scholarly journals Comparison of 90-Day Perioperative Outcomes in Shoulder Arthroplasty Between the Elderly and Nonelderly Patients

2018 ◽  
Vol 9 ◽  
pp. 215145931880384
Author(s):  
Paul D. Crook ◽  
William C. Foster ◽  
Stephen L. Kates ◽  
Jonathan R. Korpon ◽  
Gustavo A. Ortega ◽  
...  
Keyword(s):  
Risk Factor ◽  
Elderly Patients ◽  
Complication Rate ◽  
Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
Skilled Nursing Facility ◽  
The Elderly ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Discharge Disposition

Introduction: As life expectancy increases, the incidence of shoulder arthroplasty continues to increase as well. There are few shoulder arthroplasty studies investigating perioperative complication, readmission, and mortality. Furthermore, with bundled payments on the horizon, the cost of shoulder arthroplasty has become a significant issue. Clarifying risk factors for the need for postdischarge acute care will be critical information due to the high cost of such care. The goal of this study was to compare discharge disposition, length of stay (LOS), perioperative complications, readmission, and mortality in elderly and nonelderly cohorts to determine whether age is a risk factor for shoulder arthroplasty. Materials and Methods: We retrospectively compared 89 elderly patients (80 years or older) and 86 nonelderly patients (79 years or younger) who underwent hemiarthroplasty, total shoulder arthroplasty, reverse total shoulder arthroplasty, or revision shoulder arthroplasty from 2007 to 2015. Baseline characteristics were compared between the 2 cohorts. We then compared discharge disposition, LOS, 90-day complication rate, readmission, and mortality between the 2 cohorts. Results: Average length of hospitalization and percentage of patients with greater than 2 days of hospitalization were significantly higher in the elderly cohorts. Forty-four percent of the elderly cohorts were discharged to a skilled nursing facility compared to 6% in the nonelderly cohorts ( P < .0001). There were no significant differences found in 90-day major complication rate, readmission, or mortality. Discussion: Shoulder arthroplasty is a valuable surgery for various indications in the elderly population. However, the likelihood of a patient to need a prolonged hospitalization or skilled nursing facility care after surgery are important questions that need to be answered. Our study shows that age over 80 years is a risk factor for prolonged hospitalization and need for skilled nursing facility care after shoulder arthroplasty. Conclusion: We conclude that elderly patients who undergo shoulder arthroplasty are significantly more likely to have extended hospitalizations and to be discharged to skilled nursing facilities compared to nonelderly patients.

scholarly journals Assessment of geriatrics outcomes in the cardiac intensive care unit

2021 ◽  
Vol 9 (39) ◽  
pp. 1-8
Author(s):  
Carly Fabrizio ◽  
Matthew Langston ◽  
Keshab Subedi ◽  
Neil Wimmer ◽  
Usman Choudhry ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Length Of Stay ◽  
Elderly Patients ◽  
Skilled Nursing Facility ◽  
The Elderly ◽  
Cardiac Intensive Care Unit ◽  
Skilled Nursing ◽  
Discharge Disposition ◽  
Cardiac Intensive Care

Objective: Critically ill older adults greater than or equal to 80 years old are routinely admitted to contemporary cardiac intensive care units (CICU). Little has been reported about their outcomes when compared to the general CICU population. The primary aim of this study was to compare the mortality, length-of-stay, and disposition outcomes of elderly patients (greater or equal to 80 years old) admitted to the CICU with a younger cohort (less than 80 years old). Methods and Results: A single-center, retrospective cohort study was conducted including 6,194 adult patients admitted to a cardiovascular intensive care unit in Newark, Delaware, from July 1, 2012, to June 30, 2019. Coronary intensive care unit (CICU) mortality, CICU length-of-stay and discharge disposition were compared between elderly patients (greater than or equal to 80 years old) and younger patients (less than 80 years old), adjusted for comorbidities. We observed increased mortality for elderly patients (OR 1.686, CI 1.361-2.090, p<0.001) compared with patients less than 80 years old, even after adjusting for comorbidities. Median length of stay was not statistically different between the two groups. However, the elderly patients were significantly more likely to be discharged to a facility, such as a skilled nursing facility, than those less than 80 years old (26.8% versus 12.5%, respectively, p<0.001). Conclusions: Among patients admitted to the CICU, elderly patients have higher mortality rates than those less than 80 years old. Advanced age (greater or equal to 80 years old) was not a reliable predictor of outcome in the CICU. A large proportion of elderly patients are not able to live independently at home after CICU admissions. Key Words: octogenarians, nonagenarians, cardiac intensive care unit, elderly, ICU mortality

scholarly journals Thirty-day readmission after endovascular or surgical revascularization for chronic mesenteric ischemia: Insights from the Nationwide Readmissions Database

