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 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.

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.

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 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.

Abstract 16190: National Trends in RSV Hospitalizations in Children With Hemodynamically Significant Heart Disease, 1997-2009

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Patricia Y Chu ◽  
Christoph P Hornik ◽  
Jennifer S Li ◽  
Michael J Campbell ◽  
Kevin D Hill
Keyword(s):  
Heart Disease ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Early Adoption ◽  
Rsv Infection ◽  
Common Ventricle ◽  
Syncytial Virus ◽  
National Trends ◽  
Left Heart Syndrome ◽  
The Impact

Background: Children with hemodynamically significant heart disease (HS-HD) are at risk for morbidities and mortality due to respiratory syncytial virus (RSV). Palivizumab was approved for RSV prophylaxis in 1998. Guidelines released in December 2003 recommend palivizumab for all children < 2 yrs with HS-HD. We sought to define the impact of RSV prophylaxis in children with HS-HD by evaluating trends in U.S. RSV hospitalizations. Methods: The 1997, ’00, ’03, ’06 and ’09 Healthcare Cost and Utilization Project (HCUP) Kids’ Inpatient Databases (KID) were used to estimate U.S. RSV hospitalizations in children < 2 yrs, overall and in those with HS-HD, using standard HCUP weighting methods. RSV was defined by ICD-9-CM codes for RSV infection. HS-HD was defined using ICD-9-CM codes from the Clinical Classifications Software for congestive heart failure, or an ICD-9-CM code for pulmonary hypertension, common truncus, common ventricle, or hypoplastic left heart syndrome. Results: Our cohort included an estimated 461,491 RSV hospitalizations; 2,132 in children with HS-HD. Figure 1 depicts hospitalizations over time. There was no evident trend in number of overall RSV hospitalizations, however RSV hospitalizations in children with HS-HD declined by 39% from ’97 to ‘09. The largest decline was from ’97-’03. RSV hospitalizations in children with HS-HD relative to overall hospitalizations in children with HS-HD declined annually from ’97-’06 with a small increase in ‘09 (3.8%, 3.5%, 3.0%, 2.3% and 2.6% for successive analytic years). In 2009 mean hospital length of stay for children with HS-HD and RSV was 22.5 ± 2.1 days. Conclusions: RSV disease burden in children with HS-HD has declined since palivizumab approval. Much of this decline occurred before palivizumab was recommended for use in HS-HD, perhaps reflecting early adoption of prophylaxis, or greater awareness of alternative preventative strategies. RSV remains a significant cause of morbidity in children with HS-HD.

scholarly journals National trends in hospital length of stay for acute myocardial infarction in China

2015 ◽  
Vol 15 (1) ◽  
Author(s):  
Qian Li ◽  
Zhenqiu Lin ◽  
Frederick A Masoudi ◽  
Jing Li ◽  
Xi Li ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Length Of Stay ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
National Trends

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.

Differences in surgical outcomes for patients with craniosynostosis in the US: impact of socioeconomic variables and race

2016 ◽  
Vol 17 (1) ◽  
pp. 27-33 ◽  
Author(s):  
Faris Shweikeh ◽  
David Foulad ◽  
Miriam Nuño ◽  
Doniel Drazin ◽  
Matthew A. Adamo
Keyword(s):  
Private Insurance ◽  
International Classification Of Diseases ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Hospital Charges ◽  
Teaching Hospitals ◽  
National Study ◽  
Current Recommendation ◽  
National Trends ◽  
Neurosurgical Intervention

