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Background: Patients hospitalized with COVID-19 can clinically deteriorate after a period of initial stability, making optimal timing of discharge a clinical and operational challenge. Objective: To determine risks for post-discharge readmission and death among patients hospitalized with COVID-19. Design: Multicenter retrospective observational cohort study, 2020–2021, with 30-day follow-up. Participants: Adults admitted for care of COVID-19 respiratory disease between March 2, 2020, and February 11, 2021, to one of 180 US hospitals affiliated with the HCA Healthcare system. Main Measures: Readmission to or death at an HCA hospital within 30 days of discharge was assessed. The area under the receiver operating characteristic curve (AUC) was calculated using an internal validation set (33% of the HCA cohort), and external validation was performed using similar data from six academic centers associated with a hospital medicine research network (HOMERuN). Key Results: The final HCA cohort included 62,195 patients (mean age 61.9 years, 51.9% male), of whom 4704 (7.6%) were readmitted or died within 30 days of discharge. Independent risk factors for death or readmission included fever within 72 h of discharge; tachypnea, tachycardia, or lack of improvement in oxygen requirement in the last 24 h; lymphopenia or thrombocytopenia at the time of discharge; being ≤ 7 days since first positive test for SARS-CoV-2; HOSPITAL readmission risk score ≥ 5; and several comorbidities. Inpatient treatment with remdesivir or anticoagulation were associated with lower odds. The model's AUC for the internal validation set was 0.73 (95% CI 0.71–0.74) and 0.66 (95% CI 0.64 to 0.67) for the external validation set. Conclusions: This large retrospective study identified several factors associated with post-discharge readmission or death in models which performed with good discrimination. Patients 7 or fewer days since test positivity and who demonstrate potentially reversible risk factors may benefit from delaying discharge until those risk factors resolve. [ABSTRACT FROM AUTHOR]

Background: Patient-physician sex discordance (when patient sex does not match physician sex) has been associated with reduced clinical rapport and adverse outcomes including post-operative mortality and unplanned hospital readmission. It remains unknown whether patient-physician sex discordance is associated with "before medically advised" hospital discharge (BMA discharge; commonly known as discharge "against medical advice"). Objective: To evaluate whether patient-physician sex discordance is associated with BMA discharge. Design: Retrospective cohort study using 15 years (2002–2017) of linked population-based administrative health data for all non-elective, non-obstetrical acute care hospitalizations from British Columbia, Canada. Participants: All individuals with eligible hospitalizations during study interval. Main Measures: Exposure: patient-physician sex discordance. Outcomes: BMA discharge (primary), 30-day hospital readmission or death (secondary). Results: We identified 1,926,118 eligible index hospitalizations, 2.6% of which ended in BMA discharge. Among male patients, sex discordance was associated with BMA discharge (crude rate, 4.0% vs 2.9%; adjusted odds ratio [aOR] 1.08; 95%CI 1.03–1.14; p = 0.003). Among female patients, sex discordance was not associated with BMA discharge (crude rate, 2.0% vs 2.3%; aOR 1.02; 95%CI 0.96–1.08; p = 0.557). Compared to patient-physician sex discordance, younger patient age, prior substance use, and prior BMA discharge all had stronger associations with BMA discharge. Conclusions: Patient-physician sex discordance was associated with a small increase in BMA discharge among male patients. This finding may reflect communication gaps, differences in the care provided by male and female physicians, discriminatory attitudes among male patients, or residual confounding. Improved communication and better treatment of pain and opioid withdrawal may reduce BMA discharge. [ABSTRACT FROM AUTHOR]

Introduction: A number of studies have demonstrated a significant reduction of surgical time for robotically assisted surgery (RAS) total knee arthroplasty (TKA) after the learning curve between 6 and 43 cases. It is unknown if the logistics of RAS produce a longer total theatre time since published literature only reflects the surgical time. It is also unknown how RAS surgical and total theatre times compare with computer assisted surgery (CAS) TKA. Methods: This is a prospective study of 524 consecutive patients undergoing a CAS or a RAS TKA using the same cementless implant. We recorded age, sex, body mass index (BMI), incision time of the first case, total surgical time, total theatre time, length of stay and 90-day complication and readmission rate. Results: During the study period, 205 CAS and 199 RAS TKA were performed. There was no difference at baseline in age (p = 0.546), sex (p = 0.920) or BMI (p = 0.791). Surgical time for CAS was 78.3 (± 22.2) min and for RAS was 80.1 (± 25.7) min, p = 0.451. Total theatre time for CAS was 117.4 (± 27.8) min and 119.3 (± 30.7) min for RAS, p = 0.515. There was no difference in length of stay (p = 0.674), 90-day complication (p = 0.530) or readmission rate (p = 0.930). There was a difference in skin-incision average time for the first case (p = 0.022). Conclusions: Although theatre set-up for the first case is 5 min longer, RAS-TKA does not prolong the surgical time or total theatre time when compared with CAS-TKA. There was no reduction in case volume since the introduction of robotics. Level of evidence: III. [ABSTRACT FROM AUTHOR]

Purpose: Limited data exists evaluating same-day discharge for pediatric Nuss procedure; most being single-center studies. Our analysis, using the NSQIP-P registry, aimed to assess if same-day discharge for the Nuss procedure influenced post-operative outcomes. Methods: The NSQIP-P database (2017–2022) identified patients who underwent the Nuss procedure. Patients discharged same-day postoperatively (SDD) were compared to those discharged 1–7 days postoperatively (non-SDD). Results: Of 5486 patients identified, 91 (1.7%) were SDD. From 2018 to 2022, the annual SDD rate increased from 0.8% to 2.7%. There was no significant difference between SDD and non-SDD groups for 30-day readmission (1.1% vs 3.5%, p = 0.376), reoperation (0% vs 1.5%, p = 0.643), or other outcomes. Twenty-six patients required readmission or reoperation within 3-days; only one underwent SDD. The most common readmission was for pain (n = 4) and reoperation for chest-tube placement (n = 10). Asthma (OR 1.66, 95% CI 1.03–2.67, p = 0.038), and increased operative time (per 10 min increment: OR 1.060, 95% CI 1.034–1.086, p < 0.001) each increased risk of readmission or reoperation. Conclusion: Same-day discharge for the Nuss procedure, although infrequent, has increased without significant differences in complications in the 91 patients who were discharged same-day in this analysis. Same-day discharge for Nuss procedure is reasonable for non-asthmatic patients with a satisfactory postoperative x-ray and meeting other goal-based discharge criteria, including adequate pain control. Level of evidence (I–V): Level III. [ABSTRACT FROM AUTHOR]

Introduction: Malignancy-related ascites (MRA) is a common serious complication of many advanced malignant tumors with high morbidity and mortality. The high hospital expenditures induced by unplanned readmission in patients with MRA have become an urgent issue to the public. We aimed to overall assess the unplanned early readmission rate of patients with MRA and explore the potential risk factors for such readmission. Methods: A retrospective cohort study based on 2018 Nationwide Readmissions Database was performed and patients with MRA were recruited into the analysis. The primary outcome was unplanned 30-day readmission rate and inpatient outcomes. The multivariate logistic regression analysis was performed to evaluate the potential risk factors for such early readmission. Results: Data obtained from 32,457 patients with MRA were analyzed, and of these 7,799 individuals (24.03%) were unplanned readmitted within 30-day follow-up. The mortality rate in the readmitted population was 15.15%. Patients at younger age were at a higher risk of readmission. The morbidities including hypertension (OR=1.117, 95%CI: 1.054-1.184), hyperlipemia (OR=1.075, 95%CI: 1.009-1.146) and diabetes (OR=1.118, 95%CI: 1.053-1.188), gastrointestinal malignancies and peritoneal procedure significantly increased the risk of 30-day readmission in patients with MRA. Discussion: More than one in five patients with MRA was unplanned readmitted within 30-day follow-up. The above risk factors should be timely intervened and the corresponding medical care should be strengthened in patients with MRA to lessen the unplanned readmission and improve the readmission outcomes. [ABSTRACT FROM AUTHOR]

Background: This study aims to evaluate the impact of Quebec's first hospital-at-home-inspired mobile Seniors' Clinic, the "Clinique des Ainés (CDA)", on frail older adults' returns to the Emergency Department (ED), mortality, and hospital Length Of Stay (LOS) and rehospitalizations. Methods: Design: Quasi-experimental pre-post implementation cohort study. Population: Patients aged ≥ 75 years admitted to the short-term geriatric unit after an ED consultation (control) or included by the CDA (intervention). Outcomes: return to ED (RtoED), mortality, ED & hospital LOS, and rehospitalizations. Statistical analyses: Multivariable regression modelling. Results: Overall, 891 patients were included. At the intervention site (CDA) (n = 437), RtoED were similar at 30 (17.5% & 19.5%, p = 0.58), 90 (34.4% & 37.3%, p = 0.46) and 180 days (47.2% & 54.0%, p = 0.07) in the pre and post-implementation phases. No mortality differences were found. The hospitalization LOS was significantly shorter (28.26 and 14.22 days, p < 0.01). At 90 days, rehospitalization LOS was decreased by 8.51 days (p = 0.02) and by 6.48 days at 180 days (p = 0.03). Compared to the control site (n = 454) in the post-implementation phase, RtoED was 54% at the intervention site compared to 44.1% (p = 0.02) at 180 days. The CDA had a lower adjusted probability of mortality at 90 days compared to the control site (4.8% VS 11.7%, p = 0.03). No rehospitalization LOS differences were noted. Conclusions: The Clinique des Ainés showed effectiveness in caring for frail older patients in their homes by decreasing their hospital LOS by half and 90 days mortality risk. It was a safe care trajectory without a clinically significant increase in ED returns or mortality. [ABSTRACT FROM AUTHOR]

BACKGROUND: After decades of experience supporting surgical quality and safety by the American College of Surgeons (ACS), the ACS Quality Verification Program (ACS QVP) was developed to help hospitals improve surgical quality and safety. This review is the final installment of a 3-part review aimed to synthesize evidence supporting the main principles of the ACS QVP. STUDY DESIGN: Evidence was systematically reviewed for 3 principles: standardized team-based care across 5 phases of surgical care, disease-based management, and external regulatory review. MEDLINE was searched for articles published from inception to January 2019 and 2 reviewers independently screened studies for inclusion in a hierarchical manner, extracted data, and summarized results in a narrative fashion. A total of 5,237 studies across these 3 topics were identified. Studies were included if they evaluated the relationship between the standard of interest and patient-level or organization measures within the last 20 years. RESULTS: After applying inclusion criteria, a total of 150 studies in systematic reviews and primary studies were included for assessment. Despite institutional variation in standardized clinical pathways, evidence demonstrated improved outcomes such as reduced length of stay, costs, and complications. Evidence for multidisciplinary disease-based care protocols was mixed, though trended toward improving patient outcomes such as reduced length of stay and readmissions. Similarly, the evidence for accreditation and adherence to external process measures was also mixed, though several studies demonstrated the benefit of accreditation programs on patient outcomes. CONCLUSIONS: The identified literature supports the importance of standardized multidisciplinary and disease-based processes and external regulatory systems to improve quality of care. [ABSTRACT FROM AUTHOR]

