scholarly journals Asthma in COVID-19: An extra chain fitting around the neck?

2020 ◽  
Author(s):  
Mohammad Hosny Hussein ◽  
Eman Ali Toraih ◽  
Abdallah S Attia ◽  
Mohanad Youssef ◽  
Mahmoud Omar ◽  
...  
Keyword(s):  
Wide Spectrum ◽  
Univariate Analysis ◽  
Multivariable Analysis ◽  
Length Of Hospital Stay ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Icu Admission ◽  
Asthmatic Patients ◽  
Significant Difference ◽  
Novel Coronavirus

Introduction The novel coronavirus disease 2019 (COVID-19) has rapidly spread across the globe, overwhelming healthcare systems and depleting resources. The infection has a wide spectrum of presentations, and pre-existing comorbidities have been found to have a dramatic effect on the disease course and prognosis. We sought to analyze the effect of asthma on the disease progression and outcomes of COVID-19 patients. Methods We conducted a multi-center retrospective study of positively confirmed COVID-19 patients from multiple hospitals in Louisiana. Demographics, medical history, comorbidities, clinical presentation, daily laboratory values, complications, and outcomes data were collected and analyzed. The primary outcome of interest was in-hospital mortality. Secondary outcomes were Intensive Care Unit (ICU) admission, risk of intubation, duration of mechanical ventilation, and length of hospital stay. Results A total of 502 COVID-19 patients (72 asthma and 430 non-asthma cohorts) were included in the study. The frequency of asthma in hospitalized cohorts was 14.3%, higher than the national prevalence of asthma (7.7%). Univariate analysis revealed that asthma patients were more likely to be obese (75% vs 54.2%, p=0.001), with higher frequency of intubation (40.3% vs 27.8%, p = 0.036), and required longer duration of hospitalization (15.1±12.5 vs 11.5±10.6, p=0.015). After adjustment, multivariable analysis showed that asthmatic patients were not associated with higher risk of ICU admission (OR=1.81, 95%CI=0.98-3.09, p=0.06), endotracheal intubation (OR=1.77, 95%CI=0.99-3.04, p=0.06) or complications (OR=1.37, 95%CI=0.82-2.31, p=0.23). Asthmatic patients were not associated with higher odds of prolonged hospital length of stay (OR=1.48, 95%CI=0.82-2.66, p=0.20) or with the duration of ICU stay (OR=0.76, 95%CI=0.28-2.02, p=0.58). Kaplan-Meier curve showed no significant difference in overall survival of the two groups (p=0.65). Conclusion Despite the increased prevalence of hospitalization in asthmatic COVID-19 patients compared to the general population, after adjustment for other variables, it was neither associated with increased severity nor worse outcomes.

scholarly journals Outcomes of Total versus Partial Colectomy in Fulminant Clostridium Difficile Colitis. A Propensity Matched Analysis.

2021 ◽  
Author(s):  
Nasim Ahmed ◽  
YenHong Kuo
Keyword(s):  
Clostridium Difficile ◽  
Univariate Analysis ◽  
Length Of Hospital Stay ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
P Value ◽  
Improvement Program ◽  
Discharge Disposition ◽  
Significant Difference ◽  
Partial Colectomy

Abstract BackgroundThe Total Abdominal Colectomy (TAC) is the recommended procedure for Fulminant Clostridium Difficile Colitis (FCDC), however, occasionally, FCDC is also treated with partial colectomies. The purpose of the study was to identify the outcomes of partial colectomy in FCDC cases.MethodThe National Surgical Quality Improvement Program (NSQIP) database was accessed and eligible patients from 2012 through 2016 were reviewed. Patients 18 years and older who were diagnosed with FCDC and who underwent colectomies were included in the study. Patients’ demography, clinical characteristics, comorbidities, mortality, morbidities, length of hospital stay and discharge disposition were compared between the group who underwent partial colectomy and the group who underwent TAC. Univariate analysis followed by propensity matching were performed. A p value of <0.05 is considered as statistically significant. ResultsOut of 491 patients who qualified for the study, 93 (18.94%) patients underwent partial colectomy. The pair matched analysis showed no significant difference in patients’ characteristics and comorbidities in the two groups. There was no significant difference found in mortality between the two groups (30.1% vs. 30.15, P>0.99). There were no differences found in the median [95% CI] hospital length of stay [LOS] (23 days [19-31] vs. 21 [17-25], P=0.30), post-operative complications (P>0.05), and discharged disposition to home (43.1% vs. 33.8%) or transfer to rehab (21.55 vs. 12.3%, P=0.357) between the TAC and partial colectomy groups.Conclusion The overall 30 days mortality remains very high in FCDC. Partial colectomy did not increase risk of mortality or morbidities and LOS.

