The impact of day of surgery on the length of stay for major urological procedures

Introduction: Surgery performed later in the week has been associated with longer length of stay (LOS). The aim of this study was to assess if the day of the surgery impacted the LOS for two major urological procedures in a tertiary referral university teaching hospital.Methods: A retrospective review was performed of two major urological procedures consecutively performed by a single surgeon in our unit from March 2012 to December 2015. Patient demographics, histopathological characteristics, operative details, and LOS were obtained from the patients’ medical records. Procedures performed on Monday or Tuesday were defined as early in the week and procedures performed on Wednesday, Thursday, or Friday were defined as late in the week.Results: During the study period, 140 open radical prostatectomy (ORP) and 42 open partial nephrectomy (OPN) procedures were performed. There was a significant difference in median LOS for major urological procedures performed early in the week compared to late in the week (3 [3‒4] days vs. 4 [4‒5] days; p= 0.0001). There was a significant difference in median LOS for ORP performed early in the week compared to late in the week (3 [3‒4] days vs. 4 [4‒5] days; p= 0.0004). There was a similar significant difference in OPN performed early in the week compared to late in the week (4 [3‒5.5] days vs. 5 [4‒5] days; p= 0.029).Conclusions: The day of surgery impacts LOS for major urological procedures. Major procedures should be performed early in the week, when it is feasible to facilitate prompt safe discharge and better use of hospital resources.

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53. Incidence of Bloodstream Infections and Outcomes in Patients with Severe COVID-19 Pneumonia

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.363 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S156-S157

Author(s):

Aikaterini Papamanoli ◽

Jeanwoo Yoo ◽

Azad Mojahedi ◽

Robin Jacob ◽

Prabhjot Grewal ◽

...

Keyword(s):

Length Of Stay ◽

Medical Records ◽

Bloodstream Infections ◽

Blood Stream ◽

Blood Cultures ◽

High Flow ◽

University Hospital ◽

Skin Microbiota ◽

Prolonged Recovery ◽

The Impact

Abstract Background Coronavirus disease 19 (COVID-19) leading to acute respiratory distress syndrome is associated with need for intensive care (IC), mechanical ventilation (MV), and prolonged recovery. These patients are thus predisposed to blood stream infections which can worsen outcomes. This risk may be aggravated by adjunctive therapies. Methods We reviewed the medical records of all adults admitted to Stony Brook University Hospital, NY, from March 1 to April 15, 2020 with severe COVID-19 pneumonia (requiring high-ﬂow O2). Patients who received MV or died within 24h were excluded. Patients were followed until death or hospital discharge. We reviewed positive blood cultures (PBC) for pathogenic microorganisms, and calculated the incidence of bacteremia, rates of infective endocarditis (IE), and impact on mortality. Microbes isolated only once and belonging to groups defined as commensal skin microbiota were labelled as contaminants. We also examined the impact of adjunctive therapies with immunosuppressive potential (steroids and tocilizumab), on bacteremia. Results A total of 469 patients with severe COVID-19 pneumonia were included (Table 1). Of these, 199 (42.4%) required IC and 172 (36.7%) MV. Median length of stay was 13 days (8–22) and 94 (20.0%) had PBC. Of these, 43 were considered true pathogens (bacteremia), with predominance of E. faecalis and S. epidermidis, and 51 were considered contaminants (Table 2). The incidence of bacteremia (43/469, 9.2%) was 5.1 per 1000 patient-days (95%CI 3.8–6.4). An echocardiogram was performed in 21 patients, 1 had an aortic valve vegetation (IE) by methicillin sensitive S. aureus. Bacteremia rates were nonsignificantly higher with steroids (5.9 vs 3.7 per 1000 patient-days; P=0.057). Use of tocilizumab was not associated with bacteremia (5.8 vs 4.8 per 1000 patient-days; P=0.28). Mortality was nonsignificantly higher in patients with (15/43, 34.9%) vs. without (108/426, 25.4%) bacteremia (P=0.20). Length of stay was the strongest predictor of bacteremia, with risk increasing by 7% (95%CI 6%-9%, P< 0.001) per additional day. Cohort Characteristics of Patients with Severe COVID-19 Pneumonia on High-Flow O2 (N= 469) All Microorganisms Isolated from Blood Cultures Conclusion The incidence of bacteremia was relatively low and IE was uncommon in this study of severe COVID-19 patients. Risk of bacteremia increased with longer hospital stay and with steroids use, but not with tocilizumab. Disclosures All Authors: No reported disclosures

