SAT-156 Shorter Hospital Stays Are Not Associated with Increased Readmission or Complication Rates in Patients Undergoing Laparoscopic Adrenalectomies

Abstract Background : Traditionally, elective adrenalectomies have been performed as an inpatient procedure. However, the adoption of laparoscopic adrenalectomy as the gold standard has allowed for shorter postoperative stays. Our objective was to assess the safety of same-day discharge for patients undergoing laparoscopic adrenalectomy. Methods : A retrospective cohort study of patients who underwent laparoscopic adrenalectomy from 2011-2017 was conducted using The American College of Surgeons National Surgical Quality Improvement Project (ACS NSQIP) database. Demographic data was obtained. Multivariable logistic regression models to assess the association between length of stay and both postoperative complication rates and 30-day readmission rates were regressed on age, sex, race, comorbidities, functional status, postoperative diagnosis, and operative time. Statistical significance was defined as p<.05. Results : 5,611 unique patients who underwent a laparoscopic adrenalectomy were identified. 1,564 patients had a postoperative diagnosis of a pheochromocytoma (27.9%), 162 with Cushing’s syndrome (2.9%) and 210 (3.7%) had metastatic disease to the adrenal glands. The average postoperative length of stay was 2.4 days (SD=3.9). 93 patients (1.7%) were discharged on the same day as their surgery (POD0). 2,509 (44.7%) were discharged on postoperative day 1 (POD1), 1,558 (27.8%) on postoperative day 2 (POD2), and 1,451 (25.9%) after POD2. Longer hospital stays were predicted by male sex, non-white race, longer operating time, and postoperative complications in regression models. 351 patients (6.26%) experienced a complication postoperatively. Complication rates were 3.23% for patients discharged on POD0, 1.67% for those discharged on POD1, 3.27% for those discharged on POD2, and 17.57% for those discharged after POD2 (p<.01). An increased risk of postoperative complications was also associated with male sex, impaired functional status and the presence of multiple comorbidities in regression models. 290 patients (5.17%) experienced a readmission. Readmission rates were 4.30% for patients discharged on POD0, 3.67% for those discharged on POD1, 4.49% for those discharged on POD2, and 8.55% for those discharged after POD2 (p<.01). Multiple comorbidities, African American race, and post-operative complications were associated with higher readmission rates. Length of hospital stay was not associated with readmission rates in regression models. Conclusions : Readmission rates were not significantly different for patients discharged on POD0 than POD1 after a laparoscopic adrenalectomy. Readmission rates were higher for patients who had complications or multiple comorbidities. Therefore, low-risk patients with uncomplicated laparoscopic adrenalectomies can be considered for same day discharge to potentially reduce hospital spending and resource utilization.

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Is same-day discharge associated with increased 30-day postoperative complications and readmissions in patients undergoing laparoscopic adrenalectomy?

Surgery ◽

10.1016/j.surg.2020.08.018 ◽

2020 ◽

Author(s):

Omair A. Shariq ◽

Katherine A. Bews ◽

Nicholas P. McKenna ◽

Benzon M. Dy ◽

Melanie L. Lyden ◽

...

Keyword(s):

Postoperative Complications ◽

Laparoscopic Adrenalectomy ◽

Same Day Discharge

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Neuraxial anaesthesia is associated with improved outcomes and reduced postoperative complications in patients undergoing aseptic revision total hip arthroplasty

Hip International ◽

10.1177/1120700020975749 ◽

2020 ◽

pp. 112070002097574

Author(s):

Chapman Wei ◽

Alex Gu ◽

Arun Muthiah ◽

Safa C Fassihi ◽

Peter K Sculco ◽

...

