Abstract P400: Racial Disparities in Subarachnoid Hemorrhage Outcomes-A Single Center Experience

Introduction: Subarachnoid hemorrhage (SAH) has high morbidity and mortality, and prior studies have reported outcome disparities between African American (AA) and Caucasian patients. We compared demographics, risk factors, and discharge outcomes among different ethnicities treated at our comprehensive stroke center. Methods: We used data on all SAH patients admitted between July 2014 and March 2020 to our university hospital in the Southeast United States. Race was categorized into AA, Caucasian, and “other.” Pearson chi-square test and analysis of variance were used to compare these variables between the different groups. Results: A total of 578 SAH patients were identified (39% AA patients, 54% Caucasian, and 7% other). Admission Glascow Coma Score (GCS) and Hunt & Hess scores were comparable between the 3 groups. AA patients were significantly younger (51 vs 59 in Caucasian group vs 56 years in Other, p-value <0.001) and had higher BP at admission (systolic BP 152 vs 144 vs 145, p=0.002, diastolic BP 86 vs 80 vs 81, p<0.001). AA patients were more likely to have a history of hypertension (p<0.001) and had higher BMI (30 vs 28.1 vs 26, p=0.003) and Hemoglobin A1c (5.8 vs 5.6 vs 6.1, p=0.013). Modified Rankin scale (mRS) at discharge, in-hospital mortality, and discharge destination were similar between the groups, but AA patients had a longer mean hospital length of stay (19 vs 14 vs 17 days, p=0.035). Conclusion: In our cohort, AA SAH patients were significantly younger and had more comorbidities at admission. Although they had a higher length of stay, discharge outcomes were comparable to other races.

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Abstract 17103: Elevated NT-proBNP Level is Not a Prognostic Marker for Patients Hospitalized With SARS-CoV-2 Infection

Circulation ◽

10.1161/circ.142.suppl_3.17103 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Farukh G Ikram ◽

Priyanka Acharya ◽

Nicholas Nguyen ◽

Manavjot S Sidhu

Keyword(s):

Length Of Stay ◽

Surrogate Marker ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Major Adverse Cardiovascular Events ◽

P Value ◽

Chi Square ◽

Exact Test ◽

Laboratory Marker ◽

Icu Admission

Introduction: NT-proBNP is a widely available and frequently utilized laboratory marker in patients with congestive heart failure. Its availability and use as a surrogate marker for elevated ventricular filling pressures and ventricular strain that frequently manifests as shortness of breath makes it an attractive laboratory marker to triage patients with SARS-CoV-2 infection. Hypothesis: Elevated NT-proBNP is correlated with higher mortality and/or rate of major adverse cardiovascular events (MACE) in patients admitted with SARS-CoV-2 infection. Methods: A retrospective analysis was performed on 225 patients admitted for SARS-CoV-2 infection at a major metropolitan hospital located in the Southwestern United States from the period of March 2020 to May 2020. NT-proBNP levels were recorded in 117 patients (52.7%) on admission. Elevated NT-proBNP was defined as: above 450 pg/ml in patients less than 50 years old, above 900 pg/ml if 50 to 75 years old, and above 1,800 pg/ml if above 75 years old. The primary endpoint was a composite of MACE and mortality during hospitalization. MACE was defined as stroke, myocardial infarction, DVT or PE and shock requiring vasopressor support. Two-sample Wilcoxon rank-sum (Mann-Whitney) test, Pearson’s chi square test and Fisher’s exact test were utilized for data analysis. Results: Of the 117 SARS-CoV-2 positive patients that had admission NT-proBNP levels available for analysis, 23 (19.66%) met age-adjusted criteria for elevated NT-proBNP. There was no significant correlation between elevated NT-proBNP levels and MACE (p = 0.482) or mortality (p = 0.737) in patients with SARS-CoV-2 infections. There was no statistical difference in total length of stay (p-value = 0.6384) or ICU admission (p-value = 0.354) between those with elevated admission NT-proBNP and those without. Conclusions: An elevated NT-proBNP at time of admission does not significantly correlate with higher rates of MACE, hospital length of stay, ICU admission, and mortality in patients admitted with SARS-CoV-2 infection.

