Outcome of major abdominal surgeries in COVID-19 positive patients with awake anaesthesia: surgeons’ perspective

In view of the COVID-19 pandemic, the use of locoregional anaesthesia has gained popularity as the greatest number of the major abdominal surgical cases which were usually done under general anaesthesia (GA) is now shifted towards awake anaesthesia due to fear of aerosol generation. In a COVID era, with evolving risk of aerosol generation in surgery under GA and the urge for reserving ICU beds for needy patients, this study was undertaken to assess the adequacy of surgery and other benefits with awake anaesthesia. A retrospective observational study for 8 COVID-19 positive patients, undergoing emergency major abdominal surgeries with locoregional anaesthesia in pre-operatively diagnosed COVID positive from May 2020 to May 2021 was conducted. Low to medium risk patients (ASA 1-2) were considered following assessment by anaesthesiologist. We retrospectively analysed data including perioperative events, post-op follow up. The mean operative time was 103 minutes (minimum 50 minutes; maximum 170 minutes). In one case, conversion to general anaesthesia was necessary. Post-operative pain was always well controlled. None of them required postoperative intensive care support. No perioperative major complications (Clavien Dindo ≥3) occurred. Early readmission after surgery never occurred. In our experience in the COVID-19 era, RA may help to limit the intubation-related risk of contagions inside theatres and could be feasible, safe, and painless alternative to GA in selected cases and this approach could become part of an ICU-preserving strategy.

Early Readmission following NICU Discharges among a National Sample: Associated Factors and Spending

Objective Infants admitted to the neonatal intensive care unit (NICU) are at increased likelihood of hospital readmission when compared with non-NICU admitted infants, resulting in appreciable financial and emotional burdens. Early readmission, days to weeks, following NICU discharge, may be preventable. Population-based data identifying potentially modifiable factors and spending associated with early readmission are lacking. Study Design We conducted a secondary data analysis of privately insured infants in the IBM MarketScan Research Database born from 2011 to 2017 in all 50 states and admitted to the NICU. We examined demographic and clinical characteristics of early readmission within 7 days and between 8 and 30 days following NICU discharge and the payments of NICU and readmission care. Data were analyzed using univariate and multivariable logistic regression. Results Of the 86,741 NICU survivors analyzed, 3,131 infants (3.6%) were readmitted by 7 days and 2,128 infants (2.5%) between 8 and 30 days. Preterm infants had reduced odds of readmission by 7 days compared with term infants. Infants transferred to a step-down facility (vs. discharge home) and those with congenital anomalies had higher independent odds of readmission by 7 and 8 to 30 days. A higher percentage of NICU infants within the lowest quartile of initial NICU length of stay (LOS) were readmitted by 7 days compared with NICU infants in the middle and highest LOS quartiles (64 vs. 36%, p < 0.01). Median payments of readmissions at 7 and 8 to 30 days was $12,785 and 14,380, respectively. Conclusion Being term, being transferred to a step-down facility, and having a congenital anomaly were risk factors for early readmission. Shorter initial NICU LOS may be a contributing factor to readmission by 7 days, especially among term infants. These findings identify factors associated with readmission with the hope of preventing early readmission, minimizing spending, and optimizing ideal timing of NICU discharge. Key Points

Predictors for early readmission in patients hospitalized with new onset pediatric lupus nephritis

Objective The objective is to determine the 30-day hospital readmission rate following a hospitalization due to pediatric lupus nephritis of recent onset and characterize the risk factors associated with these early readmissions. Methods The study included 76 children hospitalized from 01/01/2008 to 4/30/2017 due to a new diagnosis of lupus nephritis. We calculated the 30-day hospital readmission rate and compared the characteristics of the patients that were readmitted to patients that were not readmitted using univariable and multivariable analysis. Results The 30-day readmission rate was 17.1%. Factors that predicted hospital readmission in unavailable analysis were male gender (38.5 vs 14.3%, p = 0.04), not receiving pulse steroids (30.8 vs 3.2%, p = < .001), receiving diuretic treatment (69.2 vs 34.9%, p = .02), receiving albumin infusions (46.2 vs 12.7%, p = .004), stage 2 hypertension on day one of admission (76.9 vs 41.3%, p = .02), a higher white blood cell count on discharge (13.7 × 103/mm3 vs 8.8 × 103/mm 3 , p = .023), need for non-angiotensin converting enzyme (ACE) antihypertensive drugs (76.9 vs 46%, p = .042), and being discharged on nonsteroidal anti-inflammatory drugs (NSAIDs) (23.1 vs 4.8%, p = .025). Multivariable analysis demonstrated an increased risk of readmission for patients not treated with intravenous pulse methylprednisolone (IVMP) (OR = 17.5 (1.81–168.32) p = .013), and for those who required intravenous albumin assisted diuresis for hypervolemia (OR=6.25 (1.29–30.30) p = .022). Conclusion In all, 17% of children hospitalized due to new onset lupus nephritis were readmitted within 30 days of discharge. Absence of IVMP and receiving intravenous albumin assisted diuresis during initial hospitalization increase the risk of early readmission in new onset pediatric lupus nephritis.