Keyword(s):

Postoperative Complications ◽

Total Hip Arthroplasty ◽

Length Of Stay ◽

General Anaesthesia ◽

Hip Arthroplasty ◽

Postoperative Outcomes ◽

Complication Rates ◽

Total Hip ◽

Neuraxial Anaesthesia ◽

Extended Length

Background: As the incidence of primary total hip arthroplasty (THA) continues to increase, revision THA (rTHA) is becoming an increasingly common procedure. rTHA is widely regarded as a more challenging procedure, with higher complication rates and increased medical, social and economic burdens when compared to its primary counterpart. Given the complexity of rTHA and the projected increase in incidence of these procedures, patient optimisation is becoming of interest to improve outcomes. Anaesthetic choice has been extensively studied in primary THA as a modifiable risk factor for postoperative outcomes, showing favourable results for neuraxial anaesthesia compared to general anaesthesia. The impact of anaesthetic choice in rTHA has not been studied previously. Methods: A retrospective study was performed using the American College of Surgeons National Surgical Quality Improvement Program database. Patients who underwent rTHA between 2014 and 2017 were divided into 3 anaesthesia cohorts: general anaesthesia, neuraxial anaesthesia, and combined general-regional (neuraxial and/or peripheral nerve block) anaesthesia. Univariate and multivariate analyses were used to analyse patient characteristics and 30-day postoperative outcomes. Bonferroni correction was applied for post-hoc analysis. Results: In total, 5759 patients were identified. Of these, 3551 (61.7%) patients underwent general anaesthesia, 1513 (26.3%) patients underwent neuraxial anaesthesia, and 695 (12.1%) patients underwent combined general-regional anaesthesia. On multivariate analysis, neuraxial anaesthesia was associated with decreased odds for any-one complication (OR 0.635; p < 0.001), perioperative blood transfusion (OR 0.641; p < 0.001), and extended length of stay (OR 0.005; p = 0.005) compared to general anaesthesia. Conclusions: Relative to those receiving general anaesthesia, patients undergoing neuraxial anaesthesia are at decreased risk for postoperative complications, perioperative blood transfusions, and extended length of stay. Prospective controlled trials should be conducted to verify these findings.

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Identification of complications that have a significant effect on length of stay after spine surgery and predictive value of 90-day readmission rate

Journal of Neurosurgery Spine ◽

10.3171/2015.3.spine14318 ◽

2015 ◽

Vol 23 (6) ◽

pp. 807-811 ◽

Cited By ~ 18

Author(s):

Sanjay Yadla ◽

George M. Ghobrial ◽

Peter G. Campbell ◽

Mitchell G. Maltenfort ◽

James S. Harrop ◽

...

Keyword(s):

Postoperative Complications ◽

Length Of Stay ◽

Spine Surgery ◽

Neurological Deficit ◽

Predictive Value ◽

Health Care Expenditures ◽

Pulmonary Complications ◽

Targeted Prevention ◽

Hospital Stays ◽

Prolonged Hospital

OBJECT Complications after spine surgery have an impact on overall outcome and health care expenditures. The increased cost of complications is due in part to associated prolonged hospital stays. The authors propose that certain complications have a greater impact on length of stay (LOS) than others and that those complications should be the focus of future targeted prevention efforts. They conducted a retrospective analysis of a prospectively maintained database to identify complications with the greatest impact on LOS as well as the predictive value of these complications with respect to 90-day readmission rates. METHODS Data on 249 patients undergoing spine surgery at Thomas Jefferson University from May to December 2008 were collected by a study auditor. Any complications occurring within 30 days of surgery were recorded as was overall LOS for each patient. Stepwise regression analysis was performed to determine whether specific complications had a statistically significant effect on LOS. For correlation, all readmissions within 90 days were recorded and organized by complication for comparison with those complications affecting LOS. RESULTS The mean LOS for patients without postoperative complications was 6.9 days. Patients who developed pulmonary complications had an associated increase in LOS of 11.1 days (p < 0.005). The development of a urinary tract infection (UTI) was associated with an increase in LOS of 3.4 days (p = 0.002). A new neurological deficit was associated with an increase in LOS of 8.2 days (p = 0.004). Complications requiring return to the operating room (OR) showed a trend toward an increase in LOS of 4.7 days (p = 0.09), as did deep wound infections (3.3 days, p = 0.08). The most common reason for readmission was for wound drainage (n = 21; surgical drainage was required in 10 [4.01%] of these 21 cases). The most common diagnoses for readmission, in decreasing order of incidence, were categorized as hardware malpositioning (n = 4), fever (n = 4), pulmonary (n = 2), UTI (n = 2), and neurological deficit (n = 1). Complications affecting LOS were not found to be predictive of readmission (p = 0.029). CONCLUSIONS Postoperative complications in patients who have undergone spine surgery are not uncommon and are associated with prolonged hospital stays. In the current cohort, the occurrence of pulmonary complications, UTI, and new neurological deficit had the greatest effect on overall LOS. Further study is required to determine the causative factors affecting readmission. These specific complications may be high-yield targets for cost reduction and/or prevention efforts.

