Abstract P336: Are Post-Operative Length-of-Stay and Rehospitalization Linked to Caregiving among Cardiac Surgery Patients?

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Heidi Mochari-Greenberger ◽  
Matthew Mosca ◽  
Brooke Aggarwal ◽  
Tianna M Umann ◽  
Lori Mosca
Keyword(s):  
Cardiac Surgery ◽  
Length Of Stay ◽  
Clinical Outcomes ◽  
Clinical Information System ◽  
Univariate Analysis ◽  
Participation Rate ◽  
University Hospital ◽  
Comorbid Conditions ◽  
Simple Method ◽  
Multivariable Adjustment

Background: Cardiac surgery patients are frequently cared for by family members or paid aides, potentially impacting clinical outcomes, yet data are sparse. The purpose of this study was to evaluate the association between access to paid or informal (unpaid) caregiving among cardiac surgery patients and post-operative length-of-stay, and death or rehospitalization at 1 year. Methods: We prospectively studied 665 consecutive patients admitted for cardiac surgery at a university hospital as part of a NHLBI-sponsored clinical outcomes study (93% participation rate). Participants (mean age 65 years; 35% female; 21% minority) completed an interviewer-assisted questionnaire at baseline to determine if they had a caregiver and the extent of care received. A hospital-based clinical information system was used to document post-operative length-of-stay and death or rehospitalization at 1 year (supplemented by standardized questionnaire). Demographics and comorbid conditions were documented by electronic chart assessment; comorbidity score was calculated using the Ghali comorbidity index. Associations between caregiving and clinical outcomes were evaluated by multiple logistic regression, adjusted for demographics (age, race, sex, marital status, health insurance) and comorbid conditions. Results: At baseline, 28% (183/665) of cardiac surgery patients reported having a caregiver (8% paid; 20% informal only). Having a caregiver was significantly associated with longer (>7 days) post-operative length-of-stay (OR=1.86; 95%CI=1.30−2.65). This association varied by whether patients had a paid (OR=3.00; 95%CI=1.57−5.74) or informal caregiver (OR=1.55; 95%CI=1.04−2.31) versus none and was attenuated after multivariable adjustment ( paid caregiver OR=2.15; 95%CI=1.02−4.52, informal caregiver OR=1.23;95%CI=0.78−1.95). Having a paid caregiver was significantly associated with death or rehospitalization at 1 year in univariate analysis (OR=2.09; 95%CI=1.18−3.69) and was significantly attenuated after multivariable adjustment (OR=1.40; 95%CI=0.74−2.62). There was a non-significant univariate association between having an informal caregiver and death or rehospitalization at 1 year (OR=1.39; 95%CI=0.94−2.06). Conclusions: Cardiac surgery patients who identified having a caregiver had longer post-operative stays and a higher rate of death or rehospitalization at 1 year compared to those without a caregiver, not fully explained by comorbidities/confounders. These data suggest that assessment of caregiver status may be a powerful predictor and a simple method to identify cardiac surgery patients at risk for adverse clinical outcomes.

scholarly journals Prolonged Central Venous Desaturation Measured by Continuous Oximetry Is Associated with Adverse Outcomes in Pediatric Cardiac Surgery

2011 ◽  
Vol 115 (5) ◽  
pp. 1033-1043 ◽  
Author(s):  
Ryan Crowley ◽  
Elizabeth Sanchez ◽  
Jonathan K. Ho ◽  
Kate J. Lee ◽  
Johanna Schwarzenberger ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Length Of Stay ◽  
Adverse Events ◽  
Clinical Outcomes ◽  
Pediatric Patients ◽  
Adverse Outcomes ◽  
Central Venous ◽  
Major Adverse Events

Background The role of continuous central venous oxygen saturation (ScvO₂) oximetry during pediatric cardiac surgery for predicting adverse outcomes is not known. Using a recently available continuous ScvO₂ oximetry catheter, we examined the association between venous oxygen desaturations and patient outcomes. We hypothesized that central venous oxygen desaturations are associated with adverse clinical outcomes. Methods Fifty-four pediatric patients undergoing cardiac surgery were prospectively enrolled in an unblinded observational study. ScvO₂ was measured continuously in the operating room and for up to 24 h post-Intensive Care Unit admission. The relationships between ScvO₂ desaturations, clinical outcomes, and major adverse events were determined. Results More than 18 min of venous saturations less than 40% were associated with major adverse events with 100% sensitivity and 97.6% specificity. Significant correlations resulted between the ScvO₂ area under the curve less than 40% and creatinine clearance at 12 h in the Intensive Care Unit (r = -0.58), Intensive Care Unit length of stay (r = 0.56), max inotrope use (r = 0.52), inotrope use at 24 h (r = 0.40), inotrope index score (r = 0.39), hospital length of stay (r = 0.36), and length of intubation (r = 0.32). Conclusions We demonstrate that ScvO₂ desaturations by continuous oximetry are associated with major adverse events in pediatric patients undergoing cardiac surgery. The most significant associations with major adverse events are seen in patients with greater than 18 min of central venous saturations less than 40%. Our results support the further investigation of ScvO₂ as a potential target parameter in high-risk pediatric patients to minimize the risk of major adverse events.