Backgorund: Textbook outcome (TO) is a composite measure that reflects the most desirable surgical results as a single indicator. The aim of this study was to assess the achievement of TO at a hepatopancreatobiliary (HPB) surgery unit in a Spanish tertiary hospital. Methods: We performed a retrospective observational study of all consecutive patients who underwent HPB surgery over a 4-year period. Morbidity according to the Clavien-Dindo classification at 30 days, hospital stay, risk of morbidity and mortality according to the POSSUM, and mortality and readmissions at 90 days were recorded. TO was considered when a patient presented no major complications (≥IIIA), no mortality, no readmission, and no prolonged length of stay (≤75th). Results: 283 patients were included. Morbidity >IIIA was reported in 21.6%, and 5.7% died; the median postoperative stay was 4 days. TO was achieved in 56.2% of patients. Comparing patients who presented TO with those who did not, significant differences were recorded for the type of procedure and the expected risk of morbidity and mortality calculated according to the POSSUM scale. There were significant differences between patients with major resections (TO rates: major hepatectomy (46.3%) and major pancreatectomy (52.5%)) and those with minor resections (TO rates minor hepatectomy (67.7%) and minor pancreatectomy (40.4%)). Conclusions: TO is a useful management tool for assessing postoperative results. [ABSTRACT FROM AUTHOR]

Background/Objectives: Predicting patient readmission is an important task for healthcare risk management, as it can help prevent adverse events, reduce costs, and improve patient outcomes. In this paper, we compare various conventional machine learning models and deep learning models on a multimodal dataset of electronic discharge records from an Irish acute hospital. Methods: We evaluate the effectiveness of several widely used machine learning models that leverage patient demographics, historical hospitalization records, and clinical diagnosis codes to forecast future clinical risks. Our work focuses on addressing two key challenges in the medical fields, data imbalance and the variety of data types, in order to boost the performance of machine learning algorithms. Furthermore, we also employ SHapley Additive Explanations (SHAP) value visualization to interpret the model predictions and identify both the key data features and disease codes associated with readmission risks, identifying a specific set of diagnosis codes that are significant predictors of readmission within 30 days. Results: Through extensive benchmarking and the application of a variety of feature engineering techniques, we successfully improved the area under the curve (AUROC) score from 0.628 to 0.7 across our models on the test dataset. We also revealed that specific diagnoses, including cancer, COPD, and certain social factors, are significant predictors of 30-day readmission risk. Conversely, bacterial carrier status appeared to have minimal impact due to lower case frequencies. Conclusions: Our study demonstrates how we effectively utilize routinely collected hospital data to forecast patient readmission through the use of conventional machine learning while applying explainable AI techniques to explore the correlation between data features and patient readmission rate. [ABSTRACT FROM AUTHOR]

Introduction: Chronic myeloid leukemia (CML) is a hematological malignancy with an excellent prognostic outcome. After the advancements in CML treatment and the introduction of different tyrosine kinase inhibitors (TKIs), the life expectancy of CML patients has become equivalent to that of the general population. As a result, coronary artery disease is anticipated to be the leading cause of death among CML patients. Moreover, TKI use is associated with a risk of endothelial dysfunction, thrombosis, and cardiovascular events, including myocardial infarction. In this study, we compare the outcomes of percutaneous coronary intervention (PCI) in patients with CML to their matched non-CML counterparts. Method: This is a retrospective cohort study using the Nationwide Readmission Database from January 2016 to December 2020. Adults with or without CML hospitalized for acute myocardial infarction and underwent PCI were included. The patients were identified using ICD-10 codes. The primary outcomes were in-hospital mortality and 30-day readmission rates. The secondary outcomes were PCI complications rates. Results: Out of 2,727,619 patients with myocardial infarction, 2,124 CML patients were identified. A total of 888 CML patients underwent PCI. CML patients were significantly older (mean age: 68.34 ± 11.14 vs. 64.40 ± 12.61 years, p < 0.001) than non-CML patients without a difference in sex distribution. Hypertension (85.45% vs. 78.64%), diabetes (45.48% vs. 37.29), stroke (11.84% vs. 7.78) at baseline were significantly higher in the CML group. Prior myocardial infarction events (20.51% vs. 15.17%) and prior PCI procedure (24.47% vs. 16.89%) were significantly higher in the CML group. CML patients had a significantly longer hospital stay (4.66 ± 4.40 vs. 3.75 ± 4.62 days, p = 0.001). The primary outcomes did not differ between the comparison groups. The risk of post-PCI complications did not differ between the comparison groups in the propensity matched analysis except for coronary artery dissection (odds ratio [OR]: 0.10; 95% confidence interval [CI]: 0.02–0.65, p = 0.016) and ischemic stroke (OR: 0.35; 95% CI: 0.14–0.93, p = 0.034) which were lower in the CML group. Conclusion: This analysis showed no statistically significant difference in mortality, 30-day readmission, and post PCI complications rates between CML and non-CML patients. However, interestingly, CML patients may experience lower coronary artery dissection and ischemic stroke events than those without CML diagnosis. [ABSTRACT FROM AUTHOR]

To determine the rate of outpatient cases and identify predictors for same-day discharge (SDD) after single-port transvesical enucleation of the prostate (STEP). Retrospective analysis of all consecutive STEP cases performed at a single center by 3 surgeons from February 2019 to October 2023. The cohort was categorized into SDD cases (<8 hours until discharge) and inpatient cases. Group comparisons were made and logistic regression was used to identify predictors of SDD. A total of 152 STEP cases were performed successfully without additional ports or conversions. Fifty-two patients were pre-planned admissions, leaving 100 planned outpatient cases, of which 86% were discharged on the same day (median length of stay of 4.7 hours). Comparing the groups, inpatient cases were older, had higher Charlson Comorbidity Index (CCI) scores, higher estimated blood loss (EBL) during surgery, and more intraoperative complications than SDD patients. Univariate logistic regression identified age and CCI as the predictors associated with SDD after STEP. Notably, there were no major postoperative complications or readmissions in either group. In our 4-year experience with STEP, lower age and CCI score were significant predictors of SDD. The comprehensive evaluation criteria for discharge foster a safe recovery at home, coupled with a 0% rate of major postoperative complications and readmissions. These findings underscore the safety and efficacy of STEP, guiding patient counseling and surgeon expectations. [ABSTRACT FROM AUTHOR]

Aim: The impact of cognitive dysfunction‐associated activities of daily living (ADL) on mortality and rehospitalization for heart failure has not yet been evaluated. Methods: We retrospectively evaluated DASC‐21, the incidence of all‐cause mortality, and rehospitalization for heart failure after discharge in 329 older patients with heart failure. Results: The mean age was 85.1 ± 7.4 years (62.6% women). There were 110 cases of death from any cause (33.4%) during 25.5 ± 16.1 months of follow‐up and 166 cases of rehospitalization from heart failure (50.5%) during 16.1 ± 15.2 months of follow‐up. The DASC‐21 score was not significantly associated with an increased risk of all‐cause mortality or rehospitalization. For each item of the DASC‐21 questionnaire, defective route‐finding (item 6) (HR = 2.631, P = 0.003), common sense and capacity for judgement (item 9) (HR = 1.717, P = 0.040), instrumental ADL (IADL) for shopping (item 10) (HR = 1.771, P = 0.020), and IADL for meal preparation (item 14) (HR = 1.790, P = 0.019) were significantly associated with an increased risk of all‐cause mortality. Disabilities in route finding (HR = 2.257, P = 0.005), IADL for shopping (HR = 1.632, P = 0.016), and IADL for transportation (HR = 1.537, P = 0.033) were significant risk factors for rehospitalization due to heart failure. Even in the multivariate‐adjusted model, disability in defective route‐finding was significantly associated with an increased risk of all‐cause mortality (hazard ratio [HR] = 2.148, 95% confidence interval [CI] 1.090–4.236; P = 0.027) and of rehospitalization for heart failure (HR = 2.138, 95% CI 1.153–3.963, P = 0.016). Conclusions: In older patients hospitalized for heart failure, route disability was associated with all‐cause mortality and rehospitalization for heart failure after discharge. Geriatr Gerontol Int 2024; 24: 1130–1136. [ABSTRACT FROM AUTHOR]

Background: Shunt failure is an undesirable but common occurrence following neurosurgical shunting for pediatric hydrocephalus. Little is known about the occurrence of failure in lower-middle income country (LMIC) settings in South America. The objective of this study was to evaluate shunt failure in the sole publicly funded pediatric hospital in La Paz, Bolivia, with limited resources. Methods: A retrospective review of all patients at the Children's Hospital of La Paz, Bolivia (Hospital del Niño "Dr. Ovidio Aliaga Uria"), was conducted to identify all patients whose index surgical shunting for hydrocephalus was performed between 2019 and 2023. Categorical, continuous, and shunt failure data were statistically summarized. Results: A total of 147 unique pediatric patients underwent index ventriculoperitoneal shunting for hydrocephalus in the study period. There were 90 (61%) male and 57 (39%) female patients, with a median age of 2.2 months at index shunting procedure. The most common surgical indications were congenital hydrocephalus (n = 95, 65%), followed by hydrocephalus secondary to congenital defect (n = 25, 17%) and tumor (n = 18, 12%). A total of 18 (12%) of patients experienced inpatient failure during index admission requiring surgical revision at a median time of 12.5 days after index shunting. Postoperative imaging (OR 2.97, P = 0.037) and postoperative infection (OR 3.26, P = 0.032) during index admission both independently and statistically predicted inpatient failure. Of the 96 patients (65%) with postoperative follow-up, 16 (n = 16/96, 17%) patients experienced outpatient failure requiring readmission to hospital and surgical revision at a median time of 3.7 months after discharge. Kaplan–Meier estimations of overall inpatient and outpatient failure in this cohort were 23% (95% CI 14–37) and 28% (95% CI 15–49), respectively. Conclusions: Both inpatient and outpatient shunt failures are significant complications in the management of pediatric hydrocephalus in La Paz, Bolivia. We identify multiple avenues to improve these outcomes which are institution-specific based on the review of these failures. Lessons learnt may be applicable to other similarly resourced institutions across South American LMICs. [ABSTRACT FROM AUTHOR]

