Abstract WP386: Predictors of Length of Hospitalization in Patients Admitted With Intracerebral Hemorrhage in the United States

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Saqib A Chaudhry ◽  
Mohammad Rauf A Chaudhry ◽  
Iqra N Akhtar ◽  
Adnan I Qureshi ◽  
Werdah Zafar

Background: We performed this study to determine the predictors of length of hospitalization in patients admitted with intracerebral hemorrhage using nationally representative data. Methods: We used the National Inpatient Sample (NIS) from 2010 to 2015 to assess the factors associated with length of stay in patients admitted with intracerebral hemorrhage using (ICD-9 CM diagnosis-related code 431). Patients who were transferred from another acute hospital or died within 2 days of admission were excluded. All variables pertaining to hospitalization were compared in 4 quartile groups on basis of length of hospital stay distribution (≤3, 4-6, 7-10 and ≥11 days) and median length of stay was calculated. The predictors of hospital stay exceeding the median length of stay were identified using multivariate logistic regression. Results: A total of 296,792patients were admitted with the diagnosis of intracerebral hemorrhage during the study period. The length of hospitalization was (≤3, 4-6, 7-10 and ≥11 days in 79,008 (26.5%), 89,019 (30.0%), 55,555 (18.7%) and 73,211 (24.6%) patients, respectively; median length of stay for the cohort was 6 days. In the multivariate logistic regression analysis, the following clinical factors were associated with length of hospitalization of ≥6 days (median): male (odds ratio [OR] 1.10), hypertension (OR 1.41 ), APRDRG severity (OR 2.87), history of alcohol use (OR 1.27 ), and in-hospital complications such as sepsis (OR 2.73), pneumonia (OR 2.30), urine tract infection (OR 2.34), pulmonary embolism (OR 1.42), and deep vein thrombosis (OR 5.06). Similarly in-hospital procedures such as craniotomy (OR 3.40), and transfusion (OR 2.09), were associated with length of hospitalization of ≥6 days. The excess hospitalization charges associated with length of hospitalization of ≥6 days was $107,915. Conclusion: Prolonged hospitalization is associated with significantly higher cost of hospitalization. The most important determinants being pre-existing medical comorbidities and potentially preventable in-hospital complications.

Medicina ◽  
2013 ◽  
Vol 49 (6) ◽  
pp. 40 ◽  
Author(s):  
Gytė Damulevičienė ◽  
Vita Lesauskaitė ◽  
Jūratė Macijauskienė ◽  
Kastytis Šmigelskas ◽  
Donatas Venskutonis

Background and Objective. Timely assessment and prevention of risk factors for the main perioperative complications in elderly patients provide an opportunity to avoid them, decrease mortality, and diminish costs associated with longer hospital stay. The aim of this study was to estimate perioperative factors that could potentially predict the length of stay and to estimate their predictive value using a comprehensive geriatric assessment among elderly patients. Material and Methods. The study population comprised 99 surgical patients aged 65 and more. The patients were followed up until discharge. Study data analysis included questionnaires, anthropometric measurements before surgery, assessment and interviews after surgery, and case histories. Univariate and multivariate logistic regression analysis was performed. Results. Malnutrition was detected in 53.5% of the patients. Postoperative cognitive disorder was documented in 18.2% of elderly patients. The mean length of hospital stay was 10.1 days (SD, 9.14). Multivariate logistic regression analysis revealed that the best predictors for longer hospital stay in elderly patients were malnutrition (OR, 4.2; 95% CI, 1.5–11.8; P=0.007) together with postoperative cognitive impairment (OR, 9.2; 95% CI, 1.0–83.3; P=0.048). The total predictive value of the model was 70.5%. Conclusions. Malnutrition and a postoperative cognitive disorder were independent risk factors for longer hospital stay, while depression, cognitive impairment, functional dependence, and poor physical status were not independently associated with longer hospital stay. A comprehensive geriatric assessment can help assess the risk factors for longer treatment and predict the length of hospital stay, thus enabling the planning of optimal healthcare management of elderly patients.


Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Saqib A Chaudhry ◽  
Mohammad Rauf A Chaudhry ◽  
Iqra N Akhtar ◽  
Mohsain Gill ◽  
Adnan I Qureshi

Background and Purpose: The duration of hospitalization and associated factors are not well studied in national cohorts. We identified the proportion and determinants of prolonged hospitalization and determined the impact on hospital charges using nationally representative data. Methods: National estimates of length of stay, mortality, and hospital charges incurred in patients admitted with primary diagnosis of ischemic stroke (ICD-9 CM diagnosis-related code 433.01, 433.11, 433.21, 433.31, 433.81, 433.91, 434.01, 434.11, 434.91, and 436) using Nationwide Inpatient Sample data from 2010 to 2015. Nationwide Inpatient Sample is the largest all-payer inpatient care database in the United States. Patient who were transferred from another acute hospital or had mortality within 2 days of admission were excluded from the analysis. All the variables pertaining to hospitalization were compared in four quartiles based on distribution data for length of hospital stay (≤2, 3 to 4, 5 to 6 and ≥7 days). Results: A total of 2,490,136 patients were admitted with the diagnosis of ischemic attack during the study period. The median length of stay for hospitalization was 4 days. The length of hospitalization was ≤2, 3 to 4, 5 to 6 and ≥7 days in 706,550 (28.4%), 842,872 (33.8%), 417,592 (16.8%) and 523,122 (21.0%) patients, respectively. The mean hospitalization charges were $22,819, $32,593, $ 45,486 and $97,868 for patients hospitalized in four quartiles, respectively. In the multivariate analysis, the following patient factors and in hospital complications were associated with above median length of hospitalization of ≥4 days: age >65 years (odds ratio [OR], 1.06), women (OR, 1.07), history of alcohol use (OR, 1.29), deep venous thrombosis (OR, 2.67), urinary tract infection (OR, 1.68), pneumonia (OR, 1.53), sepsis (OR, 1.85), pulmonary embolism (OR, 1.48), admission to urban teaching hospitals (OR, 1.07), Medicaid insurance (OR, 1.53), and hospital location in Northeast US region (OR, 1.86; all P values <0.0001). Conclusions: The hospital stay in more than half of patients admitted with ischemic stroke is 4 days or greater. Strategies that focus on modifiable factors associated with prolonged hospital stay may reduce the hospitalization charges in United States.


Author(s):  
Galina Leyvi ◽  
Stephen J. Forest ◽  
Vankeepuram S. Srinivas ◽  
Mark Greenberg ◽  
Nan Wang ◽  
...  

Objective The objective of this study was to compare the short-term outcomes of robotic with conventional on-pump coronary artery bypass grafting (CABG). Methods The study population included 2091 consecutive patients who underwent either conventional or robotic CABG from January 2007 to March 2012. Preoperative, intraoperative, and 30-day postoperative variables were collected for each group. To compare the incidence of rapid recovery between conventional and robotic CABG, the surrogate variables of early discharge and discharge to home (vs rehabilitation or acute care facility) were evaluated. A multivariate logistic regression analysis was used. Results One hundred fifty robotic and 1619 conventional CABG cases were analyzed. Multivariate logistic regression analysis demonstrated that robotic surgery was astrongpredictoroflower30-day complications [odds ratio (OR), 0.24; P =0.005], short length of stay (OR, 3.31; P < 0.001), and decreased need for an acute care facility (OR, 0.55; P = 0.032). In the presence of complications (New York State Complication Composite), the robotic technique was not associated with a change in discharge status. Conclusions In this retrospective review, robotic CABG was associated with a lower 30-day complication rate, a shorter length of stay, and a lower incidence of acute care facility discharge than conventional on-pump CABG. It may suggest a more rapid recovery to preoperative status after robotic surgery; however, only a randomized prospective study could confirm the advantages of a robotic approach.


2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 4617-4617
Author(s):  
M. Garzotto ◽  
S. Mongoue-Tchokote ◽  
J. Shannon ◽  
L. Peters ◽  
M. H. Sokoloff ◽  
...  