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Impact of inflammatory bowel disease on urologic oncology surgical outcomes and costs of care.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.6_suppl.470 ◽

2020 ◽

Vol 38 (6_suppl) ◽

pp. 470-470

Author(s):

Ilana Goldberg ◽

Steven Lee Chang ◽

Shilajit Kundu ◽

Eric A. Singer

Keyword(s):

Inflammatory Bowel Disease ◽

Bowel Disease ◽

Surgical Outcomes ◽

Regression Models ◽

Enhanced Recovery ◽

Hospital Costs ◽

Complication Rates ◽

Readmission Rates ◽

Urologic Oncology ◽

Inflammatory Bowel

470 Background: Recent studies suggest an association between genitourinary malignancies and inflammatory bowel disease (IBD). Our objective was to investigate clinical and financial impacts of IBD on common major urologic cancer surgeries: radical prostatectomy (RP), radical cystectomy (RC), radical nephrectomy (RN), and partial nephrectomy (PN). Methods: Using ICD9 codes, the Premier Hospital Database was queried for patients who underwent one of four surgeries: RP, RC, RN, or PN from 2003 to 2015. The cohort was segregated into IBD patients and non-IBD patients. Multivariable logistic regression models were used to determine the independent impact of IBD on complication rates (by Clavien-Dindo classification and organ system) and readmission rates. Hospital cost differences between the two cohorts, adjusted to 2016 US dollars, were examined with multivariable quantile regression models. Results: Our study population included 220,192 patients with urological malignancies, 5165 (0.4%) of whom had IBD. After controlling for clinicodemographic variables, there were significantly higher odds for any complication (Clavien ≥1) for IBD patients compared to non-IBD controls for RC (Odds ratio [OR]: 3.04, 95% confidence interval [CI]: 1.25-7.43), RN (OR: 1.57, 95% CI: 1.1-2.23), and PN (OR: 1.5, 95% CI: 1.02-2.22). Specifically, IBD patients had significantly more gastrointestinal, infectious, and soft tissue complications. Readmission rates were significantly higher for IBD patients who underwent RC (OR: 2.50, 95% CI: 1.17-5.35) and PN (OR: 1.81, 95% CI: 1.17-2.80). Hospital costs were significantly elevated for IBD patients, ranging from +$893 (95% CI: 108-1677) to +$6261 (95% CI: 1861-10660). Conclusions: There was a significantly higher overall complication rate for IBD patients undergoing RC, RN, or PN compared to the non-IBD cohort. Hospital readmission rates were significantly higher for the IBD cohort who underwent RC and PN. Hospital costs associated with surgery were also increased for IBD patients. These findings may be important when counseling IBD patients about surgical outcomes and during development of enhanced recovery pathways or bundled payment programs.

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Impact of inflammatory bowel disease on radical prostatectomy outcomes and costs of care.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.6_suppl.230 ◽

2021 ◽

Vol 39 (6_suppl) ◽

pp. 230-230

Author(s):

Ilana Goldberg ◽

Steven Lee Chang ◽

Shilajit Kundu ◽

Benjamin I. Chung ◽

Eric A. Singer

Keyword(s):

