The Outcome of Early Oral Feeding Following Elective Gastrointestinal Surgery.

Background Early oral feeding (EOF) after gastrointestinal (GI) surgery is an optimistic way to speed up recovery and shorten hospital stays, but its full effects remain unexplored. Aim This study aims to evaluate the outcomes of EOF in patients having elective gastrointestinal surgery. Methods This open-level, prospective randomized controlled trial was conducted in the Department of Surgery at Sir Salimullah Medical College Mitford Hospital, Dhaka, from March 2022 to February 2023. A total of 50 patients were enrolled and divided into two groups: early oral feeding (EOF) and traditional postoperative oral feeding (TOF), both before and after 48 hours of surgery, using a systematic random sampling technique. Informed written consent was taken from the patients. The patients were monitored on days 1, 3, 5, 7, 14, and 28 following surgeries. Postoperative complications, the duration for nasogastric tube (NGT) removal (days), the early recovery of bowel motility, and the length of the hospital stay (days) were noted. Results In this study, both EOF and TOF groups were found indifferent in terms of age distribution, gender ratio, or body mass index (BMI). However, significant differences emerged in postoperative outcomes. The TOF group experienced a significantly longer duration for nasogastric tube (NGT) removal and the initiation of oral feeding compared to the EOF group (P-value < 0.001). Complication rates, including nausea, vomiting, ileus, anastomotic leakage, wound infection, and pneumonia, did not exhibit statistically significant differences between the groups (P-value > 0.05). Moreover, the EOF group demonstrated an early recovery of bowel motility after surgery and shorter hospital stays compared to the TOF group (P-value < 0.05). Conclusion Starting oral feeding earlier does not increase complications. However, it does speed up recovery and shorten hospital stays.

Analyzing Pre-operative Hospital Stay and Incidence of Hospital Acquired Infection: A Retrospective Study.

Background and objectives: Healthcare-associated infections (HCAIs) pose a significant challenge, impacting patient safety and treatment effectiveness. This retrospective study investigates the correlation between pre-operative hospital stays and HCAIs in ICU cardiac surgery patients. Materials and methods: Medical records of 35 patients who died post-cardiac surgery in the ICU were analyzed, focusing on the duration of pre-operative hospitalization. Results: Prolonged pre-operative stays strongly correlate (r = 0.993) with increased HCAIs, indicating a critical risk factor. Conclusions: The duration of pre-operative hospital stays is pivotal in HCAI risk. Prospective multicenter studies are needed for validation, which is crucial for enhancing patient safety and treatment efficacy.

Medicare Advantage plan characteristics associated with sorting their beneficiaries to providers that generate fewer avoidable hospital stays.

OBJECTIVE: To examine whether certain Medicare Advantage (MA) plan characteristics are associated with driving beneficiaries to providers that generate fewer avoidable hospital stays. DATA SOURCES: This paper primarily used 2018-2019 MA encounter data and traditional Medicare (TM) claims data for a nationally representative 20% sample of Medicare beneficiaries. STUDY DESIGN: For each plan design aspect-plan type, carrier, star rating, and network breadth-we estimated two adjusted Poisson regressions of avoidable hospital stays: one without clinician fixed effects and the other with. We calculated the difference between the coefficients to evaluate the extent to which patient sorting affected avoidable hospital stays relative to TM. DATA EXTRACTION METHODS: Our sample included Medicare beneficiaries 65 years and older who were continuously enrolled in either MA or TM during 2018-2019. Beneficiaries in our sample had one or more chronic, ambulatory care-sensitive conditions. PRINCIPAL FINDINGS: Patient sorting can be attributed to certain characteristics of plan design aspects. For plan type, HMOs account for 86%, with PPOs accounting for only 14%. For carriers, Humana and smaller carriers account for 89%. For star ratings, high-star contracts account for 94%, with other stars only accounting for 6%. By network design, narrow network plan-counties explained 20% of the patient sorting effect. CONCLUSIONS: While MA plans were found to be associated with driving beneficiaries to providers that generate fewer avoidable hospital stays, the effect is not homogeneous across the characteristics of MA plans. HMOs and high-star contracts are drivers of this MA phenomenon.