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The Impact of Medical Comorbidities on Patient Satisfaction in Chronic Rhinosinusitis

Annals of Otology Rhinology & Laryngology ◽

10.1177/00034894211015736 ◽

2021 ◽

pp. 000348942110157

Author(s):

Amarbir S. Gill ◽

Joshua Hwang ◽

Angela M. Beliveau ◽

Jeremiah A. Alt ◽

Edward Bradley Strong ◽

...

Keyword(s):

Patient Satisfaction ◽

Hearing Impairment ◽

Chronic Rhinosinusitis ◽

Medical Comorbidities ◽

Patient Demographics ◽

Significant Difference ◽

Comorbidity Index ◽

The Mean ◽

Therapy Compliance ◽

The Impact

Background: Patient satisfaction has a significant bearing on medical therapy compliance and patient outcomes. The purpose of this study was to (1) describe patient satisfaction, as characterized by the Patient Satisfaction Questionnaire-18 (PSQ-18), in the care of patients with chronic rhinosinusitis (CRS) and (2) analyze the impact of comorbidities on satisfaction using the functional comorbidity index (FCI). Methods: Patient demographics, disease severity measures, and PSQ-18 scores for patients with CRS presenting to a tertiary rhinology clinic between November 2019 and April 2020 were collected and analyzed. FCI was calculated retrospectively using the electronic medical record; individual comorbidities were tabulated. Spearman’s correlations followed by multivariate regression was used to assess the relationship between medical comorbidities and PSQ-18. Results: Sixty-nine patients met criteria for analysis. There were no significant differences in age, gender, and Sinonasal Outcomes Test-22 scores between CRS patients with (CRSwNP) and without (CRSsNP) nasal polyps. There was no significant difference in the mean FCI for patients with CRSwNP versus CRSsNP (5.1 and 4.3, respectively) ( P = .843). Similarly, there was no significant difference in the mean sum PSQ-18 score (78/100 in both) between these cohorts ( P = .148). The mean sum PSQ-18 score was not significantly associated with anxiety ( P = .728), depression ( P = .624), or FCI ( P = .282), but was significantly associated with hearing impairment ( P < .001). Conclusion: Patient satisfaction in the care of CRS is generally high with a diagnosis of comorbid hearing impairment demonstrating a negative association with satisfaction in this cohort.

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Enhanced Recovery After Tonsillectomy

10.22541/au.161997734.46068656/v1 ◽

2021 ◽

Author(s):

Marc Logarta ◽

Anne McCready ◽

Alan Cheng ◽

Alexander Duller

Keyword(s):

Postoperative Nausea ◽

Enhanced Recovery ◽

Caloric Intake ◽

Postoperative Nausea And Vomiting ◽

Normal Function ◽

University Teaching ◽

Fasting Period ◽

Significant Difference ◽

The Impact ◽

To Receive

Objectives Investigation of whether the duration of fasting preoperatively has an impact on pain and return to normal function after tonsillectomy To investigate the impact of the duration of preoperative fasting on pain and return to normal function after tonsillectomy. Design Retrospective study with surgeon blinded to the participants undergoing tonsillectomy with or without adenoidectomy Setting University teaching hospital, Sydney, Australia Participants A total of 174 children (n=174) ages 4-12 years old between February 2017 to April 2020 were enrolled. The children were randomised to receive instructions either from the staff at the hospital (n=90) or by the anaesthetist (n=84) in terms of exact pre-operative fasting. Main Outcome measures Fasting times, clear liquid caloric intake 2 hours prior to surgery and Parents Postoperative Pain Measures (PPPM) were documented and analysed. Secondary measures of analgesia usage, number of postoperative nausea or vomiting events were also analysed. Results Observed difference were noted between the instructed fasting period and the actual fasting period. Significant difference in PPPM scores was noted between the Hospital group and the juice group (p<0.001). No significant difference was noted at first to 3rd day (p=0.11) or by the 8th to 10th postoperative day (p=0.93). There was no difference in oxycodone usage between the two groups (p=0.52), or in postoperative nausea and vomiting (p=0.43) Conclusions Significantly lower PPPM scores were noted on day of surgery in the group that had fasting minimised. The effects appeared to trend in a positive manner but larger number of cases need to be performed for results to be of greater significance. Further research is required into the impact of caloric nutrition to enhance recovery after tonsillectomy.

