scholarly journals Heart Failure Is a Poor Prognosis Risk Factor in Patients Undergoing Cholecystectomy: Results from a Spanish Data-Based Analysis

2021 ◽  
Vol 10 (8) ◽  
pp. 1731
Author(s):  
Javier Marco-Martínez ◽  
Francisco Javier Elola-Somoza ◽  
Cristina Fernández-Pérez ◽  
José Luis Bernal-Sobrino ◽  
Francisco Javier Azaña-Gómez ◽  
...  
Keyword(s):  
Heart Failure ◽  
Hospital Mortality ◽  
Hospital Stay ◽  
Average Length ◽  
National Health System ◽  
Length Of Hospital Stay ◽  
National Hospital ◽  
Mortality Models ◽  
Spanish National Health System ◽  
Discharge Database

Background: The incidence of cholecystectomy is increasing as the result of the aging worldwide. Our aim was to determine the influence of heart failure on in-hospital outcomes in patients undergoing cholecystectomy in the Spanish National Health System (SNHS). Methods: We conducted a retrospective study using the Spanish National Hospital Discharge Database. Patients older than 17 years undergoing cholecystectomy in the period 2007–2015 were included. Demographic and administrative variables related to patients’ diseases as well as procedures were collected. Results: 478,111 episodes of cholecystectomy were identified according to the data from SNHS hospitals in the period evaluated. From all the episodes, 3357 (0.7%) were excluded, as the result the sample was represented by 474,754 episodes. Mean age was 58.3 (+16.5) years, and 287,734 (60.5%) were women (p < 0.001). A primary or secondary diagnosis of HF was identified in 4244 (0.89%) (p < 0.001) and mean age was 76.5 (+9.6) years. A higher incidence of all main complications studied was observed in the HF group (p < 0.001), except stroke (p = 0.753). Unadjusted in-hospital mortality was 1.1%, 12.9% in the group with HF versus 1% in the non HF group (p < 0.001). Average length of hospital stay was 5.4 (+ 8.9) days, and was higher in patients with HF (16.2 + 17.7 vs. 5.3 + 8.8; p < 0.001). Risk-adjusted in-hospital mortality models’ discrimination was high in both cases, with AUROC values = 0.963 (0.960–0.965) in the APRG-DRG model and AUROC = 0.965 (0.962–0.968) in the CMS adapted model. Median odds ratio (MOR) was high (1.538 and 1.533, respectively), stating an important variability of risk-adjusted outcomes among hospitals. Conclusions: The presence of HF during admission increases in hospital mortality and lengthens the hospital stay in patients undergoing cholecystectomy. However, mortality and hospital stay have significantly decreased during the study period in both groups (HF and non HF patients).

P1515Female sex is an independent predictor of mortality in patients with STEMI in Spain: a study in 325,017 episodes over 11 years (2005–2015)

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Anguita ◽  
A Sambola Ayala ◽  
J Elola ◽  
J L Bernal ◽  
C Fernandez ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Hospital Mortality ◽  
Independent Predictor ◽  
National Health System ◽  
Anterior Myocardial Infarction ◽  
Female Sex ◽  
Spanish National Health System ◽  
History Of ◽  
The Impact