Temperature variability associated with respiratory disease hospitalisations, hospital stays and hospital expenses the warm temperate sub-humid monsoon climate.

OBJECTIVES: The abrupt change of climate has led to an increasing trend of hospitalised patients in recent years. This study aimed to analyse the temperature variability (TV) associated with respiratory disease (RD) hospitalisations, hospital stays and hospital expenses. STUDY DESIGN: The generalized linear model combined with distributed lag non-linear model was used to investigate the association between TV and RD hospitalisations. METHODS: TV was determined by measuring the standard deviation of maximum and minimum temperatures for the current day and the previous 7 days. RD hospitalisations data were obtained from three major tertiary hospitals in Huaibei City, namely, the Huaibei People's Hospital, the Huaibei Hospital Of Traditional Chinese Medicine and the Huaibei Maternal and Child Health Care Hospital. First, using a time series decomposition model, the seasonality and long-term trend of hospitalisations, hospital stays and hospital expenses for RD were explored in this warm temperate sub-humid monsoon climate. Second, robust models were used to analyse the association between TV and RD hospitalisations, hospital stays and hospital expenses. In addition, this study stratified results by sex, age and season. Third, using the attributable fraction (AF) and attributable number (AN), hospitalisations, hospital stays and hospital expenses for RD attributed to TV were quantified. RESULTS: Overall, 0.013% of hospitalisations were attributed to TV0-1 (i.e. TV at the current day and previous 1 day), corresponding to 220 cases, 1603 days of hospital stays and 1,308,000 RMB of hospital expenses. Females were more susceptible to TV than males, and the risk increased with longer exposure (the highest risk was seen at TV0-7 [i.e. TV at the current day and previous 7 days] exposure). Higher AF and AN were observed at ages 0-5 years and ≥65 years. In addition, it was also found that TV was more strongly linked to RD in the cool season. The hot season was positively associated with hospital stays and hospital expenses at TV0-3 to TV0-7 exposure. CONCLUSIONS: Exposure to TV increased the risk of hospitalisations, longer hospital stays and higher hospital expenses for RD. The findings suggested that more attention should be paid to unstable weather conditions in the future to protect the health of vulnerable populations.

Adverse events during the COVID-19 pandemic in Ecuador: high frequency of healthcare-associated infections and increasing hospital stay and costs.

Background: The COVID-19 pandemic generated high workloads given the high volume of seriously ill patients; conditions that could increase the risk of adverse events (AE). This study analyzed the frequency of AE in patients with COVID-19 and their effect on mortality, hospital stay and costs. Methods: This retrospective cohort study included in-patients with COVID-19 at a single hospital between March 2020-June 2021. Exposure was the occurrence of at least one AE. Hospital stay, costs and death were considered outcomes. Clinical information and direct costs were obtained from medical and billing records. Generalized linear models were used to estimate the association measures. Results: 405 patients were included, 55.8% (n=226) men, median age 56 years (IQR: 41.0-70.0) and with a history of hypertension (26.2%; n=106), diabetes mellitus (13.8%; n=56) and obesity (13.8%; n=56). The incidence of AE was 13.3% (n=54), 29 patients presented more than one AE, for a total of 70 events. Most events (74.3%; n=52) were preventable and the most frequent were healthcare-associated infections (50%; n=35), phlebitis (14.3%; n=10) and pressure ulcers (12.9%; n=9). AE prolonged hospital stay (change rate: 1.57; 95%CI: 1.26-1.95; P=0.001) and increased direct healthcare costs (change rate: 1.20; 95% CI: 1.03-1.39, P=0.019). Likewise, the risk of death was 56% higher in patients with AE. Conclusion: Pandemics are unexpected events that present challenges to safe healthcare. Improving quality policies, monitoring compliance with protocols and providing ongoing education are strategies to prevent AE such as healthcare-associated infections, which increase hospital costs and stay.