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A single-center qualitative study evaluating the safety and efficacy of a pharmacist-driven protocol for high-dose methotrexate management

Journal of Oncology Pharmacy Practice ◽

10.1177/1078155220927455 ◽

2020 ◽

pp. 107815522092745

Author(s):

Stephanie F Matta ◽

Leslie A Gieselman ◽

Robert S Mancini

Keyword(s):

Length Of Stay ◽

Kidney Injury ◽

High Dose ◽

High Dose Methotrexate ◽

Improvement Project ◽

Treatment Delays ◽

Dose Methotrexate ◽

Significant Difference ◽

The Impact ◽

Inpatient Length Of Stay

Introduction Delayed methotrexate clearance in several patients admitted to the oncology unit at a regional medical center necessitated the development of a pharmacist-driven protocol for supportive therapy with high-dose methotrexate. This performance improvement project evaluated the impact of the protocol on inpatient length of stay, patient safety, and clinical outcomes. Methods Retrospective data were collected over 14 months pre-implementation and prospective data were collected over 19 months post-implementation. Primary outcomes included mean length of stay and incidence of kidney injury. Secondary outcomes included myelosuppression, treatment delays, mucositis, protocol adherence, and pharmacist interventions. Chi-squared and unpaired two sample t-test were used for data analysis. Intervention A literature review of consensus recommendations for supportive care post high-dose methotrexate administration was conducted to develop the protocol. Education on implementation was provided to involved disciplines. Results One-hundred ten high-dose methotrexate admissions for 23 patients were analyzed: 24 pre-protocol and 86 post-protocol. Mean length of stay was 5.17 nights pre-protocol and 3.91 nights post-protocol ( p = 0.026). Incidence of kidney injury significantly decreased (16.7% pre-protocol versus 3.5% post-protocol; p = 0.0394). Lower incidences of all-grade anemia (83.3% versus 58.1%), neutropenia (62.5% versus 29.1%), and thrombocytopenia (58.3% versus 33.7%) as well as treatment delays (29.2% versus 11.6%; p = 0.036) were reported post protocol. No statistically significant difference in mucositis was detected. Pharmacist adherence to protocol was ≥80% resulting in 348 interventions with 99.4% provider acceptance. Conclusion The implementation of a pharmacist-driven high-dose methotrexate management protocol resulted in a statistically significant decrease in inpatient length of stay and kidney injury. Further studies are needed to assess the impact on additional outcomes.

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Does MIS Surgery Allow for Shorter Constructs in the Surgical Treatment of Adult Spinal Deformity?

Neurosurgery ◽

10.1093/neuros/nyw072 ◽

2017 ◽

Vol 80 (3) ◽

pp. 489-497 ◽

Cited By ~ 18

Author(s):

Juan S. Uribe ◽

Joshua Beckman ◽

Praveen V. Mummaneni ◽

David Okonkwo ◽

Pierce Nunley ◽

...