Abstract Background Recent studies reported a decrease in the mortality of ST-elevation myocardial infarction (STEMI) patients. This favorable evolution could not extend to women. The interaction between gender and mortality in STEMI remains controversial. Purpose To assess the impact of female sex on mortality of patients with STEMI through of period of 11 years. Methods We conducted a retrospective longitudinal study using information provided by the minimal database system of the Spanish National Health System to identify all hospitalizations in patients aged 35–94 years with the principal diagnosis of STEMI from 2005–2015. Results A total of 325,017 STEMI were identified. Of them, 273,182 were included, and 106,277 (38.8%) were women. Women were older than men and had more comorbidities. Through the study period 53% men vs 37.2% underwent PTCA; women presented more frequently heart failure, shock and stroke than men (p<0.001, respectively). The mean crude in-hospital mortality rate for the whole study period was higher in women (OR: 2.18; 95% CI: 2.12.-2.23, p<0.0001). Female sex was independently associated with higher in-hospital mortality (adjusted OR: 1.18; 95% CI: 1.14–1.22, p<0.001) (Table 1). The risk was maintained through the whole study period (lower OR: 1.14 in 2014; higher OR: 1.28 in 2006). Table 1. Variables independently associated with in-hospital mortality adjusted by risk in a multilevel logistic regression model, 2005–2015 STEMI In-hospital mortality Odds Ratio P 95% CI Woman 1.18 <0.001 1.14 1.22 Age 1.06 <0.001 1.06 1.06 History of PTCA 1.58 <0.001 1.40 1.77 Congestive heart failure 1.26 <0.001 1.22 1.30 Acute Myocardial Infarction 1.84 <0.001 1.54 2.20 Anterior myocardial infarction 1.47 <0.001 1.23 1.76 Cardio-respiratory failure or shock 15.25 <0.001 14.78 15.75 Hypertension 0.81 <0.001 0.79 0.84 Stroke 5.76 <0.001 5.18 6.42 Cerebrovascular disease 0.86 <0.001 0.79 0.93 Renal failure 1.95 <0.001 1.88 2.02 Vascular disease and complications 7.03 <0.001 5.72 8.63 CI, Confidence Interval. Conclusions Female sex is an independent predictor of mortality in patients with STEMI in Spain, maintaining through a period of the 11 years.

scholarly journals Impact of the Geriatric Nutritional Risk Index on In-Hospital Mortality and Length of Hospitalization in Patients with Acute Decompensated Heart Failure with Preserved or Reduced Ejection Fraction

2020 ◽  
Vol 9 (4) ◽  
pp. 1169 ◽  
Author(s):  
Susumu Hirose ◽  
Sakiko Miyazaki ◽  
Shoichiro Yatsu ◽  
Akihiro Sato ◽  
Sayaki Ishiwata ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Hospital Mortality ◽  
Hospital Stay ◽  
Risk Index ◽  
Length Of Hospital Stay ◽  
Interquartile Range ◽  
Nutritional Risk ◽  
Geriatric Nutritional Risk Index ◽  
Nutritional Risk Index

In patients with heart failure (HF), the impact of the Geriatric Nutritional Risk Index (GNRI) on in-hospital mortality and length of hospital stay remains unclear. We aimed to identify the factors associated with increased in-hospital mortality and longer length of hospital stay considering the GNRI in acute decompensated HF with reduced and preserved ejection fraction (HFrEF and HFpEF, respectively). Patients with acute decompensated HF who were admitted to our institution between 2007 and 2011 were investigated. A total of 451 (201, HFrEF; 250, HFpEF) patients were divided into the following: patients with GNRI < 92 and ≥92. In HFrEF, there were no significant differences in in-hospital mortality and length of hospital stay between patients with GNRI < 92 and ≥92 (median (interquartile range), 24.0 (23.8) days and 20.0 (15.0) days, respectively, p = 0.32). In HFpEF, despite no differences in in-hospital mortality, patients with GNRI < 92 had significantly longer length of hospital stay than those with GNRI ≥ 92 (median (interquartile range), 20.0 (22.3) days and 17.0 (16.0) days, respectively, p = 0.04). In HFpEF, GNRI < 92, along with lower hemoglobin, higher B-type natriuretic peptide, and elevated C-reactive protein levels, were the independent factors for longer length of hospital stay. Among patients with acute decompensated HF, assessment of nutritional status with GNRI is useful for stratifying patients at high risk for longer length of hospital stay in HFpEF but not in HFrEF. These observations are particularly important when considering the increasing elderly population and prevalence of HFpEF.

Pilonidal Sinus: How to Choose Between Excision and Open Granulation Versus Excision and Primary Closure?