Skull base reconstruction using in situ bone flap in patients with pituitary adenomas treated by endoscopic endonasal approach.

Objective: The objective of this study is to study the effect of in situ bone flap (ISBF) repositioning, a recently proposed rigid skull base reconstruction technique, on patients diagnosed with pituitary adenoma undergoing endoscopic endonasal approach (EEA). Method: A retrospective analysis was conducted on 188 patients with pituitary adenomas who underwent EEA from February 2018 to September 2022. Patients were divided into the ISBF group and non-ISBF group, according to whether ISBF was used during skull base reconstruction. Results: Of the 75 patients in the non-ISBF group, 6 had postoperative cerebrospinal fluid (CSF) leakage (8%), while only 1 of 113 patients in the ISBF group (0.8%) had postoperative CSF leakage, indicating that the incidence of postoperative CSF leakage in the ISBF group was significantly lower than that in the non-ISBF group (P = 0.033). In addition, we also found that the postoperative hospitalization days of patients in the ISBF group (5.34 ± 1.24) were significantly less than those in the non-ISBF group (6.83 ± 1.91, P = 0.015). Conclusion: ISBF repositioning is a safe, effective, and convenient rigid skull base reconstruction method for patients with pituitary adenoma treated by EEA, which can significantly reduce the rate of postoperative CSF leakage and shorten postoperative hospital stays.

Prevalence of Postoperative Atrial Fibrillation Following Off-Pump Coronary Artery Bypass Graft Surgery in Elderly Patients.

Background Atrial fibrillation (AF) is one of the frequent complications following coronary artery bypass surgery. Postoperative atrial fibrillation (POAF) can lead to thromboembolic events and prolong hospital stays. We aimed to determine the prevalence of POAF following off-pump coronary artery bypass surgery (OPCAB) in the elderly population.  Materials and Methods  This cross-sectional study was carried out between May 2018 to April 2020. Elderly patients (age ≥65 years) admitted for isolated elective OPCAB were eligible for the study. A total of 60 elderly patients were evaluated based on the preoperative and intraoperative risk factors and postoperative outcomes during the hospital stay. Results The mean age was 67.83±4.06 years, and the prevalence of POAF in elderly adults was 48.3%. The mean number of grafts was 3.20±0.73, and ICU stays at 3.43±1.61 days. The mean duration of the hospital stays was 10.03±2.12 days. Although stroke developed in 1.7% of post-CABG patients, no mortality was observed postoperatively. Conclusion  POAF is one of the commonly encountered complications following OPCAB. Though OPCAB is a superior revascularization procedure, preoperative planning and attention are especially needed in the elderly to reduce the prevalence of POAF.

Two-year impact of COVID-19 pandemic on hospitalized patients with skin diseases in China.

To investigate the clinical characteristics of skin disorders among hospitalized patients before and during the coronavirus disease 2019 (COVID-19) pandemic, a retrospective study was conducted based on hospitalized patients with skin diseases from Xiangya Hospital of Central South University, the largest hospital in the south-central region of China, between January 1, 2018, and December 31, 2021. A total of 3039 hospitalized patients were enrolled in the study, including 1681 patients in the prepandemic group and 1358 patients in the pandemic group. The total number of hospitalized patients in the pandemic group decreased by 19.2%, with an increased proportion of patients over 60 years of age (39.8% vs. 35.8%). Moreover, compared with the prepandemic group, there were decreases in the occurrence of most skin diseases in the pandemic group, but the proportions of keratinolytic carcinoma (6.6% vs. 5.2%), dermatitis (24.0% vs. 18.9%), and psoriasis (18.0% vs. 14.8%) were higher in the pandemic group. In addition, longer hospital stays (ß = 0.07, SE = 0.02, P = 1.35 × 10-3 ) and higher hospital costs (ß = 0.06, SE = 0.03, p = 0.031) were found in the pandemic group through general linear models, even after the corresponding adjustment. In summary, the COVID-19 pandemic has had a lasting impact on patients with skin diseases, with fewer hospitalized patients, increased proportions of older patients, longer hospital stays, and increased hospital costs. These findings will facilitate better preparation for the most effective response to future pandemics.

