29(3): p. 510-5. Prolonged air leak may be associated with an increased complication rate and certainly may increase length of stay. In multivariable model, the length of stay in ED and severity score are independently associated with mortality outcome. J Arthroplasty, 2014. Clipboard, Search History, and several other advanced features are temporarily unavailable. Complications of PTCA traditionally considered to be minor also increased length of stay significantly. BACKGROUND: Congestive heart failure affects 6.2 million people in the United States. Level of Evidence: Level III, retrospective comparative study. doi: 10.3171/2017.6.FOCUS17300. Influenza complications increased length of hospital stay. Patient and case clinical predictors of any of the reported complications and increased LOS were identified in multivariate logistic and Poisson regression analyses, respectively. This association has been established for several conditions including cardiac surgery, acute myocardial infarction, stroke, trauma, burns, pneumonia, and critical illness (5–10). They are responsible for increased hospital mortality to up to 19% as well as increased costs and length of hospital stay. Improving perioperative care for adolescent idiopathic scoliosis patients: the impact of a multidisciplinary care approach. After a C-section, you face a higher risk of potentially serious complications in a subsequent pregnancy than you would after a vaginal delivery. Among the 1286 patients with AIS who underwent spinal fusion, the mean LOS was 4.90 days [95% confidence interval (CI)=4.84-4.97; SD=1.19]. Prolonged Length-of-stay (PLOS) is associated with increased mortality and other poor outcomes. 2017 Mar;139(3):e20162574. While the correlation between length of stay following elective surgical procedures and higher health care costs is not new, researchers from Vanderbilt University Medical Center in Nashville, Tennessee, concluded that diabetic patients undergoing such procedures have higher rates of complications due to the vascular conditions and risks of infections that often accompany diabetes. J Infect Dis ... they were associated with a median length of stay longer than 6 … (Farrell & Dempsey 2013) Tool: Wound Care Guide Wound Dehiscence Wound dehiscence is associated with mortality rates as high as 45%. The American Association of Clinical Endocrinologists 21st Annual Scientific and Clinical Congress, Endocrine Physicians and Nurses Unaware of Testing Costs, Exercise in Prediabetic Patients Improves Vascular Reactivity to Normal Levels, Gastric Banding Beneficial in Obese Diabetic Patients, Integrated Team Program Improves Diabetes Outcomes, Lowers Drug Costs, Regional Differences Affect Thyroid Cancer Diagnosis, Virtual Endocrine Consultations Can Improve Outcomes for Patients in Rural Settings. Busl KM (1), Ouyang B, Boland TA, Pollandt S, Temes RE. Admissions for HF have increased over the last decade while length of stay has decreased; the reasons for this change in length of stay are uncertain. Intra- and inter-hospital transfers of older people at night can also increase the risk of delirium and, as a result, increase length of stay (Royal College of Physicians, 2012b). Epub 2017 Feb 2. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. Increased risks during future pregnancies. Source/Disclosures Source: Dawood FS. Good glycemic control has been shown to decrease length of stay (LOS) and … Comorbidities and Complications of Spinal Fusion for Scoliosis. Despite this and recent national attention highlighting the negative effects of narcotics, they remain commonly used for the management of pain in patients undergoing spine surgery. For the diabetes group, hospital length of stay (mean, 9.08 vs 4.76 days; p < 0.0001) and cost per patient ($19,547 vs $15,873; p < 0.0001) were also higher. Adolescent idiopathic scoliosis: risk factors for complications and the effect of hospital volume on outcomes. This study investigates the effect of patient-related variables, in-hospital progress and complications on length of stay. Objectives We developed an outcome indicator based on the finding that complications often prolong the patient's hospital stay. We sought to define the economic and clinical implications of an additional 1 day in the hospital for scoliosis surgery. Increased length of stay; Increased cost of care; Risk of further complications; and; Pain and discomfort. Accelerated discharge protocols for scoliosis surgery have recently been described in the literature. 9. Background Hospital length-of-Stay has been traditionally used as a surrogate to evaluate healthcare efficiency, as well as hospital resource utilization. There are limited data describing the association of length of stay (LOS) during the index admission with postoperative outcomes. Variation in Adolescent Idiopathic Scoliosis Surgery: Implications for Improving Healthcare Value. Workman JK, Wilkes J, Presson AP, Xu Y, Heflin JA, Smith JT. This study may be particularly affected if the complications were registered more often with increased length of the stay. 2016 Sep 14;9:435-445. doi: 10.2147/JMDH.S95319. ASPISAFE NG+ . Author information: (1)Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York. Dr. Figaro and colleagues determined that, out of the 13 evaluated elective procedures, results from 11 procedures showed increased cost per patient in the diabetes group. The objective of this study was to identify patient and hospital factors associated with prolonged length of stay (LOS) or complications during pediatric hospitalizations for asthma or lower respiratory infection (LRI). Ensuring the delivery of appropriate care and treatment is crucial for quality of care; length of stay in hospital may be irrelevant to this process. Materials And … Increased LOS during the index admission scoliosis surgery is associated with higher costs and an increased risk of 90-day postoperative complications. 