Prostate Cancer ◽

Inflammatory Bowel Disease ◽

Radical Prostatectomy ◽

Surgical Approach ◽

Bowel Disease ◽

Regression Models ◽

Complication Rates ◽

Readmission Rates ◽

Surgical Costs ◽

Inflammatory Bowel

230 Background: Recent studies suggest an association between prostate cancer and inflammatory bowel disease (IBD). Our objectives were to investigate clinical and financial impacts of IBD on radical prostatectomy (RP), and to determine the impact of surgical approach on our findings. Methods: The Premier Hospital Database was queried for patients who underwent RP from 2003 to 2017. Multivariable logistic regression models were used to determine the independent impact of IBD on complications and readmission rates. We determined 90-day readmissions and examined 90-day hospital costs adjusted to 2019 US dollars with multivariable quantile regression models. Results: Our study population included 262,189 men with prostate cancer, including 3,408 (1.3%) with IBD. There were higher odds for any complication for IBD patients compared to non-IBD controls for RP (15.64% vs. 10.66%). IBD patients had overall complication rates of 14.1% ( P < 0.05) for open surgery and 17.2% for MIS ( P < 0.01). Between 2013-2017, the IBD cohort had significantly more complications (OR: 2; 95% CI: 1.5 to 2.67; P < 0.0001), was more likely to have surgical costs in the top quartile (OR: 1.6; 95% CI: 1.23 to 2.1; P < 0.01), and had higher readmission rates (OR: 1.51; 95% CI: 1.1 to 2.06; P = 0.01). Conclusions: The IBD cohort who underwent MIS had the highest complication rates. Hospital readmissions and surgical costs were significantly higher for the IBD cohort who underwent RP between 2013-2017, when a minimally invasive approach was more prevalent than an open approach. These findings may be important when deciding which surgical approach to take when performing RP on men with IBD. [Table: see text]

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Comparing the outcome of ileal conduit and transuretero-cutaneostomy urinary diversion after radical cystectomy: a retrospective cohort study

African Journal of Urology ◽

10.1186/s12301-021-00163-9 ◽

2021 ◽

Vol 27 (1) ◽

Author(s):

Said Alfin Khalilullah ◽

Untung Tranggono ◽

Ahmad Zulfan Hendri ◽

R. Danarto

Keyword(s):

Postoperative Complications ◽

Length Of Stay ◽

Radical Cystectomy ◽

Urinary Diversion ◽

Operative Time ◽

Ileal Conduit ◽

Multivariable Logistic Regression Analysis ◽

Complication Rates ◽

Advantages And Disadvantages ◽

Stoma Stenosis

Abstract Background Most of the outcomes after radical cystectomy (RC) are directly associated with the type of urinary diversion. This study sets out to evaluate the outcomes of ileal conduit (IC) and transuretero-cutaneostomy (TUC) urinary diversion after RC. Methods This retrospective study included 52 patients (IC, n = 30; TUC, n = 22) at Dr. Sardjito Hospital between January 2014 and December 2019. The clinical outcomes were compared using Chi-squared tests and independent t tests. Multivariable logistic regression analysis was performed to determine the odds of developing related complications. Results Demographically, both groups were similar in terms of age, gender, ASA score, staging, body mass index, and comorbidities. IC was associated with a high incidence of postoperative complications than TUC (56.7% vs. 27.3%; p = 0.035). Long-term postoperative complications stoma stenosis was more common in the TUC than IC (p = 0.010). Multivariate analysis showed TUC was a significant predictor for stoma stenotic with odds ratio of 1.29 (95% confidence interval, 1.03–1.62; p = 0.006). Meanwhile, metabolic change was found higher in IC (p = 0.047). No difference between the rate of required blood transfusion, postoperative ileus, re-operation, and anastomotic stricture in both groups. Operative time (p = 0.000) and length of stay (p = 0.002) were lower in patients who underwent TUC. The hospitalized cost was also lower in TUC ($ 2311.8 ± 1448 for IC vs. $ 1844.2 ± 948.8 for TUC; p = 0.005). Nonetheless, the follow-up cost was higher in the TUC but not statistically significant. Additionally, there was no difference between the overall satisfaction and diversion-related symptoms scores in both groups. The psychological score was better in IC groups. Conclusions Both of these techniques can be an option in a urinary diversion after RC with various advantages and disadvantages. TUC provides reduced complication rates, operative time, shorter length of stay, and hospitalized costs, but IC may reduce postoperative stoma stenosis complications and better psychological function.