4617 Background: The escalating rate of obesity in the Western world presents a diagnostic challenge when screening for prostate cancer. Increased body-mass index (BMI) disrupts the ability to effectively screen this population due to an associated decrease in serum prostate-specific antigen (PSA) levels and an increase in prostate volume. We therefore sought to understand how BMI impacts the probability of harboring prostate cancer. Methods: Data were collected on 647 referred men with a serum PSA of ≤ 10 ng/ml who underwent an ultrasound-guided prostate biopsy. Variables analyzed included: age, BMI, digital rectal exam (DRE), PSA, PSAD (i.e. PSA ÷ prostate volume), prostate volume, hypoechoic lesions on ultrasound and cancer on biopsy. A one-way ANOVA was performed to determine differences in log2 (PSAD) among BMI groups (<25 kg/m2 vs. 25–30 kg/m2 vs. >30 kg/m2). Multivariate logistic regression analysis was performed to estimate the odds-ratio (OR) and 95% confidence intervals (CI). Results: Prostate cancer was detected in 19.2 % of patients. ANOVA showed the mean PSAD to be significantly different in the three BMI groups (F value = 7.1, p = .0009). The mean PSAD significantly decreased as the BMI level increased (p = .0002). Independent pre-biopsy predictors of prostate cancer were tabulated (see below). Conclusions: Obesity was associated with a decrease in PSA density. The multivariate logistic regression revealed that the effect of PSAD on cancer detection was significantly modified by BMI. Specifically, the OR associated with a doubling of PSAD was 1.7 when BMI was <25 kg/m2 vs. 2.1 when BMI was ≥25 kg/m2). This interaction was an independent predictor of prostate cancer risk, along with DRE and ultrasound findings. These data underscore the need to consider BMI as a potential effect modifier of traditional clinical risk factors for prostate cancer. The dramatic rise in obesity in the United States makes this effect modification particularly relevant. [Table: see text] No significant financial relationships to disclose.


2019 ◽  
Vol 104 (11) ◽  
pp. 4990-4997 ◽  
Author(s):  
Subhanudh Thavaraputta ◽  
Jeff A Dennis ◽  
Passisd Laoveeravat ◽  
Kenneth Nugent ◽  
Ana M Rivas

Abstract Context The association between hypothyroidism and sleep apnea (SA) has been studied, but results are conflicting and based mostly on small studies. Objective To determine whether there is a positive association between hypothyroidism and SA in the US population. Design Cross-sectional study. Setting US National Health and Nutrition Examination Survey, 2007–2008. Participants We included all subjects ≥18 years old who met inclusion criteria. Participants not on antithyroid medication with a TSH >5.6 mIU/L and those on thyroid hormone replacement regardless of TSH were categorized as hypothyroid. Participants not on thyroid hormone replacement or antithyroid medication who had a TSH ≥0.34 and ≤5.6 mIU/L were categorized as euthyroid. The diagnosis of SA was based on participants’ response when asked whether they had been diagnosed with SA by their doctors. Main Outcome Measures Multivariate logistic regression analyses were performed to determine the association between hypothyroidism and SA. Results A total of 5515 adults were included for data analysis. The prevalence of hypothyroidism and hyperthyroidism was calculated at 9.47% and 1.19%, respectively. Multivariate logistic regression analysis adjusted for demographics, health care access, body mass index, socioeconomic factors, alcohol use, smoking, and other comorbidities demonstrated a significant association between hypothyroidism and SA (OR = 1.88, 95% CI, 1.24 to 2.84, P < 0.01). Conclusion Hypothyroidism is associated with SA after adjustment for potential confounding variables.


2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Peihuang Lin ◽  
Wenhuang Chen ◽  
Hongbo Huang ◽  
Yijian Lin ◽  
Maosheng Cai ◽  
...  

