scholarly journals Readmissions in Patients with Cerebral Cavernous Malformations (CCMs): A National Readmission Database (NRD) Study

2021 ◽  
Author(s):  
Akhil Padarti ◽  
Amod Amritphale ◽  
Javed Khader Eliyas ◽  
Daniele Rigamonti ◽  
Jun Zhang
Keyword(s):  
High Risk ◽  
Hospital Admissions ◽  
Private Insurance ◽  
Hospital Readmissions ◽  
High Risk Patient ◽  
Neurological Sequela ◽  
Cerebral Cavernous Malformations ◽  
Index Hospitalization ◽  
Cavernous Malformations ◽  
National Readmission Database

AbstractBACKGROUNDCerebral cavernous malformations (CCMs) are microvascular CNS lesions prone to hemorrhage leading to neurological sequela such as stroke and seizure. A subset of CCM patients have aggressive disease leading to multiple bleeding events, likely resulting multiple hospitalizations. Hospital admission rates are an important metric that has direct financial impact on hospitals and an indicator of overall disease burden. Furthermore, analysis of hospital readmissions can lead to early identification of high-risk patients and provides insight into the pathogenesis of CCM lesions. The purpose of this study is to identify high risk CCM patients with increased all cause readmission and comorbidities associated with increased readmissions.METHODSAll US hospital admissions due to CCMs were searched using the 2017 National Readmission Database (NRD). Patients with readmissions within 30 days of discharge from index hospitalization were identified and analyzed, relative to the remaining population.RESULTSAmong all patients hospitalized for CCM, 14.9% (13.7-16.2%) required all cause readmission within 30 days. Multivariate logistical regression analysis showed that substance abuse (p=0.003), diabetes (p=0.018), gastrointestinal bleed (p=0.002), renal failure (p=0.027), and coronary artery disease (p=0.010) were predictive of all cause readmissions, while age group 65-74 (p=0.042), private insurance (p<0.001), and treatment at a metropolitan teaching institution (p=0.039) were protective. Approximately half of all readmissions are caused by neurological (33.9%) and infectious (14.6%) etiologies. The 30-day lesion bleeding rate after index hospitalization is 0.8% (0.5-1.2%).CONCLUSIONSAll identified comorbidities associated with increased risks of readmission contribute to vascular stress, suggesting its role in lesion pathogenesis. This is the first and only study to analyze readmission metrics for CCMs in order to identify high risk patient factors to date.

Geospatial, Clinical, and Social Determinants of Hospital Readmissions

2019 ◽  
Vol 34 (6) ◽  
pp. 607-614
Author(s):  
Yun Ye ◽  
Micah W. Beachy ◽  
Jiangtao Luo ◽  
Tammy Winterboer ◽  
Brandon S. Fleharty ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Health Care Quality ◽  
Hospital Readmissions ◽  
High Risk Patient ◽  
Care Quality ◽  
Potential Risk Factors ◽  
Risk Patients ◽  
Patient Groups ◽  
Social Demographic

Unnecessary hospital readmissions increase patient burden, decrease health care quality and efficiency, and raise overall costs. This retrospective cohort study sought to identify high-risk patients who may serve as targets for interventions aiming at reducing hospital readmissions. The authors compared geospatial, social demographic, and clinical characteristics of patients with or without a 90-day readmission. Electronic health records of 42 330 adult patients admitted to 2 Midwestern hospitals during 2013 to 2016 were used, and logistic regression was performed to determine risk factors for readmission. The 90-day readmission percentage was 14.9%. Two main groups of patients with significantly higher odds of a 90-day readmission included those with severe conditions, particularly those with a short length of stay at incident admission, and patients with Medicare but younger than age 65. These findings expand knowledge of potential risk factors related to readmissions. Future interventions to reduce hospital readmissions may focus on the aforementioned high-risk patient groups.

Is there a role for referral of high-risk patients seen in preoperative medical consultation for postoperative inpatient follow-up?

2021 ◽  
pp. 175045892110310
Author(s):  
Jessica Evans ◽  
James Chan ◽  
Delvina H Saraqini ◽  
Ranjeeta Mallick
Keyword(s):  
High Risk ◽  
Chart Review ◽  
Hospital Admissions ◽  
Hospital Readmissions ◽  
Retrospective Chart Review ◽  
Medical Consultation ◽  
Medical Assessment ◽  
Risk Patients ◽  
Lost To Follow Up

The potential benefit of referring select high-risk surgical patients who are seen during a preoperative medical consultation for postoperative inpatient medical follow-up is uncertain. Over a seven-year period, our internal medicine perioperative clinic referred 5% of 4642 preoperative consults for postoperative follow-up. A retrospective chart review found that although reasons for referral were heterogeneous, those assessed by the medical consult team postoperatively were more comorbid, had more adverse medical complications and had longer hospital admissions compared to those not referred. Physicians were best able to predict adverse cardiac and diabetes-related complications. Half of the patients who were referred for postoperative assessment were lost to follow-up, and there was a trend towards increased hospital readmissions in this group. Further research is required to identify the subset of patients who might benefit from postoperative inpatient medical assessment.