BACKGROUND: Leaving the hospital against medical advice (AMA) reflects a breakdown in the family-clinician relationship and creates ethical dilemmas in inpatient pediatric care. There are no national data on frequency or characteristics of leaving AMA from US children's hospitals. METHODS: We performed a retrospective cohort study of hospital discharges for children under 18 years old from January 1, 2018 to December 31, 2022 in 43 children's hospitals in the Pediatric Health Information System (PHIS) database. The primary outcome was leaving AMA. Exposures were demographic, geographic, and clinical characteristics. We used multivariable mixed effects logistic regression models to assess independent factors associated with leaving AMA and all-cause 14-day hospital readmission. RESULTS: Among 3 672 243 included inpatient encounters, 2972 (0.08%) ended in leaving AMA. Compared with non-Hispanic white patients, non-Hispanic Black patients had higher odds of leaving AMA (adjusted odds ratio [aOR] 1.31 [95% confidence interval (CI) 1.19-1.44]), whereas Hispanic patients (aOR 0.66 [95%CI 0.59-0.75]) had lower odds of leaving AMA. Hospitalizations for patients with noncommercial insurance were more likely to end in leaving AMA. Leaving AMA was associated with increased odds of 14-day inpatient readmission (aOR 1.41 [95% CI 1.24-1.61]) compared with patients who did not leave AMA. There was substantial interhospital variability in standardized rates of leaving AMA (range 0.18-2.14 discharges per 1000 inpatient encounters). CONCLUSIONS: Approximately 1 in 1235 inpatient encounters ended in leaving AMA. Non-Hispanic Black patients had increased odds of leaving AMA. Leaving AMA was associated with increased odds of 14-day readmission. [ABSTRACT FROM AUTHOR]

Purpose: Concerns remain with regards to safety of fast-track (FT) and especially outpatient procedures. The purpose of this study was to compare complication rates and clinical outcomes of propensity-matched patients who received FT total hip arthroplasty (THA) in outpatient versus inpatient settings. The hypothesis was that 90-day postoperative complication rates of outpatient FT THA would not be higher than after inpatient FT THA. Methods: This is a prospective study of consecutive patients who received FT THA at various rates of outpatient and inpatient surgery by 10 senior surgeons (10 centres). The decision between outpatient and inpatient surgery was made on a case-by-case basis depending on the surgeon and patient. All patients were followed until 90 days after surgery. Complications, readmissions and reoperations were collected, and their severity was assessed according to Clavien-Dindo. Patients completed Oxford Hip Score (OHS) at the latest follow-up. Results: Compared to inpatient FT THA, patients scheduled for outpatient FT THA had no significant differences in 90-day postoperative complication rates (10.7% vs. 12.9%, p = 0.129). There were no significant differences between the 2 groups in 90-day readmission rates and reoperation rates, in severity of postoperative complications, and in time of occurrence of postoperative complications. Conclusions: There were no differences in rates of intraoperative complications, 90-day postoperative complications, readmissions, or reoperations between outpatient and inpatient FT THA. These findings may help hesitant surgeons to move towards outpatient THA pathways as there is no greater risk of early postoperative complications that could be more difficult to manage after discharge. [ABSTRACT FROM AUTHOR]

Background: Same‐day discharge (SDD) following percutaneous coronary intervention (PCI) has proven safe, and global adoption of this strategy has been increasing rapidly. These data are predominantly derived from high‐volume, metropolitan centres with a relative paucity of data from regional and remote settings. Aims: The primary objective of this study was to evaluate the outcomes of a same‐day, criteria‐led discharge strategy following elective transradial PCI in a regional setting. Methods: This is a retrospective, single‐centre cohort study. Consecutive outpatients aged ≥18 years presenting for elective transradial invasive coronary angiography between March 2019 and February 2024 were included in the analysis. We report the primary composite outcome of 30‐day all‐cause mortality and unplanned hospital readmission and compare proportions between those who were discharged on the day of their procedure with those admitted overnight in hospital and discharged the next day. Results: A total of 555 eligible patients were identified, of which 330 (60%) were discharged on the day of their procedure. The composite primary end‐point occurred in seven (2%) of the SDD patients and in six (3%) of the overnight admission patients (relative risk = 0.80; 95% confidence interval = 0.27–2.34; P = 0.68). No significant differences were seen in rates of readmission, or in other clinical outcomes assessed, including death, myocardial infarction, stroke and vascular complications or bleeding. Conclusion: In a regional setting, SDD following elective transradial PCI, in select patients, is a safe approach which was not associated with higher rates of unplanned readmission or adverse clinical outcomes. [ABSTRACT FROM AUTHOR]

Background: Anecdotally, patients don't seem to be more unwell than they were 10 years ago, yet they still seem more 'complex'. Aims: The aim of this study was to use an objective measure to assess the trend in complexity of general medicine patients over a 9‐year period. Methods: Complexity was pragmatically defined as a composite of comorbidity plus dependence/frailty. We selected 100 consecutive patients discharged from General Medicine at Monash Medical Centre (a tertiary hospital in Melbourne, Australia) in the month of April of each year from 2011 to 2019. For each patient, we retrospectively calculated their burden of comorbidity and their degree of dependency/frailty. Comorbidity was measured using the Charlson Comorbidity Index (CCI), and dependence/frailty was assessed using the Katz Index of Independence in Activities of Daily Living (Katz ADL) and the Braden Scale (BS). The BS is a pressure injury risk assessment tool. Additional demographic data were collected, including length of stay, admission and discharge residence, 30‐day readmission rate and inpatient mortality. Results: There was no statistically significant change in the CCI or the Katz ADL. The median BS did however significantly decrease from 19 in 2011 to 16 in 2019 (P = 0.006), reflecting an increased risk of pressure injuries. Conclusions: Despite a stable level of comorbidity, our finding of a decreasing BS score may suggest that patients are becoming more dependent. This increase in dependency rather than a change in chronic disease burden may be the cause of apparent increasing patient complexity. [ABSTRACT FROM AUTHOR]

Purpose: One of the major advantages of a minimally invasive microdiscectomy is that when CSF leak occurs, there is minimal anatomic dead space for ongoing leakage following removal of the tubular retractor. However, there are no published reports that address the safety and long-term outcomes of same-day discharge for CSF leak after tubular microdiscectomy. Methods: This is a retrospective compartive study of 30 patients with incidental durotomy during minimally invasive tubular microdiscectomy occurring between January 1, 2009 to August 31, 2023 at our institution. Results: There were 16 patients (53%) admitted to hospital and 14 (47%) patients discharged home the same day following CSF leak. There were no differences in patient demographics between the two groups at baseline. Twenty-nine out of 30 (97%) of the patients had onlay duraplasty, and one (3%) patient was repaired using sutures through the tubular retractor. None were converted to an open approach. The hospitalized group was kept on bed rest overnight or for 24 h. The discharge group was kept on best rest for 2 h or mobilized immediately after surgery. No patients in either group required readmission or revision surgery for CSF leak. The average length of admission for the hospitalized group was 2.4 ± 4.0 days. Conclusion: Patients with CSF leak during minimally invasive tubular microdiscectomy can be safely discharged home the same day. [ABSTRACT FROM AUTHOR]

Background: Adults with cerebral palsy (CP) are a largely understudied, growing population with unique health care requirements. We sought to establish a deeper understanding of the surgical risk in adults with CP undergoing a common general surgical procedure: cholecystectomy. Methods: Data were obtained from the State Inpatient Database developed for the Healthcare Cost and Utilization Project. Inclusion criteria included patients ≥ 18 years with CP and a primary ICD-9 procedure code indicating open or laparoscopic cholecystectomy. Demographics, procedure-related factors, and comorbid conditions were analyzed, and unplanned 30 and 90 day readmission rates calculated for each variable. Reasons for readmission based on ICD-9 diagnosis codes were grouped into relevant categories. Univariate analysis identified factors significantly associated with readmission rates. Results: A total of 802 patients with CP met the inclusion criteria. Unplanned 30 and 90 day readmission rates after laparoscopic cholecystectomy were 11.4% and 18.1%, respectively. Average length of stay (LOS) after laparoscopic cholecystectomy was 7.1 days. After open cholecystectomy, 30 and 90 day readmission rates were 16.9% and 30.3% with an average LOS of 14.6 days. Infection was the most common cause for 30 and 90 day readmission. Factors associated with 30 day readmission included type of cholecystectomy, LOS, discharge to skilled nursing facility, and comorbid diabetes and malnutrition. Factors associated with 90 day readmission included type of cholecystectomy, LOS, discharge to skilled nursing facility, and comorbid heart failure, renal disease, epilepsy, and malnutrition. Conclusion: Unplanned readmission rates after open and laparoscopic cholecystectomy in adult patients with CP are much higher than previously demonstrated rates in the general population. These patients frequently suffer multiple comorbid conditions that significantly complicate their surgical care. As more and more of these patients live longer into adulthood, further study is warranted to grasp the perioperative risk of simple and complex surgical procedures. [ABSTRACT FROM AUTHOR]

Background: This study aimed to determine the relationship between preoperative arterial calcifications and postoperative outcomes after Ivor Lewis esophagectomies. Methods: This was a single-center retrospective review of Ivor Lewis esophagectomies from 2013 to 2018. Preoperative CT imaging was reviewed, and arterial calcifications were graded (absent, minor, or major) in various locations. The primary outcome included major complications (defined by the Clavien-Dindo classification III–V) and the secondary outcomes were 90-day reoperations, readmissions, and mortality. Significant associations (p < 0.05) between calcifications and outcomes on univariable analysis were evaluated using a multivariable logistic regression model (odds ratios, OR; 95% confidence intervals, CI). Results: One hundred patients underwent esophagectomies from 2013 to 2018 (79% male, 90% White, median age 68 years), and 85% were classified as ASA III. Ninety-four patients had accessible preoperative imaging. Arterial calcifications in specific areas were observed: 82 in coronary arteries (major in 33 patients), 54 in the aortic valve, 78 in supra-aortic arteries, 79 in the thoracic aorta, 82 in the abdominal aorta, and 71 in common iliac. Furthermore, 60 patients exhibited celiac axis calcifications, with 40 patients classified as major. Twenty-five patients experienced major complications. Anastomotic leak occurred in two patients, and graft necrosis occurred in one patient. Ninety-day readmission was 10%, reoperation was 12%, and mortality was 4%. On univariable analysis, major coronary artery calcifications were significantly associated with major complications (OR 4.04; 95% CI 1.34–12.16; p = 0.02) and 90-day readmissions (OR 8.20; 95% CI 1.01–68.47; p = 0.04). However, no significant associations were identified between 90-day reoperations or mortality and arterial calcifications. Conclusions: This study demonstrated that preoperative coronary calcifications increase the risk of postoperative complications, as this may be a surrogate of overall health. Nonetheless, the correlation between splanchnic calcifications and postoperative outcomes needs further exploration. [ABSTRACT FROM AUTHOR]