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Subarachnoid Hemorrhage in Hospitalized Renal Transplant Recipients with Autosomal Dominant Polycystic Kidney Disease: A Nationwide Analysis

Journal of Clinical Medicine ◽

10.3390/jcm8040524 ◽

2019 ◽

Vol 8 (4) ◽

pp. 524 ◽

Cited By ~ 2

Author(s):

Wisit Cheungpasitporn ◽

Charat Thongprayoon ◽

Patompong Ungprasert ◽

Karn Wijarnpreecha ◽

Wisit Kaewput ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Renal Transplant ◽

Kidney Disease ◽

Length Of Stay ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Polycystic Kidney ◽

Aneurysm Clipping ◽

Transplant Patients ◽

Renal Transplant Patients

Background: This study aimed to evaluate the hospitalization rates for subarachnoid hemorrhage (SAH) among renal transplant patients with adult polycystic kidney disease (ADPKD) and its outcomes, when compared to non-ADPKD renal transplant patients. Methods: The 2005–2014 National Inpatient Sample databases were used to identify all hospitalized renal transplant patients. The inpatient prevalence of SAH as a discharge diagnosis between ADPKD and non-ADPKD renal transplant patients was compared. Among SAH patients, the in-hospital mortality, use of aneurysm clipping, hospital length of stay, total hospitalization cost and charges between ADPKD and non-ADPKD patients were compared, adjusting for potential confounders. Results: The inpatient prevalence of SAH in ADPKD was 3.8/1000 admissions, compared to 0.9/1000 admissions in non-ADPKD patients (p < 0.01). Of 833 renal transplant patients with a diagnosis of SAH, 30 had ADPKD. Five (17%) ADPKD renal patients with SAH died in hospitals compared to 188 (23.4%) non-ADPKD renal patients (p = 0.70). In adjusted analysis, there was no statistically significant difference in mortality, use of aneurysm clipping, hospital length of stay, or total hospitalization costs and charges between ADPKD and non-ADPKD patients with SAH. Conclusion: Renal transplant patients with ADPKD had a 4-fold higher inpatient prevalence of SAH than those without ADPKD. Further studies are needed to compare the incidence of overall admissions in ADPKD and non-ADPKD patients. When renal transplant patients developed SAH, inpatient mortality rates were high regardless of ADPKD status. The outcomes, as well as resource utilization, were comparable between the two groups.

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Multimodal Analgesia in Lumbar Fusion Surgery: Impact Amidst the Opioid Epidemic

Neurosurgery ◽

10.1093/neuros/nyz310_622 ◽

2019 ◽

Vol 66 (Supplement_1) ◽

Author(s):

Yi Lu ◽

Erica Bertoncini

Keyword(s):

Length Of Stay ◽

Lumbar Fusion ◽

Multimodal Analgesia ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Control Group ◽

P Value ◽

Standard Group ◽

Fusion Surgery ◽

Hospital Stays

Abstract INTRODUCTION Spine surgery traditionally relies on opioid analgesics for postoperative pain management. Opioids are associated with prolonged hospital stays and opioid use disorders. Opioid-focused prescribing habits in surgery have partially contributed to the opioid epidemic. METHODS A retrospective analysis was performed comparing patients receiving a multimodal analgesia regimen after lumbar fusion surgery vs control group receiving standard analgesia regimen. The multimodal regimen consisted of Acetaminophen 975 mg TID, Toradol 7.5 mg Q6 hours for 24-ho followed by Celebrex 100 mg BID for 7-d, Robaxin 500 mg Q6 hours prn for muscle spasms, Gabapentin 300 mg/100 mg TID for 4-wk, and prn narcotic. The standard regimen consisted of Acetaminophen 975 mg TID, narcotic prn, and muscle relaxant prn. There were 12 patients in the multimodal group and 26 patients in the control group evaluated over 3-mo and 6-mo time periods respectively. Primary outcomes included hospital length-of-stay, total and IV narcotic requirements in Morphine Milligram Equivalent (MME), and VASS pain scores. RESULTS Study results demonstrate differences between patient populations when focusing on the opioid-naïve participants. Opioid-naïve patients in the multimodal group were found to have significantly lower IV narcotic requirement than the control (0.22+/−0.67 mg/d for multimodal vs 5.36+/−5.56 mg/d for standard group, P-value = .001). These patients also had shorter hospital stays than the control (2.78+/−0.83 d for multimodal vs 3.53+/−1.17 d for standard group) but the difference was just below our threshold for significance (P-value = .066). Including both opioid-naïve and opioid-tolerant patients, no significant differences were found in hospital length-of-stay, MME, IV narcotic requirement nor VASS score between the multimodal group and the control groups (P-values of .46, .81, .36, and .91, respectively). CONCLUSION Overall, the study favors using multimodal analgesia in those undergoing lumbar spinal fusion surgeries as evident by considerably reduced IV narcotic requirement and nearly significant shortened hospital length-of-stay in opioid-naïve patients compared to control.