Predicting Early and Late Readmissions Following Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy

Background Postoperative readmissions not only burden the healthcare system but may also affect clinical outcomes of cancer patients. Despite this, little is known about readmissions after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC), or their impact on survival outcomes. Patients and Methods A single-institution retrospective cohort study of CRS-HIPEC procedures from April 2001 and September 2019 was performed. Early readmission (ERA) was defined as hospitalization within 30 days of discharge post-CRS/HIPEC, while late readmission (LRA) was defined as hospitalization between day 31 and 90 after discharge. Patient demographic, oncological, and perioperative factors were analyzed to identify predictors of readmission, and comparison of survival outcomes was performed. Results Overall, 342 patients who underwent CRS-HIPEC were included in the study. The incidence of ERA and LRA was 18.5% and 7.4%, respectively. High-grade postoperative complication was the only independent predictor of ERA (HR 3.64, 95% CI 1.47–9.02), while comorbid hypertension (HR 2.71, 95% CI 1.17–6.28) and stoma creation (HR 2.83, 95% CI 1.23–6.50) were independent predictors for LRA. Patients with readmission had significantly worse disease-free survival than patients who had no readmission (NRA) (LRA 1.1 years, ERA 1.2 years, NRA 1.8 years, p = 0.002), and patients with LRA had worse median overall survival (2.1 years) than ERA patients (3.3 years) or patients without readmission (4.4 years) (p < 0.001). Conclusions Readmission following CRS-HIPEC is associated with adverse survival outcomes. In particular, LRA may portend worse prognosis than ERA.

Ocorrência de readmissões hospitalares em um município de grande porte populacional

Objetivo: analisar as readmissões hospitalares em instituições públicas e privadas de um município de grande porte populacional. Método: Estudo observacional analítico das readmissões ocorridas em Ribeirão Preto, em 2011, em hospitais públicos e privados. Resultados: Identificou-se 16.123 readmissões hospitalares em 11 hospitais, com taxa média de readmissão de 14,2%. As readmissões mais frequentes ocorreram em pacientes em idade adulta, com no mínimo uma comorbidade associada. Predominaram as readmissões pelo Sistema Único de Saúde, em hospitais com mais de 100 leitos e elevada complexidade assistencial. A readmissão precoce está associada ao sexo, tipo de convênio e tempo de permanência na internação inicial. Conclusões: Os resultados sugerem que as readmissões estejam relacionadas à dinâmica da rede de serviços e à complexidade assistencial dos casos atendidos; seu monitoramento auxilia no processo de planejamento, programação e avaliação das ações em saúde; entretanto, a utilização desse indicador de desempenho deve acontecer em conjunto com outros indicadores, analisados de acordo com a realidade institucional e dos fatores intervenientes.Palavras-chave: Readmissão do Paciente; Indicadores de Qualidade em Assistência à Saúde; Acesso aos Serviços de Saúde. Occurrence of hospital readmissions in a large population municipalityABSTRACTObjective: to analyze hospital readmissions in public and private institutions in a large population size municipality. Method: Observational analytical study of readmissions in Ribeirão Preto in 2011, in public and private hospitals. Results: 16,123 hospital readmissions were identified in 11 hospitals, with a mean readmission rate of 14.2%. The most frequent readmissions occurred in adult patients, with at least one associated comorbidity. Readmissions were predominant in the Unified Health System, in hospitals with more than 100 beds and high complexity of care. Early readmission is associated with gender, type of health insurance plan and length of stay in the initial hospitalization. Conclusions: The results suggest that readmissions are related to the dynamics of the service network and to the complexity of care of the cases seen; its monitoring assists in the process of planning, programming and evaluating health actions; however, the use of this performance indicator should occur in conjunction with other indicators, analyzed according to the institutional reality and intervening factors.Keywords: Patient Readmission; Quality Indicators, Health Care; Health Services Accessibility.

Readmission after discharge from acute mental healthcare among 231 988 people in England: cohort study exploring predictors of readmission including availability of acute day units in local areas

Background In the UK, acute mental healthcare is provided by in-patient wards and crisis resolution teams. Readmission to acute care following discharge is common. Acute day units (ADUs) are also provided in some areas. Aims To assess predictors of readmission to acute mental healthcare following discharge in England, including availability of ADUs. Method We enrolled a national cohort of adults discharged from acute mental healthcare in the English National Health Service (NHS) between 2013 and 2015, determined the risk of readmission to either in-patient or crisis teams, and used multivariable, multilevel logistic models to evaluate predictors of readmission. Results Of a total of 231 998 eligible individuals discharged from acute mental healthcare, 49 547 (21.4%) were readmitted within 6 months, with a median time to readmission of 34 days (interquartile range 10–88 days). Most variation in readmission (98%) was attributable to individual patient-level rather than provider (trust)-level effects (2.0%). Risk of readmission was not associated with local availability of ADUs (adjusted odds ratio 0.96, 95% CI 0.80–1.15). Statistically significant elevated risks were identified for participants who were female, older, single, from Black or mixed ethnic groups, or from more deprived areas. Clinical predictors included shorter index admission, psychosis and being an in-patient at baseline. Conclusions Relapse and readmission to acute mental healthcare are common following discharge and occur early. Readmission was not influenced significantly by trust-level variables including availability of ADUs. More support for relapse prevention and symptom management may be required following discharge from acute mental healthcare.