scholarly journals Outcomes and National Trends for the Surgical Treatment of Lumbar Spine Trauma

2016 ◽  
Vol 2016 ◽  
pp. 1-9 ◽  
Author(s):  
Doniel Drazin ◽  
Miriam Nuno ◽  
Faris Shweikeh ◽  
Alexander R. Vaccaro ◽  
Eli Baron ◽  
...  
Keyword(s):  
Patient Safety ◽  
Lumbar Spine ◽  
Univariate Analysis ◽  
Multivariable Analysis ◽  
Compression Fracture ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Nationwide Inpatient Sample Database ◽  
Average Patient ◽  
National Trends

Introduction. Operative treatment of lumbar spine compression fractures includes fusion and/or cement augmentation. Our aim was to evaluate postoperative differences in patients treated surgically with fusion, vertebroplasty, or kyphoplasty.Methods. The Nationwide Inpatient Sample Database search for adult vertebral compression fracture patients treated 2004–2011 identified 102,316 surgical patients: 30.6% underwent spinal fusion, 17.1% underwent kyphoplasty, and 49.9% underwent vertebroplasty. Univariate analysis of patient and hospital characteristics, by treatment, was performed. Multivariable analysis was used to determine factors associated with mortality, nonroutine discharge, complications, and patient safety.Results. Average patient age: fusion (46.2), kyphoplasty (78.5), vertebroplasty (76.7) (p<.0001). Gender, race, household income, hospital-specific characteristics, and insurance differences were found (p≤.001). Leading comorbidities were hypertension, osteoporosis, and diabetes. Risks for higher mortality (OR 2.0: CI: 1.6–2.5), nonroutine discharge (OR 1.6, CI: 1.6–1.7), complications (OR 1.1, CI: 1.0–1.1), and safety related events (OR 1.1, CI: 1.0–1.1) rose consistently with increasing age, particularly among fusion patients. Preexisting comorbidities and longer in-hospital length of stay were associated with increased odds of nonroutine discharge, complications, and patient safety.Conclusions. Fusion patients had higher rates of poorer outcomes compared to vertebroplasty and kyphoplasty cohorts. Mortality, nonroutine discharge, complications, and adverse events increased consistently with older age.

scholarly journals COPD is not associated with a poor prognosis in COVID-19

2020 ◽  
Author(s):  
Tai Joon An ◽  
Youlim Kim ◽  
Yong Bum Park ◽  
Kyungjoo Kim ◽  
Do Yeon Cho ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Subgroup Analysis ◽  
Univariate Analysis ◽  
Admission Rate ◽  
Hospital Length Of Stay ◽  
Chronic Obstructive ◽  
Icu Admission ◽  
Copd Patients ◽  
Significant Difference ◽  
Male Sex