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Feasibility of Same Day Discharge Post-Peroral Endoscopic Myotomy

Digestive Disease Interventions ◽

10.1055/s-0041-1723802 ◽

2021 ◽

Author(s):

Kara DiJoseph ◽

Carl Manzo ◽

Eric Pauli ◽

Abraham Mathew

Keyword(s):

Clinical Experience ◽

Successful Treatment ◽

Peroral Endoscopic Myotomy ◽

Complication Rates ◽

Single Institution ◽

Readmission Rates ◽

Same Day Discharge ◽

Endoscopic Myotomy ◽

Discharge Protocol

AbstractPeroral endoscopic myotomy (POEM) has emerged as a successful treatment for achalasia and other spastic disorders of the esophagus. With clinical experience, a same day discharge protocol has been developed. Readmission rates and postprocedural complications related to POEM procedures at a single institution were compared in patients discharged same day versus overnight observation. A total of 66 patients were discharged within hours after the procedure while 88 were admitted for monitoring overnight; no differences in readmissions or complications were identified. Same day discharge after POEM is relatively safe and has no difference in readmission or complication rates compared with overnight observations.

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Did the COVID-19 Pandemic Prolong the Time Till Diagnosis and Worsen Outcomes for Children with Acute Appendicitis?

Medicina ◽

10.3390/medicina57111234 ◽

2021 ◽

Vol 57 (11) ◽

pp. 1234

Author(s):

Idilė Vansevičienė ◽

Danielė Bučinskaitė ◽

Dalius Malcius ◽

Aušra Lukošiūtė-Urbonienė ◽

Mindaugas Beržanskis ◽

...

Keyword(s):

Postoperative Complications ◽

Length Of Stay ◽

Acute Appendicitis ◽

Emergency Room ◽

Pediatric Surgery ◽

Operation Time ◽

Complicated Appendicitis ◽

Complication Rates ◽

Outcomes For Children ◽

Surgery Department

Background and Objectives: Our aim was to see if the COVID-19 pandemic led to an increase of time until diagnosis, operation, and time spent in Emergency room (ER), and if it resulted in more cases of complicated appendicitis and complication rates in children. Materials and Methods: We conducted a retrospective analysis of patients admitted to the Pediatric Surgery Department with acute appendicitis during a 4-month period of the first COVID-19 pandemic and compared it to the previous year data—the same 4-month period in 2019. Results: During the pandemic, the time spent in the ER until arriving at the department increased significantly 2.85 vs. 0.98 h p < 0.001, and the time spent in the department until the operation 5.31 vs. 2.66 h, p = 0.03. However, the time from the beginning of symptoms till ER, operation time and the length of stay at the hospital, as well as the overall time until operation did not differ and did not result in an increase of complicated appendicitis cases or postoperative complications. Conclusions: The COVID-19-implemented quarantine led to an increase of the time from the emergency room to the operating room by 4 h. This delay did not result in a higher rate of complicated appendicitis and complication rates, allowing for surgery to be postponed to daytime hours if needed.

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A comparison of readmission and complication rates and charges of inpatient and outpatient multiple-level anterior cervical discectomy and fusion surgeries in the Medicare population

Journal of Neurosurgery Spine ◽

10.3171/2019.3.spine181257 ◽

2019 ◽

Vol 31 (4) ◽

pp. 486-492 ◽

Cited By ~ 1

Author(s):

Syed I. Khalid ◽

Ryan Kelly ◽

Rita Wu ◽

Akhil Peta ◽

Adam Carlton ◽

...

Keyword(s):

