Predictors for shorter and longer length of hospital stay outliers: a retrospective case-control study of 8247 patients at a university hospital trauma department

Abstract Background: More than 50% of patients worldwide die in hospitals. It is well known that end-of-life hospital care is costly.Our aims were to test whether the support of the palliative team can reduce end-of-life costs and to study the mechanisms of cost reduction.Methods: This was a one-centre descriptive retrospective case-control study. Big data from registries of routine visits were used for case-control matching. We included the expenses billed to the insurance company and added separately charged drugs and materials. We compared the groups over the duration of the terminal hospitalization, ICU days (ICU=intensive care unit), IV antibiotic use (IV=intravenous), MRI/CT scans (MRI/CR=magnetic resonance imaging/computed tomography), oncologic treatment in the last month of life, and documentation of the dying phase.We searched for all in-hospital cases who died in the university hospital in Prague with the support of the hospital palliative team from January 2019 to April 2020 and matched them with similar controls. The controls were matched according to age, sex, Charlson comorbidity index and diagnosis recorded on the death certificate.Results: We identified 213 dyads. The average daily costs were three times lower in the palliative group (4,392.4 CZK per day=171.3 EUR) than in the non-palliative group (13,992.8 CZK per day=545.8 EUR), and the difference was caused by the shorter time spent in the ICU (16% vs 33% of hospital days). This was probably due to better documentation of the dying phase in the medical records.Conclusions: To date, there are sparse hospital data available on the economic aspects of end-of-life care. We showed that the integration of the palliative care team in the dying phase can be cost saving. The evidence that hospital palliative care can save a substantial amount of money can be used to support the integration of palliative care in hospitals in middle- and low-income countries. A multicentre study with the same design is planned in the future to increase the strength of the results.

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MON-705 Islet Auto-Transplantation Following Partial Pancreatectomy Improves Glycemic Outcomes and Reduces Length of Hospital Stay: Multi-Center, Case-Control Study

Journal of the Endocrine Society ◽

10.1210/jendso/bvaa046.1783 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

Author(s):

Sushela S Chaidarun ◽

Joe B elmunzer ◽

Smith D kerrington ◽

Timothy B Gardner

Keyword(s):

Hospital Stay ◽

Pancreatic Resection ◽

Case Control Study ◽

Tertiary Care ◽

Length Of Hospital Stay ◽

Case Control ◽

Partial Pancreatectomy ◽

Pancreatic Diseases ◽

Glycemic Outcomes ◽

Control Study

Abstract Introduction: Islet auto-transplantation (IAT) is increasingly being performed to prevent brittle diabetes following pancreatic resection in patients with benign pancreatic diseases. While patients undergoing total or completion pancreatectomy clearly benefit from IAT, the glycemic benefit of IAT in patients undergoing partial pancreatic resection is not known. We aimed to determine if IAT improved glycemic outcomes in patients undergoing partial pancreatectomy for benign pancreatic diseases. Methods: We performed a multicenter, retrospective case-control study of patients who underwent partial pancreatic resection with IAT at two tertiary care centers. Case patients were compared to controls who underwent partial pancreatic resection without IAT at one center prior to offering IAT. The primary outcome was the mean change in pre vs. post-operative HgA1c following transplant as well as the development of new post-operative diabetes. Results: 9 patients requiring partial pancreatectomy for benign disease underwent IAT and were compared to 13 historical controls without IAT. Baseline characteristics were similar between groups including age, etiology of pancreatitis, the presence of diabetes and pre-operative HgA1c (5.7 vs. 5.2, p=0.448). With a median follow-up of 22 months, those who received an IAT had a smaller increase in their pre- vs. post-operative HgA1c (0.42 vs 2.83, p=0.004) and one case patient (14.3%) vs. three control patients (23.1%) developed new post-operative diabetes (p=0.581). Patients who underwent IAT had a shorter length of stay (6 days vs 11 days, p=0.039) compared to control patients. Conclusions: Patients undergoing partial pancreatic resection for benign pancreatic disease should be considered for IAT, as long-term glycemic outcomes are improved in those undergoing transplant. The shorter length of hospital stay is likely related to less brittle glucose control after the surgery with some endogenous insulin production by auto-islet graft function.

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N-acetylcysteine treatment in viral-induced acute liver failure

International Journal of Clinical Trials ◽

10.18203/2349-3259.ijct20193213 ◽

2019 ◽

Vol 6 (3) ◽

pp. 106

Author(s):

Tauseef Nabi ◽

Nadeema Rafiq

Keyword(s):