Prolonged antibiotic therapy increased necrotizing enterocolitis in very low birth weight infants without culture-proven sepsis.

Objectives: We aimed to identify the factors associated with necrotizing enterocolitis (NEC) and to assess the associations of the initial empirical antibiotic therapy (IEAT) duration and antibiotic therapy duration/hospital stay ratio (A/H ratio) before NEC with subsequent NEC in very low birth weight (VLBW) infants with gestational age less than 32 weeks without proven sepsis. Methods: A retrospective study was conducted at the NICU of the First Affiliated Hospital of Medical University of Anhui province from June 2015 to May 2022, and 567 VLBW infants with gestational age less than 32 weeks were included in the study. We divided the VLBW infants into those with and without NEC according to modified Bell's criteria. We then used descriptive statistics to identify the factors associated with NEC and multivariate analyses to evaluate the associations of IEAT duration and A/H ratio with the occurrence of NEC. Results: Of the 567 VLBW neonates admitted to our center, 547 survived and reached the normal discharge criteria. Fifty-one infants (8.99%) were diagnosed as showing NEC. Infants with NEC had a longer total parenteral nutrition time, total enteral nutrition time, and IEAT duration, as well as a higher A/H ratio than those without NEC. In multivariate analyses adjusted for the other factors, IEAT duration was associated with an increased odds of NEC [odds ratio (OR) = 1.267; 95% confidence interval (CI), 1.128-1.423], and the A/H ratio was also associated with increased odds of NEC (OR = 8.718; 95% CI, 2.450-31.030). For the A/H ratio, the area under the curve (AUC) was 0.767 and the ideal cutoff was 0.357, and the sensitivity and specificity were 0.843 and 0.645, respectively. Conclusion: Prolonged antibiotic therapy may increase the risk of NEC in VLBW infants with a gestational age of fewer than 32 weeks and should be used with caution.

Role of systemic corticosteroids in orbital cellulitis: a meta-analysis and literature review / Papel dos corticosteroides sistêmicos na celulite orbitária: uma metanálise e revisão da literatura ,

Abstract Introduction: The standard management of orbital cellulitis is to administer a combination of intravenous broad-spectrum antibiotics along with treatment of associated sinusitis. Objective: The purpose of this study was to evaluate whether the addition of corticosteroids could lead to earlier resolution of inflammation and improve disease outcome. Methods: We independently searched five databases (PubMed, SCOPUS, Embase, the Web of Science, and the Cochrane database) for studies published as recent as December 2019. Of the included studies, we reviewed orbital cellulitis and disease morbidity through lengths of hospitalization, incidence of surgical drainage, periorbital edema, vision, levels or C-reactive protein, and serum WBC levels in order to focus on comparing steroid with antibiotics treated group and only antibiotics treated group. Results: Lengths of hospitalization after admission as diagnosed as orbital cellulitis (SMD = −4.02 [−7.93; −0.12], p -value = 0.04, I2 = 96.9%) decrease in steroid with antibiotics treated group compared to antibiotics only treated group. Incidence of surgical drainage (OR = 0.78 [0.27; 2.23], p -value = 0.64,I2 = 0.0%) was lower in the steroid with antibiotics treated group compared to the antibiotics only treated group. Conclusion: Use of systemic steroids as an adjunct to systemic antibiotic therapy for orbital cellulitis may decrease orbital inflammation with a low risk of exacerbating infection. Based on our analysis, we concluded that early use of steroids for a short period can help shorten hospitalization days and prevent inflammation progression.