7-10 Berg and associates 11 compared 2 time periods (1993-1997 and 2001-2005) and found the overall rate of complications remained unchanged at 28.6%, but the prevalence of … The relationship between length of in-hospital stay (LOS) and quality of care is difficult. length of stay increasing by an average of 2.6 days (Emergency Care Intensive Support Team, 2010; Royal College of Physicians, 2012a; Alameda and Suárez, 2009). Additionally, these patients represent a significant economic problem on public health systems and their families. Importance With the health policy focus on shifting risk to hospitals and physicians, hospital leaders are increasing efforts to reduce excessive resource use, such as patients with extended length of stay (LOS) after surgery. Costs and complications of increased length of stay following adolescent idiopathic scoliosis surgery. LOS is determined by a complex interweaving network of multiple supply and demand factors which operate at macro-, meso-, and micro-levels. Always consult your doctor about your medical conditions. Please enable it to take advantage of the complete set of features! OBJECTIVETo determine whether a multidisciplinary mobility promotion quality‐improvement (QI) project would increase patient mobility and reduce hospital length of stay (LOS).PATIENTS AND METHODSImplemented using a structured QI model, the project took place between March 1, 2013 and March 1, 2014 on 2 general medicine units in a large academic medical center. Increased LOS during the index admission scoliosis surgery is associated with higher costs and an increased risk of 90-day postoperative complications. eCollection 2016. This study may be particularly affected if the complications were registered more often with increased length of the stay. Remedy (3)Division of Spine … We found that the hospital stay increased monotonically with the number of complications. (2)Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, New York. There is a large body of evidence supporting the fact that prolonged hospitalizations are associated with increased risk for in-hospital complications including infections and deep venous thrombosis [1, 2].However, most of the published data deal with pre-specified populations and the prolonged hospital stay is considered as an outcome rather than a causative factor for complications … This increases their length of stay.1. NLM Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. risks of a procedure for a given patient. Influenza complications increased length of hospital stay. Vorhies, J.S., et al., Decreased length of stay after TKA is not associated with increased readmission rates in a national Medicare sample. Prolonged length of stay in ED is independently associated with increased risk of hospital mortality in patients with critical illness with sepsis. Summary of Background Data: Previous work has associated an increased incidence of complications and length of stay following surgery in patients with increased preoperative narcotic use. doi: 10.1542/peds.2016-2574. NIH length of stay increasing by an average of 2.6 days (Emergency Care Intensive Support Team, 2010; Royal College of Physicians, 2012a; Alameda and Suárez, 2009). COVID-19 is an emerging, rapidly evolving situation. Significant differences in patients with diabetes versus those without were seen in mortality rate (1.42% vs 0.93%), myocardial infarction (1.6% vs 0.59%), pneumonia (2.88% vs 0.32%), and acute kidney injury (11.2% vs 2.53%) (p >0.0001 for all). Source/Disclosures Source: Dawood FS. Regression models were adjusted for age, sex, race, insurance, comorbidity score, and perioperative complications during the index admission. HHS Patients inadvertently pull feeding tubes out, leading to complications such as malnutrition, increase length of stay, increased unnecessary sedation, restraints and nursing time with patient. An additional 1 day in the hospital was associated with $11 033 (95% CI=7162-14 904; P<0.001) in insurance charges, $5198 (95% CI=4144-6252; P<0.001) in hospital costs, 28% increased risk (odds ratio=1.28; 95% CI=1.01-1.63; P=0.041) of all-cause 90-day readmission, and a 57% increased risk (odds ratio=1.57; 95% CI=1.13-2.17; P=0.007) of returning to the operating room within 90 days. Boylan MR(1), Riesgo AM(1), Chu A(1), Paulino CB(2), Feldman DS(1)(3). Similar biases have been demonstrated in the MBDS with the registration of comorbidity There are limited data describing the association of length of stay (LOS) during the index admission with postoperative outcomes. Sanders AE, Andras LM, Sousa T, Kissinger C, Cucchiaro G, Skaggs DL. Presented at the American Association of Clinical Endocrinologists 21st Annual Scientific and Clinical Congress; May 23-27, 2012; Philadelphia, Pennsylvania:Abstract 232. 