2019 ◽  
Vol 24 (3) ◽  
pp. 216-223 ◽  
Author(s):  
Fabio V Lima ◽  
Dhaval Kolte ◽  
David W Louis ◽  
Kevin F Kennedy ◽  
J Dawn Abbott ◽  
...  
Keyword(s):  
Mesenteric Ischemia ◽  
Skilled Nursing Facility ◽  
Home Healthcare ◽  
Index Admission ◽  
Chronic Mesenteric Ischemia ◽  
Surgical Revascularization ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Discharge Disposition ◽  
National Estimates

There are limited contemporary data on readmission after revascularization for chronic mesenteric ischemia (CMI). This study aimed to determine the rates, reasons, predictors, and costs of 30-day readmission after endovascular or surgical revascularization for CMI. Patients with CMI discharged after endovascular or surgical revascularization during 2013 to 2014 were identified from the Nationwide Readmissions Database. The rates, reasons, length of stay, and costs of 30-day all-cause, non-elective, readmission were determined using weighted national estimates. Independent predictors of 30-day readmission were determined using hierarchical logistic regression. Among 4671 patients with CMI who underwent mesenteric revascularization, 19.5% were readmitted within 30 days after discharge at a median time of 10 days. More than 25% of readmissions were for cardiovascular or cerebrovascular conditions, most of which were for peripheral or visceral atherosclerosis and congestive heart failure. Independent predictors of 30-day readmission included non-elective index admission, chronic kidney disease (CKD), and discharge to home healthcare or to a skilled nursing facility. Revascularization modality did not independently predict readmission. In a nationwide, retrospective analysis of patients with CMI undergoing revascularization, approximately one in five were readmitted within 30 days. Predictors were largely non-modifiable and included non-elective index admission, CKD, and discharge disposition.

Abstract P52: Absence of Dysphagia is a Stronger Predictor of Favorable Discharge Disposition than Stroke Severity: Insights from the UTHSC Houston Stroke Registry

2011 ◽  
Vol 4 (suppl_1) ◽  
Author(s):  
Nneka I Jones ◽  
Nusrat Harun ◽  
Elizabeth Noser ◽  
James Grotta
Keyword(s):  
Skilled Nursing Facility ◽  
Inpatient Rehabilitation ◽  
Stroke Care ◽  
Level Of Care ◽  
Stroke Severity ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Stroke Registry ◽  
Post Stroke ◽  
Discharge Disposition

Introduction: Dysphagia is one of the most common post-stroke complications. The use of feeding tubes to provide nutrition requires increased acuity of care for management, which affects costs. This care is provided at all levels, including Inpatient Rehabilitation (IR), Skilled Nursing Facility (SNF) or Sub-acute (Sub). There are limited studies of the role of dysphagia as a predictor of post-stroke disposition. Hypothesis: Low NIHSS is a predictor of higher function. We assessed the hypothesis that the absence of tube feeds as an indicator of dysphagia is a predictor of post-stroke disposition to a similar functional level. Methods: All patients admitted to the UT Stroke Service between January 2004 and October 2009 were included. Stratification occurred for age >65, NIHSS and stroke risk factors. Using multivariate logistic regression, the data was analyzed to determine if differences in post-stroke disposition were present among patients not receiving tube feeds as an indicator of dysphagia. Results: Home vs. Other Level of Care Of 3389 patients, 1668 were discharged home, 1721 to another level of care. Patients without tube feeds are 14.6 times more likely to be discharged home (P = <.0001, OR 14.66, 95% CI 8.05 to 26.69) Patients with NIHSS < 8 are 10.9 times more likely to be discharged home. IR vs. SNF Of 1546 patients, 983 were discharged to acute IR, 563 to SNF. Patients without tube feeds are 6.1 times more likely to be discharged to IR (P = <.0001, OR 6.118, 95% CI 4.34 to 8.63). Patients with NIHSS < 8 are 2.5 times more likely to be discharged to IR. SNF vs. Sub Of 738 patients, 563 were discharged to SNF, 175 to Sub. Patients without tube feeds are 3 times more likely to be discharged to SNF (P = <.0001, OR 2.999, 95% CI 2.048 to 4.390). Patients with NIHSS < 8 are 2 times more likely to be discharged to SNF. Conclusions: The absence of tube feeds as an indicator of dysphagia is a predictor of improved post-stroke disposition, with a correlation stronger than NIHSS. This study is limited by its retrospective nature and unmeasured psychosocial factors related to discharge. Prospective studies should focus on early diagnosis, therapeutic intervention and caregiver involvement in dysphagia education to improve outcomes and decrease the cost of post-stroke care.

