Acute medical illness and disability in the elderly

Acute illness and hospitalization are important events in the trajectory leading to disability in elderly people. Approximately 30-40% of elderly patients are discharged from hospitals with new disabilities. This rate may increase to 50% in people aged 85 and older. Hospitalization for an acute medical illness is a stressful and potential dangerous event for older persons that often leads to clinical complications, such as functional decline, prolonged length of stay, readmission, falls and mortality. Very old frail patients and those with preadmission functional limitation are at higher risk of complications. A new model of hospital care focused on functional status, including assessment on admission and throughout the hospital stay, promoting physical activity with early ambulation and planning for discharge home, is needed to reduce the incidence of hospitalization- associated disability and to increase the likelihood of going home reducing hospital length of stay.

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Predictive factors for prolonged hospitalisation in acute pyelonephritis patients admitted to the emergency medicine ward

Hong Kong Journal of Emergency Medicine ◽

10.1177/10249079211000976 ◽

2021 ◽

pp. 102490792110009

Author(s):

Howard Tat Chun Chan ◽

Ling Yan Leung ◽

Alex Kwok Keung Law ◽

Chi Hung Cheng ◽

Colin A Graham

Keyword(s):

Emergency Department ◽

Emergency Medicine ◽

Length Of Stay ◽

Acute Pyelonephritis ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Prolonged Length ◽

Reactive Protein ◽

Prolonged Hospital ◽

Emergency Medicine Ward

Background: Acute pyelonephritis is a bacterial infection of the upper urinary tract. Patients can be admitted to a variety of wards for treatment. However, at the Prince of Wales Hospital in Hong Kong, they are managed initially in the emergency medicine ward. The aim of the study is to identify the risk factors that are associated with a prolonged hospital length of stay. Methods: This was a retrospective cohort study conducted in Prince of Wales Hospital. The study recruited patients who were admitted to the emergency medicine ward between 1 January 2014 and 31 December 2017. These patients presented with clinical features of pyelonephritis, received antibiotic treatment and had a discharge diagnosis of pyelonephritis. The length of stay was measured and any length of stay over 72 h was considered to be prolonged. Results: There were 271 patients admitted to the emergency medicine ward, and 118 (44%) had a prolonged hospital length of stay. Univariate and multivariate analyses showed that the only statistically significant predictor of prolonged length of stay was a raised C-reactive protein (odds ratio 1.01; 95% confidence 1.01–1.02; p < 0.0001). Out of 271 patients, 261 received antibiotics in the emergency department. All 10 patients (8.5%) who did not receive antibiotics in emergency department had a prolonged length of stay (p = 0.0002). Conclusion: In this series of acute pyelonephritis treated in the emergency medicine ward, raised C-reactive protein levels were predictive for prolonged length of stay. Patients who did not receive antibiotics in the emergency department prior to emergency medicine ward admission had prolonged length of stay.

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Abstract 17191: Intraprocedural Dobutamine Use is Independently Associated With Prolonged Length of Stay (LOS) Following Ventricular Tachycardia (VT) Ablation

Circulation ◽

10.1161/circ.138.suppl_1.17191 ◽

2018 ◽

Vol 138 (Suppl_1) ◽

Author(s):

Jeffrey D Graham ◽

Michael Rosenberg ◽

Amneet Sandhu ◽

Alexis Tumolo ◽

Wendy Tzou ◽

...

Keyword(s):

Length Of Stay ◽

Patient Characteristics ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Impact Factors ◽

Vasoactive Drugs ◽

Prolonged Length ◽

Procedural Time ◽

Minimal Data ◽

Vt Ablation

Introduction: Use of inotropes such as dobutamine remains controversial in the management of heart failure (HF) due to uncertain efficacy and lack of mortality benefit. Furthermore, vasoactive drugs are frequently utilized during VT ablations despite minimal data regarding their effects on outcomes. Vasoactive drugs may impact factors such as long-term VT recurrences and hospital length of stay. Hypothesis: We sought to evaluate the hypothesis that the use of dopamine, dobutamine or phenylephrine have differential effects on outcomes after VT ablations. Methods: A retrospective analysis was completed for all VT ablations from 2013-17 at our institution. Patient characteristics and procedural details were collected for 149 VT ablation cases. Results: The cohort was 81% male, and 67% had cardiomyopathy of which 53% were ischemic with a mean EF of 29% (CI 26.7- 31.4). Average procedure time was 368 minutes (CI 347-388). Vasoactive drugs were used in 87% of patients undergoing VT ablation: phenylephrine (67%), dopamine (40%), dobutamine (37%). The median LOS for all patients was 5 days (mean 7 days, range 1 - 56 days, IQR 2 - 9 days). After adjusting for inducibility, HF and procedural time, the dose of dobutamine, but not dopamine or phenylephrine, was significantly associated with increased length of stay (Fig. 1a). Inducible VT at the end of the procedure also correlated with increased LOS (5.4±0.3 vs 8.6±0.3, p < 0.0001). Procedural time did not associate with increased LOS. Of all covariates, only the number of VTs induced during the procedure was significantly associated with increased VT recurrence (HR 1.22/VT morphology (CI 1.11-1.34, p < 0.001)). Conclusions: Dobutamine, but not phenylephrine or dopamine, was significantly associated with increased length of stay after adjusting for HF, procedural time and inducibility of VT. More research is needed regarding vasoactive drug use in VT ablations and their significance to procedural and post-procedure outcomes.

