Preoperative anemia management program reduces blood transfusion in elective cardiac surgical patients, improving outcomes and decreasing hospital length of stay

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.

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Mo1005 EARLY ENDOSCOPY IN CRITICALLY ILL PATIENTS WITH UPPER GASTROINTESTINAL BLEEDING REDUCES BLOOD TRANSFUSION REQUIREMENT AND HOSPITAL LENGTH OF STAY

Gastroenterology ◽

10.1016/s0016-5085(20)32553-1 ◽

2020 ◽

Vol 158 (6) ◽

pp. S-750-S-751

Author(s):

Parker L. Ellison ◽

Roula Sasso ◽

Isaac Jaben ◽

Don C. Rockey

Keyword(s):

Blood Transfusion ◽

Length Of Stay ◽

Gastrointestinal Bleeding ◽

Critically Ill Patients ◽

Transfusion Requirement ◽

Upper Gastrointestinal Bleeding ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Early Endoscopy ◽

Upper Gastrointestinal

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

The American Surgeon ◽

10.1177/000313481408000832 ◽

2014 ◽

Vol 80 (8) ◽

pp. 801-804 ◽

Cited By ~ 3

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.

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Is It Beneficial to Optimize Vital Signs Before Embolization for Pelvic Fractures? A Dilemma Between Resuscitation and Hemostasis

The American Surgeon ◽

10.1177/00031348211065119 ◽

2022 ◽

pp. 000313482110651

Author(s):

Ling-Wei Kuo ◽

Chen-Yu Wang ◽

Chien-An Liao ◽

Yu-Tung Wu ◽

Chien-Hung Liao ◽

...

Keyword(s):

Blood Transfusion ◽

Length Of Stay ◽

Pelvic Fracture ◽

Arterial Embolization ◽

Hospital Length ◽

Incidence Rates ◽

Pelvic Fractures ◽

Hospital Length Of Stay ◽

Blood Transfusions ◽

Icu Length Of Stay

Purpose Adequate resuscitation and definitive hemostasis are both important in the management of hemorrhage related to pelvic fracture. The goal of this study was to analyze the relationship between the amount of blood transfused before transcatheter arterial embolization (TAE) and the clinical outcome later in the disease course. Methods Patients with pelvic fractures who underwent TAE for hemostasis from January 2018 to December 2019 were studied. The characteristics of patients who received blood transfusions of >2 U (1000 mL) and ≤2 U before TAE were compared. The mortality rate, blood transfusion-related complications, and length of stay were compared between these two groups. Results Among the 75 studied patients, 39 (52.0%) received blood transfusions of ≤2 U before TAE, and the other 36 (48.0%) patients received blood transfusions of >2 U before TAE. The incidence rates of systemic inflammatory response syndrome, sepsis, and coagulopathy were significantly higher in the >2 U group (97.2% vs 81.1%, P = .027; 50.0% vs 27.0%, P = .045; and 44.4% vs 5.4%, P < .01, respectively). After nonsurvivors were excluded, the >2 U group had a significantly higher proportion (43.8% vs 14.7%, P < .001) of prolonged intensive care unit (ICU) length of stay (7 days or more) and a longer hospital length of stay (33.8 ± 15.1 vs 21.9 ± 94.0, P < .01) than the ≤2 U group. Pre-TAE blood transfusion >2 U serves as an independent risk factor for prolonged ICU length of stay and increased hospital length of stay. Conclusion Early hemostasis for pelvic fracture-related hemorrhage is suggested to prevent pre-TAE blood transfusion-associated adverse effects of blood transfusion.

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Predictors of tracheostomy in cardiac surgical patients and its impact on ICU & hospital length of stay and survival

European Journal of Anaesthesiology ◽

10.1097/00003643-200706003-00108 ◽

2007 ◽

Vol 24 (Supplement 41) ◽

pp. 33-34

Author(s):

F. Cislaghi ◽

C. Villa ◽

A. Corona ◽

A. M. Condemi

Keyword(s):

Length Of Stay ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Surgical Patients

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

Anesthesiology ◽

10.1097/aln.0000000000000891 ◽

2015 ◽

Vol 123 (6) ◽

pp. 1301-1311 ◽

Cited By ~ 56

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 < 0.001) and a longer HLOS of 5 days (P < 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 < 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 < 0.001) and 2 days longer HLOS (P < 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 < 0.05) and a 3-day longer HLOS (P < 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.

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Abstract 13167: Early Mobilization in Postoperative Cardiac Surgical Patients

Circulation ◽

10.1161/circ.142.suppl_3.13167 ◽

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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