Discharge disposition to skilled nursing facility after emergent general surgery predicts a poor prognosis

Surgery ◽  
2019 ◽  
Vol 166 (4) ◽  
pp. 489-495 ◽  
Author(s):  
Anghela Z. Paredes ◽  
Azeem T. Malik ◽  
Marcus Cluse ◽  
Scott A. Strassels ◽  
Heena P. Santry ◽  
...  
Keyword(s):  
General Surgery ◽  
Poor Prognosis ◽  
Skilled Nursing Facility ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Discharge Disposition

scholarly journals Predictors of 30-day readmission after aneurysmal subarachnoid hemorrhage: a case-control study

2016 ◽  
Vol 126 (6) ◽  
pp. 1847-1854 ◽  
Author(s):  
Jacob K. Greenberg ◽  
Ridhima Guniganti ◽  
Eric J. Arias ◽  
Kshitij Desai ◽  
Chad W. Washington ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Subarachnoid Hemorrhage ◽  
Case Control Study ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Skilled Nursing Facility ◽  
Case Control ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Discharge Disposition ◽  
Control Study

OBJECTIVEDespite persisting questions regarding its appropriateness, 30-day readmission is an increasingly common quality metric used to influence hospital compensation in the United States. However, there is currently insufficient evidence to identify which patients are at highest risk for readmission after aneurysmal subarachnoid hemorrhage (SAH). The objective of this study was to identify predictors of 30-day readmission after SAH, to focus preventative efforts, and to provide guidance to funding agencies seeking to risk-adjust comparisons among hospitals.METHODSThe authors performed a case-control study of 30-day readmission among aneurysmal SAH patients treated at a single center between 2003 and 2013. To control for geographic distance from the hospital and year of treatment, the authors randomly matched each case (30-day readmission) with approximately 2 SAH controls (no readmission) based on home ZIP code and treatment year. They evaluated variables related to patient demographics, socioeconomic characteristics, comorbidities, presentation severity (e.g., Hunt and Hess grade), and clinical course (e.g., need for gastrostomy or tracheostomy, length of stay). Conditional logistic regression was used to identify significant predictors, accounting for the matched design of the study.RESULTSAmong 82 SAH patients with unplanned 30-day readmission, the authors matched 78 patients with 153 nonreadmitted controls. Age, demographics, and socioeconomic factors were not associated with readmission. In univariate analysis, multiple variables were significantly associated with readmission, including Hunt and Hess grade (OR 3.0 for Grade IV/V vs I/II), need for gastrostomy placement (OR 2.0), length of hospital stay (OR 1.03 per day), discharge disposition (OR 3.2 for skilled nursing vs other disposition), and Charlson Comorbidity Index (OR 2.3 for score ≥ 2 vs 0). However, the only significant predictor in the multivariate analysis was discharge to a skilled nursing facility (OR 3.2), and the final model was sensitive to criteria used to enter and retain variables. Furthermore, despite the significant association between discharge disposition and readmission, less than 25% of readmitted patients were discharged to a skilled nursing facility.CONCLUSIONSAlthough discharge disposition remained significant in multivariate analysis, most routinely collected variables appeared to be weak independent predictors of 30-day readmission after SAH. Consequently, hospitals interested in decreasing readmission rates may consider multifaceted, cost-efficient interventions that can be broadly applied to most if not all SAH patients.

scholarly journals Reverse Shoulder Arthroplasty Versus Antegrade Nailing for 3- and 4-Part Proximal Humeral Fractures in Elderly Patients.