Swiss Surgery ◽  
2002 ◽  
Vol 8 (6) ◽  
pp. 255-258 ◽  
Author(s):  
Perruchoud ◽  
Vuilleumier ◽  
Givel
Keyword(s):  
Hospital Stay ◽  
Pilonidal Sinus ◽  
Primary Closure ◽  
Average Length ◽  
Length Of Hospital Stay ◽  
Healing Time ◽  
Incision And Drainage ◽  
The Mean ◽  
Primary Healing

Aims: The purpose of this study was to evaluate excision and open granulation versus excision and primary closure as treatments for pilonidal sinus. Subjects and methods: We evaluated a group of 141 patients operated on for a pilonidal sinus between 1991 and 1995. Ninety patients were treated by excision and open granulation, 34 patients by excision and primary closure and 17 patients by incision and drainage, as a unique treatment of an infected pilonidal sinus. Results: The first group, receiving treatment of excision and open granulation, experienced the following outcomes: average length of hospital stay, four days; average healing time; 72 days; average number of post-operative ambulatory visits, 40; average off-work delay, 38 days; and average follow-up time, 43 months. There were five recurrences (6%) in this group during the follow-up period. For the second group treated by excision and primary closure, the corresponding outcome measurements were as follows: average length of hospital stay, four days; average healing time, 23 days; primary healing failure rate, 9%; average number of post-operative ambulatory visits, 6; average off-work delay, 21 days. The average follow-up time was 34 months, and two recurrences (6%) were observed during the follow-up period. In the third group, seventeen patients benefited from an incision and drainage as unique treatment. The mean follow-up was 37 months. Five recurrences (29%) were noticed, requiring a new operation in all the cases. Discussion and conclusion: This series of 141 patients is too limited to permit final conclusions to be drawn concerning significant advantages of one form of treatment compared to the other. Nevertheless, primary closure offers the advantages of quicker healing time, fewer post-operative visits and shorter time off work. When a primary closure can be carried out, it should be routinely considered for socio-economical and comfort reasons.

scholarly journals Detection of influenza virus in rectal swabs of patients admitted in hospital for febrile illnesses in Thailand

2021 ◽  
Vol 9 ◽  
pp. 205031212198963
Author(s):  
Artit Sangkakam ◽  
Pasin Hemachudha ◽  
Abhinbhen W Saraya ◽  
Benjamard Thaweethee-Sukjai ◽  
Thaniwan Cheun-Arom ◽  
...  
Keyword(s):  
Influenza Virus ◽  
Gastrointestinal Tract ◽  
Hospital Stay ◽  
Rectal Swab ◽  
Average Length ◽  
Gastrointestinal Symptoms ◽  
Virus Detection ◽  
Length Of Hospital Stay ◽  
Nasopharyngeal Swab ◽  
Influenza Virus Detection

Introduction: Influenza virus favours the respiratory tract as its primary site of host entry and replication, and it is transmitted mainly via respiratory secretions. Nasopharyngeal swab is the gold standard specimen type for influenza detection, but several studies have also suggested that the virus replicates in the human gastrointestinal tract. Methods: A retrospective study was conducted on all patients positive for influenza virus and initially recruited as part of the PREDICT project from 2017 to 2018. The objectives of the study were to investigate whether rectal swab could aid in improving influenza detection, and if there was any correlation between gastrointestinal disturbances and severity of infection, using length of hospital stay as an indicator of severity. Results: Of the 51 influenza-positive patients, 12 had detectable influenza virus in their rectal swab. Among these 12 rectal swab positive patients, influenza virus was not detected in the nasopharyngeal swab of three of them. Gastrointestinal symptoms were observed for 28.2% patients with a negative rectal swab negative and 25.0% patients with a positive rectal swab. Average length of hospital stay was 4.2 days for rectal swab positive group and 3.7 days for rectal swab negative group. This difference was not statistically significant (p = 0.288). Conclusions: There is no correlation between influenza virus detection in rectal swab and gastrointestinal disturbances or disease severity, and there is currently insufficient evidence to support replicative ability in the gastrointestinal tract.

scholarly journals Why do frail patients with chronic heart failure die and become hospitalised?

