Risk Factors for Prolonged Hospital Stay and In-Hospital Mortality in Hip Fracture Patients Aged Over 65 Years: A Composite Endpoint Analysis

Abstract Objectives : This study aimed to determine the risk factors that increase the risk of in-hospital mortality and/or prolonged hospital stay in hip fracture patients aged over 65 years. Methods : We conducted a retrospective study of patients aged over 65 years who underwent hip fracture surgery in the period from January 2015 to December 2017. Our analysis included 54 variables related to medical, psychological, functional and laboratory comorbidities present at admission; treatment, complications and laboratory follow-up during the hospital stay; and functional status and destination on discharge. We performed a bivariate analysis and a multivariate analysis with a composite endpoint combining in-hospital mortality and hospital stay lasting more than 10 days. Results : We included 360 patients with an average age of 84 years. Women accounted for 75% of the sample, and 53.5% of all patients had a pertrochanteric fracture. The mean number of comorbidities per patient was 2.72, and the most common comorbidities were high blood pressure, dementia and diabetes. The rate of in-hospital mortality was 3.6% (n 13) and the mean length of hospital stay was 8.48 days, with 16.4% of patients staying in hospital for more than 10 days. Medical complications, lower hemoglobin on admission, high blood pressure, obesity and Parkinson’s disease were significantly associated with our endpoint in the multivariate analysis Conclusions : Patients who suffer medical complications during hospitalization, and those with lower hemoglobin on admission, high blood pressure, obesity or Parkinson’s disease, have an increased risk of in-hospital mortality or prolonged hospital stay

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Prognostic Significance Of Serum Urea Concentration at Admission in older patients with hip fracture

The Open Orthopaedics Journal ◽

10.2174/1874325001812010536 ◽

2018 ◽

Vol 12 (1) ◽

pp. 536-553

Author(s):

Alexander Fisher ◽

Leon Fisher ◽

Wichat Srikusalanukul ◽

Paul N Smith

Keyword(s):

Hip Fracture ◽

Inflammatory Response ◽

Hospital Mortality ◽

Hospital Stay ◽

Prognostic Significance ◽

Elevated Serum ◽

Prognostic Impact ◽

Prolonged Hospital Stay ◽

Serum Urea ◽

Prolonged Hospital

Background:There are unmet needs in objective prognostic indicators for Hip Fracture (HF) outcomes.Objectives:To evaluate the determinants and prognostic impact of elevated serum urea, a key factor of nitrogen homeostasis, in predicting hospital mortality, inflammatory complications and length of stay in HF patients.Methods:In 1819 patients (mean age 82.8±8.1 years; 76.4% women) with osteoporotic HF, serum urea level at admission along with 22 clinical and 35 laboratory variables were analysed and outcomes recorded. The results were validated in a cohort of 455 HF patients (age 82.1±8.0 years, 72.1% women).Results:Elevated serum urea levels (>7.5mmol/L) at admission were prevalent (44%), independently determined by chronic kidney disease, history of myocardial infarction, anaemia, hyperparathyroidism, advanced age and male gender, and significantly associated with higher mortality (9.4% vs. 3.3%, p<0.001), developing a high postoperative inflammatory response (HPIR, 22.1% vs.12.1%, p=0.009) and prolonged hospital stay (>20 days: 31.2% vs. 26.2%, p=0.021). The predictive value of urea was superior to other risk factors, most of which lost their discriminative ability when urea levels were normal. Patients with two abnormal parameters at admission, compared to subjects with the normal ones, had 3.6-5.6 -fold higher risk for hospital mortality, 2.7-7.8-fold increase in risk for HPIR and 1.3-1.7-fold higher risk for prolonged hospital stay. Patients with increased admission urea and a high inflammatory response had 9.7 times greater mortality odds compared to patients without such characteristics.Conclusion:In hip fracture patients admission serum urea is an independent and valuable predictor of hospital outcomes, in particular, mortality.