2020 ◽  
Author(s):  
Khalil AMRI ◽  
Rabie AYARI ◽  
Karim LATRECH TLEMSANI ◽  
Achraf ABDENNADHER ◽  
Mohamed BEN SALAH ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Shoulder Arthroplasty ◽  
Proximal Humerus ◽  
Reverse Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
The Elderly ◽  
Reverse Total Shoulder Arthroplasty ◽  
Complications Rate ◽  
Reverse Total Shoulder

Abstract Introduction: Proximal humerus fractures are prevalent and widespread, accounting for 5% of all fractures, mainly in the elderly osteoporotic patients following a low-level trauma. Three-and four-part fractures represent 13 to 16% of these fractures and are generally associated with a worse prognosis. Depending on the fracture type and the patient status, several therapeutic options would be available ranging from osteosynthesis to arthroplasty. The aim of our study was to compare the functional and radiological results, as well as the complications of reverse shoulder arthroplasty and anterograde nailing when managing these fractures. Methods: A retrospective and descriptive study was conducted within the orthopedic surgery department of the Military Hospital of Instruction of Tunis, over a period of 42 months, from January 2016 to June 2019 with an average follow-up of 18 months. We included 31 cases of complex fractures of the proximal humerus in elderly patients, aged over 65 years, 16 of whom were treated by reverse total arthroplasty and 15 by antegrade nailing. Results: Our patient pool included 8 men and 23 women with a mean age of 73 years, ranging from 65 to 85. A low-energy fall was the main cause of the fractures with the dominant side being affected in 55% of cases. Four-part fractures were predominant representing 68% of the fractures. Constant and DASH scores at the last follow-up were at 68 and 24 respectively. Most patients were satisfied with the outcome of their surgeries, with an overall satisfaction rate of 87%. The complications rate was in accordance with the literature. Functional results in the group treated with reverse total shoulder arthroplasty were better with a lower complications rate. Conclusion: Reverse total shoulder arthroplasty has become an interesting surgical alternative, as the functional and anatomical results in our study were promising, while elucidating an improved quality of life for our patients. These findings have encouraged us to continue using this technique as a first-line choice for complex fractures of the proximal humerus in the elderly

Role of ADL Independence in Postacute-Care Rehabilitation Service Needs in the Elderly Abdominal Surgery Population

2021 ◽  
Vol 75 (Supplement_2) ◽  
pp. 7512500062p1-7512500062p1
Author(s):  
Erika Dobson ◽  
Rebecca Julian ◽  
Hailey Zanette
Keyword(s):  
Abdominal Surgery ◽  
Skilled Nursing Facility ◽  
The Elderly ◽  
Rehabilitation Service ◽  
Rehabilitation Services ◽  
Service Needs ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Postacute Care

Abstract Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. More than half of all surgical patients are age 65 and older, and research suggests that a majority of these patients will require postacute-care (PAC) rehabilitation services. Despite the growing costs, characteristics related to requiring PAC in the elderly abdominal surgery population are not well studied. This project aims to describe discharge trends, as well as factors related to requiring placement at a skilled-nursing facility in the elderly abdominal surgery population. Primary Author and Speaker: Erika Dobson Contributing Authors: Rebecca Julian, Hailey Zanette

scholarly journals Integration of Geriatrician Consultation for Trauma Admissions May Benefit Patient Outcomes

2019 ◽  
Vol 5 ◽  
pp. 233372141985873 ◽  
Author(s):  
Sumit Saha ◽  
Stephen M. DiRusso ◽  
Scott Welle ◽  
Benjamin Lieberman ◽  
Joel Sender ◽  
...  
Keyword(s):  
Skilled Nursing Facility ◽  
Patient Discharge ◽  
Geriatric Trauma ◽  
Trauma Patients ◽  
Trauma Centers ◽  
Outpatient Services ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Discharge Disposition ◽  
Benefit Patient