Resumo Introdução: O tratamento padrão da celulite orbitária inicia-se com uma combinação de antibióticos intravenosos de amplo espectro concomitante ao tratamento do seio comprometido. Objetivos: O objetivo deste estudo foi avaliar se a adição de corticosteroides poderia levar a uma resolução mais precoce da inflamação e melhorar o desfecho da doença. Método: Fizemos uma pesquisa independente em cinco bancos de dados (PubMed, SCOPUS, Embase, Web of Science e o banco de dados Cochrane) em busca de estudos publicados até dezembro de 2019. Dos estudos incluídos, revisamos a celulite orbitária e a morbidade da doença através dos períodos de internação, incidência de drenagem cirúrgica, edema periorbital, visão, níveis de proteína C-reativa e níveis séricos de leucócitos com foco na comparação do grupo tratado com esteroides e antibióticos e do grupo tratado apenas com antibióticos. Resultados: Os tempos de internação após a admissão dos diagnosticados com celulite orbitária (SMD = -4,02 [-7,93; -0,12], p-valor = 0,04, I2 = 96,9%) diminuíram no grupo tratado com esteroides e antibióticos em comparação ao grupo tratado apenas com antibióticos. A incidência de drenagem cirúrgica (OR = 0,78 [0,27; 2,23], p-valor = 0,64, I2 =0,0%) foi menor no grupo tratado com esteroides e antibióticos em comparação com o grupo tratado apenas com antibióticos. Conclusão: O uso de esteroides sistêmicos como adjuvante da antibioticoterapia sistêmica para celulite orbitária pode diminuir a inflamação orbitária com baixo risco de agravar a infecção. Com base em nossa análise, concluímos que o uso precoce de esteroides por um curto período pode ajudar a encurtar os dias de internação e prevenir a progressão da inflamação.

Role of systemic corticosteroids in orbital cellulitis: a meta-analysis and literature review.

INTRODUCTION: The standard management of orbital cellulitis is to administer a combination of intravenous broad-spectrum antibiotics along with treatment of associated sinusitis. OBJECTIVE: The purpose of this study was to evaluate whether the addition of corticosteroids could lead to earlier resolution of inflammation and improve disease outcome. METHODS: We independently searched five databases (PubMed, SCOPUS, Embase, the Web of Science, and the Cochrane database) for studies published as recent as December 2019. Of the included studies, we reviewed orbital cellulitis and disease morbidity through lengths of hospitalization, incidence of surgical drainage, periorbital edema, vision, levels or C-reactive protein, and serum WBC levels in order to focus on comparing steroid with antibiotics treated group and only antibiotics treated group. RESULTS: Lengths of hospitalization after admission as diagnosed as orbital cellulitis (SMD=-4.02 [-7.93; -0.12], p-value=0.04, I2=96.9%) decrease in steroid with antibiotics treated group compared to antibiotics only treated group. Incidence of surgical drainage (OR=0.78 [0.27; 2.23], p-value=0.64, I2=0.0%) was lower in the steroid with antibiotics treated group compared to the antibiotics only treated group. CONCLUSION: Use of systemic steroids as an adjunct to systemic antibiotic therapy for orbital cellulitis may decrease orbital inflammation with a low risk of exacerbating infection. Based on our analysis, we concluded that early use of steroids for a short period can help shorten hospitalization days and prevent inflammation progression.

Perioperative Transfusion is Related to the Length of Hospital Stays in Primary Liver Cancer Patients.