Keyword(s):

Length Of Stay ◽

Blood Loss ◽

Clinical Outcomes ◽

Spinal Deformity ◽

Lumbar Lordosis ◽

Adult Spinal Deformity ◽

Radiographic Parameters ◽

Estimated Blood Loss ◽

Significant Difference ◽

The Impact

Abstract BACKGROUND: The length of construct can potentially influence perioperative risks in adult spinal deformity (ASD) surgery. A head-to-head comparison between open and minimally invasive surgery (MIS) techniques for treatment of ASD has yet to be performed. OBJECTIVE: To examine the impact of MIS approaches on construct length and clinical outcomes in comparison to traditional open approaches when treating similar ASD profiles. METHODS: Two multicenter databases for ASD, 1 involving MIS procedures and the other open procedures, were propensity matched for clinical and radiographic parameters in this observational study. Inclusion criteria were ASD and minimum 2-year follow-up. Independent t-test and chi-square test were used to evaluate and compare outcomes. RESULTS: A total of 1215 patients were identified, with 84 patients matched in each group. Statistical significance was found for mean levels fused (4.8 for circumferential MIS [cMIS] and 10.1 for open), mean interbody fusion levels (3.6 cMIS and 2.4 open), blood loss (estimated blood loss 488 mL cMIS and 1762 mL open), and hospital length of stay (6.7 days cMIS and 9.7 days open). There was no significant difference in preoperative radiographic parameters or postoperative clinical outcomes (Owestry Disability Index and visual analog scale) between groups. There was a significant difference in postoperative lumbar lordosis (43.3° cMIS and 49.8° open) and pelvic incidence-lumbar lordosis correction (10.6° cMIS and 5.2° open) in the open group. There was no significant difference in reoperation rate between the 2 groups. CONCLUSION: MIS techniques for ASD may reduce construct length, reoperation rates, blood loss, and length of stay without affecting clinical and radiographic outcomes when compared to a similar group of patients treated with open techniques.

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Impact of Contaminated Blood Cultures on Children, Families, and the Health Care System

Hospital Pediatrics ◽

10.1542/hpeds.2020-0146 ◽

2020 ◽

Vol 10 (10) ◽

pp. 836-843

Author(s):

Megan Farrell ◽

Sarah Bram ◽

Hongjie Gu ◽

Shakila Mathew ◽

Elizabeth Messer ◽

...

Keyword(s):

Health Care ◽

Length Of Stay ◽

Health Care System ◽

Peripheral Blood ◽

Blood Cultures ◽

Hospital Charges ◽

Significant Difference ◽

Contaminated Blood ◽

The Impact ◽

Care System

BACKGROUND: Contaminated blood cultures pose a significant burden. We sought to determine the impact of contaminated peripheral blood cultures on patients, families, and the health care system. METHODS: In this retrospective case-control study from January 1, 2014, to December 31, 2017, we compared the hospital course, return visits and/or admissions, charges, and length of stay of patients with contaminated peripheral blood cultures (case patients) with those of patients with negative cultures (controls). Patients were categorized into those evaluated and discharged from the emergency department (ED) (ED patients) and those who were hospitalized (inpatients). RESULTS: A total of 104 ED case patients were matched with 208 ED control patients. A total of 343 case inpatients were matched with 686 inpatient controls. There was no significant difference between case and control patient demographics, ED, or hospital course at presentation. Fifty-five percent of discharged ED patients returned to the hospital for evaluation and/or admission versus 4% of controls. There was a significant (P < .0001) increase in repeat blood cultures (43% vs 1%), consultations obtained (21% vs 2%), cerebrospinal fluid studies (10% vs 0%), and antibiotic administration (27% vs 1%) in ED patients compared with controls. Each ED patient requiring revisit to the hospital incurred, on average, $4660 in additional charges. There was a significant (P < .04) increase in repeat blood cultures (57% vs 7%), consultations obtained (35% vs 28%), broadening of antibiotic coverage (18% vs 11%), median length of stay (75 vs 64 hours), and median laboratory charges ($3723 vs $3296) in case inpatients compared with controls. CONCLUSIONS: Contaminated blood cultures result in increased readmissions, testing and/or procedures, length of stay, and hospital charges in children.

