bacteria isolated from VAP patients are often associated with high mortality and length of hospital stay. Objective: This study aimed to analyze the pattern and sensitivity among pathogens that caused VAP in ICU. Materials and Methods: The study was conducted retrospectively by extracting the data of bacterial isolates from sputum specimens in the Laboratory of Clinical Microbiology, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia and confirming the clinical data on patients suffering from VAP in ICU ward. The study started from January until December 2017. Results: The total 148 pathogens were isolated, 18 of them were diagnosed as VAP, and 130 were not VAP. The most predominant isolates in the VAP group were Acinetobacter baumannii as many as 38 (9%) followed by Pseudomonas aeruginosa 22 (2%), E. coli 16 (7%), and Klebsiella pneumoniae 11 (1%). The pathogens showed a sensitivity rate above 70% to cefoperazone-sulbactam (SCF), meropenem (MEM) and amikacin (AK). Mortality in VAP patients was 33.3% and the VAP group had a longer hospital stay compared to non-VAP group. Conclusion: The three most predominant bacteria that were found were A. baumannii, P. aeruginosa, K. pneumoniae. The pathogens had sensitivity rate above 70% to cefoperazone-sulbactam, meropenem, and amikacin.

Risk Factors for Adverse Postoperative Outcomes in Children Presenting for Cardiac Surgery with Upper Respiratory Tract Infections

2003 ◽  
Vol 98 (3) ◽  
pp. 628-632 ◽  
Author(s):  
Shobha Malviya ◽  
Terri Voepel-Lewis ◽  
Monica Siewert ◽  
Uma A. Pandit ◽  
Lori Q. Riegger ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Postoperative Complications ◽  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Healthy Children ◽  
Upper Respiratory Tract ◽  
Upper Respiratory ◽  
Tract Infections

Background Otherwise healthy children who present for elective surgery with an upper respiratory infection (URI) may be at risk for perioperative respiratory complications. This risk may be increased in children with congenital heart disease who undergo cardiac surgery while harboring a URI because of their compromised cardiopulmonary status. Therefore, this study was designed to determine the incidence of peri- and postoperative complications in children undergoing cardiac surgery while harboring a URI. Methods The study population consisted of 713 children scheduled to undergo cardiac surgery. Of these, 96 had symptoms of URI, and 617 were asymptomatic. Children were followed prospectively from induction of anesthesia to discharge from the hospital to determine the incidence of postoperative respiratory, cardiovascular, neurologic, and surgical adverse events. Duration of postoperative ventilation, time in the intensive care unit (ICU), and length of hospital stay were also recorded. Results Children with URIs had a significantly higher incidence of respiratory and multiple postoperative complications than children with no URIs (29.2 vs 17.3% and 25 vs 10.3%, respectively; P&lt; 0.01) and a higher incidence of postoperative bacterial infections (5.2 vs 1.0%; P= 0.01). Furthermore, logistic regression indicated that the presence of a URI was an independent risk factor for multiple postoperative complications and postoperative infections in children undergoing open heart surgery. Children with URIs also stayed longer in the intensive care unit than children with no URIs (75.9 +/- 89.8 h vs 57.7 +/- 63.8, respectively; P&lt; 0.01). However, the overall length of hospital stay was not significantly different (8.4 vs 7.8 days, URI vs non-URI groups; P&gt; 0.05). Conclusions The presence of a URI was predictive of postoperative infection and multiple complications in children presenting for cardiac surgery. Despite this, the presence of a URI does not appear to affect the patient's overall length of hospital stay nor the development of long-term sequelae.

Socioeconomic Costs of Open Surgery and Gamma Knife Radiosurgery for Benign Cranial Base Tumors

Neurosurgery ◽  
2006 ◽  
Vol 58 (5) ◽  
pp. 866-873 ◽  
Author(s):  
Der-Yang Cho ◽  
Meilan Tsao ◽  
Wen-Yuan Lee ◽  
Cheng-Siu Chang
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Hospital Stay ◽  
Gamma Knife ◽  
Open Surgery ◽  
Gamma Knife Radiosurgery ◽  
Length Of Hospital Stay ◽  
Indirect Costs ◽  
Cranial Base ◽  
The Mean

Abstract OBJECTIVE: The aim of this study was to evaluate the relative socioeconomic costs of benign cranial base tumors treated with open surgery and gamma knife radiosurgery. METHODS: In a retrospective study, we studied 174 patients with benign cranial base tumors, less than 3 cm in diameter (or volume less than 30 ml), admitted in the past 5 years. Group A (n = 94) underwent open surgery for removal of the tumors, whereas Group B (n = 80) underwent gamma knife radiosurgery. The socioeconomic costs were evaluated by both direct and indirect cost. The direct costs comprised intensive care unit cost, ward cost, operating room cost, and outpatient visiting cost. The indirect costs included loss of workdays and mortality. The length of hospital stay, the number of lost workdays, surgical complications, mortality, and cost-effectiveness analysis were calculated as well. Student t test and χ2 test were used for statistical analysis. RESULTS: The mean length of hospital stay for open surgery was 18.2 ± 30.4 days including 5.0 ± 14.7 days of intensive care unit stay and 13.0 ± 15.2 days of ward stay, P&lt;0.01. The mean hospital stay for gamma knife was 2.2 ± 0.9 days with no need of intensive care unit stay, P&lt;0.01. The mean loss of workdays for open surgery was 160 ± 158 days and 8.0 ± 9.0 days for gamma knife, P&lt;0.01. The gamma knife cost per hour (US $1435) is higher than the open surgery cost per hour (US $450), P&lt;0.01. The direct cost for gamma knife (US $9677 ± $6700) is higher than that for open surgery (US $5837 ± $6587), P&lt;0.01. Open surgery had more complication rates (31.2%) than gamma knife (3.8%). Open surgery had a mortality rate of 5.3%; there was no mortality for gamma knife. The indirect costs, including loss of workdays and mortality, were significantly higher for open surgery than for gamma knife, P&lt;0.01. Finally, the socioeconomic cost (US $34,453 ± $97,277) is higher for open surgery than for gamma knife (US $10,044 ± $7481), P&lt;0.01. The CEA is significantly higher in gamma knife (US $3762/quality-adjusted life year) than in open surgery (US $8996/quality-adjusted life year), P&lt;0.01. CONCLUSION: Most of the socioeconomic loss with open surgery for benign cranial base tumors comes from the indirect costs of workdays lost and mortality. Gamma knife radiosurgery is a worthwhile treatment to our patients and to our society because it may shorten hospital stays and workdays lost and reduce complications, mortality, socioeconomic loss, and achieve better cost-effectiveness.

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