Abstract 1122‐000067: Radial Versus Femoral Artery Access for Mechanical Thrombectomy Following IV tPA Administration

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Joshua S Catapano ◽  
Andrew Ducruet ◽  
Felipe C Albuquerque ◽  
Ashutosh Jadhav
Keyword(s):  
Length Of Stay ◽  
Acute Stroke ◽  
Mechanical Thrombectomy ◽  
Average Length ◽  
Linear Regression Analysis ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Access Site ◽  
Femoral Access ◽  
Iv Tpa

Introduction : The transradial artery (TRA) approach for neuroendovascular procedures has been demonstrated as a safe and effective alternative to the transfemoral artery (TFA) approach. The present study compares the efficiency and periprocedural outcomes of the TRA and TFA approach for acute stroke interventions in patients receiving intravenous alteplase. Methods : The study was designed as a retrospective analysis of patients who underwent acute mechanical thrombectomy at a large cerebrovascular center between January 2014 and March 2021. Intervention cohorts (TRA and TFA) were compared on baseline characteristics, periprocedural efficiency/efficacy, and in‐hospital outcomes. Results : A total of 314 patients underwent acute mechanical thrombectomy following IV tPA via TRA (6.7%, 21/314) or TFA (93.3%, 293/314) approach. The overall complication rate appeared higher in TFA (6.8%, 20/314) compared to TRA (4.8%,1/21) patients. Access site complications were present in 4.1%(12/293) of TFA patients and 0.0%(0/21) of TRA patients. The average length of stay (days ± standard deviation) was significantly greater in TFA (8.8 ± 8.5) vs. TRA (4.8 ± 2.9) patients (P = 0.02). Linear regression analysis found femoral access (p = 0.046), Medicaid (p = 0.004) insurance, and discharge NIHSS >10 (p = 0.045) as predictors of increased length of stay. However, when time to initial physical/occupation session was added to the model, access site was no longer significant. Conclusions : The TRA (vs. TFA) approach for acute stroke interventions following IV tPA administration may potentially reduce periprocedural complications and hospital length of stay. The reduction in length of stay with TRA access appears to be associated with earlier initiation of therapies.

scholarly journals A Supervised Pattern Analysis of the Length of Stay for Hip Replacement Admissions

Healthcare ◽  
2019 ◽  
Vol 7 (2) ◽  
pp. 58
Author(s):  
Dimitrios Zikos ◽  
Ashara Shrestha ◽  
Taylor Colotti ◽  
Leonidas Fegaras
Keyword(s):  
Length Of Stay ◽  
Hip Replacement ◽  
Linear Regression Analysis ◽  
Distribution Patterns ◽  
Multiple Linear Regression Analysis ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Government Ownership ◽  
Balanced Distribution ◽  
The Government

Hip replacement is the most common surgical procedure among Medicare patients in the US and worldwide. The hospital length of stay (LOS) for hip replacement admissions is therefore important to be controlled, contributing to savings for hospitals. This study combined medical claims and hospital structure and service data to examine LOS fluctuations and trends, and admission distribution patterns, during weekdays, for hip replacement cases. The study furthermore examined associations of these patterns with the LOS performance. Most hospitals were found to admit hip replacement cases at the start of the week (Monday through Wednesday). There is an upward LOS trend as we approach late weekday admissions. Multiple linear regression analysis showed that LOS weekday inconsistencies, a large proportion of hip replacement admissions on Thursday and Friday, the government ownership status, the bed size, and the critical access status are associated with an increased LOS. On the other hand, the rate of hip replacement admissions over total ones, and the hospital being accredited, are associated with a lower LOS. Findings stress out the need for hospitals to maintain an effective and balanced distribution of hip replacement admissions, evenly during the week, and the need for standardized case management, to avoid practice variability and, therefore, LOS fluctuations for their hip replacement cases.

Impact of acute stroke unit on hospital length of stay

2009 ◽  
Vol 49 (1) ◽  
pp. e12-e15 ◽  
Author(s):  
Liang-Kung Chen ◽  
Jacqueline McClaran ◽  
Alastair Mitchell Buchan
Keyword(s):  
Length Of Stay ◽  
Acute Stroke ◽  
Stroke Unit ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Acute Stroke Unit

scholarly journals Impact of COVID-19 Outbreak on the Emergency Presentation of Acute Appendicitis

2020 ◽  
Vol 86 (11) ◽  
pp. 1508-1512
Author(s):  
Mariana Kumaira Fonseca ◽  
Eduardo N. Trindade ◽  
Omero P. Costa Filho ◽  
Miguel P. Nácul ◽  
Artur P. Seabra
Keyword(s):  
Postoperative Complications ◽  
Length Of Stay ◽  
Acute Appendicitis ◽  
Symptom Onset ◽  
Hospital Admissions ◽  
Average Length ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Time Interval ◽  
Emergency Presentation