9. Figaro MK, Jung K, Lim D, BeLue R. The impact of diabetes on length of stay and hospital costs after elective surgical procedures. Berry JG, Glotzbecker M, Rodean J, Leahy I, Hall M, Ferrari L. Pediatrics. J Pediatr. The Statewide Planning and Research Cooperative System database was used to identify patients with adolescent idiopathic scoliosis who underwent spinal fusion from 1 October 2007 to 30 September 2012 at high-volume institutions (>20 cases/year) in the state of New York. 2019 Jan;28(1):27-31. doi: 10.1097/BPB.0000000000000543. J Arthroplasty, 2014. J Neurosurg Anesthesiol. For each patient, patient and case clinical characteristics, length of stay (LOS), and diagnosis of a nonneurologic complication (including reoperation and readmission) were abstracted. J Infect Dis ... they were associated with a median length of stay … 10. Hyperglycemia has been shown to be associated with increased mortality and morbidity and prolonged hospital stay in inpatients (1–4). M. Kathleen Figaro, MD, et al, evaluated data from the 2008 Healthcare Cost and Utilization Project Nationwide Inpatient Sample (29,589 patients with diabetes and 793,827 patients without diabetes), specifically looking at comorbidities and perioperative complications as they related to length of stay for diabetic patients in 13 procedures. Spine (Phila Pa 1976). This bias is plausible, since it is likely that the greater the severity of the complications (more hospitalization days) the more thoroughly they were registered. Patients with diabetes were more likely to have hypertension prior to surgery (72.7% vs 46.1%) and had more chronic conditions upon admission (mean of 7.6 vs 3.6 diagnoses). 10. All the eight bloodstream infections increased the length of stay in the ICU, with longer stays for the patients who eventually died (mean increase 0.7–6.0 days) compared with those who were discharged (mean increase: 0.4–3.1 days). Prolonged length of stay in ED is independently associated with increased risk of hospital mortality in patients with critical illness with sepsis. Results. Additionally, these patients represent a significant economic problem on public health systems and their families. Accelerated Discharge Protocol for Posterior Spinal Fusion Patients With Adolescent Idiopathic Scoliosis Decreases Hospital Postoperative Charges 22. This information is not designed to replace a physician's independent judgment about the appropriateness or Increased length of stay; Increased cost of care; Risk of further complications; and; Pain and discomfort. For example, new onset of atrial fibrillation, 25–27 renal dysfunction 28 and deep sternal wound infection 29 were associated with increased ICU and postoperative LOS. Reducing hospital length of stay (LOS), especially as it relates to avoiding unnecessary hospital-acquired conditions (HACs), is a primary indicator of a hospital’s success in achieving these goals. Protocols to decrease LOS for this surgery have potential benefits to patients, hospitals, and insurers. Menger RP, Kalakoti P, Pugely AJ, Nanda A, Sin A. Neurosurg Focus. In general, complications are known to prolong LOS following cardiac surgery.  |  For a five-night stay, this increased to a 5.5 per cent chance of a drug reaction, a 17.6 per cent chance of a hospital-acquired infection and a 3.1 per cent chance of an ulcer. OBJECTIVETo determine whether a multidisciplinary mobility promotion quality‐improvement (QI) project would increase patient mobility and reduce hospital length of stay (LOS).PATIENTS AND METHODSImplemented using a structured QI model, the project took place between March 1, 2013 and March 1, 2014 on 2 general medicine units in a large academic medical center. Consecutive patients undergoing conventional balloon angioplasty at nine medical centers in North America between February 1, 1992, and April 30, 1992, were prospectively enrolled in this study, which was denoted the Heparin Registry and performed as a pilot study for the Hirulog Angioplasty Study to id… This site needs JavaScript to work properly. For each patient, patient and case clinical characteristics, length of stay (LOS), and diagnosis of a nonneurologic complication (including reoperation and readmission) were abstracted. Get the latest research from NIH: https://www.nih.gov/coronavirus. Major complications such as emergency bypass surgery increased the length of stay after PTCA by 7.8±1.0 days (P<.001), and myocardial infarction increased length of stay by 3.4±0.9 days (P<.001). Patient and case clinical predictors of any of the reported complications and increased LOS were identified in multivariate logistic and Poisson regression analyses, respectively. The number of high-risk pregnancies due to maternal comorbidities and complications has significantly increased, leading to an increased number of adverse maternal health outcomes postdelivery requiring increased length of stay.  |  Endocrine Web is a Remedy Health Media, LLC web property. However, the degree to which extended LOS represents complications, patient illness, or inefficient practice style is unclear. 1. Lovald, S.T., et al., Complications, mortality, and costs for outpatient and short-stay total knee arthroplasty patients in comparison to standard-stay patients. 