Background: Enrollment of Medicare beneficiaries in medicare advantage (MA) plans has been steadily increasing. Prior research has shown differences in healthcare access and outcomes based on Medicare enrollment status. This study sought to compare utilization of minimally invasive colorectal cancer (CRC) surgery and postoperative outcomes between MA and Fee-for-Service (FFS) beneficiaries. Methods: A retrospective cohort study of beneficiaries ≥ 65.5 years of age enrolled in FFS and MA plans was performed of patients undergoing a CRC resection from 2016 to 2019. The primary outcome was operative approach, defined as minimally invasive (laparoscopic) or open. Secondary outcomes included robotic assistance, hospital length-of-stay, mortality, discharge disposition, and hospital readmission. Using balancing weights, we performed a tapered analysis to examine outcomes with adjustment for potential confounders. Results: MA beneficiaries were less likely to have lymph node (12.9 vs 14.4%, p < 0.001) or distant metastases (15.5% vs 17.0%, p < 0.001), and less likely to receive chemotherapy (6.2% vs 6.7%, p < 0.001), compared to FFS beneficiaries. MA beneficiaries had a higher risk-adjusted likelihood of undergoing laparoscopic CRC resection (OR 1.12 (1.10–1.15), p < 0.001), and similar rates of robotic assistance (OR 1.00 (0.97–1.03), p = 0.912), compared to FFS beneficiaries. There were no differences in risk-adjusted length-of-stay (β coefficient 0.03 (− 0.05–0.10), p = 0.461) or mortality at 30-60-and 90-days (OR 0.99 (0.95–1.04), p = 0.787; OR 1.00 (0.96–1.04), p = 0.815; OR 0.98 (0.95–1.02), p = 0.380). MA beneficiaries had a lower likelihood of non-routine disposition (OR 0.77 (0.75–0.78), p < 0.001) and readmission at 30-60-and 90-days (OR 0.76 (0.73–0.80), p < 0.001; OR 0.78 (0.75–0.81), p < 0.001; OR 0.79 (0.76–0.81), p < 0.001). Conclusions: MA beneficiaries had less advanced disease at the time of CRC resection and a greater likelihood of undergoing a laparoscopic procedure. MA enrollment is associated with improved health outcomes for elderly beneficiaries undergoing operative treatment for CRC. [ABSTRACT FROM AUTHOR]

Objective: To explore the decision-making factors for defunctioning ileostomy (DI) after rectal cancer surgery and to analyze the impact of the DI on perioperative outcomes. Methods: A retrospective case–control study was conducted that included rectal cancer patients who underwent low anterior resection from January 2013 to December 2023. Among them, 33 patients did not undergo DI but with anastomotic leakage (AL) after surgery, and 1030 patients were without AL. Preoperative, operative and tumor factors between these two groups were compared to explore the decision-making factors for DI. Meanwhile, the differences of perioperative outcomes between the DI group of 381 cases and non-DI group of 701 cases were compared. Results: For preoperative factors, the proportions of male patients and preoperative chemoradiotherapy (CRT) in the AL with non-DI group were greater than those in the non-AL group (p < 0.05); for operative factors, the proportion of patients in the AL with non-DI group with a surgical time > 180 min were greater (p < 0.05); for tumor factors, the proportion of T3-4 stage was higher in the AL with non-DI group (p < 0.05). Multiple regression analysis revealed that male sex and preoperative CRT were the independent risk factors affecting DI. For perioperative outcomes, the DI did not reduce the incidence of all and symptomatic AL and non-AL postoperative complications (p > 0.05) but with 12.07% stoma-related complications, and increase hospitalization costs (p < 0.05); however, it can shorten the postoperative hospital stay, pelvic drainage tube removal time, and reduce the anal tube placement rate and readmission rate (all p < 0.05). Conclusion: Male patients and preoperative CRT were the independent risk factors affect the decision of DI in our study, and DI can shorten the postoperative hospitalization, pelvic drainage tube removal time, and decrease the anal tube placement rate and readmission rate during the perioperative period but with a higher economic cost. [ABSTRACT FROM AUTHOR]

Background Ceftolozane/tazobactam and ceftazidime/avibactam are commonly used in patients with MDR- Pseudomonas aeruginosa (PSA) pneumonia (PNA). This study compared outcomes between non-COVID-19 hospitalized patients with MDR-PSA PNA who received ceftolozane/tazobactam or ceftazidime/avibactam. Methods The study included non-COVID-19 adult hospitalized patients with MDR-PSA PNA in the PINC AI Healthcare Database (2016–22) who received ceftolozane/tazobactam or ceftazidime/avibactam within 3 days of index culture for ≥2 days. Outcomes were mortality, recurrent MDR-PSA PNA, discharge destination, post-index culture day length of stay (LOS) and costs (in US dollars, USD), and hospital readmission. Results The final sample included 197 patients (117 ceftolozane/tazobactam, 80 ceftazidime/avibactam). No significant differences were observed in mortality and post-index culture LOS and costs between groups. In the multivariable analyses, patients who received ceftolozane/tazobactam versus ceftazidime/avibactam had lower recurrent MDR-PSA PNA (7.9% versus 18.0%, P  = 0.03) and 60 day PNA-related readmissions (11.1% versus 28.5%, P  = 0.03) and were more likely to be discharged home (25.8% versus 9.8%, P  = 0.03). Compared with ceftazidime/avibactam patients, ceftolozane/tazobactam patients had lower adjusted median total antibiotic costs (5052 USD versus 8099 USD, P  = 0.003) and lower adjusted median comparator (ceftolozane/tazobactam or ceftazidime/avibactam) antibiotic costs (3938 USD versus 6441 USD, P  = 0.005). In the desirability of outcome ranking (DOOR) analysis, a ceftolozane/tazobactam-treated patient was more likely to have a more favourable outcome than a ceftazidime/avibactam-treated patient [DOOR probability: 59.6% (95% CI: 52.5%–66.8%)]. Conclusions Early treatment with ceftolozane/tazobactam may offer some clinical and cost benefits over ceftazidime/avibactam in patients with MDR-PSA PNA. Further large-scale studies are necessary to comprehensively understand the outcomes associated with these treatments for MDR-PSA PNA. [ABSTRACT FROM AUTHOR]

Purpose: Practice patterns of same-day discharge for pediatric laparoscopic appendectomy for non-perforated appendicitis are not well-analyzed. Our aim is to evaluate current practice patterns and outcomes of same-day discharge for these patients. Methods: NSQIP-P retrospective registry identified patients (2017–2021) who underwent laparoscopic appendectomy for non-perforated appendicitis. Annual same-day discharge (SDD) rate was determined. SDD patients were compared to those discharged postoperative days 1–2 (non-SDD). Sub-group analysis was performed on ICD-10 code K35.30. Regression was performed. Results: Overall, 67,214 patients were identified. The SDD rate increased from 33.3% (2017) to 52.5% (2021) with decreased 30-day readmissions between SDD and non-SDD (1.3% vs 2.1%, p < 0.001). Sub-group analysis identified 7,330 patients with SDD rates from 50.7% (2019) to 60.4% (2021) with decreased 30-day readmissions (1.3% vs 2.1%, p < 0.001) for SDD versus non-SDD. No increase in adverse events for SDD occurred in either analysis. Regression identified esophageal/gastric/intestinal diseases increased odds of early readmission or reoperation (OR 1.85, p = 0.042). Conclusion: Same-day discharge after pediatric laparoscopic appendectomy for non-perforated acute appendicitis continues to increase in frequency without a significant increase in adverse outcomes. SDD rates are 20–30% lower than previously published single-center studies, indicating there is a likely a larger percentage of patients that could discharge same-day. Level of evidence (I–V): Level III. [ABSTRACT FROM AUTHOR]

Introduction: Surgical care practitioners (SCPs) are non-medical workers involved in various aspects of the management of surgical patients. The role includes assisting and performing surgical procedures. More than 60,000 laparoscopic cholecystectomies (LC) are performed annually in the UK. With ever-increasing pressure on waiting lists, it is important to look at fully utilising the skills of our entire workforce. We report what we believe is the first published series of LC performed by an SCP. Methods: A retrospective review of a prospectively collected database was performed. The primary outcome was any complication requiring intervention. Secondary outcomes were minor complications, operative time, length of stay, conversion and readmission. Results: In total, 170 patients were operated on. Indications were biliary colic in 127 (74.7%), cholecystitis in 30 (17.6%) and pancreatitis in 13 (7.6%). Mean operating time was 65min (range 35–152min). Fifty-three operations were assisted by a consultant, 110 by a specialist or associate specialist grade (SAS) doctor and 7 by a core trainee (CT2). Some 139 (81.7%) patients were discharged on the day of surgery and 24 (14.1%) stayed one night in hospital. There were no major complications. Five patients required readmission, three with pain and two with port site infections. There were no conversions or transfusions required. Conclusions: There is a paucity of published data on surgical outcomes of procedures performed by SCPs. With a structured, supervised approach, SCPs could be trained to take on more complex procedures and further strengthen the surgical workforce. This study demonstrates that elective LC can be safely performed by an appropriately trained and supervised SCP. [ABSTRACT FROM AUTHOR]

Purpose: The increasing use of advanced medical technologies to detect adverse events, for instance, artificial intelligence‐assisted technologies, has shown promise in improving various aspects within health care but may also come with substantial expenses. Therefore, understanding the potential economic benefits can guide decision‐making processes regarding implementation. We aimed to estimate the potential cost savings associated with reducing length of stay and avoiding readmissions within the framework of an artificial intelligence‐assisted vital signs monitoring system. Methods: We used data from Danish national registries and coarsened exact matching to estimate the difference in length of stay and probability of readmission among adult in‐hospital patients exposed to and not exposed to serious adverse events. We used these estimates to calculate the maximum potential savings that could be achieved by early detection of adverse events to reduce length of stay and avoid readmissions. Results: Patients exposed to serious adverse events during admission had 2.4 (95% CI: 2.4–2.5) additional hospital bed days and had 14% (95% CI 11%–17%) higher odds of readmissions compared with patients not exposed to such events. A base case scenario yielded maximum potential savings if one patient avoided a serious adverse event of EUR 2040 due to reduced length of stay and EUR 43 due to avoidance of readmissions caused by serious adverse events. Conclusion: Reductions in serious adverse events are associated with decreased healthcare costs due to reduced length of stay and avoided readmissions. Artificial intelligence‐assisted vital signs monitoring systems are one potential approach to reduce serious adverse events, however, the ability of this technology to reduce adverse events remains unclear. Comprehensive prospective analyses of such systems including the intervention and implementation costs are necessary to understand their full economic impact. [ABSTRACT FROM AUTHOR]

