scholarly journals A Propensity-Score Matched Analysis Comparing Outpatient and Short-Stay Hospitalization to Standard Inpatient Hospitalization Following Total Ankle Arthroplasty

2020 ◽  
Author(s):  
Mark A. Plantz ◽  
Alain Emil Sherman ◽  
Anish R. Kadakia
Keyword(s):  
Propensity Score ◽  
Hospital Length ◽  
Total Ankle Arthroplasty ◽  
Hospital Length Of Stay ◽  
Unplanned Readmission ◽  
Short Stay ◽  
Short Term ◽  
Inpatient Hospitalization ◽  
Ankle Arthroplasty ◽  
Significant Difference

Abstract Background Given the trend toward value-based care, there has been increased interest in minimizing hospital length of stay (LOS) after orthopaedic procedures. Outpatient total ankle arthroplasty (TAA) has become more popular in recent years; however, research on surgical outcomes of this procedure has been limited. This study sought to emply large sample, propensity-score matched analyses to assess the safety of outpatient and short-stay discharge pathways following TAA. Methods The ACS NSQIP database was used to identify 1,141 patients who underwent primary and revision TAA between 2007 and 2017. Propensity score matching was used to match patients based on several factors, including age, sex, body mass index (BMI), American Society of Anesthesiologists (ASA) classification, and several comorbidities. The incidence of various 30-day complications were compared between the short and standard LOS groups to assess for any differences in short-term outcomes. Results A total of 892 patients were included in the final propensity score matched analysis, with 446 patients in each group. The short LOS group had a significantly lower rate of medical complications (0.2% vs. 2.5%, p = 0.006) and non-home discharge (1.3% vs. 12.1%, p < 0.001). There was no significant difference in operative complications (0.4% vs. 1.8%, p = 0.107), unplanned readmission (0.4% vs. 1.1%, p = 0.451), reoperation (0.2% vs. 0.4%, p > 0.999), return to the OR (0.2% vs. 0.9%, p = 0.374), or mortality (0.7% vs. 0.0%, p > 0.249) between the short and standard LOS groups. Conclusions Outpatient and short-stay hospitalization had comparable safety to standard inpatient hospitalization after TAA. Outpatient or short-stay TAA should be considered for patients with low risk of short-term complications.

scholarly journals A Propensity Score Matched Analysis Comparing Outpatient and Short-Stay Hospitalization to Standard Inpatient Hospitalization Following Total Ankle Arthroplasty

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0006
Author(s):  
Mark A. Plantz ◽  
Alain E. Sherman ◽  
Anish R. Kadakia
Keyword(s):  
Length Of Stay ◽  
Propensity Score ◽  
Surgical Complications ◽  
Unplanned Readmission ◽  
Short Stay ◽  
Short Term ◽  
Improvement Program ◽  
Inpatient Hospitalization ◽  
Area Of Interest ◽  
American Society

Category: Ankle Introduction/Purpose: The number of total ankle arthroplasties (TAAs) performed annually has continued to increase over the last two decades. Given the current challenges of healthcare cost-control, the trend towards minimizing hospitalization and length of stay (LOS) after various procedures, including joint replacement, has become an area of interest. Currently, there are no large sample, propensity score matched analyses to assess the safety of ‘short-stay’ versus standard inpatient hospitalization following TAA. Methods: The American College of Surgeons’ National Surgical Quality Improvement Program (ACS NSQIP) was used to identify 1,141 patients who underwent primary and revision TAA between 2007 and 2017. Propensity score matching was used to compare the risk of 30-day unplanned readmission, reoperation, mortality, discharge destination, and several medical and surgical complications in patients with outpatient or short-stay inpatient hospitalization (LOS <= 1 day) versus standard inpatient hospitalization (LOS > 1 day). Patients were matched in a 1:1 ratio based on several factors, including age, sex, body mass index (BMI), American Society of Anesthesiologists (ASA) classification, and several comorbidities (diabetes, smoking, COPD, congestive heart failure, hypertension, dialysis, and chronic steroid use). The incidence of various 30-day complications were compared between the two propensity score matched groups to assess for any differences in short-term outcomes after controlling for confounding risk factors. Results: A total of 892 patients were included in the propensity-score matched analysis, with 446 patients per group. The shorter LOS group had a significantly lower rate of medical complications (0.2% vs. 2.8%, p = 0.004) and non-home discharge (1.3% vs. 12.1%, <0.001). Additionally, the shorter LOS group had lower rates of unplanned readmission (0.4% vs. 1.1%, p = 0.256), reoperation (0.2% vs. 0.4%, p = 0.564), return to the OR (0.2% vs. 0.9%, p = 0.179), and surgical complications (0.4% vs. 2.0%, p = 0.057), although these results were not statistically significant. Conclusion: Propensity score matched comparative analysis demonstrated that outpatient and short-stay inpatient hospitalization can be just as safe as standard inpatient hospitalization after TAA. Length of stay should be dictated by the overall risk of complication. Outpatient or short-stay TAA should be considered for patients with low risk of short-term complications. [Table: see text]

