Predictors of nonroutine discharge among patients undergoing surgery for grade I spondylolisthesis: insights from the Quality Outcomes Database

2020 ◽  
Vol 32 (4) ◽  
pp. 523-532 ◽  
Author(s):  
Praveen V. Mummaneni ◽  
Mohamad Bydon ◽  
John Knightly ◽  
Mohammed Ali Alvi ◽  
Anshit Goyal ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Acute Care ◽  
Body Mass ◽  
Care Facility ◽  
Older Age ◽  
Quality Outcomes ◽  
Acute Care Facility ◽  
Factors Associated ◽  
Patient Reported ◽  
The Impact

OBJECTIVEDischarge to an inpatient rehabilitation facility or another acute-care facility not only constitutes a postoperative challenge for patients and their care team but also contributes significantly to healthcare costs. In this era of changing dynamics of healthcare payment models in which cost overruns are being increasingly shifted to surgeons and hospitals, it is important to better understand outcomes such as discharge disposition. In the current article, the authors sought to develop a predictive model for factors associated with nonroutine discharge after surgery for grade I spondylolisthesis.METHODSThe authors queried the Quality Outcomes Database for patients with grade I lumbar degenerative spondylolisthesis who underwent a surgical intervention between July 2014 and June 2016. Only those patients enrolled in a multisite study investigating the impact of fusion on clinical and patient-reported outcomes among patients with grade I spondylolisthesis were evaluated. Nonroutine discharge was defined as those who were discharged to a postacute or nonacute-care setting in the same hospital or transferred to another acute-care facility.RESULTSOf the 608 patients eligible for inclusion, 9.4% (n = 57) had a nonroutine discharge (8.7%, n = 53 discharged to inpatient postacute or nonacute care in the same hospital and 0.7%, n = 4 transferred to another acute-care facility). Compared to patients who were discharged to home, patients who had a nonroutine discharge were more likely to have diabetes (26.3%, n = 15 vs 15.7%, n = 86, p = 0.039); impaired ambulation (26.3%, n = 15 vs 10.2%, n = 56, p < 0.001); higher Oswestry Disability Index at baseline (51 [IQR 42–62.12] vs 46 [IQR 34.4–58], p = 0.014); lower EuroQol-5D scores (0.437 [IQR 0.308–0.708] vs 0.597 [IQR 0.358–0.708], p = 0.010); higher American Society of Anesthesiologists score (3 or 4: 63.2%, n = 36 vs 36.7%, n = 201, p = 0.002); and longer length of stay (4 days [IQR 3–5] vs 2 days [IQR 1–3], p < 0.001); and were more likely to suffer a complication (14%, n = 8 vs 5.6%, n = 31, p = 0.014). On multivariable logistic regression, factors found to be independently associated with higher odds of nonroutine discharge included older age (interquartile OR 9.14, 95% CI 3.79–22.1, p < 0.001), higher body mass index (interquartile OR 2.04, 95% CI 1.31–3.25, p < 0.001), presence of depression (OR 4.28, 95% CI 1.96–9.35, p < 0.001), fusion surgery compared with decompression alone (OR 1.3, 95% CI 1.1–1.6, p < 0.001), and any complication (OR 3.9, 95% CI 1.4–10.9, p < 0.001).CONCLUSIONSIn this multisite study of a defined cohort of patients undergoing surgery for grade I spondylolisthesis, factors associated with higher odds of nonroutine discharge included older age, higher body mass index, presence of depression, and occurrence of any complication.

scholarly journals Predictors of Nonroutine Discharge Among Patients Undergoing Surgery for Grade I Spondylolisthesis: Insights From the Quality Outcomes Database (QOD)

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Praveen V Mummaneni ◽  
Mohamad Bydon ◽  
John Knightly ◽  
Mohammed Ali Alvi ◽  
Anshit Goyal ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Acute Care ◽  
Degenerative Spondylolisthesis ◽  
Care Facility ◽  
Quality Outcomes ◽  
Acute Care Facility ◽  
Factors Associated ◽  
Discharge Disposition ◽  
Patient Reported ◽  
The Impact

