scholarly journals The type of gastrectomy and modified frailty index as useful predictive indicators for 1-year readmission due to nutritional difficulty in patients who undergo gastrectomy for gastric cancer

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Tomohiro Osaki ◽  
Hiroaki Saito ◽  
Wataru Miyauchi ◽  
Yuji Shishido ◽  
Kozo Miyatani ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Readmission Rate ◽  
Frailty Index ◽  
Partial Gastrectomy ◽  
Readmission Rates ◽  
Modified Frailty Index ◽  
Improve Patient ◽  
Predictive Indicators

Abstract Background Patients who undergo gastrectomy for gastric cancer (GC) are likely to have nutritional difficulty after surgery. Readmission due to nutritional difficulty is common in such patients. Thus, in this study, we aim to identify the predictive indicators for readmission due to nutritional difficulty in patients who underwent gastrectomy for GC. Methods We retrospectively reviewed surgical outcomes in 516 consecutive patients who underwent gastrectomy for GC. Results The readmission rate within 1 year was 13.8%. Readmission due to nutritional difficulty was observed in 20 patients (3.9%); it was determined as the second leading cause of readmission. Multivariate analysis revealed that the type of gastrectomy and the modified frailty index (mFI) were independent predictive indicators of readmission due to nutritional difficulty. Patients were assigned 1 point for each predictive indicator, and the total points were calculated (point 0, point 1, or point 2). The readmission rates due to nutritional difficulty were 1.2%, 4.7%, and 11.5% in patients with 0, 1, and 2 points, respectively (P = 0.0008). Conclusions The readmission rate due to nutritional difficulty was noted to be high in patients who underwent total or proximal partial gastrectomy with high mFI. Intensive follow-up and nutritional support are needed to reduce readmissions due to nutritional difficulty. Reduced readmission rates can improve patient quality of life and reduce medical costs.

scholarly journals The Type of Gastrectomy and Modified Frailty Index as Useful Predictive Indicators for One-Year Readmission Due to Nutritional Difficulty in Patients Who Undergo Gastrectomy for Gastric Cancer.

2021 ◽  
Author(s):  
Tomohiro Osaki ◽  
Hiroaki Saito ◽  
Wataru Miyauchi ◽  
Yuji Shishido ◽  
Kozo Miyatani ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Total Gastrectomy ◽  
Readmission Rate ◽  
Frailty Index ◽  
Partial Gastrectomy ◽  
Readmission Rates ◽  
Modified Frailty Index ◽  
One Year ◽  
Distal Partial Gastrectomy ◽  
Predictive Indicators

Abstract Background Patients who undergo gastrectomy for gastric cancer are likely to have nutritional difficulty after surgery. Therefore, readmission due to nutritional difficulty is frequently observed in such patients. This study aimed to identify predictive indicators for readmission due to nutritional difficulty in patients who underwent gastrectomy for gastric cancer. Methods We retrospectively reviewed surgical outcomes in 516 consecutive patients who underwent gastrectomy for gastric cancer. Results The readmission rate within one year was 13.8%. Readmission due to nutritional difficulty was observed in 20 patients (3.9%), and nutritional difficulty was the second leading cause of readmission. Multivariate analysis revealed that the type of gastrectomy and the modified frailty index were independent predictive indicators of readmission due to nutritional difficulty. The readmission rates due to nutritional difficulty were 1.2%, 4.7%, and 11.5% in patients who underwent distal partial gastrectomy and had low modified frailty index, in those who underwent distal partial gastrectomy and had high modified frailty index or those who underwent either proximal partial or total gastrectomy and had low modified frailty index, and in those who underwent either proximal partial or total gastrectomy and had high modified frailty index, respectively (P = 0.0008). Conclusions Because the readmission rate due to nutritional difficulty is high in patients who underwent either total or proximal partial gastrectomy with high modified frailty index, intensive follow-up and nutritional support is needed to reduce readmission due to nutritional difficulty, which can help improve the patients’ quality of life and reduce additional medical costs.

