scholarly journals Hospital-acquired conditions: predictors and implications for outcomes following spine tumor resection

2017 ◽  
Vol 27 (6) ◽  
pp. 717-722 ◽  
Author(s):  
Nikita Lakomkin ◽  
Constantinos G. Hadjipanayis
Keyword(s):  
Risk Factors ◽  
Length Of Stay ◽  
Adverse Events ◽  
Multivariable Analysis ◽  
Tumor Resection ◽  
Improvement Program ◽  
Spine Tumor ◽  
Prolonged Length ◽  
Hospital Acquired Conditions ◽  
Hospital Acquired

OBJECTIVEHospital-acquired conditions (HACs) significantly compromise patient safety, and have been identified by the Centers for Medicare and Medicaid Services as events that will be associated with penalties for surgeons. The mitigation of HACs must be an important consideration during the postoperative management of patients undergoing spine tumor resection. The purpose of this study was to identify the risk factors for HACs and to characterize the relationship between HACs and other postoperative adverse events following spine tumor resection.METHODSThe 2008–2014 American College of Surgeons’ National Surgical Quality Improvement Program database was used to identify adult patients undergoing the resection of intramedullary, intradural extramedullary, and extradural spine lesions via current procedural terminology and ICD-9 codes. Demographic, comorbidity, and operative variables were evaluated via bivariate statistics before being incorporated into a multivariable logistic regression model to identify the independent risk factors for HACs. Associations between HACs and other postoperative events, including death, readmission, prolonged length of stay, and various complications were determined through multivariable analysis while controlling for other significant variables. The c-statistic was computed to evaluate the predictive capacity of the regression models.RESULTSOf the 2170 patients included in the study, 195 (9.0%) developed an HAC. Only 2 perioperative variables, functional dependency and high body mass index, were risk factors for developing HACs (area under the curve = 0.654). Hospital-acquired conditions were independent predictors of all examined outcomes and complications, including death (OR 2.26, 95% CI 1.24–4.11, p = 0.007), prolonged length of stay (OR 2.74, 95% CI 1.98–3.80, p < 0.001), and readmission (OR 9.16, 95% CI 6.27–13.37, p < 0.001). The areas under the curve for these models ranged from 0.750 to 0.917.CONCLUSIONSThe comorbidities assessed in this study were not strongly predictive of HACs. Other variables, including hospital-associated factors, may play a role in the development of these conditions. The presence of an HAC was found to be an independent risk factor for a variety of adverse events. These findings highlight the need for continued development of evidence-based protocols designed to reduce the incidence and severity of HACs.

NCOG-05. RISK FACTORS FOR PROLONGED LENGTH OF STAY AND POSTOPERATIVE COMPLICATIONS IN PATIENTS WITH INTRAMEDULLARY SPINAL CORD TUMORS

2021 ◽  
Vol 23 (Supplement_6) ◽  
pp. vi153-vi153
Author(s):  
Romaric Waguia Kouam ◽  
Timothy Wang
Keyword(s):  
Risk Factors ◽  
Spinal Cord ◽  
Length Of Stay ◽  
Complication Rates ◽  
Spinal Cord Tumors ◽  
Improvement Program ◽  
Primary Tumors ◽  
Intramedullary Spinal Cord ◽  
Prolonged Length ◽  
Physical Status Classification

Abstract INTRODUCTION Primary spine tumors are rare neoplasms that affect about 0.62 per 100,000 individuals in the US. Intramedullary spinal cord tumors (IMSCTs) are the rarest of all primary tumors involving the spine and can cause pain, imbalance, urinary dysfunction and neurological deficits. These types of tumors oftentimes necessitate surgical treatment, yet there is a lack of data on length of stay and complication rates following treatment. Given that treatment candidacy, quality of life, and outcomes are tied so closely to these metrics, it is important to illustrate the risk factors for prolonged length of stay and their association with post-op complications with the ultimate goal of improving patient selection and preoperative optimization. METHODS The National Surgical Quality Improvement Program (NSQIP) database was queried for all patients undergoing surgery for treatment of intramedullary spinal cord tumors between 2005 and 2017. Univariate and multivariate analysis were performed to assess patient risk factor influencing prolonged length of stay and post-op complications. RESULTS A total of 638 patients were included in the analysis. Pre-operative American Society of Anesthesiology (ASA) physical status classification of 3 and above ( OR 1.89; p=0.0005), dependent functional status ( OR 2.76; p=0.0035) and transfer from facilities other than home ( OR 8.12; p&lt; 0.0001) were independent predictors of prolonged length of stay ( &gt;5 days). The most commonly reported complications were pneumonia (5.7%), urinary tract infection (9.4%), septic shock (3.8%), superficial incisional infection (5.7%), organ or space infection (5.7%), pulmonary embolism (11.3%), DVT requiring therapy (15.1%) and wound dehiscence (5.7%). CONCLUSION Our study demonstrated the significant influence of clinical variables on prolonged hospitalization of IMSCT patients. This should be factored into clinical and surgical decision making and when counseling patients of their expected outcomes.