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Intraoperative hypotension is not associated with adverse short-term postoperative outcomes after esophagectomy in esophageal cancer patients

10.21203/rs.3.rs-37807/v3 ◽

2020 ◽

Author(s):

Ephraim Teffera Yeheyis ◽

Seyoum Kassa ◽

Hiwot Yeshitila ◽

Abebe Bekele

Keyword(s):

Blood Pressure ◽

Esophageal Cancer ◽

Systolic Blood Pressure ◽

Hospital Stay ◽

Anastomotic Leak ◽

Adverse Outcomes ◽

Prolonged Hospital Stay ◽

Intraoperative Hypotension ◽

The Mean ◽

Prolonged Hospital

Abstract Background The effect of low systolic blood pressure and its subsequent postoperative outcome during esophagectomy for esophageal cancer is not well studied. Methods Prospective study was conducted and data were collected on patients who underwent esophagectomy and esophagogastrostomy for esophageal cancer. Intraoperative Hypotension (IOH), defined as Systolic Blood Pressure (SBP) < 90 mm Hg lasting more than 5 minutes, was recorded. Patients’ 30 days post-operative composite outcome of mortality, anastomotic leak and prolonged hospital stay were analyzed as outcome variables Result A total of 54 patients underwent esophagectomy for esophageal cancer during the study period. The mean age was 54 years. The mean duration of the surgery was 208 minutes. Intraoperative mean low SBP was 80mmHg while the lowest record was 55 mmHg. IOH occurred in 51 % (n=29) of patients. Anastomotic leak occurred in 7% (n=4) (OR 1.2, 95% CI 0.26-6.3; p=0.76) . In-hospital mortality was 5 % (n=3) (OR 1.44, 95% CI 0.22- 9.3; p =0.7) and 33 % (n=18) had prolonged hospital stay (OR 0.53, 95% CI 0.14- 1.9; p=0.34 ).The overall anastomotic leak rate was 13% (n=7). The 30 days operative mortality was 9% and 55 % (30) of patients had prolonged hospital stay. Multivariate analysis (logistic regression model) showed SBP < 90mmHg for more than 5 minutes was not significantly associated either with individual or composite outcomes of mortality, anastomotic leak, and prolonged hospital stay (AOR 1.06, 95% CI 0.98-1.14; p=0.16) Conclusion In patients undergoing esophagectomy for esophageal cancer, a systolic blood pressure < 90 mm Hg for greater than 5 minutes during surgery has no significant statistical association with composite adverse outcomes of mortality, anastomotic leak, and prolonged hospital stay.

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Intraoperative hypotension is not associated with adverse short-term postoperative outcomes after esophagectomy in esophageal cancer patients

BMC Surgery ◽

10.1186/s12893-020-01015-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Ephraim Teffera Yeheyis ◽

Seyoum Kassa ◽

Hiwot Yeshitela ◽

Abebe Bekele

Keyword(s):

Blood Pressure ◽

Esophageal Cancer ◽

Systolic Blood Pressure ◽

Hospital Stay ◽

Anastomotic Leak ◽

Adverse Outcomes ◽

Prolonged Hospital Stay ◽

Intraoperative Hypotension ◽

The Mean ◽

Prolonged Hospital

Abstract Background The effect of low systolic blood pressure and its subsequent postoperative outcome during esophagectomy for esophageal cancer is not well studied. Methods A prospective study was conducted and data were collected on patients who underwent esophagectomy and esophagogastric anastomosis for esophageal cancer. Intraoperative hypotension (IOH), defined as systolic blood pressure (SBP) < 90 mm Hg lasting more than 5 min, was recorded. Patients’ 30 days post-operative composite outcome of mortality, anastomotic leak, and prolonged hospital stay were analyzed as outcome variables. Result A total of 54 patients underwent esophagectomy for esophageal cancer during the study period. The mean age was 54 years. The mean duration of the surgery was 208 min. Intraoperative mean low SBP was 80 mmHg while the lowest record was 55 mmHg. IOH occurred in 51% (n = 29) of patients. Anastomotic leak occurred in 7% (n = 4) (OR 1.2, 95% CI 0.26–6.3; p = 0.76). In-hospital mortality was 5% (n = 3) (OR 1.44, 95% CI 0.22–9.3; p = 0.7) and 33% (n = 18) had prolonged hospital stay (OR 0.53, 95% CI 0.14–1.9; p = 0.34). The overall anastomotic leak rate was 13% (n = 7). Multivariate analysis (logistic regression model) showed SBP < 90 mmHg for more than 5 min was not significantly associated either with individual or composite outcomes of mortality, anastomotic leak, and prolonged hospital stay (AOR 1.06, 95% CI 0.98–1.14; p = 0.16) Conclusion In patients undergoing esophagectomy for esophageal cancer, a systolic blood pressure < 90 mm Hg for greater than 5 min during surgery has no significant statistical association with composite adverse outcomes of mortality, anastomotic leak, and prolonged hospital stay.