PURPOSE: Blood loss may be corrected with red blood cell transfusion, but may ultimately contribute to negative impacts. This study was a retrospective analysis to assess the impact of perioperative blood transfusion on hospital stay days in liver cancer patients. METHODS: We retrospectively examined data from patients with primary liver cancer who underwent curative resection. Patients were divided into perioperative blood transfusion (PBT) and non-PBT groups. Data were given as means and SDs for continuous variables and as counts and percentage for categorical variables. The correlation between blood transfusion and hospital stay days was analyzed by Fisher's exact test. Multivariable logistic regression analyses were used to identify independent predictors of length of hospital stays. RESULTS: Totally 206/1031 patients (20.3%) were given perioperative transfusion. The mean length of hospital stay was 17.8 days in PBT and 13.9 days in non-PBT groups. Our multivariable logistic regression showed transfusion, total bilirubin, indirect bilirubin, and the ratio of albumin to bilirubin were all indicators of the length of hospital stay days. Perioperative transfusion was also associated with prolonged length of hospital stays (95% CI: 0.395-0.811, p = 0.002). Transfusion also affected intrinsic coagulation factors (activated partial thromboplastin time, fibrinogen, platelet), inflammatory index (neutrocyte to lymphocyte ratio, monocyte), albumin and bilirubin levels. CONCLUSION: Perioperative transfusion of blood was associated with a significantly increased length of hospital stays probably via changing intrinsic coagulation and inflammatory factors and bilirubin levels in plasma.

Reconstrucción de experiencias de niños, niñas y adolescentes en cuidados primarios pediátricos en clave de autonomía / Reconstruction of experiences of children and adolescents in pediatric primary care in terms of autonomy

Resumen Las estancias de hospitalización prolongadas en las áreas de cuidado primario pediatricos implican una afectación física, psicologica y familiar para los niños y niñas que las experimentan, puesto que acarrean cambios en sus dinamicas familiares, sociales y personales. El objetivo de esta investigación fue reconocer las experiencias con base en las necesidades secundarias relacionadas con el desarrollo de la autonomía de niños, niñas y adolescentes con estancias hospitalarias en el área de cuidados primarios pediátricos del Hospital Departamental de Villavicencio (HDV). Se desarrolló a través de una metodología cualitativa con entrevistas a profundidad a un grupo de 60 niños, niñas y adolescentes entre los 5 y 14 años, las cuales fueron codificadas a través de matrices de análisis. El principal resultado fue reconocer los diferentes tipos de interpretaciones y prácticas que los participantes construyen para comprender su dignostico y experiencias dentro del contexto hospitalario. Como conclusión, se estableció la importancia de la autonomía como una necesidad primaria a satisfacer en los contextos hospitalarios, en términos de socialización, juego y tiempo libre, como una forma de garantizar la adherencia al tratamiento y procesos de resiliencia y adaptación.

Abstract Prolonged hospital stays in pediatric primary care areas imply a physical, psychological and family affectation for the children who experience them, since they entail changes in their family, social and personal dynamics. The objective of this research was to recognize the experiences based on the secondary needs related to the development of the autonomy of children and adolescents with hospital stays in the primary pediatric care area of the Departmental Hospital of Villavicencio (HDV, for its initials in Spanish). It was developed through a qualitative methodology with in-depth interviews to a group of 60 children and adolescents between 5 and 14 years old, which were codified through analysis matrices. The main result was to recognize the different types of interpretations and practices that the participants construct to understand their dignity and experiences within the hospital context. As a conclusion, the importance of autonomy was established as a primary need to be satisfied in hospital contexts, in terms of socialization, play and free time, as a way to ensure adherence to treatment and processes of resilience and adaptation.

From downcoding to upcoding: DRG based payment in hospitals.

A prospective disease group-based payment is a reimbursement rule used in a wide array of countries. It turns to be the hospital's payment rule to imply. The secret of this payment is a fee payment as well as a hospital's activity based payment. There is a consensus to consider this rule of payment as the least likely to be manipulated by the actors. However, the defined fee per group depends on recorded information that is then processed using complex algorithms. What if the data itself can be manipulated? The result would be a fee per group based on manipulated factors that would lead to an inefficient budget allocation between hospitals. Using a unique French longitudinal database with 145 million stays, I unambiguously demonstrate that the implementation of a finer classification led to an upcoding-learning effect. The end result has been a budget transfer from public non-research hospitals to for-profit hospitals. The 2009 policy lead to upcoding disconnected from any changes in the trend of production of care.

Shelter-In-Place Orders Reduced COVID-19 Mortality And Reduced The Rate Of Growth In Hospitalizations.