Liver Failure ◽

Acute Liver Failure ◽

Hospital Stay ◽

Case Control Study ◽

Length Of Hospital Stay ◽

Case Control ◽

Control Group ◽

Duration Of Hospital Stay ◽

Baseline Characteristics ◽

Control Study

Background: Acute liver failure (ALF) is characterized by acute derangement of liver function and carries high mortality. Viral hepatitis is still one of the main causes of ALF in the India as well in world. A prospective case control study was carried with the aim to determine the effect of N-acetylcysteine (NAC) on survival of viral-ALF patients.Methods: 37 patients with a diagnosis of viral-ALF were included in the study. 18 patients received NAC infusion for 72 hrs whereas 19 patients in control group received placebo. The variables evaluated were demographic, biochemical, outcome and length of hospital stay.Results: Out of 37 viral-ALF patients, acute HEV-induced ALF (48.6%) was most common followed by HBV (24.3%) and HAV (21.6%). The two groups were comparable for the various baseline characteristics (age, INR, bilirubin, ALT, creatinine, albumin, grade of encephalopathy, mean grade of coma etc.). Use of NAC was associated with a shorter length of hospital stay of survived patients (p=0.024). A total of 20 of 37 (54.1%) patients died with ALF complications; 7 (38.9%) patients belonged to NAC group and 13 (68.4%) patients to control group (p=0.079). HEV induced ALF showed significant improved in survival than Non HEV induced ALF with NAC administration (p=0.022).Conclusions: HEV was the most frequently cause of viral-ALF. Overall survival was not improved by NAC. HEV induced ALF showed significant improved in survival than Non HEV induced ALF with NAC administration. NAC reduced duration of hospital stay.

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Valproic Acid-Induced Liver Injury: A Case-Control Study from a Prospective Pharmacovigilance Program in a Tertiary Hospital

Journal of Clinical Medicine ◽

10.3390/jcm10061153 ◽

2021 ◽

Vol 10 (6) ◽

pp. 1153

Author(s):

Enrique S. Meseguer ◽

Mikel U. Elizalde ◽

Alberto M. Borobia ◽

Elena Ramírez

Keyword(s):

Valproic Acid ◽

Liver Injury ◽

Case Control Study ◽

Monitoring Program ◽

Case Control ◽

University Hospital ◽

Control Groups ◽

Retrospective Case ◽

Drug Induced ◽

Control Study

Introduction: Valproic acid (VPA) is an antiepileptic drug extensively used for treating partial and generalised seizures, acute mania and as prophylaxis for bipolar disorder. Drug-induced liver injury (DILI) persists as a significant issue related to fatal outcomes by VPA. The aim of this study was to increase our knowledge about this condition and to better identify patients affected. Methods: We conducted an observational retrospective case-control study that identified cases of DILI by VPA from the Pharmacovigilance Programme from our Laboratory Signals at La Paz University Hospital from January 2007 to December 2019. From the Therapeutic VPA Monitoring program, two control groups were assigned, VPA-tolerant patients and the other with patients who developed mild VPA-related liver injury but who did not meet the DILI criteria, matched for date, age and sex. Results: A total of 60 patients were included in the study: 15 cases of DILI, 30 VPA-tolerant controls and 15 controls with mild liver injury. Mean age for the cases was 45.7 years, 4 (26.7%) were women and 5 (33.34%) were children under 18 years, of them 3 (20%) were fatal. Polytherapy with other antiepileptic drugs (p = 0.047) and alcohol consumption (p < 0.001) were associated with a greater risk of developing DILI by VPA. A diagnosis of epileptic seizure was more frequently related to DILI when compared with the VPA-tolerant controls (p < 0.001). The cases developed hepatocellular liver injury (p < 0.001), while the mild hepatic damage controls had a higher rate of cholestatic liver injury (p < 0.001). The laboratory lactate dehydrogenase values were statistically higher (even at baseline) in patients with DILI than in both control groups (p = 0.033 and p = 0.039). Conclusions: VPA hepatotoxicity remains a considerable problem. This study offers interesting findings for characterising VPA-induced liver injury and at-risk patients.

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Hyperglycemia: A bad prognostic factor for neonate.

The Professional Medical Journal ◽

10.29309/tpmj/2020.27.10.4499 ◽

2020 ◽

Vol 27 (10) ◽

pp. 2133-2137

Author(s):

Muhammad Anwar ◽

Muhammad Asghar Ali ◽

Ali Hammad

Keyword(s):

Birth Weight ◽

Hospital Stay ◽

Case Control Study ◽

Length Of Hospital Stay ◽

Case Control ◽

P Value ◽

Increased Risk ◽

Study Participants ◽

Study Setting ◽

Control Study

Objectives: The study was aimed to find out morbidity and mortality associated with hyperglycemia among neonates at our setting. Study Design: Observational Case-Control study. Setting: Department of Neonatology, Civil Hospital, Bahawalpur. Period: From 1st July 2019 to 31st December 2019. Material & Methods: The study included 194 neonates (97 each for cases and controls). Data like age (days), gender and weight were noted for all while presence of morbidities like IVH, NEC or infections were also recorded. Outcome among study participants of both groups was noted in terms of length of hospital stay and discharged/expired. Results: Out of a total of 194 study participants, majority, 114 (58.8%) were male, 101 (52.1%) had age between 1 to 7 days, and 84 (43.3%) had birth weight below 1.5 kilograms. Significantly more neonates had morbidity. Significantly more cases, 57 (58.8%) expired in comparison to 38 (39.2%) controls (p value 0.006). Length of hospital stay was also significantly more prolonged among cases. Conclusion: Neonates having hyperglycemia not only are at significantly increased risk of having morbidities and mortality.