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8: IMPACT OF LATE USE MAGNESIUM SULFATE IN INNER CITY CHILDREN HOSPITALIZED FOR ASTHMA EXACERBATION

Journal of Investigative Medicine ◽

10.1136/jim-2016-000080.8 ◽

2016 ◽

Vol 64 (3) ◽

pp. 802.1-802

Author(s):

P Shukla ◽

E Aragona ◽

J Wang ◽

D Pillai

Keyword(s):

Length Of Stay ◽

Magnesium Sulfate ◽

Severe Asthma ◽

Asthma Exacerbation ◽

Status Asthmaticus ◽

Asthma Severity ◽

Day Length ◽

Multiple Doses ◽

Significant Difference ◽

The Impact

Purpose of StudyAsthma is typically treated acutely with β2-agonists and systemic steroids. Adjunctive therapies such as magnesium sulfate (MgSO4) have proven useful with early addition potentially improving clinical outcomes in asthma (reduced hospital admission rates, length of stay and intubation rates). Exact administration time and impact on outcomes in children are not fully understood. We sought to identify the impact of timing of initiating MgSO4 therapy in innercity children admitted for status asthmaticus.Methods UsedWe performed a retrospective chart review of children (age 2–21 yrs) admitted to a children's hospital over a 12 month period with asthma exacerbation and administered MgSO4. Data collected included ethnicity, gender, medications, timing of interventions, length of stay, BMI percentile, comorbidities and NAEPP asthma severity. Statistical analysis performed with SPSS 22.Summary of Results150 innercity children were admitted for asthma exacerbation and received MgSO4 during the study period. 85% were African American, 36% female, 39% had moderate/severe asthma and mean time to initial MgSO4 was 3.8 hours from triage. Those receiving initial MgSO4 after 4 hours were more likely to receive multiple doses of MgSO4 (OR2.8 [95%CI:1.4–5.6]). Time of initial MgSO4 dose (<4 vs. >4 hrs) showed no significant difference in other parameters including age, obesity, asthma severity, and comorbidities. A sub-analysis of children that received 1 dose vs. >1 MgSO4 dose demonstrated that those receiving >1 MgSO4 doses were more likely to be obese (OR2.7 [1.3–5.7]), have moderate/severe asthma (OR3.2 [1.6–6.8]) and have increased length of stay (p=0.005) and charges (p=0.042). Additionally, obese children (OR8.9 [2.2–35.2]), and intermittent/mild asthmatic children (OR6.4 [1.2–31.2]) receiving >1 MgSO4 dose were more likely to have >2 day length of stay.ConclusionsDelay in administration of MgSO4 in children hospitalized for status asthmaticus may be associated with poor outcomes including multiple doses of MgSO4 which in turn is associated with longer length of stay and increased charges. Obesity and asthma severity are important factors associated with these outcomes. A prospective analysis in a larger cohort is recommended to further evaluate these findings.

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Evaluation of an Initial Specimen Diversion Device (ISDD) on Rates of Blood Culture Contamination in the Emergency Department

Kansas Journal of Medicine ◽

10.17161/kjm.vol1413804 ◽

2021 ◽

Vol 14 ◽

pp. 73-76

Author(s):

Blake Buzard ◽

Patrick Evans ◽

Todd Schroeder

Keyword(s):

Emergency Department ◽

Length Of Stay ◽

Blood Culture ◽

Blood Cultures ◽

Contamination Rate ◽

Total Hospital Cost ◽

Initial Specimen ◽

Significant Difference ◽

Secondary Outcomes ◽

The Impact

Introduction: Blood cultures are the gold standard for identifying bloodstream infections. The Clinical and Laboratory Standards Institute recommends a blood culture contamination rate of <3%. Contamination can lead to misdiagnosis, increased length of stay and hospital costs, unnecessary testing and antibiotic use. These reasons led to the development of initial specimen diversion devices (ISDD). The purpose of this study is to evaluate the impact of an initial specimen diversion device on rates of blood culture contamination in the emergency department. Methods: This was a retrospective, multi-site study including patients who had blood cultures drawn in an emergency department. February 2018 to April 2018, when an ISDD was not utilized, was compared with June 2019 to August 2019, a period where an ISDD was being used. The primary outcome was total blood culture contamination. Secondary outcomes were total hospital cost, hospital and intensive care unit length of stay, vancomycin days of use, vancomycin serum concentrations obtained, and repeat blood cultures obtained. Results: A statistically significant difference was found in blood culture contamination rates in the Pre-ISDD group vs the ISDD group (7.47% vs 2.59%, p<0.001). None of the secondary endpoints showed a statistically significant difference. Conclusions: Implementation of an ISDD reduces blood culture contamination in a statistically significant manner. However, we were unable to capture any statistically significant differences in the secondary outcomes.