30-Day Outcomes for Total Ankle Arthroplasty in Patients With Anemia

2021 ◽  
pp. 107110072110175
Author(s):  
Jordan R. Pollock ◽  
Matt K. Doan ◽  
M. Lane Moore ◽  
Jeffrey D. Hassebrock ◽  
Justin L. Makovicka ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Univariate Analysis ◽  
Hospital Length ◽  
Total Ankle Arthroplasty ◽  
Hospital Length Of Stay ◽  
Preoperative Anemia ◽  
Improvement Project ◽  
Average Hospital ◽  
Ankle Arthroplasty ◽  
Reoperation Rates

Background: While anemia has been associated with poor surgical outcomes in total knee arthroplasty and total hip arthroplasty, the effects of anemia on total ankle arthroplasty remain unknown. This study examines how preoperative anemia affects postoperative outcomes in total ankle arthroplasty. Methods: A retrospective analysis was performed using the American College of Surgeons National Surgery Quality Improvement Project database from 2011 to 2018 for total ankle arthroplasty procedures. Hematocrit (HCT) levels were used to determine preoperative anemia. Results: Of the 1028 patients included in this study, 114 patients were found to be anemic. Univariate analysis demonstrated anemia was significantly associated with an increased average hospital length of stay (2.2 vs 1.8 days, P < .008), increased rate of 30-day readmission (3.5% vs 1.1%, P = .036), increased 30-day reoperation (2.6% vs 0.4%, P = .007), extended length of stay (64% vs 49.9%, P = .004), wound complication (1.75% vs 0.11%, P = .002), and surgical site infection (2.6% vs 0.6%, P = .017). Multivariate logistic regression analysis found anemia to be significantly associated with extended hospital length of stay (odds ratio [OR], 1.62; 95% CI, 1.07-2.45; P = .023) and increased reoperation rates (OR, 5.47; 95% CI, 1.15-26.00; P = .033). Anemia was not found to be a predictor of increased readmission rates (OR, 3.13; 95% CI, 0.93-10.56; P = .066) or postoperative complications (OR, 1.27; 95% CI, 0.35-4.56; P = .71). Conclusion: This study found increasing severity of anemia to be associated with extended hospital length of stay and increased reoperation rates. Providers and patients should be aware of the increased risks of total ankle arthroplasty with preoperative anemia. Level of Evidence: Level III, retrospective comparative study.

Short-Term Outcomes of Primary Total Ankle Arthroplasty in Octogenarians: A National Database Analysis

2020 ◽  
pp. 193864002096054
Author(s):  
Matthew Partan ◽  
Nicholas Frane ◽  
Cesar Iturriaga ◽  
Prashant Matai ◽  
Adam Bitterman
Keyword(s):  
Risk Factors ◽  
The Elderly ◽  
Adverse Outcomes ◽  
Total Ankle Arthroplasty ◽  
Hospital Length Of Stay ◽  
National Database ◽  
Short Term ◽  
Ankle Arthroplasty ◽  
Increased Risk ◽  
Independent Risk Factors