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Valproic Acid-Induced Liver Injury: A Case-Control Study from a Prospective Pharmacovigilance Program in a Tertiary Hospital

10.20944/preprints202101.0316.v1 ◽

2021 ◽

Author(s):

Enrique Seco Meseguer ◽

Mikel Urroz Elizalde ◽

Alberto M. Borobia ◽

Elena Ramírez

Keyword(s):

Valproic Acid ◽

Liver Injury ◽

Case Control Study ◽

Tertiary Hospital ◽

Case Control ◽

University Hospital ◽

Control Groups ◽

Retrospective Case ◽

Drug Induced ◽

Control Study

Introduction: Valproic acid (VPA) is an antiepileptic drug extensively used for treating partial and generalised seizures, acute mania and as prophylaxis for bipolar disorder. Drug-induced liver injury (DILI) persists as a significant issue related to fatal outcomes by VPA. The aim of this study was to increase our knowledge about this condition and to better identify patients affected. Methods: We conducted an observational retrospective case-control study that identified cases of DILI by VPA from the Pharmacovigilance Programme from our Laboratory Signals at La Paz University Hospital from January 2007 to December 2019. From the Therapeutic VPA Monitoring Programme, two control groups were assigned, VPA-tolerant patients and the other with patients who developed mild VPA-related hepatitis but who did not meet the DILI criteria, matched for date, age and sex. Results: A total of 60 patients were included in the study: 15 cases of DILI, 30 VPA-tolerant controls and 15 controls with mild hepatitis. Mean age for the cases was 45.7 years, 4(26.7%) were women and 5(33.34%) were children under 18 years, of them 3(20%) were fatal. Polytherapy with other antiepileptic drugs (p=0.047) and alcohol consumption (p<0.001) were associated with a greater risk of developing DILI by VPA. A diagnosis of epileptic seizure was more frequently related to DILI when compared with the VPA-tolerant controls (p<0.001). The cases developed hepatocellular hepatitis (p<0.001), while the mild hepatitis controls had a higher rate of cholestatic hepatitis (p<0.001). The laboratory lactate dehydrogenase values were statistically higher (even at baseline) in patients with DILI than in both control groups (p= 0.033 and p=0.039). Conclusions: VPA hepatotoxicity remains a considerable problem. This study offers interesting findings for characterising VPA-induced liver injury and at-risk patients.

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Does binge drinking between the age of 18 and 25 years predict alcohol dependence in adulthood? A retrospective case–control study in France

BMJ Open ◽

10.1136/bmjopen-2018-026375 ◽

2019 ◽

Vol 9 (5) ◽

pp. e026375 ◽

Cited By ~ 3

Author(s):

Marie-Pierre Tavolacci ◽

Quentin Berthon ◽

Damiano Cerasuolo ◽

Pierre Dechelotte ◽

Joel Ladner ◽

...

Keyword(s):

Risk Factor ◽

Alcohol Dependence ◽

Binge Drinking ◽

Case Control Study ◽

Clinical Investigation ◽

Case Control ◽

University Hospital ◽

Retrospective Case ◽

Control Study ◽

Alcohol Dependent

ObjectiveA retrospective case–control study was conducted to evaluate whether frequent binge drinking between the age of 18 and 25 years was a risk factor for alcohol dependence in adulthood.SettingThe Department of Addictive Medicine and the Clinical Investigation Center of a university hospital in France.ParticipantsCases were alcohol-dependent patients between 25 and 45 years and diagnosed by a psychiatrist. Consecutive patients referred to the Department of Addictive Medicine of a university hospital between 1 January 2017 and 31 December 2017 for alcohol dependence were included in the study. Controls were non-alcohol-dependent adults, defined according to an Alcohol Use Disorders Identification Test score of less than 8, and were matched on age and sex with cases. Data on sociodemographics, behaviour and alcohol consumption were retrospectively collected for three life periods: before the age of 18 years; between the age of 18 and 25 years; and between the age of 25 and 45 years. Frequency of binge drinking between 18 and 25 years was categorised as frequent if more than twice a month, occasional if once a month and never if no binge drinking.Results166 adults between 25 and 45 years were included: 83 were alcohol-dependent and 83 were non-alcohol-dependent. The mean age was 34.6 years (SD: 5.1). Frequent binge drinking between 18 and 25 years occurred in 75.9% of cases and 41.0% of controls (p<0.0001). After multivariate analysis, frequent binge drinking between 18 and 25 years was a risk factor for alcohol dependence between 25 and 45 years: adjusted OR=2.83, 95% CI 1.10 to 7.25.ConclusionsFrequent binge drinking between 18 and 25 years appears to be a risk factor for alcohol dependence in adulthood. Prevention measures for binge drinking during preadulthood, especially frequent binge drinking, should be implemented to prevent acute consequences as injury and death and long-term consequences as alcohol dependence.Trial registration numberNCT03204214; Results.

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