Background The global crisis resulting from the coronavirus pandemic has imposed a large burden on health systems worldwide. Nonetheless, acute abdominal surgical emergencies are major causes for nontrauma-related hospital admissions and their incidences were expected to remain unchanged. Surprisingly, a significant decrease in volume and a higher proportion of complicated cases are being observed worldwide. Methods The present study assesses the local impact of the coronavirus pandemic on the emergency presentation of acute appendicitis in a Brazilian hospital. A retrospective analysis was conducted on patients undergoing emergency surgery for the clinically suspected diagnosis of acute appendicitis during the 2-month period of March and April 2020 and the same time interval in the previous year. Data on demographics, timing of symptom onset and hospital presentation, intraoperative details, postoperative complications, hospital length of stay, and histological examination of the specimen were retrieved from individual registries. Results The number of appendectomies during the pandemic was 36, which represents a 56% reduction compared to the 82 patients operated during the same period in 2019. The average time of symptom onset to hospital arrival was significantly higher in 2020 (40.6 vs. 28.2 hours, P = .02). The classification of appendicitis revealed a significant higher proportion of complicated cases than the previous year (33.3% vs. 15.2%, P = .04). The rate of postoperative complications and the average length of stay were not statistically different between the groups. Conclusion Further assessment of patients’ concerns and systematic monitoring of emergency presentations are expected to help us understand and adequately address this issue.

656 Autologous Skin Cell Suspension is Associated with Decreased Hospital Length of Stay and Limited Surgical Interventions

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S194-S194
Author(s):  
Nicole M Kopari ◽  
Yazen Qumsiyeh
Keyword(s):  
Length Of Stay ◽  
Cell Suspension ◽  
Average Length ◽  
Total Body Surface Area ◽  
Hospital Length ◽  
Care Quality ◽  
Hospital Length Of Stay ◽  
Burn Patients ◽  
Burn Care ◽  
Skin Cell

Abstract Introduction Hospital length of stay is a measure of burn care quality and resource allocation. Traditionally, the average length of stay (LOS) for patients with burns is estimated at 1 day/% total body surface area (TBSA) although the 2016 American Burn Association National Burn Repository predicts closer to 3 days/%TBSA. Recent literature has shown that application of autologous skin cell suspension (ASCS) is associated with decreased hospital LOS and therefore is considered economically advantageous. Our study evaluated the LOS as it related to TBSA as well as the number of operations in patients treated with ASCS. Methods This is a single institution, retrospective review of burn patients at an American Burn Associated verified burn center admitted from August 2019 - August 2020 who underwent epidermal autografting. Patients were treated for partial thickness and full thickness burns either with epidermal grafting alone or in combination with widely meshed skin grafting. Demographics included age and sex of patient. The TBSA, LOS, number of operations, and re-admission rates were also collected. Results A total of 52 patients were included in the review. 73% were male with an average age of 42 years (range 15 months to 88 years. The patients were stratified into 4 different categories based on their burn TBSA: 0-10% (n=25), 11-20% (n=16), 21-30% (n=5), and >30% (n=6). The average number of operations increased with %TBSA (0-10%=1, 11-20%=1, 21-30%=2, >30%=4). The average LOS overall was 0.9 days/%TBSA (0-10%=1.0, 11-20%=0.7, 21-30%=0.9, >30%=0.8). Only one patient required re-admission after the first dressing takedown and underwent a second application of ASCS with subsequent healing. No patients required reconstructive surgery. Conclusions Burn patients treated with ASCS continue to demonstrate a decreased LOS/%TBSA and an overall decrease in the number of operations. The most significant impact may be noted as burn size increases.

Abstract WP358: Impact of an Emergency Department-Based Acute Stroke MRI Protocol on Cost, tPA Administration, and Hospital Length of Stay

Stroke ◽  
2019 ◽  
Vol 50 (Suppl_1) ◽  
Author(s):  
Chris Orlando ◽  
Laura Needham ◽  
Scott McNally ◽  
Erin Ekstrom ◽  
Nabeel Chauhan ◽  
...  
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Acute Stroke ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Mri Protocol

Percutaneous access for endovascular aortic aneurysm repair: A systematic review and meta-analysis

Vascular ◽  
2016 ◽  
Vol 24 (6) ◽  
pp. 638-648 ◽  
Author(s):  
Shahin Hajibandeh ◽  
Shahab Hajibandeh ◽  
Stavros A Antoniou ◽  
Emma Child ◽  
Francesco Torella ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Meta Analysis ◽  
Endovascular Aneurysm Repair ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
World Health ◽  
Percutaneous Technique ◽  
Femoral Access ◽  
Percutaneous Access ◽  
Aneurysm Repair