Aim: To determine the effects of nurse‐coordinated interventions in improving readmissions, cumulative hospital stay, mortality, functional ability and quality of life for frail older adults discharged from hospital. Design: Systematic review with meta‐analysis. Methods: A systematic search using key search terms of 'frailty', 'geriatric', 'hospital' and 'nurse'. Covidence was used to screen individual studies. Studies were included that addressed frail older adults, incorporated a significant nursing role in the intervention and were implemented during hospital admission with a focus on transition from hospital to home. Data Sources: This review searched MEDLINE (Ovid), CINAHL (EBSCO), PubMed (EBSCO), Scopus, Embase (Ovid) and Cochrane library for studies published between 2000 and September 2023. Results: Of 7945 abstracts screened, a total 16 randomised controlled trials were identified. The 16 randomised controlled trials had a total of 8795 participants, included in analysis. Due to the heterogeneity of the outcome measures used meta‐analysis could only be completed on readmission (n = 13) and mortality (n = 9). All other remaining outcome measures were reported through narrative synthesis. A total of 59 different outcome measure assessments and tools were used between studies. Meta‐analysis found statistically significant intervention effect at 1‐month readmission only. No other statistically significant effects were found on any other time point or outcome. Conclusion: Nurse‐coordinated interventions have a significant effect on 1‐month readmissions for frail older adults discharged from hospital. The positive effect of interventions on other health outcomes within studies were mixed and indistinct, this is attributed to the large heterogeneity between studies and outcome measures. Relevance to Clinical Practice: This review should inform policy around transitional care recommendations at local, national and international levels. Nurses, who constitute half of the global health workforce, are ideally situated to provide transitional care interventions. Nurse‐coordinated models of care, which identify patient needs and facilitate the continuation of care into the community improve patient outcomes. Implications for the Profession and/or Patient Care: Review findings will be useful for key stakeholders, clinicians and researchers to learn more about the essential elements of nurse‐coordinated transitional care interventions that are best targeted to meet the needs of frail older adults. Impact: When frail older adults experience transitions in care, for example discharging from hospital to home, there is an increased risk of adverse events, such as institutionalisation, hospitalisation, disability and death. Nurse‐coordinated transitional care models have shown to be a potential solution to support adults with specific chronic diseases, but there is more to be known about the effectiveness of interventions in frail older adults. This review demonstrated the positive impact of nurse‐coordinated interventions in improving readmissions for up to 1 month post‐discharge, helping to inform future transitional care interventions to better support the needs of frail older adults. Reporting Method: This systematic review was reported in accordance with the Referred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. Patient or Public Contribution: No Patient or Public Contribution. [ABSTRACT FROM AUTHOR]

We conducted a retrospective chart review of patients with neuromuscular scoliosis following spinal fusion surgery who were cared for post-operatively by either a hospitalist/orthopedics co-management team or a complex care clinic (CCC). Assignment to either treatment group was not random. To account for baseline differences between groups, we calculated propensity scores and used these as probability weights in generalized linear models. After matching, the CCC had a shorter length of stay (LOS, coefficient = −2.60; P =.04) without a significant difference in 30-day readmission rate (P =.62). For secondary outcomes, there were some significant resource utilization benefits favoring the complex care group without significant difference in complication outcomes between groups. In managing patients after spinal fusion surgery, both groups had similar LOS compared with prior studies of children after spinal fusion surgery. Management by the CCC may confer some outcome benefits for their patients. [ABSTRACT FROM AUTHOR]

Purpose: Previous studies showed that long-term use of proton pump inhibitors (PPIs) was associated with cardiovascular events. However, the impact of short-term PPI exposure on intensive care unit (ICU) patients with myocardial infarction (MI) remains largely unknown. This study aims to determine the precise correlation between short-term PPI usage during hospitalization and prognostic outcomes of ICU-admitted MI patients using Medical Information Mart for Intensive Care IV database (MIMIC-IV). Methods: Propensity score matching (PSM) was applied to adjust confounding factors. The primary study outcome was rehospitalization with mortality and length of stay as secondary outcomes. Binary logistic, multivariable Cox, and linear regression analyses were employed to estimate the impact of short-term PPI exposure on ICU-admitted MI patients. Results: A total of 7249 patients were included, involving 3628 PPI users and 3621 non-PPI users. After PSM, 2687 pairs of patients were matched. The results demonstrated a significant association between PPI exposure and increased risk of rehospitalization for MI in both univariate and multivariate [odds ratio (OR) = 1.157, 95% confidence interval (CI) 1.020–1.313] analyses through logistic regression after PSM. Furthermore, this risk was also observed in patients using PPIs > 7 days, despite decreased risk of all-cause mortality among these patients. It was also found that pantoprazole increased the risk of rehospitalization, whereas omeprazole did not. Conclusion: Short-term PPI usage during hospitalization was still associated with higher risk of rehospitalization for MI in ICU-admitted MI patients. Furthermore, omeprazole might be superior to pantoprazole regarding the risk of rehospitalization in ICU-admitted MI patients. [ABSTRACT FROM AUTHOR]

Aim: To examine the likelihood of mortality or rehospitalization following acute coronary syndrome with glyburide versus gliclazide use in adults with type 2 diabetes undergoing cardiac catheterization. Research Design and Methods: This retrospective cohort study used clinical data linked with administrative health data from Alberta, Canada between April 2008 and March 2021. Three methods were used to define exposure to glyburide and gliclazide in the year before catheterization. Multivariable logistic regression was used to compare the likelihood of a composite outcome of 1‐year mortality or rehospitalization with use of glyburide versus use of gliclazide. Results: A total of 11 140 individuals with type 2 diabetes had a cardiac catheterization for acute coronary syndrome. Their mean age was 66 years and 31% were female. In the year before catheterization, 5% used glyburide and 19% used gliclazide. Any glyburide or gliclazide exposure in the year before catheterization was associated with a similar likelihood of all‐cause mortality or rehospitalization (adjusted odds ratio [aOR] 1.14, 95% confidence interval [CI] 0.93–1.41; p = 0.20). However, current glyburide exposure (aOR 1.37, 95% CI 1.06–1.79; p = 0.018) and long exposure to glyburide (aOR 1.37, 95% CI 1.03–1.83; p = 0.030) were associated with a higher likelihood of the composite outcome compared to current and long exposure to gliclazide, respectively. Conclusions: Current and long exposure to glyburide was associated with a greater likelihood of mortality or rehospitalization following cardiac catheterization for acute coronary syndrome, when compared to similar gliclazide exposure definitions. This study adds further evidence of the need to avoid using glyburide if a sulphonylurea is required for type 2 diabetes management. [ABSTRACT FROM AUTHOR]

Individuals with chronic obstructive pulmonary disease (COPD) constitute a significant portion of patients who present to the emergency department with dyspnea. However, there is no ideal method for predicting mortality or making hospitalization decisions in the emergency department (ED). In this regard, objective findings are needed for these patients. Since there are no objective findings regarding the hospitalization decision, there may be an increase in the re-admission rate of patients who needed hospitalization but were decided to be discharged. Side-stream end-tidal carbon dioxide (EtCO 2) measurements offer a non-invasive, easy-to-interpret, quickly accessible, and reproducible method that can be applied at the bedside. The aim of this study was to evaluate the relationship between the alpha angle values obtained by capnography and readmission rates within 30 days for patients experiencing COPD exacerbations who presented to the ED with dyspnea and were discharged after treatment. In this study, we studied with 130 participants presented to the emergency department of a tertiary care university hospital with dyspnea, who are >18 y. Forty patients were excluded after evaluation for eligibility for the study. Thus, the data of 90 patients included were analyzed. We obtained alpha angle and EtCO 2 values for all patients at the time of admission and also after treatment. The primary outcome measure of the study was the relationship between the patients' readmission situations within 30 days of the alpha angle measurements. The secondary outcome measure was the association between patients' EtCO 2 values ​​and readmission within 30 days. It was observed that both the pretreatment alpha angle values and the posttreatment alpha angle variables were statistically significant in predicting the readmission of the patients within 30 days (p = 0.001, p = 0.003) The results of this study show that alpha angle values measured for patients with COPD who present to the ED with the complaint of dyspnea may be used to predict readmission. [ABSTRACT FROM AUTHOR]

Background: Adequate energy intake is essential for good clinical outcomes. The association between energy intake and readmission burden of patients with heart failure (HF) still needs to be clarified. Objective: In this study, our aim was to determine the association between energy intake and readmission in patients with HF. Methods: A total of 311 inpatientswith HF were recruited. Demographic and clinical information were collected during hospitalization; the daily diets of the participants were collected in the second week after discharge using the 3-day diet record, and the energy intake was calculated using a standardized nutrition calculator. The inadequate energy intake was defined as <70% x 25 kcal/kg of ideal body weight. The participantswere followed up for 12weeks after discharge. The number, reasons, and length of stay of unplanned readmissions were collected. Regression analyses were used to evaluate the associations between inadequate energy intake, and readmission rate and readmission days. Results: The median of the energy intake of participantswas 1032 (interquartile range, 809-1266) kcal/d. The prevalence of inadequate energy intakewas 40%. Patientswith inadequate energy intake had a higher risk of unplanned readmission (odds ratio, 5.616; 95% confidence interval, 3.015-10.462; P < .001) and more readmission days (incidence rate ratio, 5.226; 95% confidence interval, 3.829-7.134, P < .001) after adjusting for potential confounders. Conclusions: Patients with HF had a high incidence of inadequate dietary energy intake, and it increases the burden of readmission. [ABSTRACT FROM AUTHOR]