scholarly journals Impact of Heart Failure Focused Follow-Up Care at the “Heart Success Clinic” on 30-Day Readmission Rates in Patients with Congestive Heart Failure

2020 ◽  
pp. 1-3
Author(s):  
Deepti Bhandare ◽  
Keyword(s):  
Heart Failure ◽  
Patient Outcomes ◽  
Readmission Rate ◽  
The United States ◽  
Hospital Data ◽  
Readmission Rates ◽  
Medication Reviews ◽  
Improve Patient

Nearly 6.2 million people in the United states are affected by heart failure, it is predicted that this number will rise to 8.5 million by 2030 Significant effort has been made to prevent heart failure and its exacerbations. The Hospital Readmission Reduction Program (HRRP), a Medicaare based program, was established to link payment to quality of care. Payment is reduced to hospitals when patients are readmitted within 30 days for heart failure The “Heart Success Clinic” is an outpatient clinic started to improve patient outcomes and reduce readmission rates. Patients are provided with heart failure focused visits which includes detailed medication reviews, diet modification, weight loss, disease education, etc. During the six months prior to the opening of the clinic, the readmission rate was 15.27% at AdventHealth Sebring hospital which is a community-based hospital. Data was collected on the patients who attended the “Heart Success Clinic” for six months. Zero patients from the clinic were readmitted, bringing the readmission rate down from 15.27% to 0%. This pilot study gives promising initial results. Further studies can be conducted over a longer period time as to gather more patients. Overall, the study demonstrates that there is value in providing heart failure focused follow up visits in improving patient outcomes and readmission rates.

536 QUALITY OF LIFE AND FOLLOW-UP AFTER ESOPHAGEAL AND GASTRIC CANCER SURGERY. PROTOCOL FOR DEVELOPING AND TESTING A NEW FOLLOW-UP MODEL

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
I Hovdenak Jakobsen ◽  
D Kjaer
Keyword(s):  
Quality Of Life ◽  
Gastric Cancer ◽  
Adverse Effects ◽  
Prospective Study ◽  
Patient Involvement ◽  
Complex Interventions ◽  
National Implementation ◽  
Patient Reported

Abstract   Esophageal and gastric cancers are aggressive diseases. Due to extensive treatment, many patients experience adverse effects such as dysphagia, dumping, pain, fatigue, fear of recurrence and depression—all negatively impacting quality of life (QoL). The purpose of this study is to develop and test a follow-up model for patients after surgery for esophageal and gastric cancer. The model targets handling of adverse effects and psychosocial distress, aiming at improving patients’ QoL and functional level. Methods Development of the model follows recognized principles for complex interventions by the Medical Research Counsil. Extensive patient involvement is included in the development process, by means of a national patient advisory board. The assumed effect of the new model will be tested in a national two-part prospective study, executed before and after national implementation of the model, in both parts including approximately200 patients. Participants will be recruited prior to surgery, and follow-up is one year. Patient-reported data will be collected pre-operatively, at 3, 6, 9 and 12 months postoperatively, along with clinical and sociodemographic data. Results Development of the follow-up model after surgery will be completed in august 2020 and inclusion of patients for the prospective study part one, before implementation of the model, will commence summer 2020. Conclusion The perspectives of this study may be crucial for future follow-up of esophageal and gastric cancer patients. First, the extensive patient involvement in developing the model will ensure a patient-centred approach to follow-up. And second, the follow-up studies will provide important and up-to-date knowledge about clinical and patient-reported outcomes in a population-based, national cohort.

scholarly journals 763. 30 Day Readmission Outcomes in Patients Over 80 Years of Age Enrolled in an Outpatient Parenteral Antibiotic Therapy (OPAT) Program

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S339-S340
Author(s):  
Kathleen R Sheridan ◽  
Joshua Wingfield ◽  
Lauren McKibben ◽  
Natalie Clouse
Keyword(s):  
Readmission Rate ◽  
Chart Review ◽  
Age Groups ◽  
Retrospective Chart Review ◽  
Model Of Care ◽  
Readmission Rates ◽  
Parenteral Antibiotic ◽  
Patient Demographics