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Childhood Nephrotic Syndrome Management and Outcome: A Single Center Retrospective Analysis

International Journal of Nephrology ◽

10.1155/2017/2029583 ◽

2017 ◽

Vol 2017 ◽

pp. 1-7 ◽

Cited By ~ 7

Author(s):

Chia-shi Wang ◽

Jia Yan ◽

Robert Palmer ◽

James Bost ◽

Mattie Feasel Wolf ◽

...

Keyword(s):

Nephrotic Syndrome ◽

Length Of Stay ◽

Hospital Length ◽

Hospital Length Of Stay ◽

High Morbidity ◽

Metropolitan Statistical Area ◽

Childhood Nephrotic Syndrome ◽

Steroid Dependent ◽

Increased Risk ◽

Serious Disease

There is a paucity of information on outpatient management and risk factors for hospitalization and complications in childhood nephrotic syndrome (NS). We described the management, patient adherence, and inpatient and outpatient usage of 87 pediatric NS patients diagnosed between 2006 and 2012 in the Atlanta Metropolitan Statistical Area. Multivariable analyses were performed to examine the associations between patient characteristics and disease outcome. We found that 51% of the patients were treated with two or more immunosuppressants. Approximately half of the patients were noted to be nonadherent to medications and urine protein monitoring. The majority (71%) of patients were hospitalized at least once, with a median rate of 0.5 hospitalizations per patient year. Mean hospital length of stay was 4.0 (3.8) days. Fourteen percent of patients experienced at least one serious disease complication. Black race, frequently relapsing/steroid-dependent and steroid-resistant disease, and the first year following diagnosis were associated with higher hospitalization rates. The presence of comorbidities was associated with longer hospital length of stay and increased risk of serious disease complications. Our results highlight the high morbidity and burden of NS and point to particular patient subgroups that may be at increased risk for poor outcome.

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Predictive modeling of hospital Length of Stay in COVID-19 patients using Artificial Neural Networks

10.21203/rs.3.rs-1024483/v1 ◽

2021 ◽

Author(s):

Azam Orooji ◽

Mostafa Shanbehzadeh ◽

Hadi Kazemi-Arpanahi ◽

Mohsen Shafiee

Keyword(s):

Neural Network ◽

Length Of Stay ◽

Correlation Coefficient ◽

Prediction Models ◽

Hospital Length ◽

Hospital Length Of Stay ◽

P Value ◽

Bed Management ◽

Hospital Bed ◽

Artificial Neural

Abstract BackgroundThe current pandemic of coronavirus disease (COVID-19) causes unexpected economic burdens to worldwide health organizations with severe shortages in hospital bed capacity and other related medical resources. Therefore, predicting the length of stay (LOS) is essential to ensure optimal allocating scarce hospital resources and inform evidence-based decision-making. Thus, the purpose of this research is to construct a model for predicting COVID-19 patients' hospital LOS by multiple multilayer perceptron-artificial neural network (MLP-ANN) algorithms. Material and MethodsUsing a single-center registry, the records of 1225 laboratory-confirmed COVID-19 hospitalized cases from February 9, 2020, to December 20, 2020, were analyzed. The correlation coefficient technique was developed to determine the most significant variables as the input of the ANN models. Only variables with a correlation coefficient at the P-value< 0.2 were used in model construction. Ultimately the prediction models were developed based on 12 ANN techniques according to selected variables. ResultsAfter implementing feature selection, a total of 20 variables was determined as the most relevant predictors to build the models. The results indicated that the best performance belongs to a neural network with 20 and 10 neurons in the hidden layer of the Bayesian Regularization classifier for whole and selected features with RMSE of 1.6213 and 2.2332, respectively. ConclusionThe developed model in this study can help in the better calculation of LOS in COVID-19 patients. This model also can be leveraged in hospital bed management and optimized resource utilization.