scholarly journals Association between low body mass index and increased 28-day mortality of severe sepsis in Japanese cohorts

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Takehiko Oami ◽  
◽  
Satoshi Karasawa ◽  
Tadanaga Shimada ◽  
Taka-aki Nakada ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Severe Sepsis ◽  
Clinical Outcomes ◽  
Body Mass ◽  
Validation Cohort ◽  
Univariate Analysis ◽  
University Hospital ◽  
Primary Analysis ◽  
Derivation Cohort ◽  
Asian Populations

AbstractCurrent research regarding the association between body mass index (BMI) and altered clinical outcomes of sepsis in Asian populations is insufficient. We investigated the association between BMI and clinical outcomes using two Japanese cohorts of severe sepsis (derivation cohort, Chiba University Hospital, n = 614; validation cohort, multicenter cohort, n = 1561). Participants were categorized into the underweight (BMI < 18.5) and non-underweight (BMI ≥ 18.5) groups. The primary outcome was 28-day mortality. Univariate analysis of the derivation cohort indicated increased 28-day mortality trend in the underweight group compared to the non-underweight group (underweight 24.4% [20/82 cases] vs. non-underweight 16.0% [85/532 cases]; p = 0.060). In the primary analysis, multivariate analysis adjusted for baseline imbalance revealed that patients in the underweight group had a significantly increased 28-day mortality compared to those in the non-underweight group (p = 0.031, adjusted odds ratio [OR] 1.91, 95% confidence interval [CI] 1.06–3.46). In a repeated analysis using a multicenter validation cohort (underweight n = 343, non-underweight n = 1218), patients in the underweight group had a significantly increased 28-day mortality compared to those in the non-underweight group (p = 0.045, OR 1.40, 95% CI 1.00–1.97). In conclusion, patients with a BMI < 18.5 had a significantly increased 28-day mortality compared to those with a BMI ≥ 18.5 in Japanese cohorts with severe sepsis.

Abstract P75: Association Between Caregiving, 30-Day Outcomes, and Baseline Risk Status Among Hospitalized Cardiac Patients

2011 ◽  
Vol 4 (suppl_2) ◽  
Author(s):  
Lori Mosca ◽  
Brooke Aggarwal ◽  
Heidi Mochari-Greenberger ◽  
Ming Liao ◽  
Niurka Suero-Tejeda ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Participation Rate ◽  
Cardiac Patients ◽  
University Hospital ◽  
Baseline Risk ◽  
Risk Status ◽  
Available N ◽  
Comorbidity Score ◽  
History Of ◽  
Comorbidity Index

BACKGROUND: Caregivers might represent a unique opportunity to improve clinical outcomes among cardiovascular disease (CVD) patients, however prospective data are limited. PURPOSE: To determine if having a caregiver is associated with 30-day clinical outcomes and baseline risk status among hospitalized CVD patients. METHODS: We prospectively studied 4500 consecutive patients admitted to the CVD service line at a university hospital as part of the NHLBI-sponsored F amily Cardiac Caregiver I nvestigation T o Evaluate O utcomes ( FIT-O ) Study. Clinical outcomes included rehospitalization or death within 30-days. Patients [N=4500, 59% white, 62% male, 93% participation rate] completed a standardized interviewer assisted questionnaire in English/Spanish about caregiving (paid or non-paid). In a subsample of patients with baseline data available (n=1324), comorbidities, labs, and medications were analyzed by caregiver status. Comorbidity score was calculated using the Ghali Comorbidity Index (range 0-11). The association between caregiving and clinical outcomes was evaluated by logistic regression adjusted for confounders. RESULTS: At 30-days, 11% (475/4500) of patients had been rehospitalized or had died. Cardiac patients who had a caregiver vs. those who did not were significantly more likely to have been rehospitalized or to have died within 30-days (OR=1.4, 95%CI=1.2-1.7). This association was similar when analyzed by paid (OR=1.7, 95%CI=1.2-2.3) or non-paid (OR=1.2, 95%CI=1.0-1.6) caregiver status, and was not materially altered when adjusted for demographic confounders. In a subsample (n=1324), cardiac patients who had caregivers vs. those who did not were significantly (p<.05) more likely to have a history of diabetes, renal failure, CVD, COPD, creatinine >2.5 mg/dL, HbA1C ≥7%, comorbidity score >1, and take ≥11 medications. The association between caregiving and 30-day outcomes was not significant after adjustment for demographics, baseline risk factors, and comorbidities (OR=1.2, 95%CI=0.4-3.3). CONCLUSION: Cardiac patients who had a caregiver vs. those who did not had significantly higher rehospitalization and mortality rates at 30-days; this association is largely explained by their higher baseline risk status.