OBJECT Craniosynostosis is often treated with neurosurgical intervention. The aim of this study was to report and analyze the clinical and socioeconomic characteristics of patients with craniosynostosis and to present current national trends. METHODS Using the Kids’ Inpatient Database for the years 2000, 2003, 2006, and 2009, the authors identified patients with craniosynostosis using International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes and their associated procedure codes. Clinical features, demographics, inpatient procedures, outcomes, and charges were collected and analyzed. RESULTS Of the 3415 patients identified, 65.8% were White, 21.4% were Hispanic, and 3.2% were Black. More than 96% were treated at urban teaching hospitals and 54.2% in southern or western regions. White patients were younger (mean 6.1 months) as compared with Blacks (mean 10.9 months) and Hispanics (mean 9.1 months; p < 0.0001) at the time of surgery. A higher fraction of Whites had private insurance (70.3%) compared with nonwhites (34.0%–41.6%; p < 0.001). Approximately 12.2% were nonelective admissions, more so among Blacks (16.9%). Mean hospital length of stay (LOS) was 3.5 days with no significant differences among races. Following surgical treatment, 12.1% of patients developed complications, most commonly pulmonary/respiratory (4.8%), wound infection (4.4%), and hydrocephalus (1.4%). The mean overall hospital charges were significantly lower for Whites than nonwhites ($34,527 vs $44,890–$48,543, respectively; p < 0.0001). CONCLUSIONS The findings of this national study suggest a higher prevalence of craniosynostosis in Hispanics. The higher predisposition among males was less evident in Hispanics and Blacks. There was a significant percentage of nonelective admissions, more commonly among Blacks. Additionally, Hispanics and Blacks were more likely to receive surgery at an older age, past the current recommendation of the optimum age for surgical intervention. These findings are likely associated with a lack of early detection. Although mean LOS and rate of complications did not significantly differ among different races, nonwhites had, on average, higher hospital charges of $10,000–$14,000. This discrepancy may be due to differences in type of insurance, craniosynostosis type, rates of comorbidities, and delay in treatment. Although there are several limitations to this analysis, the study reports on relevant disparities regarding a costly neurosurgical intervention, and ways to diminish these disparities should be further explored.

scholarly journals Multicenter assessment of the Brain Injury Guidelines and a proposal of guideline modifications

2020 ◽  
Vol 5 (1) ◽  
pp. e000483 ◽  
Author(s):  
Abid D Khan ◽  
Anna J Elseth ◽  
Jacqueline A Brosius ◽  
Eliza Moskowitz ◽  
Sean C Liebscher ◽  
...  
Keyword(s):  
Patient Safety ◽  
Brain Injury ◽  
Length Of Stay ◽  
Resource Utilization ◽  
Injury Severity ◽  
Improve Patient Safety ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Head Ct ◽  
The Brain

BackgroundThe Brain Injury Guidelines provide an algorithm fortreating patients with traumatic brain injury (TBI) and intracranial hemorrhage(ICH) that does not mandate hospital admission, repeat head CT, orneurosurgical consult for all patients. The purposes of this study are toreview the guidelines’ safety, to assess resource utilization, and to proposeguideline modifications that improve patient safety and widespreadreproducibility.MethodsA multi-institutional review of TBI patients was conducted. Patients with ICH on CT were classified as BIG 1, 2, or 3 based on the guidelines. BIG 3 patients were excluded. Variables collected included demographics, Injury Severity Score (ISS), hospital length of stay (LOS), intensive care unit LOS, number of head CTs, type of injury, progression of injury, and neurosurgical interventions performed.Results269 patients met inclusion criteria. 98 were classifiedas BIG 1 and 171 as BIG 2. The median length of stay (LOS) was 2 (2,4)days and the ICU LOS was 1 (0,2) days. Most patients had a neurosurgeryconsultation (95.9%) and all patients included had a repeat head CT. 370repeat head CT scans were performed, representing 1.38 repeat scans perpatient. 11.2% of BIG 1 and 11.1% of BIG 2 patients demonstratedworsening on repeat head CT. Patients who progressed exhibited a higherISS (14 vs. 10, p=0.040), and had a longer length of stay (4 vs. 2 days;p=0.015). After adjusting for other variables, the presence of epiduralhematoma (EDH) and intraparenchymal hematoma were independent predictors ofprogression. Two BIG 2 patients with EDH had clinical deteriorationrequiring intervention.DiscussionThe Brain Injury Guidelines may improve resourceallocation if utilized, but alterations are required to ensure patientsafety. The modified Brain Injury Guidelines refine the originalguidelines to enhance reproducibility and patient safety while continuing toprovide improved resource utilization in TBI management.

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