Risk Factors for Prolonged Length of Stay or Complications During Pediatric Respiratory Hospitalizations

2015 ◽  
Vol 5 (9) ◽  
pp. 461-473 ◽  
Author(s):  
S. V. Kaiser ◽  
L.-A. Bakel ◽  
M. J. Okumura ◽  
A. D. Auerbach ◽  
J. Rosenthal ◽  
...  
Keyword(s):  
Risk Factors ◽  
Length Of Stay ◽  
Prolonged Length

scholarly journals Risk factors for wound-related reoperations in patients with metastatic spine tumor

2018 ◽  
Vol 28 (6) ◽  
pp. 663-668 ◽  
Author(s):  
Hannah M. Carl ◽  
A. Karim Ahmed ◽  
Nancy Abu-Bonsrah ◽  
Rafael De la Garza Ramos ◽  
Eric W. Sankey ◽  
...  
Keyword(s):  
Risk Factors ◽  
Univariate Analysis ◽  
Tumor Resection ◽  
Multivariate Model ◽  
Wound Complications ◽  
Karnofsky Performance Scale ◽  
Thromboembolic Events ◽  
Spine Tumor ◽  
Wound Breakdown ◽  
Metastatic Spine Tumor

OBJECTIVEResection of metastatic spine tumors can improve patients’ quality of life by addressing pain or neurological compromise. However, resections are often complicated by wound dehiscence, infection, instrumentation failures, and the need for reoperation. Moreover, when reoperations are needed, the most common indication is surgical site infection and wound breakdown. In turn, wound reoperations increase morbidity as well as the length and cost of hospitalization. The aim of this study was to examine perioperative risk factors associated with increased rate of wound reoperations after metastatic spine tumor resection.METHODSA retrospective study of patients at a single institution who underwent metastatic spine tumor resection between 2003 and 2013 was conducted. Factors with a p value < 0.200 in a univariate analysis were included in the multivariate model.RESULTSA total of 159 patients were included in this study. Karnofsky Performance Scale score > 70, smoking status, hypertension, thromboembolic events, hyperlipidemia, increasing number of vertebral levels, and posterior approach were included in the multivariate analysis. Thromboembolic events (95% CI 1.19–48.5, p = 0.032) and number of levels involved were independently associated with increased wound reoperation rates in the multivariate model. For each additional spinal level involved, the risk for wound reoperations increased by 21% (95% CI 1.03–1.43, p = 0.018).CONCLUSIONSAlthough wound complications and subsequent reoperations are potential risks for all patients with metastatic spine tumor, due to adjuvant radiotherapy and other medical comorbidities, this study identified patients with thromboembolic events or those requiring a larger incision as being at the highest risk. Measures intended to decrease the occurrence of perioperative venous thromboembolism and to improve wound care, especially for long incisions, may decrease wound-related revision surgeries in this vulnerable group of patients.

scholarly journals Risk factors for prolonged length of stay after colorectal surgery

2013 ◽  
Vol 33 (1) ◽  
pp. 22-27 ◽  
Author(s):  
Luiz Felipe de Campos Lobato ◽  
Patrícia Cristina Alves Ferreira ◽  
Elizabeth C. Wick ◽  
Ravi P. Kiran ◽  
Feza H. Remzi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Colorectal Surgery ◽  
Length Of Stay ◽  
Prolonged Length

scholarly journals Mortality is not increased with Diabetes in Hospitalised Very Old Adults: A multi-site review.

2020 ◽  
Author(s):  
Peter Smerdely
Keyword(s):  
Length Of Stay ◽  
Adverse Events ◽  
Negative Binomial ◽  
Negative Impact ◽  
Outcome Data ◽  
Teaching Hospitals ◽  
Very Old ◽  
Old Adults ◽  
Lengths Of Stay ◽  
Hospital Acquired

Abstract Background: Few data exist regarding hospital outcomes in people with diabetes aged beyond 75 years. This study aimed to explore the association of diabetes with hospital outcome in the very old patient.Methods: A retrospective review was conducted of all presentations of patients aged 65 years or more admitted to three Sydney teaching hospitals over six years (2012-2018), exploring primarily the outcomes of in-hospital mortality, and secondarily the outcomes of length of stay, the development of hospital-acquired adverse events and unplanned re-admission to hospital within 28 days of discharge. Demographic and outcome data, the presence of diabetes and comorbidities were determined from ICD10 coding within the hospital's electronic medical record. Logistic and negative binomial regression models were used to assess the association of diabetes with outcome. Results: A total of 139130 separations (mean age 80 years, range 65 to 107 years; 51% female) were included, with 49% having documented comorbidities and 26.1% a diagnosis of diabetes. When compared to people without diabetes, diabetes was not associated with increased odds of mortality (OR: 0.89 SE (0.02), p<0.001). Further, because of a significant interaction with age, diabetes was associated with decreased odds of mortality beyond 80 years of age. While people with diabetes overall had longer lengths of stay (10.2 days SD (13.4) v 9.4 days SD (12.3), p<0.001), increasing age was associated with shorter lengths of stay in people aged more than 90 years. Diabetes was associated with increased odds of hospital-acquired adverse events (OR: 1.09 SE (0.02), p<0.001) and but not 28-day re-admission (OR: 0.88 SE (0.18), p=0.523).Conclusion: Diabetes has not been shown to have a negative impact on mortality or length of stay in hospitalised very old adults from data derived from hospital administrative records. This may allow a more measured application of diabetic guidelines in the very old hospitalised patient.

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