Postoperative Complications ◽

Geriatric Patients ◽

Anterior Cervical Discectomy ◽

Complication Rates ◽

Outpatient Basis ◽

Readmission Rates ◽

Surgical Interventions ◽

Cervical Discectomy ◽

Outpatient Procedures ◽

Increased Risk

OBJECTIVEThis study aims to assess the relationship of comorbidities and postoperative complications to rates of readmission for geriatric patients undergoing anterior cervical discectomy and fusion (ACDF) involving more than 2 levels on an inpatient or outpatient basis. With the rising costs of healthcare in the United States, understanding the safety and efficacy of performing common surgical interventions (including ACDF) as outpatient procedures could prove to be of great economic impact.Objective This study aims to assess the effect of comorbidities and postoperative complications on the rates of readmission of geriatric patients undergoing multilevel anterior cervical discectomy and fusion (ACDF) procedures (i.e., ACDF involving 3 or more levels) on an inpatient or outpatient basis. Same-day surgery has been demonstrated to be a safe and cost-effective alternative to the traditional inpatient option for many surgical interventions. With the rising costs of healthcare, understanding the safety and efficacy of performing common surgical interventions as outpatient procedures could prove to be of great economic impact.METHODSThe study population included total of 2492 patients: 2348 inpatients and 144 outpatients having ACDF procedures involving 3 or more levels in the Medicare Standard Analytical Files database. Age, sex, comorbidities, postoperative complications, readmission rates, and surgical procedure charges were compared between both cohorts. For selected variables, logistic regression was used to model odds ratios for various comorbidities against readmission rates for both inpatient and outpatient cohorts. Chi-square tests were also calculated to compare these comorbidities with readmission in each cohort.RESULTSOverall complication rates within 30 postoperative days were greater for inpatients than for outpatients (44.2% vs 12.5%, p < 0.001). More inpatients developed postoperative urinary tract infection (7.9% vs 0%, p < 0.001), and the inpatient cohort had increased risk of readmission with comorbidities of anemia (OR 1.52, p < 0.001), smoking (OR 2.12, p < 0.001), and BMI ≥ 30 (OR 1.43, p < 0.001). Outpatients had increased risk of readmission with comorbidities of anemia (OR 2.78, p = 0.047), diabetes mellitus type 1 or 2 (OR 3.25, p = 0.033), and BMI ≥ 30 (OR 3.95, p = 0.008). Inpatients also had increased readmission risk with a postoperative complication of surgical site infection (OR 2.38, p < 0.001). The average charges for inpatient multilevel ACDF were significantly higher than for multilevel ACDF performed on an outpatient basis ($12,734.27 vs $12,152.18, p = 0.0019).CONCLUSIONSThis study suggests that ACDF surgery involving 3 or more levels performed as an outpatient procedure in the geriatric population may be associated with lower rates of readmissions, complications, and surgical charges.

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Reducing ICU Length of Stay: The Impact of a Multidisciplinary Perioperative Pathway in Vestibular Schwannoma

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0040-1722666 ◽

2021 ◽

Author(s):

Robert J. Yawn ◽

Ashley M. Nassiri ◽

Jacqueline E. Harris ◽

Nauman F. Manzoor ◽

Saniya Godil ◽

...

Keyword(s):

Nursing Education ◽

Postoperative Complications ◽

Length Of Stay ◽

Outcome Measures ◽

Vestibular Schwannoma ◽

Quality Care ◽

Secondary Outcome ◽

Readmission Rates ◽

Postoperative Rehabilitation ◽

The Impact

Abstract Objective This study was aimed to evaluate the impact of a multidisciplinary perioperative pathway on length of stay (LOS) and postoperative outcomes after vestibular schwannoma surgery. Setting This study was conducted in a tertiary skull base center. Main Outcome Measures The impact of the pathway on intensive care unit (ICU) LOS was evaluated as the primary outcome measure of the study. Overall resource LOS, postoperative complications, and readmission rates were also evaluated as secondary outcome measures. Methods Present study is a retrospective review. Results A universally adopted perioperative pathway was developed to include standardization of preoperative education and expectations, intraoperative anesthetic delivery, postoperative nursing education, postoperative rehabilitation, and utilization of stepdown and surgical floor units after ICU stay. Outcomes were measured for 95 consecutive adult patients who underwent surgical resection for vestibular schwannoma (40 cases before implementation of the perioperative pathway and 55 cases after implementation). There were no significant differences in the two groups with regard to tumor size, operative time, or medical comorbidities. The mean ICU LOS decreased from 2.1 in the preimplementation group to 1.6 days in the postimplementation group (p = 0.02). There were no significant differences in overall resource LOS postoperative complications or readmission rates between groups. Conclusion Multidisciplinary, perioperative neurotologic pathways can be effective in lowering ICU LOS in patients undergoing vestibular schwannoma surgery without compromising quality of care. Further research is needed to continue to sustain and continuously improve these and other measures, while continuing to provide high-quality care to this patient population.

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