scholarly journals Time to Grow Positive Blood Cultures and Its Impact on Clinical Outcomes in Patients with Bacteremia Admitted to Intensive Care Unit

2021 ◽  
pp. 1-6
Author(s):  
Rashid Nadeem ◽  
Ashraf M. Elhoufi ◽  
Lamiaa Salama ◽  
Mayada Mahmoud ◽  
Islam Bon ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Blood Culture ◽  
Clinical Outcomes ◽  
Severity Of Illness ◽  
Bloodstream Infections ◽  
Blood Cultures ◽  
Comorbid Conditions ◽  
Mortality And Morbidity ◽  
Causes Of Mortality ◽  
The Impact

Introduction: Bloodstream infections are one of the leading causes of mortality and morbidity. Time to positive blood culture may be reflective of the severity of infection. We aim to study the impact of time to positivity (TTP) of blood culture upon clinical outcome. Methods: Data from blood cultures for 17 months duration reviewed. Outcome measures included in-hospital mortality and length of stay in ICU (LOSICU). TTP was determined for each sample. Demographics (age, gender, BMI, and nationality), APACHE-2 score for severity of illness, comorbid conditions, and other confounding factors were recorded. Results: One hundred and one patients with 346 positive blood cultures with mean age of 62 and mean APACHE-2 score of 18.9 + 9.7 (mean +SD) with overall observed mortality of 61%. Median TTP was 20.2 h with quartiles cutoff Q1 = 15.3, Q2 = 20.2, Q3 = 28, and range 8–104 h. Only APACHE-2 scores predict LOSICU. TTP is not a significant predictor for mortality or LOSICU. Discussion: Data on TTP of blood cultures have a complex interaction with clinical outcomes. Conclusion: TTP of blood cultures does not predict mortality or length of stay in ICU.

Medical Comorbidity in Psychiatric Inpatients: Relation to Clinical Outcomes and Hospital Length of Stay

2002 ◽  
Vol 43 (1) ◽  
pp. 24-30 ◽  
Author(s):  
Constantine G. Lyketsos ◽  
Gary Dunn ◽  
Michael J. Kaminsky ◽  
William R. Breakey
Keyword(s):  
Length Of Stay ◽  
Clinical Outcomes ◽  
Psychiatric Inpatients ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Medical Comorbidity

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.

Global leadership in paediatric and congenital cardiac care: “Humility in Leadership – an interview with Katarina Hanséus, MD, PhD, President of the Association for European Paediatric and Congenital Cardiology (AEPC)”

2021 ◽  
Vol 31 (5) ◽  
pp. 689-695
Author(s):  
Justin T. Tretter ◽  
Jeffrey P. Jacobs
Keyword(s):  
Cardiac Surgery ◽  
Global Leadership ◽  
University Hospital ◽  
Cardiac Care ◽  
Paediatric Surgery ◽  
Cross Sectional ◽  
Paediatric Cardiology ◽  
Pediatric Society ◽  
European Paediatric ◽  
Paediatric Cardiac Surgery

AbstractDr. Katarina Hanséus is the focus of our fourth in a series of interviews in Cardiology in the Young entitled, “Global Leadership in Paediatric and Congenital Cardiac Care”. Dr. Hanséus was born in Malmö, Sweden. She attended undergraduate school in her home town in Malmö, Sweden, graduating in 1974. Dr. Hanséus then went on to complete medical school at University of Lund in Lund, Sweden, graduating in 1980, where additionally she completed a Doctoral Dissertation in the evaluation of cardiac function and chamber size in children using Doppler and cross-sectional echocardiography. Under the Swedish Board of National Welfare, Dr. Hanséus completed her authorisation as a paediatrician in 1986, followed by her authorisation as a paediatric cardiologist in 1988, at University of Lund. She was appointed head of Paediatric Cardiology in 2000 at the Children’s Heart Center, Skane University Hospital, Lund, Sweden. The programme at Lund serves as one of the two national referral centres for comprehensive paediatric and congenital cardiac care, including paediatric cardiac surgery, in Sweden. From 2006 to 2013, she served as the clinical and administrative head of the Department of Neonatology, Paediatric Surgery, Paediatric Intensive Care, Paediatric Cardiology, and Paediatric Cardiac Surgery, returning as the head of Paediatric Cardiology in 2013, for which she currently holds the position.Dr. Hanséus is a recognised leader in the field of Paediatric Cardiology and has been involved in leadership within the Swedish Pediatric Society, the Swedish Association for Pediatric Cardiology, and the Association for European Paediatric and Congenital Cardiology throughout her career. Within the Association for European Paediatric and Congenital Cardiology, she served as the Secretary General from 2011 to 2016, the President Elect in 2018, and is the current President serving from 2019 until 2022. This article presents our interview with Dr. Hanséus, an interview that covers her experience as a leader in the field of Paediatric Cardiology, including the history and goals of the Association for European Paediatric and Congenital Cardiology, and her role and vision as their current President.

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