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Abstract 15580: The Impact of Sex and Gender-related Factors on Length-of-stay Following NSTEMI: A Multicountry Analysis

Circulation ◽

10.1161/circ.142.suppl_3.15580 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Uri Bender ◽

Colleen M Norris ◽

Valeria Raparelli ◽

Tadiri Christina ◽

Louise Pilote

Keyword(s):

Length Of Stay ◽

Cardiac Risk ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Bivariate Analysis ◽

P Value ◽

Sex And Gender ◽

Related Factors ◽

And Gender ◽

The Impact

Introduction: Gender refers to psycho-socio-cultural characteristics typically ascribed to men, women and gender-diverse individuals and has been shown to be associated with adverse clinical outcomes in AMI independent of sex. Substantial heterogeneity in hospital length of stay exists among patients admitted with NSTEMI. Whether sex and gender-based differences contribute to length-of-stay (LOS) among patients with NSTEMI remains unknown. Methods: To examine the relationship between sex, gender-related factors and LOS in adults hospitalized for NSTEMI, data from the GENESIS-PRAXY (n=1,210, Canada, U.S. and Switzerland), EVA (n=430, Italy) and VIRGO (n=3,572, U.S., Spain and Australia) studies of adults hospitalized for AMI were combined and analyzed. A best-fit linear regression model was selected through incremental analysis by stepwise addition of gender-related variables thought to be different in either impact or distribution between men and women. Results: Among the overall cohort (n=5,212), 2,218 participants with a diagnosis of NSTEMI were included in the final cohort (66% women, mean age 48.5 years, 67.8% U.S.). Half of the patients had a LOS of longer than 4 days (n=1,124) and were more likely to be white and have a clustering of cardiac risk factors in comparison to those with shorter LOS. No association between sex and LOS was observed in the bivariate analysis (p=0.87). In the multivariable model adjusted for sex, age, country of hospitalization, level of education, marital status, employment status, income, and social support, age (0.062 days/year, p=0.0002), being employed (-0.63 days in workers, p=0.01) and the treatment country relative to Canada (Italy=4.1 days; Spain=1.7 days; and the U.S.=-1.0 days, all p-value<0.001) were significant predictors of LOS. Conclusions: Employed individuals are more likely to experience a shorter LOS following NSTEMI. Variation in LOS exists across different countries and is likely due to institutional policy, resource allocation, and differences in cultural and psychosocial influences.

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556 Hospital Length of Stay for Patients with Small and Medium Burns Impacted by Distance to Burn Center

Journal of Burn Care & Research ◽

10.1093/jbcr/iraa024.184 ◽

2020 ◽

Vol 41 (Supplement_1) ◽

pp. S118-S119

Author(s):

Stephen Sibbett ◽

Jamie Oh ◽

Saman Arbabi ◽

Gretchen J Carrougher ◽

Nicole S Gibran

Keyword(s):

Length Of Stay ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Site Location ◽

Chi Square ◽

Hispanic Males ◽

Burn Care ◽

Burn Center ◽

Significant Difference ◽

Hospital Stays

Abstract Introduction Understanding contributors to patient length of stay is critical for burn center resource management and efficiency. In this study, we analyzed how distance from patient homes to a burn center impacts hospital length of stay. Methods Under IRB approval, we reviewed our trauma registry for burn patients admitted to a regional burn center from 2011 to 2018. Inclusion was limited to patients from the burn center state. Patients were grouped by distance from the home zip code to the burn center (≤100 and >100 miles) according to what might be ground or air transport. Chi-square and Mann-Whitney tests were used to determine differences between groups by race, burn size (TBSA), hospital length of stay (LOS), LOS/TBSA, mortality, and disposition to home. Burn size was categorized by TBSA into small (0–20%), medium (21–50%) and large (51–100%) burns. Results Our study population was predominantly white, non-Hispanic males. Mean burn size was significantly higher in patients who traveled more than the >100 miles to the burn center (Table). Mean LOS/TBSA was not significant between the two groups. However, controlling for burn size, patients with small and medium burns that lived farther from the burn center had significantly longer hospital stays. There was no significant difference in length of stay for patients with large burns, mortality or disposition to home between the two distance groups. Conclusions At a burn center with a large catchment area, patients with burn size < 50%TBSA who lived more than 100 miles from the burn center had significantly longer hospital stays than those who lived closer to the burn center. This may indicate that patients who are referred to a regional burn center for care of smaller burns may require care beyond the level of their local hospitals. It is worth noting that using burn size as an indication of complexity of care may be misleading as body site location of the burn (e.g. hand, face or feet) impacts the recovery. Applicability of Research to Practice For a burn center that serves patients across a vast region, this investigation might be useful in identifying opportunities to provide care for patients who live far from tertiary burn care.