Abstract Background OPAT is a well-established model of care for the monitoring of patients requiring long-term IV antibiotics1. We have previously reported a reduction in the 30-day readmission rate to our facility for patients managed in our OPAT program. However, little has been published to date regarding outcomes in OPAT patients over 80 years of age 2–3. Our OPAT program was established in 2013. Patients can be discharged to a facility or home to complete their course of antibiotics. Methods We conducted a retrospective chart review of all OPAT patients discharged from our facility from 2015 to 2018. Patients were divided into two groups based on age, <80 (n = 4618) and >80 (n = 562). Results Patient demographics are listed in Table 1. The overall 30-day readmission rate for patients older than 80 was 27.8%. For patients over 80 that had a follow-up ID clinic appointment, the 30-day readmission rate decreased to 15.7%. For patients younger than 80, the 30-day readmission rate was 36.0% with a decrease to 16.2% if patients were evaluated in the outpatient clinic. Figure 1. Staphylococcus Aureus was the predominant organism in both age categories. Vancomycin was the most common antibiotic used in both age groups followed by β lactams. Conclusion In general, patients aged over 80 years were more likely to be discharged to a facility to complete their antibiotic course than younger patients. These patients also were more likely to have other comorbidities. The 30-day readmission rate in each age group was relatively similar. OPAT in patients over age 80 can have similar 30-day readmission rates as for patients less than 80 years of age Disclosures All authors: No reported disclosures.

scholarly journals Trajectory Modelling to Assess Trends in Long-Term Readmission Rate among Abdominal Aortic Aneurysm Patients

2018 ◽  
Vol 2018 ◽  
pp. 1-10
Author(s):  
Ahsan Rao ◽  
Alex Bottle ◽  
Collin Bicknell ◽  
Ara Darzi ◽  
Paul Aylin
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Readmission Rate ◽  
High Impact ◽  
Short Term ◽  
Readmission Rates ◽  
Abdominal Aortic ◽  
High Readmission Rate ◽  
Trajectory Modelling

Introduction. The aim of the study was to use trajectory analysis to categorise high-impact users based on their long-term readmission rate and identify their predictors following AAA (abdominal aortic aneurysm) repair. Methods. In this retrospective cohort study, group-based trajectory modelling (GBTM) was performed on the patient cohort (2006-2009) identified through national administrative data from all NHS English hospitals. Proc Traj software was used in SAS program to conduct GBTM, which classified patient population into groups based on their annual readmission rates during a 5-year period following primary AAA repair. Based on the trends of readmission rates, patients were classified into low- and high-impact users. The high-impact group had a higher annual readmission rate throughout 5-year follow-up. Short-term high-impact users had initial high readmission rate followed by rapid decline, whereas chronic high-impact users continued to have high readmission rate. Results. Based on the trends in readmission rates, GBTM classified elective AAA repair (n=16,973) patients into 2 groups: low impact (82.0%) and high impact (18.0%). High-impact users were significantly associated with female sex (P=0.001) undergoing other vascular procedures (P=0.003), poor socioeconomic status index (P<0.001), older age (P<0.001), and higher comorbidity score (P<0.001). The AUC for c-statistics was 0.84. Patients with ruptured AAA repair (n=4144) had 3 groups: low impact (82.7%), short-term high impact (7.2%), and chronic high impact (10.1%). Chronic high impact users were significantly associated with renal failure (P<0.001), heart failure (P = 0.01), peripheral vascular disease (P<0.001), female sex (P = 0.02), open repair (P<0.001), and undergoing other related procedures (P=0.05). The AUC for c-statistics was 0.71. Conclusion. Patients with persistent high readmission rates exist among AAA population; however, their readmissions and mortality are not related to AAA repair. They may benefit from optimization of their medical management of comorbidities perioperatively and during their follow-up.

scholarly journals Thirty-day readmission rate as a surrogate marker for quality of care in neurosurgical patients: a single-center Canadian experience