Abstract INTRODUCTION Discharge to an in-patient rehabilitation facility or another acute care facility not only constitutes a postoperative challenge for patients and their care team but also contributes significantly to health-care costs. In the era of changing dynamics of healthcare payment models where the risk of cost over-runs are being increasingly shifted to surgeons and hospitals, it is important to understand better outcomes such as discharge disposition. In the current manuscript, we sought to develop a predictive model for factors associated with nonroutine discharge after surgery for grade I spondylolisthesis. METHODS We queried the Quality Outcomes Database for patients with grade 1 lumbar degenerative spondylolisthesis undergoing a surgical intervention between July 2014 and June 2016. Only those patients enrolled in a multiside study investigating the impact of fusion on clinical and Patient Reported Outcomes (PROs) among patients with grade 1 spondylolisthesis were evaluated. Nonroutine discharge was defined as those that were discharged to postacute or nonacute care setting in the same hospital or transferred to another acute care facility. RESULTS Of the 605 patients eligible for inclusion, 9.4% (n = 57) had a nonroutine discharge (8.7%, n = 53 discharged to an inpatient postacute or nonacute care in the same hospital and 0.7%, n = 4 transferred to another acute care facility). On multivariable logistic regression, after adjusting for an array of demographic, socioeconomic, clinical, and operative variables, factors found to be independently associated with higher odds of nonroutine discharge included higher age (OR 10.53, 95% CI 3.8-29.2, P < .001), higher BMI (OR 2.42, 95% CI 1.45-4.05, P < .001), depression (OR 4.97, 95% CI 2.10-11.77, P < .001), and length of stay (OR 3.4, 95% CI 2.3-4.9, P < .001). CONCLUSION In this multisite study of a defined cohort of patients undergoing surgery for grade I spondylolisthesis, factors associated with higher odds of nonroutine discharge included higher age, higher BMI, presence of depression, and higher length of stay.

scholarly journals Multiple Sclerosis Wellness Shared Medical Appointment Model: A Pilot Study

2021 ◽  
Author(s):  
Justin R. Abbatemarco ◽  
Jeffrey A. Cohen ◽  
Belinda L. Udeh ◽  
Sunakshi Bassi ◽  
Mary R. Rensel
Keyword(s):  
Multiple Sclerosis ◽  
Health Care ◽  
Body Mass Index ◽  
Health Care Utilization ◽  
Body Mass ◽  
Private Insurance ◽  
Emergency Department Visits ◽  
Care Utilization ◽  
Patient Reported ◽  
The Impact

Abstract Background: Shared medical appointments (SMAs) are group medical visits combining medical care and patient education. We examined the impact of a wellness-focused pilot SMA in a large multiple sclerosis (MS) clinic. Methods: We reviewed data on all patients who participated in the SMA from January 2016 through June 2019. Data were collected 12 months pre/post SMA; included demographics, body mass index, patient-reported outcomes, and health care utilization; and were compared using Wilcoxon rank sum test. Results: Fifty adult patients (mean ± SD age, 50.1 ± 12.3 years) attended at least one MS wellness SMA. Most patients had private insurance (50%), and 26% had Medicaid coverage. The most common comorbidity was depression/anxiety (44%). Pre/post SMA outcomes showed a small but significant reduction in body mass index (30.2 ± 7.3 vs 28.8 ± 7.1, P = .03), and Patient Health Questionnaire-9 scores decreased from 7.3 ± 5.5 to 5.1 ± 5.6 (P = .001). The number of emergency department visits decreased from 13 to two (P = .0005), whereas follow-up visits increased with an attendees’ primary care provider from 19 to 41 (P &lt; .001), physical therapist from 15 to 27 (P = .004), and psychologist from six to 19 (P = .003). Conclusions: This pilot MS wellness SMA was associated with improved physical and psychological outcomes. There was increased, lower-cost health care utilization with reduced acute, high-cost health care utilization, suggesting that SMAs may be a cost-effective and beneficial method in caring for patients with MS.