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Impact of classification systems (DSM-5, DSM-IV, CAM and DRS-R98) on outcomes of delirium

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.615 ◽

2017 ◽

Vol 41 (S1) ◽

pp. s496-s497

Author(s):

G. McCarthy ◽

D. Meagher ◽

D. Adamis

Keyword(s):

Length Of Stay ◽

Diagnostic Method ◽

Hospital Length ◽

Classification Systems ◽

University Hospital ◽

Hospital Length Of Stay ◽

Discharge Destination ◽

Dsm 5 ◽

Dsm Iv ◽

Prospective Longitudinal

IntroductionPrevious studies showed different classification systems lead to different case identification and rates of delirium. No one has previously investigated the influence of different classification systems on the outcomes of delirium.Aims and objectivesTo determine the influence of DSM-5 criteria vs. DSM-IV on delirium outcomes (mortality, length of stay, institutionalisation) including DSM-III and DSM-IIR criteria, using CAM and DRS-R98 as proxies.MethodologyProspective, longitudinal, observational study of elderly patients 70+ admitted to acute medical wards in Sligo University Hospital. Participants were assessed within 3 days of admission using DSM-5, and DSM-IV criteria, DRS-R98, and CAM scales.ResultsTwo hundred patients [mean age 81.1 ± 6.5; 50% female]. Rates (prevalence and incidence) of delirium for each diagnostic method were: 20.5% (n = 41) for DSM-5; 22.5% (n = 45) for DSM-IV; 18.5% (n = 37) for DRS-R98 and 22.5%, (n = 45) for CAM. The odds ratio (OR) for mortality (each diagnostic method respectively) were: 3.37, 3.11, 2.42, 2.96. Breslow-Day test on homogeneity of OR was not significant x2= 0.43, df: 3, P = 0.93. Those identified with delirium using the DSM-IV, DRS-R98 and CAM had significantly longer hospital length of stay(los) compared to those without delirium but not with those identified by DSM-5 criteria. Re-institutionalisation, those identified with delirium using DSM-5, DSM-IV and CAM did not have significant differences in discharge destination compared to those without delirium, those identified with delirium using DRS-R98 were more likely discharged to an institution (z = 2.12, P = 0.03)ConclusionAssuming a direct association between delirium and examined outcomes (mortality, los and discharge destination) different classification systems for delirium identify populations with different outcomes.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Respiratory syncytial virus hospitalisation trends in children with haemodynamically significant heart disease, 1997–2012

Cardiology in the Young ◽

10.1017/s1047951116000470 ◽

2016 ◽

Vol 27 (1) ◽

pp. 16-25 ◽

Cited By ~ 6

Author(s):

Patricia Y. Chu ◽

Christoph P. Hornik ◽

Jennifer S. Li ◽

Michael J. Campbell ◽

Kevin D. Hill

Keyword(s):

Heart Disease ◽

Respiratory Syncytial Virus ◽

Length Of Stay ◽

The United States ◽

Hospital Length ◽

Cost Utility ◽

Hospital Length Of Stay ◽

Chi Square ◽

Before And After ◽

Syncytial Virus

AbstractObjectiveThe aim of the study was to evaluate the trends in respiratory syncytial virus-related hospitalisations and associated outcomes in children with haemodynamically significant heart disease in the United States of America.Study designThe Kids’ Inpatient Databases (1997–2012) were used to estimate the incidence of respiratory syncytial virus hospitalisation among children ⩽24 months with or without haemodynamically significant heart disease. Weighted multivariable logistic regression and chi-square tests were used to evaluate the trends over time and factors associated with hospitalisation, comparing eras before and after publication of the 2003 American Academy of Pediatrics palivizumab immunoprophylaxis guidelines. Secondary outcomes included in-hospital mortality, morbidity, length of stay, and cost.ResultsOverall, 549,265 respiratory syncytial virus-related hospitalisations were evaluated, including 2518 (0.5%) in children with haemodynamically significant heart disease. The incidence of respiratory syncytial virus hospitalisation in children with haemodynamically significant heart disease decreased by 36% when comparing pre- and post-palivizumab guideline eras versus an 8% decline in children without haemodynamically significant heart disease (p<0.001). Children with haemodynamically significant heart disease had higher rates of respiratory syncytial virus-associated mortality (4.9 versus 0.1%, p<0.001) and morbidity (31.5 versus 3.5%, p<0.001) and longer hospital length of stay (17.9 versus 3.9 days, p<0.001) compared with children without haemodynamically significant heart disease. The mean cost of respiratory syncytial virus hospitalisation in 2009 was $58,166 (95% CI:$46,017, $70,315).ConclusionsThese data provide stakeholders with a means to evaluate the cost–utility of various immunoprophylaxis strategies.

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