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S Sze ◽  
P Pellicori ◽  
J Zhang ◽  
J Weston ◽  
A.L Clark
Keyword(s):  
Heart Failure ◽  
Cause Of Death ◽  
Hospital Admissions ◽  
Average Length ◽  
Significant Proportion ◽  
Length Of Hospital Stay ◽  
Clinical Frailty Scale ◽  
Frail Patients ◽  
Increased Risk

Abstract Background Frailty is common in patients with heart failure (HF) and is associated with increased morbidity and mortality. A better understanding of the causes of hospitalisations and death in frail patients might help to tailor interventional strategies for these at-risk patients. Purpose We studied the cause of death and hospitalisations in ambulatory patients with HF and frailty. Methods We assessed frailty using the clinical frailty scale (CFS) in consecutive HF patients attending a routine follow-up visit. Those with CFS ≥5 were classified as frail. Mortality and hospitalisations were ascertained from medical records (updated systematically using an NHS electronic database), discharge letters, autopsy reports and death certificates. We studied the primary cause of death and hospitalisations within one year of enrolment. Results 467 patients (67% male, median (IQR) age 76 (69–82) years, median (IQR) NT-proBNP 1156 (469–2463) ng/L) were enrolled. 206 (44%) patients were frail. Frail patients were more likely to not receive or receive suboptimal doses of ACEi/ARB and Beta-blockers; while non-frail patients were more likely to be treated with optimal doses. At 1-year follow up, there were 56 deaths and 322 hospitalisations, of which 46 (82%) and 215 (67%) occurred in frail patients. Frailty was associated with an increased risk of all-cause mortality (HR (95% CI): 4.27 (2.60–7.01)) and combined mortality/ hospitalisation (HR (95% CI): 2.85 (2.14–3.80)), all p&lt;0.001. 57% (n=26) of frail patients died of cardiovascular causes (of which 58% were due to HF progression); although deaths due to non-cardiovascular causes (43%, n=20), especially severe infections, were also common (26%, n=12). (Figure 1) The proportion of frail patients who had non-elective hospital admissions within 1 year was more than double that of non-frail patients (46% (n=96) vs 21% (n=54); p&lt;0.001). Compared to non-frail patients, frail patients had more recurrent (≥2) hospitalisations (28% (n=59) vs 9% (n=24); p&lt;0.001) but median (IQR) average length of hospital stay was not significantly different (frail: 6 (4–11) vs non-frail: 6 (2–12) days, p=0.50). A large proportion of hospitalisations (64%, n=137) in frail patients were due to non-cardiovascular causes (of which 34%, 30% and 20% were due to infections, falls and comorbidities respectively). Of cardiovascular hospitalisations (36%, n=78), the majority were due to decompensated HF (67%, n=46). (Figure 1) Conclusion Frailty is common in patients with HF and is associated with an increased risk of mortality and recurrent hospitalisations. A significant proportion suffered non-cardiovascular deaths and hospitalisations. This implies that interventions targeted at HF alone can only have limited impact on outcomes in frail patients. Figure 1 Funding Acknowledgement Type of funding source: None

scholarly journals Risk factors for high length of hospital stay and in-hospital mortality in hip fractures in the elderly

2021 ◽  
Vol 65 (5) ◽  
pp. 322-330
Author(s):  
J. Salvador Marín ◽  
F.J. Ferrández Martínez ◽  
C. Fuster Such ◽  
J.M. Seguí Ripoll ◽  
D. Orozco Beltrán ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hospital Mortality ◽  
Hospital Stay ◽  
Hip Fractures ◽  
Length Of Hospital Stay ◽  
The Elderly ◽  
High Length

Trends in hospitalization and in-hospital mortality of patients with heart failure in Spain. A population-based study (2003–2015)