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Intraoperative hypotension is not associated with adverse short-term postoperative outcomes after esophagectomy in esophageal cancer patients

10.21203/rs.3.rs-37807/v2 ◽

2020 ◽

Author(s):

Ephraim Teffera Yeheyis ◽

Seyoum Kassa ◽

Hiwot Yeshitila ◽

Abebe Bekele

Keyword(s):

Blood Pressure ◽

Esophageal Cancer ◽

Systolic Blood Pressure ◽

Hospital Stay ◽

Anastomotic Leak ◽

Adverse Outcomes ◽

Prolonged Hospital Stay ◽

Intraoperative Hypotension ◽

The Mean ◽

Prolonged Hospital

Abstract Background The effect of low systolic blood pressure and its subsequent postoperative outcome during esophagectomy for esophageal cancer is not well studied.MethodsA prospective study was conducted and data were collected on patients who underwent esophagectomy and esophagogastrostomy for esophageal cancer. Intraoperative Hypotension (IOH), defined as Systolic Blood Pressure (SBP) < 90 mm Hg lasting more than 5 minutes, was recorded. Patients’ 30 days post-operative composite outcome of mortality, anastomotic leak, and prolonged hospital stay were analyzed as outcome variables.ResultA total of 54 patients underwent esophagectomy for esophageal cancer during the study period. The mean age was 54 years. The mean duration of the surgery was 208 minutes. Intraoperative mean low SBP was 80mmHg while the lowest record was 55 mmHg. IOH occurred in 51 % (n=29) of patients. Anastomotic leak occurred in 7% (n=4) (OR 1.2, 95% CI 0.26-6.3; p=0.76). In-hospital mortality was 5 % (n=3) (OR 1.44, 95% CI 0.22- 9.3; p=0.7) and 33 % (n=18) had prolonged hospital stay (OR 0.53, 95% CI 0.14- 1.9; p=0.34).The overall anastomotic leak rate was 13% (n=7). The 30 days operative mortality was 9% and 55 % (30) of patients had prolonged hospital stay. Multivariate analysis (logistic regression model) showed SBP < 90mmHg for more than 5 minutes was not significantly associated either with individual or composite outcomes of mortality, anastomotic leak, and prolonged hospital stay (AOR 1.06, 95% CI 0.98-1.14; p=0.16)ConclusionIn patients undergoing esophagectomy for esophageal cancer, a systolic blood pressure < 90 mm Hg for greater than 5 min during surgery has no significant statistical association with composite adverse outcomes of mortality, anastomotic leak, and prolonged hospital stay.

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Prolonged hospital stay before hip fracture surgery in the elderly: a single parameter but multiple roles

International Orthopaedics ◽

10.1007/s00264-017-3689-6 ◽

2017 ◽

Vol 42 (2) ◽

pp. 447-448

Author(s):

Paolo Mazzola

Keyword(s):

Hip Fracture ◽

Hospital Stay ◽

The Elderly ◽

Multiple Roles ◽

Single Parameter ◽

Prolonged Hospital Stay ◽

Hip Fracture Surgery ◽

Surgery In The Elderly ◽

Prolonged Hospital ◽

Fracture Surgery

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Pressure Ulcers and Prolonged Hospital Stay in Hip Fracture Patients Affected by Time-to-Surgery

European Journal of Trauma and Emergency Surgery ◽

10.1007/s00068-007-6212-8 ◽

2007 ◽

Vol 33 (3) ◽

pp. 238-244 ◽

Cited By ~ 18

Author(s):

Leonard M. F. Rademakers ◽

Tryfon Vainas ◽

Stefan W. A. M. Zutphen ◽

Peter R. G. Brink ◽

Sven H. Helden

Keyword(s):

Hip Fracture ◽

Hospital Stay ◽

Pressure Ulcers ◽

Prolonged Hospital Stay ◽

Time To Surgery ◽

Prolonged Hospital

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Maximal diameter of liver abscess independently predicts prolonged hospitalization and poor prognosis in patients with pyogenic liver abscess

BMC Infectious Diseases ◽

10.1186/s12879-021-05873-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Chang Hun Lee ◽

Hoon Gil Jo ◽

Eun Young Cho ◽

Jae Sun Song ◽

Gum Mo Jung ◽

...