Predictive Model for Length of Stay Among Patients Undergoing Surgery for Grade I Spondylolisthesis: Analysis From the Quality Outcomes Database

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Praveen V Mummaneni ◽  
Mohamad Bydon ◽  
John J Knightly ◽  
Anshit Goyal ◽  
Mohammed A Alvi ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Resource Utilization ◽  
Operative Time ◽  
Degenerative Spondylolisthesis ◽  
Quality Outcomes ◽  
Factors Associated ◽  
Discharge Disposition ◽  
Patient Reported ◽  
The Impact ◽  
Type Of Surgery

Abstract INTRODUCTION Recent changes in healthcare policies implemented as per the Affordable Care Act (ACA) have resulted in providers and hospitals seeking ways to optimize resource utilization and improve patient outcomes. Length of stay (LOS) after surgery has increasingly been used as a surrogate for resource utilization. In the current study, we investigated factors associated with longer LOS after surgery for grade 1 spondylolisthesis. METHODS We queried the Quality Outcomes Database for patients with grade 1 lumbar degenerative spondylolisthesis undergoing a surgical intervention between July 2014 and June 2016. Only those patients enrolled in a multi-side study investigating the impact of fusion on clinical and patient reported outcomes (PROs) among patients with grade 1 spondylolisthesis were evaluated. A multivariable (MV) proportional odds regression model was fitted to determine factors associated with longer LOS. RESULTS A total of 608 patients undergoing surgery were identified (555 single-level, 53 2-level surgeries). Median LOS was 3 d (IQR: 2-4 d). On MV analysis, factors found to be independently predictive of longer LOS included nonroutine home discharge (home with healthcare: OR: 3.5 (1.9-6.8); postacute care: OR: 9.6 (5.2-17.7)), higher baseline ODI (interquartile OR: 1.44 (1.21-1.86)), longer operative time (OR: 1.98 (1.56-2.51), 2-level surgery (OR: 2.91 (1.37-6.21), ref = 1-level surgery); assisted ambulation (OR: 1.9 (1.1-3.3)) and higher American Society of Anesthesiologists (ASA) score (OR: 1.6 (1.1-2.3) while decompression alone (OR: 0.05 (0.03-0.09)), anterior/lateral approaches (OR: 0.25 (0.11-0.56, ref = posterior) and use of MIS (OR: 0.42 (0.30-0.59) were associated with shorter length of stay. Predictor importance analysis revealed that type of surgery (decompression vs fusion), discharge disposition, operative time, use of Minimally invasive spine surgery (MIS) and surgical approach were the top predictors determining duration of stay. CONCLUSION These results from a multi-site study of patients undergoing surgery for grade I spondylolisthesis indicate that patients undergoing fusion, discharged to nonhome, with longer operative time and posterior surgical approaches may have longer LOS. Type of surgery and discharge destination are top predictors determining length of stay.

The Effects of Patient Occupation, Hobbies, and Body Mass Index on Kneeling after Total Knee Arthroplasty

2019 ◽  
Author(s):  
Karim G. Sabeh ◽  
Victor H. Hernandez ◽  
Wayne B. Cohen-Levy ◽  
Alvin Ong ◽  
Fabio Orozco ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Total Knee Arthroplasty ◽  
Body Mass ◽  
Knee Arthroplasty ◽  
Univariate Analysis ◽  
Substantial Impact ◽  
Significant Difference ◽  
Patient Reported ◽  
Total Knee ◽  
The Impact

AbstractA common patient concern after total knee arthroplasty (TKA) is the ability to kneel. Kneeling may have a substantial impact on the patients' ability to perform many activities of daily living, occupations, and hobbies. The purpose of this study was to quantify the percentage of patients able to kneel after TKA after 2 years and to evaluate preoperative patient characteristics that influence the patient's perceived ability to kneel after TKA such as obesity, occupation, and hobbies. We retrospectively assessed a cohort of 404 patients who underwent primary TKA with patellar resurfacing. We assessed the impact of patient hobbies, occupation, employment status, and body mass index (BMI) on the kneeling capacity and patient-reported satisfaction. Univariate analysis was performed using Fisher's exact test, and multivariate analysis was performed using logistic regression with multiple imputations. A total of 404 patients were included. Sixty percent of patients were unable to kneel after TKA. Males (p < 0.001) and patients with occupations or hobbies requiring kneeling (p < 0.05) were more likely to kneel after surgery. We identified an inverse relationship between BMI and the ability to kneel. No correlation was found between duration and frequency of kneeling relative to patient-reported ease or difficulty with kneeling. Patient-reported factors that prevented patients from kneeling were pain, physical inability, and fear of damaging the prosthesis. Patient education may be helpful in improving patient expectations about kneeling after surgery. A small but significant difference in subjective patient satisfaction was observed when comparing patients able to kneel with those unable to kneel.