Abstract Background: Coronavirus disease 2019 (COVID-19) is a worldwide pandemic. The effect of underlying chronic obstructive pulmonary disease (COPD) on COVID-19 is controversial. We set this study to examine the clinical outcomes of COVID-19 according to the underlying COPD.Methods: COVID-19 patients were assessed using nationwide health insurance data. COPD patients were operationally defined. Comorbidities were evaluated by using the modified Charlson Comorbidity Index (mCCI) which excluded the factors of COPD from conventional CCI scores. Baseline characteristics and clinical outcomes of COVID-19, such as mortality, hospital length of stay (LOS), and intensive care unit (ICU) admission, were assessed. Subgroup analysis about the effect of inhaled corticosteroid of COPD patients on COVID-19 was performed.Results: COPD group were older (71.3±11.6 vs. 47.7±19.1, p < 0.001) and have higher CCI scores (2.6±1.9 vs. 0.8±1.3, p < 0.001) than non-COPD group. Mortality was higher in COPD groups than in non-COPD group (22.9% vs. 3.2%, p < 0.001). The ICU admission rate and hospital LOS were not significantly different between the two groups. In univariate analysis, ages, male sex, mCCI, socioeconomic status, and underlying COPD were associated with mortality. In multivariate analysis, underlying COPD was not associated with mortality after adjusted. On the other hand, other variables are still associated with mortality. Older ages (odds ratio [OR] 1.12; 95% confidence interval [CI] 1.11–1.14; p < 0.001), male sex (OR 2.29; 95% CI 1.67–3.12; p < 0.001), higher mCCI (OR 1.30; 95% CI 1.20–1.41; p < 0.001), and medical aid insurance (OR 1.55; 95% CI 1.03–2.32; p = 0.035) were associated with mortality of COVID-19. Underlying COPD was also not associated with hospital LOS and ICU admission rates in the adjusted analyses. In the subgroup analysis, there was no significant difference between the ICS user and nonuser including mortality and hospital LOS. In the adjusted analyses, the use of ICS in COPD patients was not associated with mortality and hospital LOS in COVID-19.Conclusions: Mortality, hospital LOS, and ICU admission rate were not associated with underlying COPD in COVID-19.

Abstract 9: Predictors of Poor Outcome in Patients Not Thrombolysed Due to Mild or Resolving Symptoms ("Too Good To Treat")

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
Syed F Ali ◽  
Urooba Faheem ◽  
Aneesh B Singhal ◽  
Anand Viswanathan ◽  
Scott B Silverman ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Univariate Analysis ◽  
Multivariable Analysis ◽  
Time Frame ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Factors Associated ◽  
Poor Outcome ◽  
Poor Outcomes ◽  
Iv Tpa

Introduction: A common reason for exclusion of patients with acute ischemic stroke presenting within the time frame for IV tPA is that they are “too good to treat” due to rapidly improving or mild symptoms. Several studies have reported poor outcomes in this group which motivated us to evaluate patient factors associated with poor outcomes. Methods: Using our institutional GWTG database, we analyzed 2,745 consecutive stroke admissions (01/2009 - 07/2013). Univariate and multivariable analysis were carried out to determine factors associated with poor outcome, defined as not being discharged home. Results: Of the total 2,745 patients, 306 (11.1%) presented within the window for IV tPA but did not receive the treatment due to symptoms too mild or rapidly improving as judged by the treating team. Of these 306, 64.1% were discharged home, 26.5% to IRF, 7.2% to SNF and 2.9% expired/hospice. Patients with poor outcome were older, more frequently Hispanic and presented with more vascular risk factors such as hypertension, diabetes, CAD, PAD and atrial fibrillation than good outcome patients. They also had higher median initial NIHSS. Patients in both groups had similar adherence to early antithrombotics, dysphagia screening and DVT prophylaxis. Poor outcome patients had higher rates of in-hospital complications and a longer hospital length of stay (Table 1). On univariate analysis, factors associated with poor outcome included age [OR 1.50 (1.30 - 1.70), p<0.0001], ethnicity [4.15 (1.25 - 13.81), p=0.020], diabetes mellitus [1.91 (1.11 - 3.29), p=0.019], atrial fibrillation [1.82 (1.02 - 3.25), p=0.042], PAD [9.02 (1.04 - 78.20), p=0.046], NIHSS [1.16 per point (1.06 - 1.27), p=0.001], in-hospital pneumonia (all cases had poor outcome) or UTI [7.04 (1.92 - 25.81), p=0.003]. In multivariable analysis, only age [1.50 (1.30 - 1.70), p<0.0001], ethnicity [6.61 (1.83 - 23.85), p=0.004], NIHSS [1.14 per point (1.04 - 1.26), p=0.007] and UTI [7.30 (1.72 - 31.00), p=0.007] remained significant. Conclusion: A substantial percentage of patients deemed “too good” for IV tPA were unable to be discharged home. Factors such as advanced age and higher NIHSS should be considered in tPA decision-making to optimize outcomes. Large, multi-center prospective studies are underway to study the predictors of poor outcomes in this group.