Keyword(s):

Hospital Mortality ◽

Hospital Stay ◽

Liver Abscess ◽

Poor Prognosis ◽

Pyogenic Liver Abscess ◽

Prolonged Hospital Stay ◽

Factors Associated ◽

Prolonged Hospitalization ◽

Maximal Diameter ◽

Prolonged Hospital

Abstract Background/aims This study aimed to investigate the factors associated with prolonged hospital stay and in-hospital mortality in patients with pyogenic liver abscess. Methods We retrospectively reviewed data from patients with pyogenic liver abscess who were admitted between 2005 and 2018 at three tertiary hospitals in Jeonbuk province, South Korea. Prolonged hospital stay was defined as a duration of hospital admission of more than 21 days. Results A total of 648 patients (406 men and 242 women) diagnosed with pyogenic liver abscess were enrolled in the study. The mean maximal diameter of the liver abscess was 5.4 ± 2.6 cm, and 74.9% of the lesions were single. The three groups were divided according to the maximal diameter of the abscess. Laboratory parameters indicated a more severe inflammatory state and higher incidence of complications and extrahepatic manifestations with increasing abscess size. Rates of percutaneous catheter drainage (PCD) insertion, multiple PCD drainage, and salvage procedures as well as duration of drainage were also higher in the large liver abscess group. Of note, the duration of hospitalization and in-hospital mortality were significantly higher in the large hepatic abscess group. A multivariate analysis revealed that underlying diabetes mellitus, hypoalbuminemia, high baseline high-sensitivity C-reactive protein (hs-CRP) and procalcitonin levels, and large maximal abscess diameter were independent factors associated with prolonged hospital stay. Regarding in-hospital mortality, acute kidney injury at admission and maximal diameter of the abscess were independent factors associated with in-hospital mortality. Conclusions A large maximal diameter of the liver abscess at admission indicated prolonged hospitalization and poor prognosis. More aggressive treatment strategies with careful monitoring are warranted in patients with large liver abscesses.

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Comparison of QSOFA and SIRS Scores for the Prediction of Adverse Outcomes of Secondary Peritonitis in a Tertiary Teaching Hospital in Uganda: a Prospective Cohort Study

10.21203/rs.3.rs-537264/v1 ◽

2021 ◽

Author(s):

Emmanuel Nkonge ◽

Olivia Kituuka ◽

William Ocen

Keyword(s):

Cohort Study ◽

Hospital Mortality ◽

Hospital Stay ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Adverse Outcomes ◽

Secondary Peritonitis ◽

Mulago Hospital ◽

Prolonged Hospital Stay ◽

Prolonged Hospital

Abstract Background: SIRS and qSOFA are two ancillary scoring tools that have been used globally, inside and outside of ICU to predict adverse outcomes of infections such as secondary peritonitis. Mulago hospital uses SIRS outside the ICU to identify patients with secondary peritonitis, who are at risk of adverse outcomes. However it’s associated with delays in decision making given its partial reliance on laboratory parameters. In response to the practical limitations of SIRS, the sepsis-3 task force recommends qSOFA as a better tool, however its performance in patients with secondary peritonitis in comparison to that of SIRS has not been evaluated in Mulago hospital, Uganda.Objective: To compare the performance of qSOFA and SIRS scores in predicting adverse outcomes of secondary peritonitis in Mulago hospital, Uganda.Methods: This was a prospective cohort study of patients with clinically confirmed secondary peritonitis, from March 2018 to January 2019 at the A&E, Mulago hospital. QSOFA and SIRS scores were generated for each of the patient, with a score of ≥ 2 recorded as high risk, while a score of ≤ 2 recorded as low risk for the adverse outcome respectively. After surgery, patients were followed up until discharge or death. In-hospital mortality and prolonged hospital stay were the primary and secondary adverse outcomes, respectively. Sensitivity, specificity, PPV, NPV and accuracy at 95% confidence interval were calculated for each of the scores using STATA v.13Results: A total of 153 patients were enrolled. Of these, 151(M: F, 2.4:1) completed follow up and were analysed, 2 were excluded. Mortality rate was 11.9%. Fourty (26.5%) patients had a prolonged hospital stay. QSOFA predicted in-hospital mortality with AUROC of 0.52 versus 0.62, for SIRS. Similarly, qSOFA predicted prolonged hospital stay with AUROC of 0.54 versus 0.57, for SIRS.Conclusion: SIRS is superior to qSOFA in predicting both mortality and prolonged hospital stay among patients with secondary peritonitis. However, overall, both scores showed a poor discrimination for both adverse outcomes and therefore not ideal tools.

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