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J.L Bonilla Palomas ◽  
M.P Anguita-Sanchez ◽  
F.J Elola ◽  
J.L Bernal ◽  
C Fernandez-Perez ◽  
...  
Keyword(s):  
Heart Failure ◽  
Mortality Rate ◽  
Hospital Mortality ◽  
National Health System ◽  
Admission Rate ◽  
Population Data ◽  
Principal Diagnosis ◽  
Data Set ◽  
Discharge Rates ◽  
Mortality Ratio

Abstract Background Heart failure (HF) is one of the most pressing current public health concerns. However, in Spain there is a lack of population data. Purpose To investigate trends in HF hospitalization and in-hospital mortality rates. Methods We conducted a retrospective observational study of patients discharged with the principal diagnosis of HF from The National Health System' acute hospitals during 2003–2015. The source of the data was the Minimum Basic Data Set of the Ministry of Health, Consumer and Social Welfare. We analyzed trends in hospital discharge rates for HF (discharge rates were weighted by age and gender) an in-hospital mortality. The risk-standardized in-hospital mortality ratio (RSMR) was defined as the ratio between predicted mortality (which individually considers the performance of the hospital where the patient is attended) and expected mortality (which considers a standard performance according to the average of all hospitals) multiplied by the crude rate of mortality. RSMR was calculated using a risk adjustment multilevel logistic regression models developed by the Medicare and Medicaid Services. Temporal trend during the observed period was modelled using Poisson regression analysis with year as the only independent variable. In this model, the incidence rate ratio (IRR) and their 95% confidence intervals (95% CI) was calculated. Results A total of 1 254 830 episodes of HF were selected. Throughout 2003–2015 the number of hospital discharges with principal diagnosis of HF increased by 61% (IRR: 1.04; CI: 1.03–1.04; p&lt;0.001), meanwhile the crude mortality rate and the mean length of stay (LOS) diminished significantly (IRR: 0.99; CI: 0.98–1; and IRR: 1.04; CI: 0.99–0.99; p&lt;0.001, for both). Discharge rates weighted by age and sex showed a statistically significant increase during the period (IRR: 1.03; CI: 1.03–1.03; p&lt;0.001); however, whereas discharge rates increased significantly in older groups of age (≥75 years old) (IRR: 1–1.02; p&lt;0.001) they diminished in younger groups of age (45–74 years old) (IRR: 0.99; p&lt;0.001 and there was not a significant trend in the discharge rates for the group of 35–44 years old (Figure). The risk-standardized in-hospital mortality ratio did not significantly change throughout 2003–2015 (IRR: 0.997; CI: 0.992–1; p=0.32), however the risk-standardized LOS ratio diminished from 1.07 in 2003 to 0.97 in 2015 (IRR: 0.98: IC: 0.98–0.99; p&lt;0.001). Conclusions From 2003 to 2015, HF admission rate increased significantly in Spain as a consequence of the sustained increase of hospitalization in the population over 75. The crude in-hospital mortality rate diminished significantly for the same period, but the risk-standardized in-hospital mortality ratio did not significantly change. Figure 1 Funding Acknowledgement Type of funding source: None

scholarly journals Critical Pathway and Hospital-Hospital Cooperation in Acute Stroke Reduction of the Length of Hospital Stay

2000 ◽  
Vol 6 (1_suppl) ◽  
pp. 251-255 ◽  
Author(s):  
Y. Hashimoto ◽  
T. Terasaki ◽  
T. Yonehara ◽  
M. Tokunaga ◽  
T. Hirano ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Hospital Stay ◽  
Acute Stroke ◽  
Neurological Disease ◽  
Average Length ◽  
Length Of Hospital Stay ◽  
Stroke Patients ◽  
Critical Pathway ◽  
Hospital Days ◽  
Other Neurological Disease

Stroke patients tend to stay longer in one hospital compared to patients with other neurological disease. After the introduction of 3 types of critical pathway dedicated for various severity of acute ischemic stroke in 1995, the average length of in-hospital days declined from 30.0 days (1993) to 15.3 days (1998), ie 49% reduction. This reduction was achieved by the use of critical pathway and the hospital-hospital cooperation.

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