scholarly journals Preoperative Care Assessment of Need Scores Are Associated With Postoperative Mortality and Length of Stay in Veterans Undergoing Knee Replacement

2021 ◽  
Author(s):  
Karthik Raghunathan
Keyword(s):  
Length Of Stay ◽  
Knee Replacement ◽  
Postoperative Mortality ◽  
Preoperative Care ◽  
Care Assessment ◽  
Assessment Of Need

scholarly journals Development of severity-adjusted length of stay in knee replacement surgery

2015 ◽  
Vol 13 (2) ◽  
pp. 215-225
Author(s):  
Sung-Ok Hong ◽  
Young-Teak Kim ◽  
Youn-Hee Choi ◽  
Jong-Ho Park ◽  
Sung-Hong Kang
Keyword(s):  
Length Of Stay ◽  
Knee Replacement ◽  
Knee Replacement Surgery ◽  
Replacement Surgery

The Cardinal Needs Schedule – a modified version of the MRC Needs for Care Assessment Schedule

1995 ◽  
Vol 25 (3) ◽  
pp. 605-617 ◽  
Author(s):  
M. Marshall ◽  
L. I. Hogg ◽  
D. H. Gath ◽  
A. Lockwood
Keyword(s):  
Social Services ◽  
Care Management ◽  
Social Care ◽  
Community Care ◽  
Reliability And Validity ◽  
Systematic Account ◽  
Needs For Care ◽  
Care Assessment ◽  
Modified Schedule ◽  
Assessment Of Need

SYNOPSISThis paper describes a modified version of the MRC Needs for Care Schedule (the Cardinal Needs Schedule), for measuring needs for psychiatric and social care amongst patients with severe psychiatric disorders. The modified schedule has three new features: (i) it is quick and easy to use; (ii) it takes systematic account of the views of patients and their carers; (iii) it defines and identifies need in a way that is concise and easy to interpret. The paper describes why the three new features were considered necessary, and then gives an overview of the structure of the Cardinal Needs Schedule, together with a description of how the three new features were developed. During a study of social services care management the practicality of the modified schedule was investigated and further data were obtained on the reliability and validity of the standardized approach to measuring need, in domains not previously investigated. Because of its speed and simplicity, the Cardinal Needs Schedule offers a new choice to researchers who wish to use a standardized and practical assessment of need in evaluative studies of community care. Examples of the usage of the modified schedule are given in an Appendix.

Malnutrition as a risk factor of adverse postoperative outcomes in patients undergoing hepatic resection: analysis of US hospitals

2021 ◽  
pp. 1-28
Author(s):  
David Uihwan Lee ◽  
Edwin Wang ◽  
Gregory Hongyuan Fan ◽  
David Jeffrey Hastie ◽  
Elyse Ann Addonizio ◽  
...  
Keyword(s):  
Risk Factor ◽  
Postoperative Complications ◽  
Length Of Stay ◽  
Hepatic Resection ◽  
Nearest Neighbor ◽  
Postoperative Mortality ◽  
Wound Complications ◽  
Hospital Death ◽  
Study Approach ◽  
Hospitalization Costs

Abstract In patients with liver cancer or space-occupying cysts, they suffer from malnutrition due to compression of gastric and digestive structures, liver and cancer-mediated dysmetabolism, and impaired nutrient absorption. As proportion of these patients require removal of lesions through hepatic resection, it is important to evaluate the effects of malnutrition on post-hepatectomy outcomes. In our study approach, 2011-2017 National Inpatient Sample was used to isolate in-hospital hepatectomy cases, which were stratified using malnutrition (composite of malnutrition, sarcopenia, and weight loss/cachexia). The malnutrition-absent controls were matched to cases using nearest neighbor propensity score match method and compared to following endpoints: mortality, length of stay, hospitalization costs, and postoperative complications. There were 2531 patients in total who underwent hepatectomy with matched number of controls from the database; following the match, malnutrition cohort (compared to controls) were more likely to experience in-hospital death (6.60% vs 5.25% p<0.049, OR 1.27 95%CI 1.01-1.61), and were more likely to have higher length of stay (18.10d vs 9.32d p<0.001) and hospitalization costs ($278,780 vs $150,812 p<0.001). In terms of postoperative complications, malnutrition cohort was more likely to experience bleeding (6.52% vs 3.87% p<0.001 OR 1.73 95%CI1.34-2.24), infection (6.64% vs 2.49% p<0.001, OR 2.79 95%CI 2.07-3.74), wound complications (4.5% vs 1.38% p<0.001, OR 3.36 95%CI 2.29-4.93), and respiratory failure (9.40% vs 4.11% p<0.001 OR 2.42 95%CI 1.91-3.07). In multivariate, malnutrition was associated with higher mortality (p<0.028, aOR 1.3 95%CI 1.03-1.65). Thus, we conclude that malnutrition is an independent risk factor of postoperative mortality in patients undergoing hepatectomy.