Results of Hallux Valgus Surgery in Diabetic Patients With Good Glycemic Control

2020 ◽  
Vol 41 (8) ◽  
pp. 945-953
Author(s):  
Gin Way Law ◽  
Kae Sian Tay ◽  
Akshay Padki ◽  
Khai Cheong Wong ◽  
Karen Ting Zhang ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Glycemic Control ◽  
Hallux Valgus ◽  
Body Mass ◽  
Deformity Correction ◽  
Diabetic Patients ◽  
Complication Rates ◽  
Patient Reported ◽  
The Impact ◽  
Reoperation Rates

Background: Literature is sparse on whether diabetes affects outcomes of hallux valgus surgery. With the rising global prevalence of diabetes and diabetes being an independent predictor of poorer outcomes, particularly in foot and ankle surgery, we aimed to investigate the impact of diabetes on the outcomes of hallux valgus surgery. Methods: We conducted a retrospective comparative cohort study of prospectively collected registry data of 951 feet in 721 patients who underwent surgery for symptomatic hallux valgus between 2007 and 2015 at our institution. All patients with diabetes were identified and matched with patients without diabetes for age, sex, and body mass index in a 1:2 ratio to construct the matched cohorts for analysis. Glycemic control in the diabetic cohort was assessed using preoperative HbA1c. The primary outcome measure was complication rates. Secondary outcomes were (1) deformity correction using the hallux valgus and intermetatarsal angles; (2) patient-reported outcomes using visual analog scale (VAS) for pain, Short Form–36 (SF-36) Physical and Mental Health subscales, and American Orthopaedic Foot & Ankle Society (AOFAS) scores; (3) patient satisfaction; and (4) reoperation rates up to 2 years postoperatively. Forty diabetic patients were identified and matched to 80 nondiabetic patients. Although matching was only performed for age, sex, and body mass index, the diabetic and the nondiabetic cohorts were also similar in hallux valgus severity, preoperative scores, and types of procedures performed. Results: The mean preoperative HbA1c in our diabetic cohort was 7.1%. Both the diabetic and nondiabetic cohorts showed excellent AOFAS and VAS scores with no differences in degree of deformity correction, complication profiles, reoperation rates, outcome scores, and satisfaction at both 6 months and 2 years postoperatively. Conclusion: We believe stringent patient selection was key to reduced complication rates and good outcomes in diabetic patients. Well-selected diabetic patients remain suitable candidates for hallux valgus surgery. Level of Evidence: Level III, retrospective comparative study.

Establishing Institution-Specific Normative Data for the BREAST-Q Reconstruction Module: A Prospective Study

2019 ◽  
Vol 40 (6) ◽  
pp. NP348-NP355
Author(s):  
Kevin M Klifto ◽  
Pathik Aravind ◽  
Melissa Major ◽  
Rachael M Payne ◽  
Wen Shen ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Body Mass ◽  
Well Being ◽  
Level Of Evidence ◽  
Related Factors ◽  
Patient Reported ◽  
History Of ◽  
Research Populations ◽  
A Prospective Study ◽  
The Impact