scholarly journals Early versus Delayed Oral Feeding in Patients following Total Laryngectomy

2014 ◽  
Vol 2014 ◽  
pp. 1-10 ◽  
Author(s):  
Ashley Hay ◽  
Lisa Pitkin ◽  
Kurinchi Gurusamy
Keyword(s):  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Hospital Length ◽  
Oral Feeding ◽  
Hospital Length Of Stay ◽  
Pharyngocutaneous Fistula ◽  
Early Oral Feeding ◽  
Significant Difference ◽  
Randomised Control Trials ◽  
Fistula Rate

Objectives. To assess the effects of early oral feeding in laryngectomy patients versus delayed oral feeding. The outcomes used are mortality, pharyngocutaneous fistula rate, quality of life, hospital length of stay, and complications. Method. We performed searches within five major databases until June 2013. We considered randomised control trials (RCTs) and included nonrandomised studies for the assessment of harms. Results. We included four RCTs for assessment of benefits and three nonrandomised studies for assessment of harms (393 participants). There was no statistically significant difference detected in mortality at six months, pharyngocutaneous fistulae, or complications. The length of hospital stay was shorter in the early feeding group, MD −2.72 days [95% CI −5.34 to −0.09]. Conclusion. Early oral feeding appears to have similar incidence of complications and has the potential to shorten the length of hospital stay. Further well-designed RCTs are necessary because of weakness in the available evidence.

scholarly journals Lymphopenia is associated with poor outcomes of patients with community-acquired pneumonia and sepsis

2021 ◽  
Author(s):  
Catia Cillóniz ◽  
Héctor José Peroni ◽  
Albert Gabarrús ◽  
Carolina García-Vidal ◽  
Juan M Pericàs ◽  
...  
Keyword(s):  
Pleural Effusion ◽  
Chronic Renal Disease ◽  
Multivariable Analysis ◽  
Pneumococcal Vaccination ◽  
Hospital Length ◽  
Community Acquired Pneumonia ◽  
Hospital Length Of Stay ◽  
Icu Admission ◽  
Tertiary Teaching ◽  
The Impact

Abstract Background Lymphopenia is a marker of poor prognosis in patients with community-acquired pneumonia (CAP), yet its impact on outcomes in patients with CAP and sepsis remains unknown. We aim to investigate the impact of lymphopenia on outcomes, risk of ICU admission and mortality in CAP patients with sepsis. Methods This was a retrospective, observational study of prospectively collected data from an 800-bed tertiary teaching hospital (2005-2019). Results Of the 2,203 patients with CAP and sepsis, 1,347 (61%) did not have lymphopenia, while 856 (39%) did. When compared to the non-lymphopenic group, patients with sepsis and lymphopenia more frequently required intensive care unit (ICU) admission (p=0.001), had a longer hospital length of stay (p˂0.001), and presented with a higher rate of in-hospital (p˂0.001) and 30-day mortality (p=0.001). Multivariable analysis showed that C-reactive protein ≥15 mg/dL, lymphopenia, pleural effusion and acute respiratory distress syndrome within 24h of admission were risk factors for ICU admission; age ≥80 years was independently associated with decreased ICU admission. In addition, age (≥80 years), chronic renal disease, chronic neurologic disease, nursing home resident, lymphopenia and pleural effusion were independently associated with increased 30-day mortality, whereas pneumococcal vaccination, diabetes mellitus and fever were independently associated with reduced 30-day mortality. Conclusions Lymphopenia was independently associated with the risk of ICU admission and higher in-hospital and 30-day mortality in patients with CAP and sepsis. Early identification of lymphopenia could help identify septic patients with CAP who require or will shortly require critical care.