Objective: Geriatric admissions to trauma centers have increased, and in 2013, our center integrated geriatrician consultation with the management of admitted patients. Our goal is to describe our experience with increasing geriatric fall volume to help inform organized geriatric trauma programs. Method: We retrospectively analyzed admitted trauma patients ≥65 years old, suffering falls from January 1, 2006, to December 31, 2017. We examined descriptive statistics and changes in outcomes after integration. Results: A total of 1,335 geriatric trauma patients were admitted, of which 1,054 (79%) had suffered falls. Falls increased disproportionately (+280%) compared with other mechanisms of injury (+97%). After 2013, patient discharge disposition to skilled nursing facility decreased significantly (–67%, p < .001), with a concomitant increase in safe discharges home with outpatient services. Regression analysis revealed association between integration of geriatrician consultation and outcomes. Discussion: Geriatrician consultation is associated with optimized discharge disposition of trauma patients. We recommend geriatrician consultation for all geriatric trauma activations.

Total Knee Arthroplasty in Patients with Dementia

2020 ◽  
Author(s):  
Nicholas M. Hernandez ◽  
Daniel J. Cunningham ◽  
William A. Jiranek ◽  
Michael P. Bolognesi ◽  
Thorsten M. Seyler
Keyword(s):  
Emergency Department ◽  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Skilled Nursing Facility ◽  
National Database ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Discharge Disposition ◽  
Increased Risk ◽  
Total Knee

AbstractThere are few studies evaluating total knee arthroplasty (TKA) in patients with dementia. The purpose of this study was to evaluate the rate of revision, complication, emergency department (ED) visitation, and discharge disposition in patients with dementia undergoing primary TKA. In this retrospective study, we evaluated patients from 2007 to 2017 using a national database. Ninety-day complications in patients with dementia undergoing TKA were increased risk of ED visitation and skilled nursing facility (SNF) disposition (p  ≤  0.05). Two-year complications in patients with dementia undergoing TKA were increased risk of ED visitation and SNF disposition (p  ≤  0.05). Patients with dementia undergoing TKA are at an increased risk of resource utilization.

scholarly journals Clinical and Socioeconomic Differences in Methamphetamine-Positive Burn Patients

2019 ◽  
Vol 40 (6) ◽  
pp. 734-742
Author(s):  
Eve A Solomon ◽  
David G Greenhalgh ◽  
Soman Sen ◽  
Tina L Palmieri ◽  
Kathleen S Romanowski
Keyword(s):  
Socioeconomic Status ◽  
Skilled Nursing Facility ◽  
Inhalation Injury ◽  
Burn Patients ◽  
Lower Socioeconomic Status ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Methamphetamine Use ◽  
Discharge Disposition ◽  
Lower Socioeconomic

Abstract Previous research on burn patients who test positive for methamphetamines (meth) has yielded mixed results regarding whether meth-positive status leads to worse outcomes and longer hospitalizations. We hypothesized that meth-positive patients at our regional burn center would have worse outcomes. We reviewed burn admissions from January 2014 to December 2017 and compared total patients versus meth-positive, and matched meth-negative versus meth-positive for total BSA burn, length of stay (LOS), intensive care unit (ICU) days, days on ventilator, discharge status (lived/died), number of operating room (OR) visits, number of procedures, socioeconomic status, comorbidities, and discharge disposition. Of 1363 total patients, 264 (19.4%) were meth-positive on toxicology screen. We matched 193 meth-positive patients with meth-negative controls based on TBSA burn, age, and inhalation injury. In the total population comparison, meth-positive patients had larger burns (15.6% vs 12.2%; P = .004), longer LOS (17.8 vs 14.3 days; P = .041), and fewer operations/TBSA (0.12 vs 0.2; P = .04), and lower socioeconomic status. Meth-positive patients were less likely to be discharged to a skilled nursing facility, and more likely to leave against medical advice. In the matched patients, we found no significant differences in LOS or OR visits/TBSA burn. Meth-positive patients have lower socioeconomic status, larger burns, and longer LOS compared to the total burn population. Methamphetamine use, by itself, does not appear to change outcomes. Methamphetamine use leads to larger burns in a population with fewer resources than the general population.

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