Purpose Our objective was to undertake a comprehensive review of the literature and conduct an analysis of the outcomes of percutaneous endovascular aneurysm repair. Methods MEDLINE; EMBASE; CINAHL; CENTRAL; the World Health Organization International Clinical Trials Registry; ClinicalTrials.gov; and ISRCTN Register, and bibliographic reference lists were searched to identify all studies providing comparative outcomes of the percutaneous technique for endovascular aneurysm repair. Success rate and access-related complications were defined as the primary outcome parameters. Combined overall effect sizes were calculated using fixed effect or random effects models. We conducted a network meta-analysis of different techniques for femoral access applying multivariate meta-analysis assuming consistency. Findings Three randomised controlled trials and 18 observational studies were identified. Percutaneous access was associated with a lower frequency of groin infection ( p < 0.0001) and lymphocele ( p = 0.007), and a shorter procedure time ( p < 0.0001) and hospital length of stay ( p = 0.03) compared with open surgical access. Moreover, percutaneous endovascular aneurysm repair did not increase the risk of haematoma, pseudoaneurysm, and arterial thrombosis or dissection. Conclusion Percutaneous access demonstrates advantages over conventional surgical exposure for endovascular aneurysm repair, as indicated by access-related complications and hospital length of stay. Further research is required to define its impact on resource utilization, cost-effectiveness and quality of life.

scholarly journals The SOAR stroke score predicts hospital length of stay in acute stroke: an external validation study

2015 ◽  
Vol 69 (6) ◽  
pp. 659-665 ◽  
Author(s):  
C. S. Kwok ◽  
A. B. Clark ◽  
S. D. Musgrave ◽  
J. F. Potter ◽  
G. Dalton ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Acute Stroke ◽  
Validation Study ◽  
External Validation ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
External Validation Study

scholarly journals 182. Missed Opportunities to Discontinue Unnecessary Vancomycin During Pharmacist Therapeutic Monitoring

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S98-S98
Author(s):  
Corey J Medler ◽  
Mary Whitney ◽  
Juan Galvan-Cruz ◽  
Ron Kendall ◽  
Rachel Kenney ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Adverse Drug Events ◽  
Academic Medical Center ◽  
Total Duration ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Therapeutic Monitoring ◽  
Resistant Bacteria ◽  
Therapeutic Drug ◽  
Missed Opportunities

Abstract Background Unnecessary and prolonged IV vancomycin exposure increases risk of adverse drug events, notably nephrotoxicity, which may result in prolonged hospital length of stay. The purpose of this study is to identify areas of improvement in antimicrobial stewardship for vancomycin appropriateness by clinical pharmacists at the time of therapeutic drug monitoring (TDM). Methods Retrospective, observational cohort study at an academic medical center and a community hospital. Inclusion: patient over 18 years, received at least three days of IV vancomycin where the clinical pharmacy TDM service assessed for appropriate continuation for hospital admission between June 19, 2019 and June 30, 2019. Exclusion: vancomycin prophylaxis or administered by routes other than IV. Primary outcome was to determine the frequency and clinical components of inappropriate vancomycin continuation at the time of TDM. Inappropriate vancomycin continuation was defined as cultures positive for methicillin-susceptible Staphylococcus aureus (MRSA), vancomycin-resistant bacteria, and non-purulent skin and soft tissue infection (SSTI) in the absence of vasopressors. Data was reported using descriptive statistics and measures of central tendency. Results 167 patients met inclusion criteria with 38.3% from the ICU. SSTIs were most common indication 39 (23.4%) cases, followed by pneumonia and blood with 34 (20.4%) cases each. At time of vancomycin TDM assessment, vancomycin continuation was appropriate 59.3% of the time. Mean of 4.22 ± 2.69 days of appropriate vancomycin use, 2.18 ± 2.47 days of inappropriate use, and total duration 5.42 ± 2.94. 16.4% patients developed an AKI. Majority of missed opportunities were attributed to non-purulent SSTI (28.2%) and missed MRSA nares swabs in 21% pneumonia cases (table 1). Conclusion Vancomycin is used extensively for empiric treatment of presumed infections. Appropriate de-escalation of vancomycin therapy is important to decrease the incidence of adverse effects, decreasing hospital length of stay, and reduce development of resistance. According to the mean duration of inappropriate therapy, there are opportunities for pharmacy and antibiotic stewardship involvement at the time of TDM to optimize patient care (table 1). Missed opportunities for vancomycin de-escalation Disclosures All Authors: No reported disclosures

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