Most states enacted shelter-in-place orders when mitigating the coronavirus disease 2019 (COVID-19) pandemic. Emerging evidence indicates that these orders have reduced COVID-19 cases. Using data starting at different dates in March and going through May 15, 2020, we examined the effects of shelter-in-place orders on daily growth rates of both COVID-19 deaths and hospitalizations, using event study models. We found that shelter-in-place orders reduced both the daily mortality growth rate nearly three weeks after their enactment and the daily growth rate of hospitalizations two weeks after their enactment. After forty-two days from enactment, the daily mortality growth rate declined by up to 6.1 percentage points. Projections suggest that as many as 250,000-370,000 deaths were possibly averted by May 15 in the forty-two states plus Washington, D.C., that had statewide shelter-in-place orders. The daily hospitalization growth rate examined in nineteen states with shelter-in-place orders and three states without them that had data on hospitalizations declined by up to 8.4 percentage points after forty-two days. This evidence suggests that shelter-in-place orders have been effective in reducing the daily growth rates of COVID-19 deaths and hospitalizations.

Pneumococcal vaccination reduces in-hospital mortality, length of stay and medical expenditure in hospitalized elderly patients.

Pneumococcal vaccination has been shown to reduce occurrence of invasive pneumococcal diseases in elderly patients. In this study, we investigated the real-world efficacy of pneumococcal vaccination implemented in elderly individuals in Japan. We reviewed the in-patient database of Juntendo University Hospital and selected elderly patients (≥65 years-old) who had received in-patient care in the general medicine department during 2014-2018. A total of 1355 patients were retrospectively enrolled and comprised of 1045 unvaccinated and 315 vaccinated elderly individuals. Prior vaccination was found associated with all-cause shorter hospital stays (adjusted RR = 0.66, 95% CI = 0.57 to 0.76) and less medical expenditure (adjusted RR = 0.76, 95% CI = 0.66 to 0.87) compared with no vaccination, as well as protection for all-cause in-hospital mortality (adjusted OR = 0.42, 95% CI = 0.22 to 0.83). The association of shorter hospital stays and less medical expenditure with vaccination was also observed in the context of pneumonia, although no altered risk in mortality was observed. In conclusion, this study is one of the first reporting real-world data after the initiation of pneumococcal vaccination program in 2014 in Japan. The national PPV23 vaccination program contributed to the reduction of all-cause in-patient days, mortality, and medical expenses in the elderly aged ≥65 years. Further data is warranted to evaluate the contribution from influenza vaccination and protein-conjugate based pneumococcal vaccine.

Interrupting Violence From Within The Trauma Unit And Well Beyond.

Hoping to reduce the number of repeat visitors, one Washington, D.C., hospital is providing short- and long-term support to victims of violence.

Increased Surgical Duration Associated With Prolonged Hospital Stay After Isolated Posterior Cruciate Ligament Reconstruction.

PURPOSE: Although often performed using a variety of reconstructive techniques and strategies, no clinically significant differences presently exist between the approaches available for isolated PCL reconstructions. Given the operatively challenging nature of these procedures, there lies a potentially increased risk of postoperative complications and healthcare expenditures. Our investigation sought to identify patient and surgical risk factors associated with prolonged hospital stays following isolated PCL reconstruction and determine the incidence of 30-day complications after PCL reconstruction using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. METHOD: Patients undergoing isolated PCL reconstructions between 2005 and 2016 were identified in the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database using Current Procedural Terminology codes. Baseline patient and operative characteristics were evaluated as possible risk factors for overnight hospital admissions following PCL reconstruction and analyzed using multivariate analyses. RESULTS: A total of 249 patients were identified. Multivariate analyses demonstrated that increased operative duration >120 mins (OR 5.04, CI 2.44-10.40; p <0.001) was associated with an increased risk of overnight hospital stay. Major complications occurred in 0.4% (N=1), and minor complications occurred in 0.8% (N=2) with overall complications occurring in 1.2% (N=3) of all patients. Wound dehiscence was the only major complication while superficial surgical site infection and deep vein thrombosis were the only minor complications. 34.1% (N=85) of patients required an overnight hospital stay postoperatively. CONCLUSION: Surgical duration >120 mins carried an increased risk of overnight hospital stay after isolated PCL reconstructions. As there are presently minimal significant clinical differences between current PCL reconstruction techniques, improved surgeon familiarity and comfort with a single technique is recommended to decrease operative time and avoid prolonged hospital stays and healthcare expenditures. LEVEL OF EVIDENCE: III, retrospective comparative study.