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EARLY TRACHEOSTOMY IN THE ELDERLY SURGICAL ICU (SICU) PATIENT IS ASSOCIATED WITH DECREASED ICU AND HOSPITAL LENGTH OF STAY.

Critical Care Medicine ◽

10.1097/00003246-200612002-00427 ◽

2006 ◽

Vol 34 ◽

pp. A124 ◽

Cited By ~ 2

Author(s):

Richard H Savel ◽

Evan Goldstein ◽

Deborah Riedinger ◽

Herbert E Lehman ◽

Yizhak Kupfer

Keyword(s):

Length Of Stay ◽

The Elderly ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Early Tracheostomy ◽

Surgical Icu

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Prolonged Length of Stay After Liver Transplantation

ICU Director ◽

10.1177/1944451612439315 ◽

2012 ◽

Vol 3 (2) ◽

pp. 75-79

Author(s):

Andrew T. Young ◽

Gebhard Wagener

Keyword(s):

Liver Transplantation ◽

Length Of Stay ◽

Hospital Stay ◽

Kidney Injury ◽

Hospital Length ◽

Meld Score ◽

Hospital Length Of Stay ◽

Prolonged Hospital Stay ◽

Prolonged Length ◽

Prolonged Hospital

Prolonged hospital length of stay after liver transplantation uses a large amount of hospital resources. The authors evaluated factors associated with prolonged hospital stay in a large single center series. Prolonged hospital stay was defined as more than 30 days. A total of 578 adult cadaveric liver transplants were included, and of these, 160 (27.7%) had a prolonged hospital stay. These patients had shorter waitlist time, higher preoperative MELD (model for end-stage liver disease) scores and received organs from donors with lower donor risk indices. In multivariate analysis, only preoperative MELD score remained significant. Postoperatively, there was no difference in the incidence of acute kidney injury; however, patients with prolonged hospital stay were more likely to have early allograft dysfunction and a higher 90-day mortality.

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Is delirium after general anesthesia in the elderly an independent predictor of hospital length of stay?

European Journal of Anaesthesiology ◽

10.1097/00003643-201406001-00770 ◽

2014 ◽

Vol 31 ◽

pp. 267

Author(s):

V. Gherghina ◽

I. Cindea ◽

D. Costea ◽

R. Popescu ◽

A. Balcan

Keyword(s):

Length Of Stay ◽

General Anesthesia ◽

Independent Predictor ◽

The Elderly ◽

Hospital Length ◽

Hospital Length Of Stay

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Perioperative Individualized Goal Directed Therapy for Cardiac Surgery: A Historical-Prospective, Comparative Effectiveness Study

Journal of Clinical Medicine ◽

10.3390/jcm10030400 ◽

2021 ◽

Vol 10 (3) ◽

pp. 400

Author(s):

Davinder Ramsingh ◽

Huayong Hu ◽

Manshu Yan ◽

Ryan Lauer ◽

David Rabkin ◽

...

Keyword(s):

Cardiac Surgery ◽

Length Of Stay ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Patient Specific ◽