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Emergency Medical Services vs. Police: Impact of Pre-Hospital Transportation Method on Outcomes of Trauma Patients with Firearm Injuries

10.21203/rs.3.rs-103342/v1 ◽

2020 ◽

Author(s):

Christina Wohler ◽

Rachel Denneny ◽

Allegra Bermudez ◽

Robert Wilson ◽

Douglas Gouchoe ◽

...

Keyword(s):

Emergency Medical Services ◽

The United States ◽

Hospital Length Of Stay ◽

Medical Services ◽

Hospital Treatment ◽

Firearm Injuries ◽

Patient Demographics ◽

Emergency Medical ◽

Significant Difference ◽

The Impact

Abstract Background Firearms are a significant cause of morbidity and mortality in the United States. Few studies exist to investigate the impact of pre-hospital transportation methods on trauma patient outcomes. Methods Patients with firearm injuries were identified using an institutional trauma registry (2008 to 2017). Data on patient demographics, hospital transportation, treatments, and outcomes was collected and analyzed. Patient characteristics between Emergency Medical Services (EMS) vs. police transport groups were compared using Kruskal-Wallis, chi-square, or Fisher’s exact tests as appropriate. Results Of 224 patients identified, 147 (66%) were transported by EMS and 77 (34%) were transported by police. There was no significant difference in patient demographics between groups. Most patients were male (94.2%) and African American (69.2%), with a mean age of 27.1 years. 84.4% of patients suffered from an externally-inflicted gunshot wound, while 9.4% of patients had inflicted the wound themselves. Handguns were the weapon most commonly used. There was no significant difference in in-hospital treatments or mortality between patients transported by EMS vs. police. 44.1% of patients underwent surgery, and 34.8% required specialist consultation. The mean hospital length of stay for all patients was 1 day, and 27.7% of all patients expired during admission. Conclusions There is no difference in hospital treatment or mortality between firearm victims transported by EMS vs. police.

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Day of surgery: the impact on patient length of stay in a tertiary vascular unit

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2019.0075 ◽

2020 ◽

Vol 102 (2) ◽

pp. 98-103 ◽

Cited By ~ 1

Author(s):

NC Holford ◽

C Ní Ghuidhir ◽

L Hands

Keyword(s):

Length Of Stay ◽

Hospital Stay ◽

Support Services ◽

Length Of Hospital Stay ◽

Abdominal Aortic Aneurysm Repair ◽

Significant Difference ◽

Postoperative Length ◽

The Difference ◽

Aneurysm Repair ◽

The Impact

Background Our hypothesis was that patients undergoing surgery earlier in the week would have better access to physiotherapy and other discharge services after surgery and, as a result, would have a shorter length of hospital stay compared with patients undergoing surgery later in the week. This study aimed to assess whether there is a significant difference in postoperative length of hospital stay between the groups with secondary assessment by operation subtype. Methods We identified all patients admitted for vascular surgery in 2015 from a prospectively collected database and divided the week into Monday to Wednesday and Thursday to Friday. Endovascular cases were included but day cases were excluded. Further analysis was performed with a breakdown in both groups by operation type. Statistical analysis was performed using SPSS version 16.0. Results We identified 652 patients who met our criteria. Within the elective patient group, there was a significantly longer length of stay of three days for the late-week group compared with two days for the early-week group (P = 0.016). Femoral artery procedures had a median length of stay of two days for those operated on early in the week compared with four days later in the week (P < 0.005). Open abdominal aortic aneurysm repair showed a trend to longer length of stay in the late-week group (P = 0.06). Conclusion Day of surgery appears to impact on patients’ length of stay following vascular procedures, with the greatest impact on medium-sized procedures. This difference could be explained by the difference in weekend support services, but further evaluation is required following introduction of weekend support services to assess this.

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