Association of CLABSI With Hospital Length of Stay, Readmission Rates, and Mortality: A Retrospective Review

Abstract Background Although opioids remain the standard therapy for the treatment of postoperative pain, the prevalence of opioid misuse is rising. The extent to which opioid abuse or dependence affects readmission rates and healthcare utilization is not fully understood. It was hypothesized that surgical patients with a history of opioid abuse or dependence would have higher readmission rates and healthcare utilization. Methods A retrospective cohort analysis was performed of patients undergoing major operating room procedures in 2013 and 2014 using the National Readmission Database. Patients with opioid abuse or dependence were identified using International Classification of Diseases codes. The primary outcome was 30-day hospital readmission rate. Secondary outcomes included hospital length of stay and estimated hospital costs. Results Among the 16,016,842 patients who had a major operating room procedure whose death status was known, 94,903 (0.6%) had diagnoses of opioid abuse or dependence. After adjustment for potential confounders, patients with opioid abuse or dependence had higher 30-day readmission rates (11.1% vs. 9.1%; odds ratio 1.26; 95% CI, 1.22 to 1.30), longer mean hospital length of stay at initial admission (6 vs. 4 days; P < 0.0001), and higher estimated hospital costs during initial admission ($18,528 vs. $16,617; P < 0.0001). Length of stay was also higher at readmission (6 days vs. 5 days; P < 0.0001). Readmissions for infection (27.0% vs. 18.9%; P < 0.0001), opioid overdose (1.0% vs. 0.1%; P < 0.0001), and acute pain (1.0% vs. 0.5%; P < 0.0001) were more common in patients with opioid abuse or dependence. Conclusions Opioid abuse and dependence are associated with increased readmission rates and healthcare utilization after surgery.

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Modified-Frailty Index Does Not Independently Predict Complications, Hospital Length of Stay or 30-Day Readmission Rates Following Posterior Lumbar Decompression and Fusion for Spondylolisthesis

The Spine Journal ◽

10.1016/j.spinee.2021.05.011 ◽

2021 ◽

Author(s):

Aladine A. Elsamadicy ◽

Isaac G. Freedman ◽

Andrew B. Koo ◽

Wyatt B David ◽

Benjamin C. Reeves ◽

...

Keyword(s):

Length Of Stay ◽

Frailty Index ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Readmission Rates ◽

Lumbar Decompression ◽

Modified Frailty Index

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IMPACT OF SERUM EOSINOPHIL COUNTS ON HOSPITAL LENGTH OF STAY, READMISSION RATES, AND IN-HOSPITAL OUTCOMES IN PATIENTS WITH ACUTE EXACERBATION OF COPD

CHEST Journal ◽

10.1016/j.chest.2020.08.1546 ◽

2020 ◽

Vol 158 (4) ◽

pp. A1770

Author(s):

Tinashe Maduke ◽

Armin Krvavac ◽

Sara Tepe ◽

Pooja Nair ◽

Trent Bailey ◽

...

Keyword(s):

Length Of Stay ◽

Acute Exacerbation ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Readmission Rates ◽

Hospital Outcomes ◽

Acute Exacerbation Of Copd ◽

Exacerbation Of Copd ◽

Eosinophil Counts

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1951. Extended Infusions of Β-lactam Antibiotics are Feasible and May Improve Mortality in the Pediatric Population

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz359.128 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S59-S60

Author(s):

Rachael L Schortemeyer ◽

Tracy N Zembles ◽

Glenn Bushee ◽

Evelyn Kuhn ◽

Michelle L Mitchell

Keyword(s):

Length Of Stay ◽

Clinical Outcomes ◽

Critically Ill ◽

Interim Analysis ◽

Pediatric Population ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Readmission Rates ◽