Goal Directed Therapy ◽

Prolonged Length ◽

Icu Length Of Stay ◽

Increased Risk ◽

Comparative Effectiveness Study

Introduction: Cardiac surgery patients are at increased risk for post-operative complications and prolonged length of stay. Perioperative goal directed therapy (GDT) has demonstrated utility for non-cardiac surgery, however, GDT is not common for cardiac surgery. We initiated a quality improvement (QI) project focusing on the implementation of a GDT protocol, which was applied from the immediate post-bypass period into the intensive care unit (ICU). Our hypothesis was that this novel GDT protocol would decrease ICU length of stay and possibly improve postoperative outcomes. Methods: This was a historical prospective, QI study for patients undergoing cardiac surgery requiring cardiopulmonary bypass (CPB). Integral to the QI project was education towards all associated providers on the concepts related to GDT. The protocol involved identifying patient specific targets for cardiac index and mean arterial pressure. These targets were maintained from the post-CPB period to the first 12 h in the ICU. Statistical comparisons were performed between the year after GDT therapy was launched to the last two years prior to protocol implementation. The primary outcome was ICU length of stay. Results: There was a significant decrease in ICU length of stay when comparing the year after the protocol initiation to years prior, from a median of 6.19 days to 4 days (2017 vs. 2019, p < 0.0001), and a median of 5.88 days to 4 days (2018 vs. 2019, p < 0.0001). Secondary outcomes demonstrated a significant reduction in total administered volumes of inotropic medication(milrinone). All other vasopressors demonstrated no differences across years. Hospital length of stay comparisons did not demonstrate a significant reduction. Conclusion: These results suggest that an individualized goal directed therapy for cardiac surgery patients can reduce ICU length of stay and decrease amount of inotropic therapy.

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Prevalence of Hospital Admissions for Low Back Pain: Protocol for a Systematic Review and Meta-Analysis

10.31219/osf.io/ym9ka ◽

2020 ◽

Author(s):

Harrison J Lord ◽

Danielle Coombs ◽

Christopher Maher ◽

Gustavo C Machado

Keyword(s):

Emergency Department ◽

Low Back Pain ◽

Back Pain ◽

Length Of Stay ◽

Hospital Admission ◽

Hospital Admissions ◽

Functional Decline ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Low Back

Low back pain is the leading cause of years lived with disability in most countries and creates a huge burden for healthcare systems globally. Around the globe, 4.4% of all emergency department attendances are attributed to low back pain, and subsequent admissions to hospital seem to be common. These hospitalisations can result in unnecessary medical care, functional decline and high costs. There are no systematic reviews summarising the global prevalence of hospital admission for low back pain, identifying the sources of admissions or estimating hospital length of stay. This information would be valuable for health and medical researchers, front-line clinicians, and health planners aiming to improve and increase the value of their health services. The objectives of this study are to estimate the prevalence of hospital admission for low back pain from different healthcare facilities across the globe, including the emergency department, as well as investigate hospital length of stay and explore sources of heterogeneity when categorising studies according to low back pain definitions, sources of admission, study period, study setting and country’s region and income level.

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Multicenter Osteopathic Pneumonia Study in the Elderly: Subgroup Analysis on Hospital Length of Stay, Ventilator-Dependent Respiratory Failure Rate, and In-hospital Mortality Rate

The Journal of the American Osteopathic Association ◽

10.7556/jaoa.2016.117 ◽

2016 ◽

Vol 116 (9) ◽

pp. 574 ◽

Cited By ~ 7

Author(s):

Donald R. Noll ◽

Brian F. Degenhardt ◽

Jane C. Johnson

Keyword(s):

Respiratory Failure ◽

Mortality Rate ◽

Length Of Stay ◽

Hospital Mortality ◽

Failure Rate ◽

Subgroup Analysis ◽

The Elderly ◽

Hospital Length ◽

Hospital Length Of Stay

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Vasoactive-ventilation-renal score: a reliable prognostic index for perioperative outcomes following congenital heart surgery in adults

Cardiology in the Young ◽

10.1017/s1047951120004588 ◽

2020 ◽

pp. 1-7

Author(s):

Diana M. Torpoco Rivera ◽

Richard U. Garcia ◽

Sanjeev Aggarwal

Keyword(s):

Length Of Stay ◽

Heart Surgery ◽

Strong Predictor ◽

Prognostic Index ◽

Congenital Heart Surgery ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Perioperative Outcomes ◽

Study Cohort ◽

Prolonged Length

Abstract Introduction: The number of adults requiring surgeries for CHD is increasing. We sought to evaluate the utility of the vasoactive-ventilation-renal (VVR) score as a predictor of prolonged length of stay in adults following CHD surgery. Methods: This is a retrospective review of 158 adult patients who underwent CHD surgery involving cardiopulmonary bypass. VVR score was calculated upon arrival to ICU and every 6 hours for the first 48 hours post-operatively. Our primary outcome was prolonged length of stay defined as hospital length of stay greater than 75th percentile for the cohort (≥8 days). Results: The study cohort had a median age of 25.6 years (18–60 years), and 83 (52.5%) were male. The groups with and without prolonged length of stay were comparable in age, gender, race, and surgical severity score. VVR score was significantly higher at all time points in the group with prolonged length of stay. The first post-operative day peak VVR score ≥13 had a sensitivity of 81% and specificity of 75% for predicting prolonged length of stay (p = 0.0001). On regression analysis, peak VVR score during the first day was independently associated with prolonged length of stay. Conclusions: Peak VVR score during the first post-operative day was a strong predictor of prolonged length of stay in adults following CHD surgery.

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