Abstract Background Breast satisfaction in general female populations is relatively unknown and prior research populations do not reflect our community. Objectives We sought to assess breast satisfaction in a cohort of female participants utilizing the BREAST-Q and determine the impact of participant-related factors. Methods Females with no history of breast cancer or breast surgery attending gynecology appointments completed preoperative BREAST-Q reconstruction modules and demographic forms in this prospective, single-center, patient-reported outcomes study. We also assessed participant-related factors capable of influencing BREAST-Q scores. Results Three hundred females were included. Increasing body mass index had significant associations with lower Satisfaction with Breasts and Psychosocial Well-being scores. Increasing age was associated with significantly lower Sexual Well-being scores. African Americans had significantly higher scores for Satisfaction with Breasts, Psychosocial Well-being, and Sexual Well-being compared with Caucasians. Bra cup sizes A and C were associated with significantly higher Psychosocial Well-being scores than other sizes. Bra cup sizes A, B, and C were associated with significantly higher Sexual Well-being and Physical Well-being: Chest scores than larger sizes. Bra cup sizes B and C were associated with significantly higher Physical Well-being: Abdomen scores than size DD. Bra cup size A was associated with significantly higher Satisfaction with Breasts scores than sizes DD and &gt;DD. Bra cup size C was associated with significantly higher Satisfaction with Breasts scores than larger sizes. Conclusions Body mass index, age, race, and bra cup sizes significantly impact BREAST-Q scores in our population. Determining normative BREAST-Q scores in female populations could represent important baselines for breast outcomes research. Level of Evidence: 2

scholarly journals Hypertension in HIV-Infected Patients Receiving Antiretroviral Therapy in Northeast Ethiopia

2019 ◽  
Vol 2019 ◽  
pp. 1-7 ◽  
Author(s):  
Temesgen Fiseha ◽  
Alemu Gedefie Belete ◽  
Henok Dereje ◽  
Abebe Dires
Keyword(s):  
Body Mass Index ◽  
Antiretroviral Therapy ◽  
Body Mass ◽  
High Body Mass Index ◽  
Male Gender ◽  
Older Age ◽  
Factors Associated ◽  
High Body ◽  
Northeast Ethiopia ◽  
Living With Hiv

Background. With prolonged survival and aging of persons with HIV on combination antiretroviral therapy (ART), hypertension has emerged as a significant cause of morbidity and mortality globally. However, little is known about the burden of this comorbid condition among adults living with HIV in sub-Saharan Africa. In this study, we aimed to determine the prevalence and factors associated with hypertension among HIV-infected patients receiving ART in Northeast Ethiopia. Methods. A cross-sectional study was conducted at the ART clinic of Dessie Referral Hospital, Northeast Ethiopia, between January and May 2018. HIV-infected patients who were on ART for at least 12 months were included in the study. Demographic, clinical, and laboratory data were collected from each participant. Hypertension was defined as a systolic blood pressure (BP) of ≥140 mmHg and/or diastolic BP of ≥90 mmHg or a reported use of antihypertensive medication. Univariable and multivariate analyses were performed to identify factors associated with hypertension. Results. A total of 408 patients were studied with a mean (±SD) age of 37 ± 10.3 years, and 66.9% were female. The prevalence of hypertension was 29.7% (95% CI, 25.3–35.0%). Nearly 75% of the patients with hypertension were previously undiagnosed. In a univariate analysis, older age, male gender, a family history of hypertension, duration of HIV infection, duration on ART, high body mass index, low CD4 count, diabetes, and renal impairment were associated with hypertension. Multivariate analysis revealed older age (AOR = 2.08; 95% CI, 1.13–3.83), male gender (AOR = 1.64; 95% CI, 1.01–2.65), longer duration on ART (AOR = 1.91; 95% CI, 1.14–3.20), high body mass index (AOR = 3.32; 95% CI, 1.13–9.77), and diabetes (AOR = 2.76; 95% CI, 1.29–5.89) as independent risk factors of hypertension. Conclusions. Hypertension is highly prevalent among HIV-infected patients on ART attending our clinic in Northeast Ethiopia but is mostly undiagnosed. These findings highlight the need for integrating hypertension management into routine HIV care to prevent adverse outcomes and improve health of people living with HIV on ART.

Assessing the impact of body mass index (BMI) on quality outcomes among women undergoing hysterectomy for benign indications

2021 ◽  
Vol 43 (5) ◽  
pp. 667
Author(s):  
Marta Cybulsky ◽  
Ally Murji ◽  
Adebanke Bianca Adekola ◽  
Zahra Sunderji ◽  
Jodi Shapiro ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Body Mass ◽  
Quality Outcomes ◽  
The Impact
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