Drug Concentrations ◽

All Cause Mortality

Abstract Background Infections due to multi-drug-resistant organisms (MDRO) are associated with poor clinical outcomes. Due to limited treatment options for MDROs, it is essential to improve the delivery of available antibiotics. Optimal efficacy of β-lactam antibiotics can be achieved when free drug concentrations exceed the minimum inhibitory concentration of the organism for at least 50% of the dosing interval. This is more feasible when extending the duration of infusion. Adult literature supporting the use of extended infusion β-lactams (EIBL) is robust; however, pediatric data are limited. Furthermore, extended infusions (EI) may be more difficult to achieve in pediatric patients due to limited intravenous line access. The purpose of this study was to determine the feasibility of EIBLs as the standard of care and compare clinical outcomes between standard infusions (SI) and extended infusions (EI). Methods This retrospective chart analysis included hospitalized patients less than 18 years old between October 1, 2017 and March 31, 2019 who received at least 72 hours of cefepime, piperacillin/tazobactam, or meropenem. Patients weighing less than 3.5 kg or requiring continuous renal replacement therapy were excluded. EI were defined as antibiotic delivery over 3–4 hours, while SI were delivered over 30 minutes. The percent of patients completing therapy utilizing EI was measured. Clinical outcomes compared hospital length of stay; time to blood culture clearance, defervescence, inflammatory marker normalization; 30-day readmission rates; and 30-day all-cause mortality between the SI and EI groups. Results A total of 560 patients were included in the interim analysis. Over 90% of patients were able to complete therapy utilizing EI (Figure 1). The EI group had lower readmission rates, but the interim analysis has not yet controlled for planned admissions. A sub-analysis of critically ill patients requiring vasopressors identified a lower mortality rate (5.1% vs. 23.1%, P = 0.023) and decreased the length of stay (554 vs. 1,055 hours, P = 0.035) in the EI compared with SI group (Table 1). Conclusion EIBLs are feasible in the pediatric population and may lead to improved outcomes including decreased all-cause mortality and hospital length of stay, especially in critically ill children. Disclosures All Authors: No reported Disclosures.

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Multimodal Clinical Pathway With Adductor Canal Block Decreases Hospital Length of Stay, Improves Pain Control, and Reduces Opioid Consumption in Total Knee Arthroplasty Patients: A Retrospective Review

The Journal of Arthroplasty ◽

10.1016/j.arth.2018.03.053 ◽

2018 ◽

Vol 33 (8) ◽

pp. 2440-2448 ◽

Cited By ~ 12

Author(s):

Terry A. Ellis ◽

Hassan Hammoud ◽

Philip Dela Merced ◽

Nishankkumar P. Nooli ◽

Farhad Ghoddoussi ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Length Of Stay ◽

Knee Arthroplasty ◽

Retrospective Review ◽

Pain Control ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Adductor Canal Block ◽

Adductor Canal ◽

Total Knee

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THE EFFECTS OF PERIOPERATIVE DEXAMETHASONE ON GLYCEMIC CONTROL AND POSTOPERATIVE OUTCOMES

Endocrine Practice ◽

10.4158/ep-2019-0252 ◽

2020 ◽

Vol 26 (2) ◽

pp. 218-225 ◽

Cited By ~ 1

Author(s):

Rebecca A. Herbst ◽

Onala T. Telford ◽

John Hunting ◽

W. Michael Bullock ◽

Erin Manning ◽

...

Keyword(s):

Diabetes Mellitus ◽

Length Of Stay ◽

Confidence Interval ◽

Orthopedic Surgery ◽

Geometric Mean ◽

Hospital Length ◽

Hazard Ratio ◽

Hospital Length Of Stay ◽

Geometric Mean Ratio ◽

Readmission Rates

Objective: Perioperative glucocorticoids are commonly given to reduce pain and nausea in patients undergoing surgery. However, the glycemic effects of steroids and the potential effects on morbidity and mortality have not been systematically evaluated. This study investigated the association between perioperative dexamethasone and postoperative blood glucose, hospital length of stay (LOS), readmission rates, and 90-day survival. Methods: Data from 4,800 consecutive orthopedic surgery patients who underwent surgery between 2000 and 2016 within a single health system were analyzed retrospectively. Results: Patients with and without diabetes mellitus (DM) who were given a single dose of dexamethasone had higher rates of hyperglycemia during the first 24 hours after surgery as compared to those who did not receive dexamethasone (hazard ratio [HR] was 1.81, and 95% confidence interval [CI] was [1.46, 2.24] for the DM cohort; HR 2.34, 95% CI [1.66, 3.29] for the nonDM cohort). LOS was nearly 1 day shorter in patients who received dexamethasone (geometric mean ratio [GMR] 0.79, 95% CI [0.75, 0.83] for patients with DM; GMR 0.75, 95% CI [0.72, 0.79] for patients without DM), and there was no difference in 90-day readmission rates. In patients without DM, dexamethasone was associated with a higher 90-day overall survival (99.07% versus 96.90%; P = .004). Conclusion: In patients with and without DM who undergo orthopedic surgery, perioperative dexamethasone was associated with a transiently higher risk of hyperglycemia. However, dexamethasone treatment was associated with a shorter LOS in patients with and without DM, and a higher overall 90-day survival rate in patients without DM, compared to patients who did not receive dexamethasone. Abbreviations: BMI = body mass index; CAD = coronary artery disease; CI = confidence interval; DM = diabetes mellitus; GMR = geometric mean ratio; HR = hazard ratio; IV = intravenous; LOS = length of stay; POD = postoperative day

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