Hospital Costs and Severity of Illness in Three Types of Elective Surgery

1997 ◽  
Vol 86 (1) ◽  
pp. 92-100 ◽  
Author(s):  
Alex Macario ◽  
Terry S. Vitez ◽  
Brian Dunn ◽  
Tom McDonald ◽  
Byron Brown
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Length Of Stay ◽  
Operating Room ◽  
Knee Replacement ◽  
Charlson Comorbidity Index ◽  
Elective Surgery ◽  
Hospital Costs ◽  
Severity Of Illness ◽  
Total Hospital ◽  
Comorbidity Index

Background If patients who are more severely ill have greater hospital costs for surgery, then health-care reimbursements need to be adjusted appropriately so that providers caring for more seriously ill patients are not penalized for incurring higher costs. The authors' goal for this study was to determine if severity of illness, as measured by either the American Society of Anesthesiologists Physical Status (ASA PS) or the comorbidity index developed by Charlson, can predict anesthesia costs, operating room costs, total hospital costs, or length of stay for elective surgery. Methods The authors randomly selected 224 inpatients (60% sampling fraction) having either colectomy (n = 30), total knee replacement (n = 100), or laparoscopic cholecystectomy (n = 94) from September 1993 to September 1994. For each surgical procedure, backward-elimination multiple regression was used to build models to predict (1) total hospital costs, (2) operating room costs, (3) anesthesia costs, and (4) length of stay. Explanatory candidate variables included patient age (years), sex, ASA PS, Charlson comorbidity index (which weighs the number and seriousness of coexisting diseases), and type of insurance (Medicare/Medicaid, managed care, or indemnity). These analyses were repeated for the pooled data of all 224 patients. Costs (not patient charges) were obtained from the hospital cost accounting software. Results Mean total hospital costs were $3,778 (95% confidence interval +/- 299) for laparoscopic cholecystectomy, $13,614 (95% CI +/- 3,019) for colectomy, and $18,788 (95% CI +/- 573) for knee replacement. The correlation (r) between ASA PS and Charlson comorbidity scores equaled 0.34 (P &lt; .001). No consistent relation was found between hospital costs and either of the two severity-of-illness indices. The Charlson comorbidity index (but not the ASA PS) predicted hospital costs only for knee replacement (P = .003). The ASA PS, but not the Charlson index, predicted operating room and anesthesia costs only for colectomy (P &lt; .03). Conclusions Severity of illness, as categorized by ASA PS categories 1-3 or by the Charlson comorbidity index, was not a consistent predictor of hospital costs and lengths of stay for three types of elective surgery. Hospital resources for these lower-risk elective procedures may be expended primarily to manage the consequences of the surgical disease, rather than to manage the patient's coexisting diseases.

Impact of cytoreductive nephretomy on timing of systemic therapy in metastatic kidney cancer.

2017 ◽  
Vol 35 (6_suppl) ◽  
pp. 503-503
Author(s):  
Liam Connor Macleod ◽  
Atreya Dash ◽  
George Schade ◽  
Jonathan D. Harper ◽  
Daniel W. Lin ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Systemic Therapy ◽  
Performance Status ◽  
Postoperative Mortality ◽  
Poor Performance ◽  
Prognostic Models ◽  
Poor Performance Status ◽  
Surgical Morbidity ◽  
Factors Associated ◽  
Node Positive Disease

503 Background: High rates of disease control with systemic therapy (ST) in the post-cytokine era for metastatic renal cell carcinoma (mRCC) cause apprehension that cytoreductive nephrectomy (CN) may delay effective therapy. We therefore evaluated factors associated with early mortality and time to ST after CN. We hypothesized markers of poor performance status and morbid CN would be associated with postoperative mortality and therapeutic delays. Methods: The National Cancer Database was screened for adult mRCC cases having CN followed by ST, years 2006-2013. We classified a delay in systemic therapy as interval > 45 days (median time to ST in the cohort). Multivariable logistic regression was performed, identifying factors associated with perioperative mortality and delays to initiation of ST. Results: Of 10,913 patients with initial CN (45% of mRCC), 30- and 90-day mortality were 3% and 11%, respectively. 6,362 later received ST (87% targeted therapy, 13% immunotherapy), median start was 45 days post-operatively (IQR 9-72), with 73% receiving ST within 30 days of CN. Multivariable factors associated with 30-day mortality included, older age, (OR 2.3, 95% CI 1.5-3.5 for those >75 [referent < 55 years]), Charlson index >0 (OR 1.3, 95% CI 1.0-1.6), lack of insurance (OR 1.9, 95% CI 1.2-2.8 [referent private payer]), node-positive disease (OR 1.4 95% CI 1.1-1.7), length of stay > 90th percentile (> 10 days, OR 3.2, 95% CI 2.0-5.3), larger tumor size (T4 lesion OR 1.7, 95% CI 1.2-2.5 [referent T1]). Delayed ST was associated with travel burden > 50 miles (OR 1.2, 95% CI 1.0-1.4), concurrent metastasectomy (OR 1.3, 95% CI 1.2-1.5), and length of stay > 90th percentile (OR 1.5, 95% CI 1.1-2.3). Conclusions: These data suggest that markers of frailty, more progressive disease, and surgical morbidity may contribute to surgical-related deaths or hinder patients receiving potentially disease-controlling therapy when treated with initial CN in mRCC. Going forward, existing surgical prognostic models could incorporate risks of surgical-related mortality and delay to ST when considering CN.

scholarly journals Factors associated with prolonged length of stay following a total knee replacement in patients aged over 75

2012 ◽  
Vol 36 (8) ◽  
pp. 1601-1608 ◽  
Author(s):  
Shruti Raut ◽  
Stephan Christian Mertes ◽  
Graciela Muniz-Terrera ◽  
Vikas Khanduja
Keyword(s):  
Length Of Stay ◽  
Total Knee Replacement ◽  
Knee Replacement ◽  
Prolonged Length ◽  
Factors Associated ◽  
Total Knee
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