AbstractTo determine factors associated with delayed discharge of hospitalized patients with coronavirus disease (COVID-19). This retrospective cohort study included 47 patients with COVID-19 admitted to three hospitals in Quanzhou City, Fujian Province, China, between January 21, 2020 and March 6, 2020. Univariate and multivariate logistic regression analyses were conducted to identify factors associated with delayed discharge. The median length of hospital stay was 22 days. Patients in the delayed discharge group (length of hospital stay ≥ 21 days, n = 27) were more likely to have diarrhea, anorexia, decreased white blood cell counts, increased complement C3 and C-reactive protein levels, air bronchograms, undergo thymalfasin treatment, and take significantly longer to convert to a severe acute respiratory syndrome coronavirus (SARS-CoV-2) RNA-negative status than those in the control group (length of hospital stay, < 21 days; n = 20). In multivariate logistic regression analysis, the time to SARS-CoV-2 RNA-negative conversion (odds ratio [OR]: 1.48, 95% confidence interval [CI] 1.09–2.04, P = 0.01) and complement C3 levels (OR 1.14 95% CI 1.02–1.27, P = 0.03) were the only risk factors independently associated with delayed discharge from the hospital. Dynamic monitoring of complement C3 and SARS-CoV-2 RNA levels is useful for predicting delayed discharge of patients.


2017 ◽  
Vol 44 (3-4) ◽  
pp. 105-112 ◽  
Author(s):  
Yoshiteru Shimoda ◽  
Satoru Ohtomo ◽  
Hiroaki Arai ◽  
Ken Okada ◽  
Teiji Tominaga

Background: The presence of high-density starry dots around the intracerebral hemorrhage (ICH), which we termed as a satellite sign, is occasionally observed in CT. The relationship between ICH with a satellite sign and its functional outcome has not been identified. This study aimed to determine whether the presence of a satellite sign could be an independent prognostic factor for patients with ICH. Methods: Patients with acute spontaneous ICH were retrospectively identified and their initial CT scans were reviewed. A satellite sign was defined as scattered high-density lesions completely separate from the main hemorrhage in at least the single axial slice. Functional outcome was evaluated using the modified Rankin Scale (mRS) at discharge. Poor functional outcome was defined as mRS scores of 3-6. Univariate and multivariate logistic regression analyses were applied to assess the presence of a satellite sign and its association with poor functional outcome. Results: A total of 241 patients with ICH were enrolled in the study. Of these, 98 (40.7%) had a satellite sign. Patients with a satellite sign had a significantly higher rate of poor functional outcome (95.9%) than those without a satellite sign (55.9%, p < 0.0001). Multivariate logistic regression analysis revealed that higher age (OR 1.06; 95% CI 1.03-1.10; p = 0.00016), large hemorrhage size (OR 1.06; 95% CI 1.03-1.11; p = 0.00015), and ICH with a satellite sign (OR 13.5; 95% CI 4.42-53.4; p < 0.0001) were significantly related to poor outcome. A satellite sign was significantly related with higher systolic blood pressure (p = 0.0014), higher diastolic blood pressure (p = 0.0117), shorter activated partial thromboplastin time (p = 0.0427), higher rate of intraventricular bleeding (p < 0.0001), and larger main hemorrhage (p < 0.0001). Conclusions: The presence of a satellite sign in the initial CT scan is associated with a significantly worse functional outcome in ICH patients.


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Xuan JI ◽  
Weiqi KE

Abstract Background Evidence regarding the relationship between the type of anaesthesia and length of hospital stay is controversial. Therefore, the objective of this research was to investigate whether the type of anaesthesia was independently related to the length of hospital stay in patients undergoing unilateral total knee arthroplasty (TKA) after adjusting for other covariates. Methods The present study was a cohort study. A total of 2622 participants underwent total knee arthroplasty (TKA) at a hospital in Singapore from 2013 to 1-1 to 2014-6-30. The target independent variable and the dependent variable were two types of anaesthesia and length of hospital stay, respectively. The covariates included age, BMI, hemoglobin (Hb), length of stay (LOS), duration of surgery, sex, ethnicity, American Society of Anesthesiologist (ASA) Status, smoking, obstructive sleep apnea (OSA), diabetes mellitus (DM), DM on insulin, ischemic heart disease (IHD), congestive cardiac failure (CCF), cerebrovascular accident (CVA), creatinine > 2 mg/dl, day of week of operation. Multivariate linear and logistic regression analyses were performed on the variables that might influence the choice of the two types of anaesthesia and the LOS. This association was then tested by subgroup analysis using hierarchical variables. Results The average age of 2366 selected participants was 66.57 ± 8.23 years old, and approximately 24.18% of them were male. The average LOS of all enrolled patients was 5.37 ± 4.87 days, 5.92 ± 6.20 days for patients receiving general anaesthesia (GA) and 5.09 ± 3.98 days for patients receiving regional anaesthesia (RA), P < 0.05. The results of fully adjusted linear regression showed that GA lasted 0.93 days longer than RA (β = 0.93, 95% CI (0.54, 1.32)), P < 0.05. The results of fully adjusted logistic regression showed that LOS > 6 days was 45% higher for GA than for RA (OR = 1.45, 95% CI (1.15, 1.84)), P < 0.05. Through the subgroup analysis, the results were basically stable and reliable. Conclusion Our study showed that GA increased the length of stay during unilateral TKA compared with RA. This finding needs to be validated in future studies.