Infective Endocarditis

1995 ◽  
Vol 16 (4) ◽  
pp. 148-154 ◽  
Author(s):  
Delores Danilowicz
Keyword(s):  
At Risk ◽  
High Risk ◽  
Hospital Admissions ◽  
Opportunistic Infections ◽  
Heart Defects ◽  
Tertiary Care ◽  
High Risk Patient ◽  
Febrile Illness ◽  
Diagnostic Dilemma ◽  
Indwelling Catheters

A high level of suspicion is of utmost importance in the diagnosis of endocarditis, particularly in the patient at risk who may have received antibiotic treatment for the prodrome. Treatment with adequate levels of a bactericidal drug based on an identified organism will give the highest percentage of cures. Early treatment may prevent damage to cardiac structures and lessen further complications related to emboli or progressively enlarging vegetations. The combination of a high-risk patient with either resistant bacterial endocarditis or fungal [See table in the PDF file] endocarditis carries a higher morbidity and will account for most of the mortality. Although not an ideal answer, SBE prophylaxis is justified from observations in animals and should be recommended strongly to the parents and to the patient as she or he gets older. Because an increasing number of children survive their congenital heart defects but remain at risk for acquiring SBE and because an increasing number of preterm infants and neonates are exposed to indwelling catheters, the pediatrician will continue to see IE presenting as both a diagnostic dilemma and an acute treatment problem. The emergence of children who are human immunodeficiency virus-positive or who have acquired immunodeficiency syndrome has increased the group at immunologic risk, as has an increasing population of children surviving organ transplants. These children can present more often with infections caused by nosocomial, resistant agents because of their frequent hospitalizations, and they may have a variety of opportunistic infections from organisms that normally are not pathogens. Unfortunately, a higher mortality rate can be expected among these children. The diagnosis of IE is made even more of a challenge because it accounts for only about 1/1000 to 1/4500 hospital admissions to pediatric services. In tertiary care hospitals that have an active pediatric cardiac service, the numbers may be higher. The most important element in diagnosing endocarditis remains its early consideration as a possibility in any child who has a persistent unexplained febrile illness and its being the first consideration in a high-risk child.

A(H1N1)v cases of the 2009/2010 and 2010/2011 influenza seasons in the Medical and Health Sciences Centre of Debrecen University

2012 ◽  
Vol 153 (17) ◽  
pp. 649-654
Author(s):  
Piroska Orosi ◽  
Judit Szidor ◽  
Tünde Tóthné Tóth ◽  
József Kónya
Keyword(s):  
High Risk ◽  
Influenza Season ◽  
National Level ◽  
Organ Transplant ◽  
High Risk Patient ◽  
Risk Groups ◽  
Health Sciences ◽  
World Health ◽  
Transplant Patients ◽  
Health Organization

The swine-origin new influenza variant A(H1N1) emerged in 2009 and changed the epidemiology of the 2009/2010 influenza season globally and at national level. Aims: The aim of the authors was to analyse the cases of two influenza seasons. Methods: The Medical and Health Sciences Centre of Debrecen University has 1690 beds with 85 000 patients admitted per year. The diagnosis of influenza was conducted using real-time polymerase chain reaction in the microbiological laboratories of the University and the National Epidemiological Centre, according to the recommendation of the World Health Organization. Results: The incidence of influenza was not higher than that observed in the previous season, but two high-risk patient groups were identified: pregnant women and patients with immunodeficiency (oncohematological and organ transplant patients). The influenza vaccine, which is free for high-risk groups and health care workers in Hungary, appeared to be effective for prevention, because in the 2010/2011 influenza season none of the 58 patients who were administered the vaccination developed influenza. Conclusion: It is an important task to protect oncohematological and organ transplant patients. Orv. Hetil., 2012, 153, 649–654.

Endovascular Repair of an Aortoenteric Fistula in a High-Risk Patient

1999 ◽  
Vol 6 (4) ◽  
pp. 379-384 ◽  
Author(s):  
Arvind Deshpande ◽  
Mark Lovelock ◽  
Peter Mossop ◽  
Michael Denton ◽  
John Vidovich ◽  
...  
Keyword(s):  
High Risk ◽  
Endovascular Repair ◽  
High Risk Patient ◽  
Aortoenteric Fistula ◽  
Risk Patient
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