scholarly journals Development and Validation of a web-based Postoperative Clostridioides difficile infection risk prediction model

2020 ◽  
Author(s):  
Sang H. Woo ◽  
Bryan Hess ◽  
Lily Ackermann ◽  
Scott W. Cowan ◽  
Jennifer Valentine
Keyword(s):  
Length Of Stay ◽  
Prediction Model ◽  
Risk Prediction ◽  
Infection Risk ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Surgical Patients ◽  
Training Cohort ◽  
Acs Nsqip ◽  
Clostridioides Difficile

AbstractBackgroundClostridioides difficile infection is associated with significant morbidity, mortality and increased costs. Assessment of the postoperative C. difficile infection risk is necessary to improve the outcome of surgical patients.ObjectiveTo develop and validate a risk prediction tool for C. difficile infection after surgery.MethodsIn this retrospective cohort study, 2,451,169 surgical patients from the American College of Surgeons National Surgical Quality Improvement Program Database (ACS-NSQIP) over 2015-2017 were included. Nine predictors were selected for the model: age, preoperative leukocytosis (>12 ×109/L), hematocrit (≤30%), chronic dialysis, insulin dependent diabetes, weight loss, steroid use, presence of preoperative sepsis, and surgery type. A second model included hospital length of stay as a predictor. A predictive model was developed using ACS-NSQIP 2015-2016 training cohort (n=1,435,157) and tested using 2017 validation cohort (n=1,016,012). Multivariate logistic regression was used for the model.Main outcomeThe primary outcome was postoperative 30-day C. difficile infection (CDI).Results0.39% of the patients (n=9,675) developed CDI and 42.3% (n=4,091) of CDI occurred post-discharge. The Clostridioides difficile risk prediction model had excellent AUC (area under the receiver operating characteristic curve) for postoperative C. difficile infection (training cohort=0.804, test cohort= 0.803). The model that includes hospital length of stay has a high AUC (training cohort=0.841, test cohort=0.838).ConclusionThe C. difficile prediction model provides a robust predictive tool for postoperative C. difficile infection.

scholarly journals Development and Validation of Postoperative Venous Thromboembolism risk prediction model

2020 ◽  
Author(s):  
Sang H. Woo ◽  
Ruben Rhoades ◽  
Lily Ackermann ◽  
Scott W. Cowan ◽  
Jillian Zavodnick ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Length Of Stay ◽  
Prediction Model ◽  
Risk Prediction ◽  
Hospital Length ◽  
Risk Prediction Model ◽  
Hospital Length Of Stay ◽  
Improvement Program ◽  
Acs Nsqip ◽  
Using Data

AbstractBackgroundVTE is a serious postoperative complication after surgery with resultant higher morbidity and mortality. Despite years of experience with current risk models, rates continue to be high and more information is needed on individual patient risk in the prophylaxis era.Research QuestionsCan we assess the individualized risk of postoperative venous thromboembolism (VTE) for broad categories of surgery?MethodsThis study was performed using data from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) Database. Patient data (n=2,875,190) from 2015-2017 were used for study analysis. Eight predictors were selected for the model: age, preoperative platelet count≥450 (×109/L), disseminated cancer, corticosteroid use, serum albumin ≤2.5 g/dL, preoperative sepsis, hospital length of stay and surgery type. The second model included 7 predictors without hospital length of stay. A predictive model was trained using ACS-NSQIP data from 2015-2016 (n=1,859,227) and tested using data from 2017 (n= 1,015,963). Primary outcomes are postoperative 30-day VTE, including deep vein thrombosis (DVT) and/or pulmonary embolism (PE).ResultsVTE occurred in 23,249 patients (0.81%) and 49.9% of VTE occurred after discharge from index hospitalization. The risk prediction model had high AUC (area under the receiver operating characteristic curve) for postoperative VTE of 0.78 (training cohort) and 0.78 (test cohort).InterpretationThis clinical prediction model is a validated, practical and easy-to-use tool to identify surgical patients at the highest risk of postoperative VTE and provide an individualized assessment of risk based on clinical factors and type of surgery. This prediction model may be used as a tool to assess individualized risk of postoperative VTE and promote broader discussion and awareness of the VTE risk during the perioperative period.

Agency for Healthcare Research and Quality Patient Safety Indicators and Mortality in Surgical Patients

2014 ◽  
Vol 80 (8) ◽  
pp. 801-804 ◽  
Author(s):  
Rajesh Ramanathan ◽  
Patricia Leavell ◽  
Luke G. Wolfe ◽  
Therese M. Duane
Keyword(s):  
Patient Safety ◽  
Length Of Stay ◽  
Medical Center ◽  
Academic Medical Center ◽  
Hospital Length ◽  
Healthcare Research ◽  
Hospital Length Of Stay ◽  
Surgical Patients ◽  
Patient Safety Indicators ◽  
Academic Medical