[Outlier patient admissions and their relationship with the emergence of clinical complications and prolonged hospital stays]. / Los ingresos ectópicos y su relación con la aparición de complicaciones y estancias prolongadas.

OBJECTIVE: To analyze the relationship between the type of hospital admission (outlier and non-outlier admissions) and the appearance of clinical complications and the average stay. METHODS: From a retrospective epidemiological study of a cohort of patients admitted to the Hospital Complejo Asistencial Universitario de Salamanca (Salamanca, Spain) over a six-month period, outlier and non-outlier patients were identified. This project had access to the admissions department database, the hospital's CMBD (in Spanish, Conjunto Mínimo Básico de Datos) for hospitalisation, the AP-DRG (All Patient-Diagnosis Related Groups) and ALCOR (a clinical-statistics analytics tool). It then proceeded to break down the results by DRG, looking at the five most common DRGs in that period. RESULTS: 8.4% of the total 11,842 admissions were medical outliers. In the overall study, the average stay was longer for outlier patients (8. 11 days) than for other patients (7.15 days). The mortality rate was, likewise, higher for outlier patients, although there was a reduced incidence of complications (7.6% for outlier patients as opposed to 8.4% for others). The analysis by DRG corroborated these results in three of the five cases investigated, showing longer average stays but fewer clinical complications in the case of outlier patients. CONCLUSIONS: On admission to hospital, a significant proportion of patients were allocated beds on inappropriate wards (outlier patients). It was more common to find medical patients placed on surgical wards than vice versa. The average stay of outlier patients was longer than that of patients admitted to the correct ward. The study found no significant difference between the two groups in terms of clinical complication rates.

Using data from a multi-hospital clinical network to explore prevalence of pediatric rickets in Kenya.

Background: Nutritional rickets is a public health concern in developing countries despite tropical climates and a re-emerging issue in developed countries. In this study, we reviewed pediatric admission data from the Clinical Information Network (CIN) to help determine hospital and region based prevalence of rickets in three regions of Kenya (Central Kenya, Western Kenya and Nairobi County). We also examine the association of rickets with other diagnosis, such as malnutrition and pneumonia, and study the effect of rickets on regional hospital stays. Methods: We analyzed discharge records for children aged 1 month to 5 years from county (formerly district) hospitals in the CIN, with admissions from February 1 st 2014 to February 28 th 2015. The strength of the association between rickets and key demographic factors, as well as with malnutrition and pneumonia, was assessed using odds ratios. The Fisher exact test was used to test the significance of the estimated odd ratios. Kaplan-Meier curves were used to analyze length of hospital stays. Results: There was a marked difference in prevalence across the three regions, with Nairobi having the highest number of cases of rickets at a proportion of 4.01%, followed by Central Region at 0.92%. Out of 9756 admissions in the Western Region, there was only one diagnosis of rickets. Malnutrition was associated with rickets; this association varied regionally. Pneumonia was found to be associated with rickets in Central Kenya. Children diagnosed with rickets had longer hospital stays, even when cases of malnutrition and pneumonia were excluded in the analysis. Conclusion: There was marked regional variation in hospital based prevalence of rickets, but in some regions it is a common clinical diagnosis suggesting the need for targeted public health interventions. Factors such as maternal and child nutrition, urbanization and cultural practices might explain these differences.