Background Total ankle arthroplasty (TAA) is an increasingly popular option for end-stage ankle arthritis. Americans over the age of 80 years grew to 16.7 million in 2010, but there are scarce data assessing the outcomes of octogenarians undergoing TAA. This study evaluated (1) perioperative factors, (2) 30-day postoperative complications compared to a nonoctogenarian cohort, and (3) independent risk factors for adverse outcomes. Methods A national database registry was queried for patients who had undergone primary TAA. This yielded 1113 patients, under (n = 1059) and over (n = 54) age 80 years. Demographics and perioperative data were compared using Fisher’s exact, χ2, and independent-samples t tests. Logistic and Poisson regressions were used to calculate odds ratio (OR) of complications and independent risk factors. Results The octogenarian cohort had longer in-hospital length of stay (1.9 vs 2.5 days, P < .0001). Octogenarians were not significantly more likely to develop any complication (OR = 1.32; 95% confidence interval = 0.29-6.04; P = .722), or increased number of complications (OR = 1.18; 95% CI = 0.27-5.18; P = .820). Octogenarians had significantly increased risk of being discharged to rehab/skilled nursing (OR = 6.60; 95% CI = 2.16-20.15; P < .001) instead of home. Conclusion Although the elderly population may carry inherent risk factors, octogenarians do not present an increased risk of short-term complications following TAA. Levels of Evidence Therapeutic, Level III: Retrospective cohort study.

scholarly journals Mortality after cardiopulmonary resuscitation on a medical ICU

2021 ◽  
Author(s):  
Richard Rezar ◽  
Bernhard Wernly ◽  
Michael Haslinger ◽  
Clemens Seelmaier ◽  
Philipp Schwaiger ◽  
...  
Keyword(s):  
Cardiopulmonary Resuscitation ◽  
Neurological Outcome ◽  
Cox Regression ◽  
Cerebral Performance Category ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Study Endpoint ◽  
Primary Study ◽  
Postresuscitation Care ◽  
Significant Difference

Summary Background Performing cardiopulmonary resuscitation (CPR) and postresuscitation care in the intensive care unit (ICU) are standardized procedures; however, there is evidence suggesting sex-dependent differences in clinical management and outcome variables after cardiac arrest (CA). Methods A prospective analysis of patients who were hospitalized at a medical ICU after CPR between December 2018 and March 2020 was conducted. Exclusion criteria were age < 18 years, hospital length of stay < 24 h and traumatic CA. The primary study endpoint was mortality after 6 months and the secondary endpoint neurological outcome assessed by cerebral performance category (CPC). Differences between groups were calculated by using U‑tests and χ2-tests, for survival analysis both univariate and multivariable Cox regression were fitted. Results A total of 106 patients were included and the majority were male (71.7%). No statistically significant difference regarding 6‑month mortality between sexes could be shown (hazard risk, HR 0.68, 95% confidence interval, CI 0.35–1.34; p = 0.27). Neurological outcome was also similar between both groups (CPC 1 88% in both sexes after 6 months; p = 1.000). There were no statistically significant differences regarding general characteristics, pre-existing diseases, as well as the majority of clinical and laboratory parameters or measures performed on the ICU. Conclusion In a single center CPR database no statistically significant sex-specific differences regarding post-resuscitation care, survival and neurological outcome after 6 months were observed.

scholarly journals Does emergency medicine length of stay predict trauma outcomes at a Level 1 Trauma Center?

2015 ◽  
Vol 4 (5) ◽  
pp. 1 ◽  
Author(s):  
Erin Powers Kinney ◽  
Kamal Gursahani ◽  
Eric Armbrecht ◽  
Preeti Dalawari
Keyword(s):  
Length Of Stay ◽  
Trauma Center ◽  
Injury Severity ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Trauma Patients ◽  
Hospital Capacity ◽  
Significant Difference ◽  
Level 1 ◽  
Level 1 Trauma Center