2019 ◽  
Vol 130 (5) ◽  
pp. 1692-1698 ◽  
Author(s):  
Mitchell P. Wilson ◽  
Andrew S. Jack ◽  
Andrew Nataraj ◽  
Michael Chow
Keyword(s):  
Multivariate Analysis ◽  
Quality Of Care ◽  
Readmission Rate ◽  
Univariate Analysis ◽  
Surrogate Marker ◽  
Readmission Rates ◽  
Factors Associated ◽  
Neurosurgical Patients ◽  
Avoidable Readmissions

OBJECTIVEReadmission to the hospital within 30 days of discharge is used as a surrogate marker for quality and value of care in the United States (US) healthcare system. Concern exists regarding the value of 30-day readmission as a quality of care metric in neurosurgical patients. Few studies have assessed 30-day readmission rates in neurosurgical patients outside the US. The authors performed a retrospective review of all adult neurosurgical patients admitted to a single Canadian neurosurgical academic center and who were discharged to home to assess for the all-cause 30-day readmission rate, unplanned 30-day readmission rate, and avoidable 30-day readmission rate.METHODSA retrospective review was performed assessing 30-day readmission rates after discharge to home in all neurosurgical patients admitted to a single academic neurosurgical center from January 1, 2011, to December 31, 2011. The primary outcomes included rates of all-cause, unplanned, and avoidable readmissions within 30 days of discharge. Secondary outcomes included factors associated with unplanned and avoidable 30-day readmissions.RESULTSA total of 184 of 950 patients (19.4%) were readmitted to the hospital within 30 days of discharge. One-hundred three patients (10.8%) were readmitted for an unplanned reason and 81 (8.5%) were readmitted for a planned or rescheduled operation. Only 19 readmissions (10%) were for a potentially avoidable reason. Univariate analysis identified factors associated with readmission for a complication or persistent/worsening symptom, including age (p = 0.009), length of stay (p = 0.007), general neurosurgery diagnosis (p < 0.001), cranial pathology (p < 0.001), intensive care unit (ICU) admission (p < 0.001), number of initial admission operations (p = 0.01), and shunt procedures (p < 0.001). Multivariate analysis identified predictive factors of readmission, including diagnosis (p = 0.002, OR 2.4, 95% CI 1.4–5.3), cranial pathology (p = 0.002, OR 2.7, 95% CI 1.4–5.3), ICU admission (p = 0.004, OR 2.4, 95% CI 1.3–4.2), and number of first admission operations (p = 0.01, OR 0.51, 95% CI 0.3–0.87). Univariate analysis performed to identify factors associated with potentially avoidable readmissions included length of stay (p = 0.03), diagnosis (p < 0.001), cranial pathology (p = 0.02), and shunt procedures (p < 0.001). Multivariate analysis identified only shunt procedures as a predictive factor for avoidable readmission (p = 0.02, OR 5.6, 95% CI 1.4–22.8).CONCLUSIONSAlmost one-fifth of neurosurgical patients were readmitted within 30 days of discharge. However, only about half of these patients were admitted for an unplanned reason, and only 10% of all readmissions were potentially avoidable. This study demonstrates unique challenges encountered in a publicly funded healthcare setting and supports the growing literature suggesting 30-day readmission rates may serve as an inappropriate quality of care metric in neurosurgical patients. Potentially avoidable readmissions can be predicted, and further research assessing predictors of avoidable readmissions is warranted.

scholarly journals A meta-analysis of fast track surgery for patients with gastric cancer undergoing gastrectomy

2015 ◽  
Vol 97 (1) ◽  
pp. 3-10 ◽  
Author(s):  
S Chen ◽  
Z Zou ◽  
F Chen ◽  
Z Huang ◽  
G Li
Keyword(s):  
Gastric Cancer ◽  
Perioperative Care ◽  
Fast Track ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Fast Track Surgery ◽  
Short Term ◽  
Readmission Rates ◽  
Randomised Controlled