Background: We aimed to compare the omentopexy and clipping reinforcement methods performed along the staple line during laparoscopic sleeve gastrectomy (LSG) in terms of the effectiveness on postoperative bleeding. Methods: In this prospective randomized controlled study, patients were divided into two groups: clips group (CG) and omentopexy group (OG). The groups were compared in terms of postoperative bleeding, duration of surgery, length of hospital stay, hospital readmissions in the postoperative first 30-days. Results: A total of 148 patients were included in the study. Postoperative bleeding was observed in 11 patients (14.9%) of CG and 2 patients (2.7%) of the OG, and the difference between the groups was found to be significant (p = 0.009). Similarly, the number of patients with bleeding that did not require intervention was 9 (12.2%) in CG and 2 (2.7%) in OG, and the difference between the groups was also significant (p = 0.028). The duration of surgery in the CG was 30 (27 to 36) minutes, whereas in the OG, it was 43 (39 to 45) minutes, with a significant difference noted (p < 0.001). Additionally, the rate of patients readmitted to the hospital within the first 30 days was 16 (21.6%) in the CG and 7 (9.5%) in the OG, with a significant difference observed (p = 0.041). Conclusion: In terms of bleeding requiring intervention, there was no difference between omentopexy and clipping techniques. In addition, omentopexy showed more satisfactory results than clipping in terms of non-interventional bleeding, but its clinical significance is unclear. [ABSTRACT FROM AUTHOR]

Background Immune checkpoint inhibitors (ICI) are associated with a distinct spectrum of toxicities. Data on irAE hospitalization rates and clinical course of patients with thoracic malignancies are lacking. Methods Patients with advanced thoracic malignancy treated with ICI (2/2016 to 6/2021) were retrospectively identified. Demographic and clinical data of confirmed irAE hospitalizations were extracted from the medical record and a descriptive analysis was performed. Results From February 2016 to June 2021, 1312 patients with thoracic malignancy received ICI (monotherapy, combination with 2nd ICI or other agents) with 102 patients (7.7%) hospitalized for irAEs. Treatment intent was first-line therapy in most patients (N  = 50, 49%) with 9% (n = 9) receiving adjuvant ICI (N  = 9). Sixty patients (59%) received ICI alone, 32% (N  = 33) chemo plus immunotherapy, and 7% (N  = 7) dual ICI. The median age on admission was 68 years. The median time between ICI initiation and admission was 64 days (1-935 days). Pneumonitis (32.3%; 33/102) was the most frequent indication for admission followed by gastroenterocolitis (19.6%; 20/102), hepatitis (12.7%; 13/102), myo/pericarditis (9.8%; 10/102), and endocrinopathies (9.8%; 10/102). Multi-organ toxicity occurred in 36% (N  = 37) of patients. Overall, 85.2% (87/102) of patients received systemic corticosteroids and 17.6% (18/102) required additional lines of immunosuppression. The median length of hospitalization stay was 7 days (2-28 days) with a 25.5% (n  = 26) readmission rate within 60 days and an 11.8% (n  = 12) in house mortality rate. Conclusions Severe irAE requiring inpatient admission, although infrequent, results in considerable morbidity, mortality, and healthcare utilization. Pneumonitis was the most common irAE requiring inpatient management in our patient population with a significant risk of mortality despite the use of guideline-directed systemic immunosuppression. This study highlights the continued need for collaborative efforts amongst medical specialties for improving the diagnostic and therapeutic management of patients with irAEs. [ABSTRACT FROM AUTHOR]

(1) Background: The evidence to support transitional care in reducing acute hospital utilization is variable. Despite changes in the healthcare landscape with a rapidly aging population, there is a lack of local and regional studies to evaluate the effectiveness of transitional home care programs. This study investigates whether a transitional home care program delivered by an acute tertiary hospital can reduce acute hospital utilization. (2) Methods: A pre-post design was used to evaluate the effectiveness of the program. A total of 2004 enrolments from 1679 unique patients that fulfilled the criteria of enrolment were included. The transitional care program is delivered through telephone follow-up and home visits. The Wilcoxon Signed-Rank Test was used to assess the differences between the three periods of baseline, enrolment, and post-enrolment. (3) Results: All 2004 enrolments were analyzed. The re-attendances at the emergency department reduced significantly by 31.2% and 71.9% during enrolment and post-enrolment (p < 0.001), respectively. Similarly, patients had a 38.7% and 76.2% reduction in hospital admissions during enrolment and post-enrolment (p < 0.001), respectively. For patients who were admitted, there was no significant difference in the length of stay between these groups (p = 0.23). (4) Conclusions: The transitional home care program can effectively reduce emergency department re-attendances and inpatient admissions. Not only was the total number of emergency department re-attendances reduced significantly, but the number of frequent re-attendances also dropped significantly. The outcomes were consistent during COVID-19 and post-pandemic phases. These findings can be used as a guide in program planning and future scalability. [ABSTRACT FROM AUTHOR]

Purpose: Readmissions to the hospital are expensive and can have negative health consequences for patients. Older adults are at greater risk of readmission. Patient perspectives are valuable in identifying areas for improvement in the transition of care. The purpose of this qualitative study is to increase our understanding of patients' perspectives on the transition of care from hospital to primary care. Design/methodology/approach: This study employs a qualitative methodology to conduct semi-structured interviews with patients who have been discharged from hospitals in the Ireland East Hospital Group region. Remote interviews were conducted with 18 participants from eight general practices. Transcripts were analysed using thematic analysis as described by Braun and Clarke. Findings: The three main themes identified were communication, outpatient supports and patient education. Gaps in communication do occur, but patients are often too external to comment. Patients benefit from a wide variety of outpatient supports including general practice, family, carers, allied health professionals and voluntary organisations. Access and cost are barriers to these supports. Participants were generally positive towards proposed primary care-based interventions such as follow-up appointments with general practitioners (GPs) and education sessions. Originality/value: This study highlights a number of areas for improvement in the transition of care in current practice including communication between services and access to outpatient care. It also suggests directions for further research, such as explorations of healthcare provider perspectives and pilot studies of readmission reduction interventions. [ABSTRACT FROM AUTHOR]

Background: Electroconvulsive therapy (ECT) induces a generalized seizure under anesthesia with an electrical current for treatment-resistant patients and may be underutilized. To our knowledge, no large-scale, American, nationwide hospital system retrospective study has examined how ECT affects psychiatric rehospitalization chances. Methods: We analyzed initial inpatient encounters for adults aged > 18 years at HCA Healthcare Behavioral Health Units from 2016 to 2021 with diagnoses of major depressive disorder with/without psychosis, bipolar disorder with/without psychosis, schizoaffective disorder, and schizophrenia. Excluding pregnancy and incarceration cases, we compared psychiatric rehospitalization rates within 365 days for patients receiving ECT versus those with the same diagnoses not receiving ECT. Subgroup analyses were conducted by diagnosis, length of stay, sex, and race. Detailed statistical analyses included bivariate analyses with Fisher's Exact Test and Wilcoxon Rank Sum Test. Results: We analyzed 38,109 distinct patients, 637 of which received ECT. The rehospitalization rate was 37.52% for ECT recipients versus 20.71% for non-ECT patients (p < 0.0001). ECT was associated with higher rehospitalization rates, particularly for severe diagnoses like psychosis (87.28%), schizoaffective disorder (3.77%), and schizophrenia (6.59%). ECT patients had significantly longer rehospitalization lengths of stay (mean 14.53 days vs. 6.54 days for non-ECT, p < 0.0001). White patients received ECT more frequently. Females received ECT more often, while males had higher rehospitalization rates. Conclusions: ECT was associated with higher psychiatric rehospitalization rates and longer lengths of stay. This suggests ECT is more commonly used for complex, severe cases which may contribute to higher rehospitalization. Stronger social support and hospital and geographic ties among ECT patients may also play a role. [ABSTRACT FROM AUTHOR]

Background: Hospital readmission after discharge for stroke is associated with high morbidity and mortality. There is a paucity of data on the burden of stroke readmission in most sub-Saharan African countries. We aimed to determine the rate, reasons and predictors of hospital readmission and the mortality rate within 12 months of discharge among stroke survivors in Cameroon. Methods: This prospective cohort included patients who survived hospitalization for an acute stroke and who were discharged from two referral hospitals in the capital city of Cameroon between January 2013 and December 2013.We performed logistic regression analysis to identify demographic and clinical factors associated with readmission within 1 year of discharge and causes of readmission. Results: Of the 254 consecutive patients admitted for acute stroke, 198 were discharged alive. There were 107 (54%) males, and their mean age (SD) was 61.7 (13.9) years (range: 10 to 95 years). A total of 30 (15.2%) patients were readmitted following discharge from the index admission over a mean follow-up time of 286.9 (127.6) days. Of these, 14 (46.7%) were discharged and 16 (53.3%) died after readmission. Thirty percent (30%) of readmissions occurred within the first month. The most frequent causes of readmissions were infections (30%) and recurrent stroke (26.7%). Factors associated with readmission in bivariate analysis were initial admission temperature > 37.5°C (risk ratio [RR]: 1.3, p = 0.021) and initial admission Glasgow Coma Score < 14 (RR: p = 1.23, p = 0.019). After stratified adjustment for age and sex, temperature > 37.5°C (adjusted RR: 1.3, 95% CI: 1–1.7, p = 0.036) and GCS <14 (adjusted RR: 1.23, 95% CI: 1–1.6, p = 0.041) were associated with readmission. Conclusion: Readmission after discharge for stroke was common with nearly one third occurring within the first month and more than half dying following readmission. The most common causes of readmission were infections and recurrent stroke. [ABSTRACT FROM AUTHOR]

Background: Readmissions in psychiatric inpatient care may reflect problems in the provision of care, but the underlying factors are not well known. We examined the associations of patient characteristics (sociodemographic factors, diagnoses), treatment (duration, previous episodes, neuromodulation) and ward overload with psychiatric inpatient readmissions and multiple readmissions in Finland. Methods: We used a routinely collected data pool from one hospital district and followed all 2052 hospitalizations that started in 2018. The outcomes were readmission within 30 days and one year, and among those with readmission, the number of readmissions. Results: Of the patients, 11% had readmission within 30 days and 33% had readmission within one year. Women, those with previous hospitalizations, those with an ICD-10 diagnosis from the 'behavioural syndromes associated with physiological disturbances and physical factors / disorders of adult personality and behaviour' group, those with a diagnosis from the 'neurotic, stress-related and somatoform disorders' group, those with psychotic disorders, and those who received neuromodulation treatment were more likely to have readmissions. Having a diagnosis of 'disorders of psychological development' or 'behavioural and emotional disorders with onset usually occurring in childhood and adolescence' was associated with a lower likelihood of readmission. The duration of treatment and ward overload during the index period were not associated with readmission. Conclusions: The findings of this study suggest possible risk factors for readmission and can be used to plan psychiatric care. To some degree, the risk factors varied between different readmission types. It is important to examine whether there are unmet treatment needs in psychiatric inpatient care for children and adolescents. [ABSTRACT FROM AUTHOR]