30-Day Outcomes for Total Ankle Arthroplasty in Patients With Anemia

2021 ◽  
pp. 107110072110175
Author(s):  
Jordan R. Pollock ◽  
Matt K. Doan ◽  
M. Lane Moore ◽  
Jeffrey D. Hassebrock ◽  
Justin L. Makovicka ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Univariate Analysis ◽  
Hospital Length ◽  
Total Ankle Arthroplasty ◽  
Hospital Length Of Stay ◽  
Preoperative Anemia ◽  
Improvement Project ◽  
Average Hospital ◽  
Ankle Arthroplasty ◽  
Reoperation Rates

Background: While anemia has been associated with poor surgical outcomes in total knee arthroplasty and total hip arthroplasty, the effects of anemia on total ankle arthroplasty remain unknown. This study examines how preoperative anemia affects postoperative outcomes in total ankle arthroplasty. Methods: A retrospective analysis was performed using the American College of Surgeons National Surgery Quality Improvement Project database from 2011 to 2018 for total ankle arthroplasty procedures. Hematocrit (HCT) levels were used to determine preoperative anemia. Results: Of the 1028 patients included in this study, 114 patients were found to be anemic. Univariate analysis demonstrated anemia was significantly associated with an increased average hospital length of stay (2.2 vs 1.8 days, P < .008), increased rate of 30-day readmission (3.5% vs 1.1%, P = .036), increased 30-day reoperation (2.6% vs 0.4%, P = .007), extended length of stay (64% vs 49.9%, P = .004), wound complication (1.75% vs 0.11%, P = .002), and surgical site infection (2.6% vs 0.6%, P = .017). Multivariate logistic regression analysis found anemia to be significantly associated with extended hospital length of stay (odds ratio [OR], 1.62; 95% CI, 1.07-2.45; P = .023) and increased reoperation rates (OR, 5.47; 95% CI, 1.15-26.00; P = .033). Anemia was not found to be a predictor of increased readmission rates (OR, 3.13; 95% CI, 0.93-10.56; P = .066) or postoperative complications (OR, 1.27; 95% CI, 0.35-4.56; P = .71). Conclusion: This study found increasing severity of anemia to be associated with extended hospital length of stay and increased reoperation rates. Providers and patients should be aware of the increased risks of total ankle arthroplasty with preoperative anemia. Level of Evidence: Level III, retrospective comparative study.

scholarly journals Mortality after cardiopulmonary resuscitation on a medical ICU

2021 ◽  
Author(s):  
Richard Rezar ◽  
Bernhard Wernly ◽  
Michael Haslinger ◽  
Clemens Seelmaier ◽  
Philipp Schwaiger ◽  
...  
Keyword(s):  
Cardiopulmonary Resuscitation ◽  
Neurological Outcome ◽  
Cox Regression ◽  
Cerebral Performance Category ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Study Endpoint ◽  
Primary Study ◽  
Postresuscitation Care ◽  
Significant Difference

Summary Background Performing cardiopulmonary resuscitation (CPR) and postresuscitation care in the intensive care unit (ICU) are standardized procedures; however, there is evidence suggesting sex-dependent differences in clinical management and outcome variables after cardiac arrest (CA). Methods A prospective analysis of patients who were hospitalized at a medical ICU after CPR between December 2018 and March 2020 was conducted. Exclusion criteria were age < 18 years, hospital length of stay < 24 h and traumatic CA. The primary study endpoint was mortality after 6 months and the secondary endpoint neurological outcome assessed by cerebral performance category (CPC). Differences between groups were calculated by using U‑tests and χ2-tests, for survival analysis both univariate and multivariable Cox regression were fitted. Results A total of 106 patients were included and the majority were male (71.7%). No statistically significant difference regarding 6‑month mortality between sexes could be shown (hazard risk, HR 0.68, 95% confidence interval, CI 0.35–1.34; p = 0.27). Neurological outcome was also similar between both groups (CPC 1 88% in both sexes after 6 months; p = 1.000). There were no statistically significant differences regarding general characteristics, pre-existing diseases, as well as the majority of clinical and laboratory parameters or measures performed on the ICU. Conclusion In a single center CPR database no statistically significant sex-specific differences regarding post-resuscitation care, survival and neurological outcome after 6 months were observed.

scholarly journals Older trauma patients are at high risk of delirium, especially those with underlying dementia or baseline frailty