Introduction This meta-analysis evaluated the safety and efficacy of fast track surgery (FTS) for patients with gastric cancer undergoing gastrectomy. Methods Randomised controlled trials (RCTs) published between 1 January 1995 and 21 June 2013 comparing FTS with conventional perioperative care for patients with gastric cancer undergoing gastrectomy were identified in the PubMed, Embase™ and Cochrane Library databases, and were analysed systematically using RevMan software (Nordic Cochrane Centre, Copenhagen, Denmark). Results Seven RCTs (524 patients) were analysed. Compared with conventional perioperative care, FTS treatment with/without laparoscopy was associated with shorter postoperative hospitalisation, less hospitalisation expenditure (both p<0.00001), less pain and better quality of life. Short-term morbidity and readmission rates did not differ between treatments. No incidents of death occurred during the short-term follow-up period. Conclusions In patients with gastric cancer undergoing gastrectomy, the FTS pathway reduces the length and cost of postoperative hospitalisation while maintaining short-term morbidity, readmission and mortality rates comparable with those of conventional care.

Total vs Partial Gastrectomy in Gastric Cancer: A Comparison of Quality of Life and Clinical Outcomes in 2 Patients

2018 ◽  
Vol 113 (Supplement) ◽  
pp. S1449
Author(s):  
Sameer Prakash ◽  
Shayan Siddiqui ◽  
Chandralekha Ashangari ◽  
Edward Trevino ◽  
Juan Garrido ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Gastric Cancer ◽  
Clinical Outcomes ◽  
Partial Gastrectomy

A prospective multicenter observational study of surgical palliation examining postoperative quality of life in patients treated for malignant gastric outlet obstruction caused by incurable advanced gastric cancer.

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 6-6 ◽  
Author(s):  
Kazumasa Fujitani ◽  
Masahiko Ando ◽  
Kentaro Sakamaki ◽  
Masanori Terashima ◽  
Ryohei Kawabata ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Gastric Cancer ◽  
Gastric Outlet Obstruction ◽  
Outlet Obstruction ◽  
Oral Intake ◽  
Malignant Gastric Outlet Obstruction ◽  
Surgical Palliation ◽  
The Mean

6 Background: Decision-making for surgical palliation remains one of the most challenging clinical scenarios since quality of life (QOL) is a key component of cancer care. We conducted this study to examine the impacts of surgical palliation on postoperative QOL in patients (pts) with malignant gastric outlet obstruction (GOO) caused by incurable primary gastric cancer (GC). Methods: Eligibility included (1) no oral intake or liquids only requiring parenteral nutrition (2) aged ≥20 (3) surgically fit (4) ECOG PS of 0-2 and (5) written IC. Patients underwent either palliative distal/total gastrectomy (DG/TG) or gastrojejunostomy (GJS). Treatment choice was left to the discretion of the physician. Validated QOL instruments (EORTC QLQ-STO22 and EuroQol-5D) assessed QOL at baseline, 2 weeks (wks), 1 month (m), and 3 months following the surgical palliation, and two observational outcomes (postoperative improvement of oral intake, and safety of surgical intervention) were evaluated. Results: 104 pts, 71 males and 33 females with a median age of 68 years, were enrolled. The types of surgery were DG in 23 pts, TG in 9 pts, GJS in 70 in pts, and exploratory laparotomy in 2 pts. Baseline QOL questionnaires were completed by 103 (99.0%) pts. Among the 104 pts, 98 (94.2%), 100 (96.1%), and 81 (77.9%) completed the 2-wk, 1-m, and 3-m follow-up survey, respectively. The mean baseline EQ-5D score was 0.74 (SD, 0.21). During the follow-up period, the mean scores remained consistent with the baseline scores; the change from baseline score was within ± 0.05 for the index. Many pts came to eat solid food at 2 wks postsurgery and remained tolerable thereafter (from 0 at baseline to 82, 85, 75 pts at 2 wks, 1 m, and 3 ms, respectively). Overall morbidity rate of ≥grade 3 on Clavien-Dindo classification and 30-day postoperative mortality rate was 9.6% (10 pts) and 2.0% (2 pts) with a median hospital stay of 13 days and re-operation rate of 3.9% (4 pts). Conclusions: In pts with malignant GOO caused by advanced GC, surgical palliation maintained patient QOL while improving solid food intake with an acceptable surgical safety. Clinical trial information: UMIN000023494.

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