Patient safety indicators (PSI), developed by the Agency for Healthcare Research and Quality, use administrative billing data to measure and compare patient safety events at medical centers. We retrospectively examined whether PSIs accurately reflect patients’ risk of mortality, hospital length of stay, and intensive care unit (ICU) requirements at an academic medical center. Surgical patient records with PSIs were reviewed between October 2011 and September 2012 at our urban academic medical center. Primary outcomes studied included mortality, hospital length of stay, and ICU requirements. Subset analysis was performed for each PSI and its association with the outcome measures. PSIs were more common among surgical patients who died as compared with those alive at discharge (35.3 vs 2.7 PSIs/100 patients, P < 0.01). Although patients who died with PSIs had shorter hospital courses, they had a significantly greater ICU requirement than those without a PSI (96.0 vs 61.1%, P < 0.01) and patients who were alive at discharge (96.0 vs 48.0%, P < 0.01). The most frequently associated PSIs with mortality were postoperative metabolic derangements (41.7%), postoperative sepsis (38.5%), and pressure ulcers (33.3%). PSIs occur at a higher frequency in surgical patients who die and are associated with increased ICU requirements.

scholarly journals Minor Postoperative Increases of Creatinine Are Associated with Higher Mortality and Longer Hospital Length of Stay in Surgical Patients

2015 ◽  
Vol 123 (6) ◽  
pp. 1301-1311 ◽  
Author(s):  
Felix Kork ◽  
Felix Balzer ◽  
Claudia D. Spies ◽  
Klaus-Dieter Wernecke ◽  
Adit A. Ginde ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Tertiary Care ◽  
Hospital Length ◽  
Noncardiac Surgery ◽  
Adverse Outcomes ◽  
Hospital Length Of Stay ◽  
Surgical Patients ◽  
Risk Of Death ◽  
Postoperative Changes ◽  
Increased Risk

Abstract Background Surgical patients frequently experience postoperative increases in creatinine levels. The authors hypothesized that even small increases in postoperative creatinine levels are associated with adverse outcomes. Methods The authors examined the association of postoperative changes from preoperative baseline creatinine with all-cause in-hospital mortality and hospital length of stay (HLOS) in a retrospective analysis of surgical patients at a single tertiary care center between January 2006 and June 2012. Results The data of 39,369 surgical patients (noncardiac surgery n = 37,345; cardiac surgery n = 2,024) were analyzed. Acute kidney injury (AKI)—by definition of the Kidney Disease: Improving Global Outcome group—was associated with a five-fold higher mortality (odds ratio [OR], 4.8; 95% CI, 4.1 to 5.7; P &lt; 0.001) and a longer HLOS of 5 days (P &lt; 0.001) after adjusting for age, sex, comorbidities, congestive heart failure, preoperative hemoglobin, preoperative creatinine, exposure to radiocontrast agent, type of surgery, and surgical AKI risk factors. Importantly, even minor creatinine increases (Δcreatinine 25 to 49% above baseline but &lt; 0.3 mg/dl) not meeting AKI criteria were associated with a two-fold increased risk of death (OR, 1.7; 95% CI, 1.3 to 2.4; P &lt; 0.001) and 2 days longer HLOS (P &lt; 0.001). This was more pronounced in noncardiac surgery patients. Patients with minor creatinine increases had a five-fold risk of death (OR, 5.4; 95% CI, 1.5 to 20.3; P &lt; 0.05) and a 3-day longer HLOS (P &lt; 0.01) when undergoing noncardiac surgery. Conclusions Even minor postoperative increases in creatinine levels are associated with adverse outcomes. These results emphasize the importance to find effective therapeutic approaches to prevent or treat even mild forms of postoperative kidney dysfunction to improve surgical outcomes.

Abstract 13167: Early Mobilization in Postoperative Cardiac Surgical Patients

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Michael Goldfarb ◽  
Diana Dima ◽  
Yves Langlois
Keyword(s):  
Cardiac Surgery ◽  
Length Of Stay ◽  
Functional Status ◽  
Tertiary Care ◽  
Early Mobilization ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Surgical Patients ◽  
Tertiary Care Centre ◽  
Optimal Method

Introduction: Early mobilization (EM) is recommended by cardiac surgical societies. However, the optimal method of EM delivery has yet to be determined. Our objective was to assess whether a bedside nurse-driven EM strategy is safe and associated with improved outcomes following cardiac surgery. Methods: Consecutive post-cardiac surgery patients in a cardiovascular intensive care unit (CVICU) at an academic tertiary care centre from 2017 to 2019 prior to and after EM program implementation were reviewed. Postoperative cardiac surgery patients were initially managed in a general ICU and transferred to the CVICU when hemodynamic stability was achieved, typically postoperative day 1 or 2. Functional status was assessed by the nurse on CVICU admission using the Level of Function (LOF) Mobility Scale, which ranges from LOF 0 (bed immobile) to LOF 5 (walks > 50 feet). The nurse uses the LOF score to guide twice-daily level-specific mobility activities. The primary outcome was hospital length of stay. Results: There were 504 patients included in the study (preintervention, N=329; Intervention, N=175). There was no difference in age, sex or comorbid illness between the groups (Table). The LOF was 4.7 ± 0.5 prior to surgery, 3.4 ± 1.1 on CVICU admission, and 4.3 ± 0.6 on CVICU discharge in patients undergoing EM. Patients were mobilized during nearly all mobilization opportunities (98.7%; 685/694). Adverse events were rare (0.4%; 8 events/1901 mobilization activities), minor and transient. There was no difference is postoperative hospital length of stay, in-hospital mortality, discharge home or 30-day hospital re-admission (all P>0.05). Conclusion: A nurse-driven EM program was safe and associated with improvement in functional status in postoperative cardiac surgery patients. The EM program was not associated with improved short-term outcomes. Further studies are needed to understand optimal delivery of EM in cardiac surgical patients.

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