2020 ◽  
Vol 11 (6) ◽  
pp. 704-711
Author(s):  
Richard D. Mainwaring ◽  
William L. Patrick ◽  
Mihir Dixit ◽  
Akhil Rao ◽  
Michal Palmon ◽  
...  

Background: Unifocalization and pulmonary artery reconstructions have been developed to treat complex disorders of pulmonary artery development. These procedures require extremely long periods of cardiopulmonary bypass (CPB) to facilitate surgical repair. The objective of this study was to document the prevalence of complications in patients undergoing unifocalization or pulmonary artery reconstructions associated with prolonged periods of CPB. Methods: This was a retrospective review of 100 consecutive patients who underwent unifocalization (n = 66) or pulmonary artery reconstructions (n = 34) with CPB times in excess of five hours. Thirty-eight of these operations were primary procedures, whereas 62 were reoperations. Results: The median age at surgery was 15 months, median duration of CPB was 473 minutes, median number of postoperative complications was 5, and the median length of hospital stay was 24 days. The most frequently encountered complications were low cardiac output (43%), open sternum (40%), reintubation (24%), arrhythmia (17%), and bronchoscopy (17%). There was a correlation between the total number of complications and overall length of hospital stay ( R 2 = 0.64). Major adverse cardiac events (MACE) occurred in 11 patients with one hospital mortality. Patients who experienced MACE had a median length of stay that was 35 days longer (56 vs 21 days) than patients who did not experience MACE. Conclusions: The data demonstrate that complications were relatively frequent in this cohort of patients and had a linear association with hospital length of stay. Major adverse cardiac events were encountered at a modest prevalence but had a profound impact on measures of outcome.


2017 ◽  
Vol 5 (1) ◽  
Author(s):  
Antonio E. Pontiroli ◽  
Lara Loreggian ◽  
Marco P. L. Rovati ◽  
Elena De Patto ◽  
Laura Folini ◽  
...  

Abstract Background Low albumin levels and low lymphocyte counts are intra hospital conditions that exert a negative influence on prognosis, healing and length of hospitalization. The study aimed to analyze the correlation between low blood levels of albumin, low lymphocytes, and length of stay. The secondary aim was to identify other co-morbidities associated with prolonged hospital stay. Methods Retrospective pilot study was conducted by analyzing anamnestic and biochemical data, related to 4038 patients admitted to ten wards of Hospital San Paolo (Milan), collected from July 1st 2012 to December 31st 2012. A statistical analysis was carried out using the Correlation method, Multivariate Analysis and Regression. Lymphocyte count and co-morbidities were evaluated in the whole cohort, albumin levels in 1437 patients. Results In the whole sample, low albumin levels and low lymphocyte counts were directly correlated to longer hospitalizations. The stratification of the results by department and diagnosis suggests that there is a higher correlation in certain subpopulations, and albumin shows a greater correlation with length of stay than lymphocytes. Also advanced age, high platelets, type of diagnosis, male gender and emergency admission led to longer hospitalizations. Conclusions A routine check of albumin, lymphocytes and a spectrum of significant variables can provide precious information which can eventually lead to a shorter hospital stay. Knowledge of the general health status of a patient and the possibility to estimate his/her length of hospital stay are essential information for Clinical Governance, and for the improvement of internal services of hospitals on a large scale.


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