2015 Jan;27(1):31-6. doi: 10.1097/ANA.0000000000000085. Get the latest public health information from CDC: https://www.coronavirus.gov. USA.gov. Elective operations evaluated included thyroidectomy, hysterectomy, mastectomy, colectomy, cholecystectomy, amputations, fracture repairs, and total joint replacements, among others. (Farrell & Dempsey 2013) Tool: Wound Care Guide Wound Dehiscence Wound dehiscence is associated with mortality rates as high as 45%. Association of Postoperative Complications with Hospital Costs and Length of Stay in a Tertiary Care Center Nadia A. Khan, MD, MSc,1 Hude Quan, MD, PhD,2 Jennifer M. Bugar MD,3 Jane B. Lemaire, MD,3 Rollin Brant, PhD,2 William A. Ghali, MD, MPH2,3 1Department of Medicine, University of British Columbia, BC, Canada; 2Department of Community Health Sciences, University of Calgary, Health Media & EndocrineWeb do not provide medical advice, diagnosis or treatment. In the perioperative period, 605 (47.05%) underwent transfusion and 202 (15.71%) had problems with pain control. doi: 10.1016/j.jpeds.2017.12.031. 2020; 146(6):790e-795e (ISSN: 1529-4242) Levy-Lambert D; Ramly EP; Kantar RS; Alfonso AR; Levine JP. El Camino Hospital, a 395-bed multi-specialty community hospital in Mountain View, Calif., places a high priority on keeping patients safe. Other problems inherent in a study of this nature are associated with the limitations of the ICD9CM itself, and with the aspect of obtaining data retrospectively. In one study 53.6% of the germs identified were gram-negative bacteria, 39.3% gram-positive bacteria, and 7.1% were fungi . 29(3): p. 510-5. Prolonged Length-of-stay (PLOS) is associated with increased mortality and other poor outcomes. Level of Evidence: Level III, retrospective comparative study. Drug Demonstrates Sustained Efficacy for Weight Loss in Obese Patients, © 2020 Remedy Health Media, LLC ALL RIGHTS RESERVED. Plast Reconstr Surg. 2017 Jan 15;42(2):92-97. doi: 10.1097/BRS.0000000000001666. In multivariable model, the length of stay in ED and severity score are independently associated with mortality outcome. conditional upon your acceptance of our user agreement. Intra- and inter-hospital transfers of older people at night can also increase the risk of delirium and, as a result, increase length of stay (Royal College of Physicians, 2012b).  |  For each patient, patient and case clinical characteristics, length of stay (LOS), and diagnosis of a nonneurologic complication (including reoperation and readmission) were abstracted. Overall, investigators concluded that diabetes patients incurred greater rates of complications, had higher hospital costs, and had longer lengths of stay than non-diabetes patients following 11 major elective procedures, either common or uncommon.1 In light of these findings, Dr. Figaro stressed the importance of preoperative opportunities for health care professionals to control … Failure to wean off of ventilator in 48 hours, urinary tract infection, and pneumonia were associated with length of stay outlier (odds ratios = 3.7, 2.7, and 2.7; all p < 0.001). We sought to define the economic and clinical implications of an add … Costs and Complications of Increased Length of Stay Following Adolescent Idiopathic Scoliosis Surgery J Pediatr Orthop B. 2018 Apr;195:213-219.e3. Prolonged mechanical ventilation is associated with pulmonary complications, increased length of stay, and unfavorable discharge destination among patients with subdural hematoma. Prolonged mechanical ventilation is associated with pulmonary complications, increased length of stay, and unfavorable discharge destination among patients with subdural hematoma. Vorhies, J.S., et al., Decreased length of stay after TKA is not associated with increased readmission rates in a national Medicare sample. Protocols to decrease LOS for this surgery have potential benefits to patients, hospitals, and insurers. A higher percentage of patients with an unexpectedly long length of stay (UL-LOS) compared to the national average may indicate shortcomings in patient safety. Overall, investigators concluded that diabetes patients incurred greater rates of complications, had higher hospital costs, and had longer lengths of stay than non-diabetes patients following 11 major elective procedures, either common or uncommon.1 In light of these findings, Dr. Figaro stressed the importance of preoperative opportunities for health care professionals to control blood glucose levels more effectively in an effort to decrease elective surgical complications in diabetic patients. Setting We used data of 61 Dutch hospitals. We explored the utility of the UL-LOS indicator. Use of this website is 2017 Oct;43(4):E3. Across the board, results showed variations between the 2 patient cohorts. Congestive Heart Failure Predicts Major Complications and Increased Length of Stay in Lower Extremity Pedicled Flap Reconstruction. Lovald, S.T., et al., Complications, mortality, and costs for outpatient and short-stay total knee arthroplasty patients in comparison to standard-stay patients. Importantly, DMa patients who did not experience any postoperative complication experienced significantly higher rates of prolonged length of stay (23.0% vs. 11.8%, p<0.001), readmissions (10.0% vs. 5.2%, p<0.001), discharges to a facility (13.2% vs. 9.5%, p<0.001), and 30-day mortality (4.7% vs. 0.8%, p<0.001) compared to matched non-DMa patients. J Multidiscip Healthc.

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