Background: Total knee arthroplasty (TKA) is an effective treatment for knee osteoarthritis; however, early readmissions due to complications are common. This study assessed the ability of the hemoglobin-to-red cell distribution width ratio (HRR), hemoglobin-to-monocyte ratio (HMR), and hemoglobin-to-leukocyte ratio (HLR) to predict readmission within 14 days after TKA. Methods: Data from the Chang Gung Medical Research Database (CGRD) from 2014 to 2022 were retrospectively analyzed. Patients ≥ 20 years old who underwent primary TKA were eligible for inclusion. Patients with incomplete data on the indices of interest or follow-up < 14 days were excluded. Patient demographic, clinical, and comorbidity data were collected. Logistic regression was utilized to determine the associations between HRR, HMR, and HLR and 14-day readmission. Results: Data from 1,137 patients were analyzed. Multivariable analysis revealed that a higher HMR was significantly associated with lower 14-day readmission risk (adjusted OR [aOR] = 0.72, 95% confidence interval [CI]: 0.51–0.997), an HMR ≥ 2.18 (optimal cutoff value) was predictive of a significantly lower 14-day readmission risk (aOR = 0.61, 95% CI: 0.39–0.96). The composite indicator, HRR-HMR-HLR score, derived from the 3 indices assessed, was significantly associated with a lower 14-day readmission risk (score 2 vs. score 0: aOR = 0.51, 95% CI: 0.27–0.98; score 3 vs. score 0: aOR = 0.37, 95% CI: 0.17–0.82). Conclusions: High HMR and the HRR-HMR-HLR score are independently associated with a lower 14-day readmission risk after TKA. Implementing these indices into clinical practice may enhance postoperative management. [ABSTRACT FROM AUTHOR]

Aim Methods Results Conclusions Hospitalisation rates for paediatric bone and joint infection (BJI) in New Zealand (NZ) are among the highest globally. This study aims to quantify hospitalisation costs of BJI in 2018–2019.National hospitalisation data from the NZ Ministry of Health was used to describe costs associated with all paediatric hospitalisations coded for osteomyelitis or septic arthritis in those aged <16 years. Data included age, ethnic group, area level deprivation, diagnosis‐related‐group coding, admission length and cost‐weight. Readmissions up to 24 months following the initial encounter were analysed for associated costs.More than ten million dollars was spent on hospitalisation for paediatric BJI over the study period (NZ$10 819 474). There were 869 primary hospitalisations and 229 related readmissions. Median length of stay was 7.4 days (95% confidence interval 6.8–7.9). Re‐admission costs were NZ$1 196 640 within 24 months following diagnosis.Higher median hospitalisation costs occurred for children residing in the most deprived versus least deprived neighbourhoods (NZ$12 126 vs. NZ$9010, P < 0.01). NZ Māori compared with non‐Māori children had longer length of stay (8.4 vs. 6.3 days, P = 0.04), more complex and severe illnesses (53% vs. 17%, P < 0.01), and higher median hospitalisation costs (NZ$11 796 vs. NZ$9581, P = 0.03).Direct BJI hospitalisation costs in 2018–2019 were NZ$10 819 474 with 11% of costs due to re‐admission. Direct hospitalisation costs for paediatric BJI in NZ vary by deprivation and ethnic group. Illness complexity of paediatric BJI varies by ethnic group. Interventions are needed to reduce incidence and severity of these debilitating infections. [ABSTRACT FROM AUTHOR]

Introduction Objectives Methods Results Conclusion There is a paucity of data evaluating early initiation of sodium‐glucose cotransporter‐2 inhibitors (SGLT2i) in patients with diabetes following acute coronary syndrome (ACS) and coronary artery bypass graft surgery (CABG).To describe the efficacy and safety of SGLT2i initiated early after CABG in patients with type 2 diabetes who experienced ACS.This is a retrospective cohort study of patients with type 2 diabetes (T2DM) who experienced ACS and subsequent CABG with follow up at 3 and 12 months. Patients who filled a SGLT2i prescription within 14 days of discharge were allocated to the SGLT2i group and those who did not were included in the no SGLT2i group. The primary efficacy end point was first occurrence of a 4‐point Major Adverse Cardiovascular Event (MACE), and the primary safety end point was a composite of hypoglycemia, hypotension, diabetic ketoacidosis, acute kidney injury, and urinary tract infection. Secondary end points included a comparative analysis of the primary outcome, 30‐day readmission rates, and subgroup analyses of key populations.A total of 1629 patients were included: 226 received a SGLT2i within 14 days of discharge and 1403 did not. At 12 months, 8.9% and 15.3% of patients experienced MACE in the SGLT2i and no SGLT2i groups, respectively (adjusted Hazard Ratio [aHR] 0.65, 95% confidence interval [CI] 0.41–1.04). The primary safety outcome occurred in 12.0% of the SGLT2i group and 19.1% of the no SGLT2i group at 12 months (aHR 0.68, 95% CI 0.45–1.01).Early initiation of SGLT2i use was not associated with a reduction in MACE in patients with T2DM who experienced ACS and underwent subsequent CABG surgery. However, no apparent safety concerns were identified. Adequately powered trials are required to confirm this finding. [ABSTRACT FROM AUTHOR]

Background: The geriatric nutritional risk index (GNRI) is a valuable tool that may predict the prognosis of elderly patients with heart failure (HF). Malnutrition and low GNRI scores have been associated with a higher risk of hospitalization and mortality. This study aimed to investigate the association between GNRI and 6‐month readmission for HF in elderly Chinese patients. Materials and Methods: The study utilized data from hospitalized HF patients by combining electronic medical records from the PhysioNet restricted health data database with external outcome data. In our study, we used the GNRI as the independent variable and assessed its association with the risk of readmission within 6 months. The main analytical methods were multivariable Cox regression, stratified analysis with interaction, threshold effect analysis, and Kaplan–Meier survival curves. Results: This study involved 767 elderly HF patients, 61.3% of whom had malnutrition. In the threshold analysis, HF patients' 6‐month readmission risk was significantly reduced with increasing GNRI, with a hazard ratio (HR) and 95% confidence interval (CI) of 0.99 (0.97.1). Malnutrition group was associated with a higher risk of readmission within 6 months for HF patients in analyses that were controlled for confounding factors, with HRs and their 95% CI of 1.17 (0.99, 1.38), 1.18 (1, 1.4), and 1.44 (1.08,1.93), respectively. Subgroup analysis showed that GNRI levels had a consistent impact on outcome events, unaffected by covariates. Conclusions: GNRI was negatively correlated with the outcome event of readmission within 6 months in elderly HF patients. Malnutrition group showed a higher risk of readmission within 6 months. [ABSTRACT FROM AUTHOR]

Key Points: Question: What is the long-term prognosis of myocarditis after COVID-19 mRNA vaccination and do clinical outcomes and medical management differ from myocarditis of other origins? Finding: In this nationwide cohort study including 4635 patients hospitalized for myocarditis in France during the first 1.5 years after COVID-19 vaccination, the 558 individuals with postvaccine myocarditis had less severe cardiovascular events than those with myocarditis of other origins at 18 months of follow-up. However, affected patients, mainly healthy young men, may require medical management up to several months after hospital discharge. Meaning: These elements should be taken into account for ongoing and future mRNA vaccine recommendations. Importance: Although patients with myocarditis after COVID-19 mRNA vaccination appear to have a good prognosis near hospital discharge, their longer-term prognosis and management remain unknown. Objective: To study the cardiovascular complications of post–COVID-19 mRNA vaccination myocarditis and other types of myocarditis during an 18-month follow-up, as well as disease management based on a study of the frequency of medical procedures and drug prescriptions. Design, Setting, and Participants: In this cohort study based on the French National Health Data System, all individuals aged 12 to 49 years hospitalized for myocarditis in France between December 27, 2020, and June 30, 2022, were identified. Exposure: Individuals were categorized as having postvaccine myocarditis (within 7 days after COVID-19 mRNA vaccine), post–COVID-19 myocarditis (within 30 days of SARS-CoV-2 infection), or conventional myocarditis. Main Outcomes and Measures: The occurrence of clinical outcomes (hospital readmission for myopericarditis, other cardiovascular events, all-cause death, and a composite outcome of these events) over the 18 months following hospital admission were analyzed using weighted Cox models to standardize the comparisons with the conventional myocarditis group. Also, medical management after hospital discharge was longitudinally assessed using generalized estimated equation models. Results: In total, 4635 individuals were hospitalized for myocarditis: 558 with postvaccine myocarditis, 298 with post–COVID-19 myocarditis, and 3779 with conventional myocarditis. Patients with postvaccine myocarditis were younger than those with post–COVID-19 and conventional myocarditis (mean [SD] age of 25.9 [8.6], 31.0 [10.9], and 28.3 [9.4] years, respectively) and were more frequently men (84%, 67%, and 79%). Patients with postvaccine myocarditis had a lower standardized incidence of the composite clinical outcome than those with conventional myocarditis (32/558 vs 497/3779 events; weighted hazard ratio, 0.55 [95% CI, 0.36-0.86]), whereas individuals with post–COVID-19 myocarditis had similar results (36/298 events; weighted hazard ratio, 1.04 [95% CI, 0.70-1.52]). The standardized frequency of medical procedures and drugs prescribed in patients with postvaccine myocarditis or post–COVID-19 myocarditis followed a similar trend in the 18 months following hospital discharge to that of patients with conventional myocarditis. Conclusions and Relevance: Patients with post–COVID-19 mRNA vaccination myocarditis, contrary to those with post–COVID-19 myocarditis, show a lower frequency of cardiovascular complications than those with conventional myocarditis at 18 months. However, affected patients, mainly healthy young men, may require medical management up to several months after hospital discharge. This cohort study examines cardiovascular complications of postvaccine and other types of myocarditis (ie, post–COVID-19 and conventional myocarditis) during 18-month follow-up. [ABSTRACT FROM AUTHOR]