Objective: Previous studies looking at emergency department (ED) crowding and delays of care on outcome measures for certain medical and surgical patients excluded trauma patients. The objectives of this study were to assess the relationship of trauma patients’ ED length of stay (EDLOS) on hospital length of stay (HLOS) and on mortality; and to examine the association of ED and hospital capacity on EDLOS.Methods: This was a retrospective database review of Level 1 and 2 trauma patients at a single site Level 1 Trauma Center in the Midwest over a one year period. Out of a sample of 1,492, there were 1,207 patients in the analysis after exclusions. The main outcome was the difference in hospital mortality by EDLOS group (short was less than 4 hours vs. long, greater than 4 hours). HLOS was compared by EDLOS group, stratified by Trauma Injury Severity Score (TRISS) category (< 0.5, 0.51-0.89, > 0.9) to describe the association between ED and hospital capacity on EDLOS.Results: There was no significant difference in mortality by EDLOS (4.8% short and 4% long, p = .5). There was no significant difference in HLOS between EDLOS, when adjusted for TRISS. ED census did not affect EDLOS (p = .59), however; EDLOS was longer when the percentage of staffed hospital beds available was lower (p < .001).Conclusions: While hospital overcrowding did increase EDLOS, there was no association between EDLOS and mortality or HLOS in leveled trauma patients at this institution.

scholarly journals Effects of statins on clinical outcomes in hospitalized patients with community-acquired pneumonia

2020 ◽  
Vol 48 (8) ◽  
pp. 030006052093858
Author(s):  
Rony M. Zeenny ◽  
Hanine Mansour ◽  
Wissam K Kabbara ◽  
Nibal Chamoun ◽  
Myriam Audi ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Length Of Stay ◽  
Hospital Length ◽  
Community Acquired Pneumonia ◽  
Hospital Length Of Stay ◽  
Comorbid Conditions ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Significant Difference ◽  
Chronic Use

Objective We evaluated the effect of chronic use of statins based on C-reactive protein (CRP) levels and hospital length of stay (LOS) in patients admitted with community-acquired pneumonia (CAP). Methods We conducted a retrospective study over 12 months at a teaching hospital in Lebanon comparing patients with CAP taking chronic statins with patients not taking statins. Included patients with CAP were older than age 18 years and had two CRP level measures during hospitalization. CURB-65 criteria were used to assess the severity of pneumonia. A decrease in CRP levels on days 1 and 3, LOS, and normalization of fever were used to assess the response to antibiotics. Results Sixty-one patients were taking statins and 90 patients were not taking statins. Patients on statins had significantly more comorbid conditions; both groups had comparable CURB-65 scores. In both groups, no statistically significant difference was seen for the decrease in CRP level on days 1 and 3 and LOS. No difference in days to normalization of fever was detected in either group. Conclusion No association was found between the chronic use of statins and CRP levels, LOS, or days to fever normalization in patients with CAP.

Outcomes of Tube Thoracostomies Performed by Advanced Practice Providers vs Trauma Surgeons

2008 ◽  
Vol 17 (4) ◽  
pp. 357-363 ◽  
Author(s):  
Laura C. Bevis ◽  
Gina M. Berg-Copas ◽  
Bruce W. Thomas ◽  
Donald G. Vasquez ◽  
Ruth Wetta-Hall ◽  
...  
Keyword(s):  
Nurse Practitioners ◽  
Insertion Site ◽  
Physician Assistants ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Complication Rates ◽  
Advanced Practice ◽  
Trauma Centers ◽  
Significant Difference ◽  
Trauma Surgeons

Background The role of advanced registered nurse practitioners and physician assistants in emergency departments, trauma centers, and critical care is becoming more widely accepted. These personnel, collectively known as advanced practice providers, expand physicians’ capabilities and are being increasingly recruited to provide care and perform invasive procedures that were previously performed exclusively by physicians. Objectives To determine whether the quality of tube thoracostomies performed by advanced practice providers is comparable to that performed by trauma surgeons and to ascertain whether the complication rates attributable to tube thoracostomies differ on the basis of who performed the procedure. Methods Retrospective blinded reviews of patients’ charts and radiographs were conducted to determine differences in quality indicators, complications, and outcomes of tube thoracostomies by practitioner type: trauma surgeons vs advanced practice providers. Results Differences between practitioner type in insertion complications, complications requiring additional interventions, hospital length of stay, and morbidity were not significant. The only significant difference was a complication related to placement of the tube: when the tube extended caudad, toward the feet, from the insertion site. Interrater reliability ranged from good to very good. Conclusions Use of advanced practice providers provides consistent and quality tube thoracostomies. Employment of these practitioners may be a safe and reasonable solution for staffing trauma centers.

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