2021 ◽  
Vol 6 (1) ◽  
pp. e000639
Author(s):  
Danielle Ní Chróinín ◽  
Nevenka Francis ◽  
Pearl Wong ◽  
Yewon David Kim ◽  
Susan Nham ◽  
...  
Keyword(s):  
Older Patients ◽  
Multivariable Analysis ◽  
Primary Outcome Measure ◽  
Hospital Length ◽  
Assessment Tools ◽  
Hospital Length Of Stay ◽  
Trauma Patients ◽  
Level Of Evidence ◽  
Increased Risk ◽  
History Of

BackgroundGiven the increasing numbers of older patients presenting with trauma, and the potential influence of delirium on outcomes, we sought to investigate the proportion of such patients who were diagnosed with delirium during their stay—and patient factors associated therewith—and the potential associations between delirium and hospital length of stay (LOS). We hypothesized that delirium would be common, associated with certain patient characteristics, and associated with long hospital LOS (highest quartile).MethodsWe conducted a retrospective observational cohort study of all trauma patients aged ≥65 years presenting in September to October 2019, interrogating medical records and the institutional trauma database. The primary outcome measure was occurrence of delirium.ResultsAmong 99 eligible patients, delirium was common, documented in 23% (23 of 99). On multivariable analysis, adjusting for age, frailty and history of dementia, frailty (OR 4.09, 95% CI 1.08 to 15.53, p=0.04) and dementia (OR 5.23, 95% CI 1.38 to 19.90, p=0.02) were independently associated with likelihood of delirium. Standardized assessment tools were underused, with only 34% (34 of 99) screened within 4 hours of arrival. On univariate logistic regression analysis, having an episode of delirium was associated with long LOS (highest quartile), OR of 5.29 (95% CI 1.92 to 14.56, p<0.001). In the final multivariable model, adjusting for any (non-delirium) in-hospital complication, delirium was independently associated with long LOS (≥16 days; OR 4.81, p=0.005).DiscussionIn this study, delirium was common. History of dementia and baseline frailty were associated with increased risk. Delirium was independently associated with long LOS. However, many patients did not undergo standardized screening at admission. Early identification and targeted management of older patients at risk of delirium may reduce incidence and improve care of this vulnerable cohort. These data are hypothesis generating, but support the need for initiatives which improve delirium care, acknowledging the complex interplay between frailty and other geriatric syndromes in the older trauma patients.Level of evidenceIII.

scholarly journals The independent patient factors that affect length of stay following hip fractures

2018 ◽  
Vol 100 (7) ◽  
pp. 556-562 ◽  
Author(s):  
T Richards ◽  
A Glendenning ◽  
D Benson ◽  
S Alexander ◽  
S Thati
Keyword(s):  
Hip Fracture ◽  
Length Of Stay ◽  
Hospital Stay ◽  
Hip Fractures ◽  
Length Of Hospital Stay ◽  
Hospital Length ◽  
Acute Hospital ◽  
Hospital Length Of Stay ◽  
Patient Factors ◽  
Mobility Status

Introduction Management of hip fractures has evolved over recent years to drive better outcomes including length of hospital stay. We aimed to identify and quantify the effect that patient factors influence acute hospital and total health service length of stay. Methods A retrospective observational study based on National Hip Fracture Database data was conducted from 1 January 2014 to 31 December 2015. A multiple regression analysis of 330 patients was carried out to determine independent factors that affect acute hospital and total hospital length of stay. Results American Society of Anesthesiologists (ASA) grade 3 or above, Abbreviated Mental Test Score (AMTS) less than 8 and poor mobility status were independent factors, significantly increasing length of hospital stay in our population. Acute hospital length of stay can be predicted as 8.9 days longer when AMTS less than 8, 4.2 days longer when ASA grade was 3 or above and 20.4 days longer when unable to mobilise unaided (compared with independently mobile individuals). Other factors including total hip replacement compared with hemiarthroplasty did not independently affect length of stay. Conclusions Our analysis in a representative and generalisable population illustrates the importance of identifying these three patient characteristics in hip fracture patients. When recognised and targeted with orthogeriatric support, the length of hospital stay for these patients can be reduced and overall hip fracture care improved. Screening on admission for ASA grade, AMTS and mobility status allows prediction of length of stay and tailoring of care to match needs.

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