Introduction Methods Results Conclusion Evidence from the literature suggests that social determinants of health (SDOH) account for 80% of health outcomes and are associated with hospital readmissions. Readmissions negatively impact the quality of life of patients and increase healthcare costs. The Agency for Healthcare Research and Quality reports that there were 3.8 million 30‐day adult hospital readmissions in 2018 with an average readmission cost of $15,000.A literature search in CINAHL, PubMed, ClinicalKey, Google Scholar, and Medline databases using the keywords “SDOH”, “social determinants of health”, “healthcare disparities”, “patient discharge”, “readmission”, “interdisciplinary”, and “multidisciplinary” yielded 287 articles. After title and abstract screening and a full‐text review of 90 articles, five articles were selected for critical appraisal. We used the critical appraisal skills programme (CASP) and Appraisal of Guidelines for Research & Evaluation II (AGREE II) tools for the selected articles’ appraisal process.Ten high‐quality strong evidence recommendations emerged from the evidence review process. These recommendations were bundled together to create an evidence‐based methodology to decrease 30‐day readmissions.The findings provide strong evidence of the effectiveness of a bundled discharge approach in reducing hospital readmissions and improving patient outcomes. [ABSTRACT FROM AUTHOR]

Background: The left atrial (LA) volume has been demonstrated to be an important predictor of adverse outcome in patients with various cardiac conditions, including acute myocardial infarction (AMI). However, new treatment strategies in patients with AMI have led to better patient outcomes. We hypothesised that increased LA size could still predict mortality in patients with AMI despite improved treatment strategies. Methods: We included patients with AMI in a prospective multicenter cohort study and the study patients were enrolled from 2014 to 2022. We recorded echocardiographic and clinical data during their index hospitalisation. Indexed LA volume (LAVi) was assessed in all patients and was used as a continuous variable in the univariate and multivariate Cox regression analysis. The study took place over a period of five years and median follow-up time was 3.8 years (range 3.1 to 5.0 years). The primary study outcomes were all-cause mortality and major adverse cardiac events (MACE). MACE was defined as hospital readmission due to myocardial infarction, cardiac arrest, stroke, heart failure, or onset of new atrial fibrillation. Results: We included 487 patients (69 ± 12 years old, 26% female) with AMI. During the follow-up period all-cause mortality was 50 (10.3%) and patients who reached the primary outcomes were 153 (31.4%). The deceased patients had higher LAVi compared to survivors (40.0 ± 12.9 mL/m2 vs. 29.7 ± 11.2 mL/m2, p < 0.001). Factors associated with all-cause mortality and MACE were age, year of enrollment, left ventricular (LV) ejection fraction, LV global longitudinal strain (GLS), LV filling pressure, moderate or severe mitral regurgitation and LAVi. GLS and EF were segregated into two distinct models due to their moderately high correlation (r = 0.57, p < 0.001). LAVi remained as an independent echocardiographic predictor of primary outcomes after adjusting for the covariates above in two separates multivariable Cox regression models (hazard ratio 1.02/1.02 mL/m2 [95% CI 1.01–1.03/1.01–1.03], p = 0.006/0.003). Conclusions: Our study demonstrated that LA dilatation is an independent echocardiographic predictor of mortality and MACE in patients with AMI despite improved treatment strategies. This finding highlights the potential of using LAVi as a marker for prognostication in these patients. [ABSTRACT FROM AUTHOR]

Diverting loop ileostomy is performed after colectomy to allow for anastomotic healing, and prevention of pelvic sepsis when an anastomotic leak occurs. There is no consensus on the optimal timing of ileostomy closure, and there is limited data on complications associated with ileostomy closure greater than 12 months after creation. The aim of this study is to investigate outcomes of delayed loop ileostomy closure greater than 12 months after creation. Patients undergoing loop ileostomy closure between 2013 and 2023 at Carilion Medical Center, in Roanoke, VA were reviewed. Cohorts compared were defined as Control Group (closure < 4 months) and Delayed Group (closure > 12 months). Demographics and outcomes were compared. Statistical comparisons were performed using either Wilcoxon rank sum test, Pearson's Chi-squared test or Fisher's exact test. Statistical modeling included binary logistic regression for 30-day readmissions and a generalized linear modeling for days till bowel function returns. Adjusted odds ratios, confidence intervals, and p-values were calculated. There were 135 patients in the Control Group and 19 patients in the Delayed Group. Demographics were similar between the groups except for a higher percentage of patients with diabetes, renal failure and history of cancer in Delayed Group (all p < 0.05). Operative time was longer for Delayed loop ileostomy closure (p < 0.05). Patients in the Delayed Group demonstrated a higher hospital readmission rate within 30 days (p < 0.05). Both groups had similar return of bowel function on post-operative day 2, similar length of stay, and similar rates of postoperative ileus (p = NS). Delayed loop ileostomy closure more than 12 months after creation does not delay return of bowel function but may lead to higher hospital readmission rates within 30 days. [ABSTRACT FROM AUTHOR]

Background: Despite the implementation of enhanced recovery programs, the reported average postoperative length of stay after robotic lobectomy remains as 4 days. In this prospective study, we present the outcomes of early discharge (on day 2) with telehealth home monitoring device after robotic lobectomy for lung cancer in selected patients. Methods: All patients with a caregiver were discharged on postoperative day 2 (POD 2) with a telemonitoring device provided they met the specific discharge criteria. Inclusion criteria: <75 years old, stage I-II NSCLC, with caregiver, ECOG 0–2, scheduled for lobectomy, logistic proximity to hospital (<60 km); intra-postoperative exclusion criteria: conversion to open surgery, early complications needing hospital monitoring or redo-operation, difficult pain management, <92 HbO2% saturation on room air or need for O2 supplementation, altered vital or laboratory parameters. Teleconsultations were scheduled as follows: the first one in afternoon of POD2, two on POD3, then once a day until chest tube removal. After discharge, patients recorded their vital signs at least four times a day using the device, which allowed two surgeons to monitor them via a mobile application. In the event of sudden changes in vital signs or the occurrence of adverse events, patients had access to a direct phone line and a dedicated re-hospitalization pathway. The primary outcome was safety, assessed by the occurrence of post-discharge complications or readmissions, as well as feasibility. Secondary outcomes: comparison of safety profile with a matched control group in which the standard of care and the evaluation of resource optimization were maintained and economic evaluation. Results: Between July 2022 and February 2024, 48 patients were enrolled in the present study. Six patients (12.5%) dropped out due to unsatisfied discharge criteria on POD2. Exclusion causes were: significant air leaks (n:2) requiring monitoring and the use of suction device, uncontrolled pain (n:2), atrial fibrillation, and occurrence of cerebral ischemia (n:1 each). The adherence rate to vital signs monitoring by patients was 100%. A mean number of four measurements per day was performed by each patient. During telehealth home monitoring, a total of 71/2163 (1.4%) vital sign measurements violated the established acceptable threshold in 22 (52%) patients. All critical violations were managed at home. During the surveillance period (defined as the time from POD 2 to the day of chest tube removal), a persistent air leak was recorded in one patient requiring readmission to the hospital (on POD 13) and re-intervention with placement of a second thoracic drainage due to unsatisfactory lung expansion. No other postoperative complication occurred nor was there any readmission needed. Compared to the control group, the discharge gain was 2.5 days, with an economic benefit of 528 €/day (55.440 € on the total enrolled population). Conclusions: Our results confirm that the adoption of telehealth home monitoring is feasible and allows a safe discharge on postoperative day two after robotic surgery for stage I-II NSCLC in selected patients. A potential economic benefit (141 days of hospitalizations avoided) for the healthcare system could result from the adoption of this protocol. [ABSTRACT FROM AUTHOR]

Background/Objectives: We assessed the impact of frailty on outcomes of endoscopic retrograde cholangiopancreatography (ERCP) in the United States. Methods: The National Readmission Database (2016–2020) was used to identify index and 30-day ERCP readmissions, which were categorized into low-frailty, intermediate-frailty, and high-frailty groups based on the Hospital Frailty Risk Score (HFRS). Outcomes were then compared. Results: Of 885,416 index admissions, 9.9% were readmitted within 30 days of ERCP. The odds of 30-day readmission were higher in the intermediate-frailty group (12.59% vs. 8.2%, odds ratio [OR] 1.67, 95% confidence interval [CI] 1.64–1.71, p < 0.001) and the high-frailty group (10.57% vs. 8.2%, OR 1.62, 95% CI 1.52–1.73, p < 0.001) compared to the low-frailty group. On readmission, a higher HFRS also increased mean length of stay (intermediate-frailty vs. low-frailty: 8.49 vs. 4.22 days, mean difference (MD) 4.26, 95% CI 4.19–4.34, p < 0.001; high-frailty vs. low-frailty: 10.9 vs. 4.22 days, MD 10.9 days, 95% CI 10.52–11.28, p < 0.001) and mean total hospitalization charges (intermediate-frailty vs. low-frailty: $118,996 vs. $68,034, MD $50,962, 95% CI 48, 854–53,069, p < 0.001; high-frailty vs. low-frailty: $195,584 vs. $68,034, MD $127,550, 95% CI 120,581–134,519, p < 0.001). The odds of inpatient mortality were also higher for the intermediate-frailty and high-frailty compared to the low-frailty subgroup. Conclusions: Frailty was associated with worse clinical outcomes after ERCP. [ABSTRACT FROM AUTHOR]

Introduction and Objective: To report our initial experience with enhanced MOSES 2.0 technology in patients who underwent holmium laser enucleation of the prostate (HoLEP) for the treatment of benign prostatic hyperplasia (BPH), in comparison to those who underwent HoLEP with MOSES 1.0 technology at our institution. Methods: We retrospectively reviewed data of patients who underwent HoLEP using MOSES 1.0 or MOSES 2.0 pulse-modulation technology from December 2020 to September 2023. Preoperative and intraoperative parameters, postoperative outcomes, as well as perioperative complications were collected and analyzed. Results: A total of 196 patients were included in the study. Among them, 146 patients underwent MOSES 1.0 HoLEP, while 50 had MOSES 2.0 HoLEP. No statistically significant differences in preoperative characteristics were observed between the two groups. The median prostate volume for the MOSES 1.0 and MOSES 2.0 HoLEP groups was 109 cc and 117.5 cc, respectively. Patients in the MOSES 2.0 group had a shorter median enucleation time (52.5 vs. 42.5 min, p < 0.001) and hemostasis time (8 vs. 6 min, p = 0.002), along with lower laser energy usage (101 vs. 86.4 kJ, p = 0.012), when compared to those in the MOSES 1.0 cohort. Postoperative outcomes, including IPSS, QoL, Qmax, and PVR, were comparable between the two groups at 1, 3, and 6 months postoperative. The incidence of hospital readmission (p = 0.42), as well as one-month postoperative urge urinary incontinence (p = 0.2) and stress urinary incontinence (p = 0.13) were also comparable between the cohorts. Conclusions: HoLEP with second-generation MOSES 2.0 technology is a safe and effective treatment option for BPH. It offers notable improvements, including reduced enucleation and hemostasis times, while using less energy when compared to MOSES 1.0. [ABSTRACT FROM AUTHOR]