Textbook outcome was associated with better survival in oral cancer surgery in southern Taiwan.

OBJECTIVE: To explore the impact of textbook outcome (TO) on long-term survival in oral cancer surgery. SUBJECTS AND METHODS: In total, 386 patients with tumor resection, neck dissection (ND), and reconstruction between 2011 and 2020 were included. TO was defined as negative margin; adequate ND; no 3-day emergency room revisit; no 30-day readmission; and length of stay ≤22 days. Multivariate Cox regression was used to evaluate the impact of TO and 5-year overall survival (OS). RESULTS: The TO rate was 35%. Younger age, subsite in buccal area, Charlson Comorbidity Index Score of 0, higher body mass index, higher hemoglobin, higher albumin, and unilateral ND were associated with TO. 5-year OS was 70.5% in overall TO patients and 49.0% in non-TO patients (HR, 0.47; 95% CI, 0.31-0.70; p < 0.001). Non-TO was associated with an increased mortality rate (aHR, 1.73; 95% CI, 1.14-2.63) after adjusting other factors and the result remained robust with inverse probability of treatment weighting analysis. The impact of TO on OS was more significant in age <60, advanced stage, and diagnosis year before 2018. CONCLUSION: Not achieving TO in oral cancer surgery was associated with worse long-term outcome. TO could be used as a proxy for surgical quality improvement.

Potentially preventable hospital readmissions after patients' first stroke in Taiwan.

Readmission is an important indicator of the quality of care. The purpose of this study was to explore the probabilities and predictors of 30-day and 1-year potentially preventable hospital readmission (PPR) after a patient's first stroke. We used claims data from the National Health Insurance (NHI) from 2010 to 2018. Multinomial logistic regression was used to assess the predictors of 30-day and 1-year PPR. A total of 41,921 discharged stroke patients was identified. We found that hospital readmission rates were 15.48% within 30-days and 47.25% within 1-year. The PPR and non-PPR were 9.84% (4123) and 5.65% (2367) within 30-days, and 30.65% (12,849) and 16.60% (6959) within 1-year, respectively. The factors of older patients, type of stroke, shorter length of stay, higher Charlson Comorbidity Index (CCI), higher stroke severity index (SSI), regional hospital, public and private hospital, and hospital in the lower urbanized area were associated significantly with the 30-day PPR. In addition, the factors of male, hospitalization year, and monthly income were associated significantly with 1-year PPR. The ORs of long-term PPR showed a decreasing trend since implementing the national health insurance post-acute care (PAC) program in 2014 and a dramatic drop in 2018 after the government expanded the long-term care plan-LTC 2.0 in 2017. The results showed that better discharge planning, implementing post-acute care programs and long-term care plan-LTC 2.0 may benefit the care of stroke patients and help reduce long-term readmission in Taiwan.

Holiday ratio of hospitalization and 30-day readmission rates among cancer patients after major surgery.

BACKGROUND: To determine the association of 30-day readmission with weekend discharge and the number of holiday days during a hospital stay (holiday ratio). METHODS: This retrospective cohort study used the clinical research database and cancer registry data of our hospital from January 1, 2011 to December 31, 2017. Patient characteristics, tumor factors, clinical laboratory data, and proxies of continuity of care, such as weekend discharge or holiday ratio (holiday days/total hospitalization days), received statistical analysis. Multivariate logistic regression identified the independent factors for 30-day potentially avoidable readmission rate (PAR). RESULTS: Of 1433 patients receiving tumor resection, 520 (36.29%) had colon cancer; 440 (30.70%) had head and neck cancer (HNC), and 473 (33.01%) had other cancers (lung, liver, and prostate). The rate of 30-day PAR was 6.3% for those with colon cancer, 8.6% for HNC, and 3.6% for other cancers. The 30-day PAR did not significantly differ by discharge on a weekend versus weekday for those with colon cancer (8.33% vs. 5.90%; p = 0.379), HNC (7.06% vs. 9.01%; p = 0.566), or other cancers (0.00% vs. 4.28%; p = 0.960). Colon cancer patients with holiday ratio >0.3 had a higher readmission rate (9.58% vs. 4.82%, p = 0.041). In multivariate analysis, a holiday ratio >0.3 (adjusted odds ratio 2.16; 95% Confidence Interval, 1.05-4.39) in those with colon cancer was an independent predictor of 30-day PAR. CONCLUSIONS: Weekend discharge after major surgery did not affect 30-day readmission rates in cancer patients, but the holiday ratio did affect 30-day PAR for those with colon cancer.

Knowledge, attitude and behaviour of university students regarding salt and iodine: a multicentre cross-sectional study in six countries in Europe and Asia.

BACKGROUND: Strategies to reduce salt intake are encouraged to be implemented in parallel with those that aim to ensure iodine adequacy at the population level. The aim of the present study was to assess and compare knowledge, attitudes and behaviours related to salt and iodine among students in Europe and Asia. METHODS: A multicentre cross-sectional study was conducted with 2459 university students in total (42.7% males, median age 21 years) from four countries in Europe and two countries in Asia. Data were collected with the use of a self-administered questionnaire, and univariate and multivariate statistical analyses were performed to explore any association between variables. RESULTS: Only 6.5% of all participants knew the correct salt recommendations. Nearly a quarter of them (24.4%) found salt recommendations confusing and/or contradictory. There were significant differences between European and Asian participants, with those from Europe being better informed about salt recommendations, but significantly less knowledgeable about iodine. The reported frequency of use of salt and salt-containing sauces either at the table or for cooking, as well as knowledge about ways to reduce salt intake among those who indicated to make conscious efforts to do so, differed significantly between countries. Significant differences between countries were also observed with respect to the type of salt used, with about one third of all participants (34%) not being aware of the kind of salt they used. CONCLUSION: The results of this survey highlight serious salt- and iodine-related knowledge gaps among university students in Europe and Asia. Raising awareness and conducting information campaigns is needed to promote changes in behaviour that would result in a reduction of salt intake and conscious use of iodised salt at the individual level.

Real-world cost-effectiveness of drug-eluting stents vs. bare-metal stents for coronary heart disease-A five-year follow-up study.

OBJECTIVE: To evaluate the cost-effectiveness of using drugeluting stents (DES) compared to bare-metal stents (BMS) for coronary heart disease (CHD). DATA SOURCES/STUDY SETTING: Data were obtained from the National Health Insurance Longitudinal Health Insurance Database, which contains claims data for 1,000,000 beneficiaries. The data were randomly sampled from all beneficiaries. STUDY DESIGN: A retrospective claims data analysis. DATA COLLECTION/EXTRACTION METHODS: Patients with stable coronary heart disease who underwent coronary stent implantation from 2007 to 2008 were recruited and followed to the end of 2013. After a 2:1 propensity score matched by gender, age, stent number, and the Charlson comorbidity index (CCI), 852 patients with 568 stents in the BMS group and 284 stents in the DES group were included. The cumulative medical costs for both matched groups were estimated with the Kaplan-Meier Sample Average (KMSA), and then the incremental cost-effectiveness ratio (ICER) was estimated. PRINCIPAL FINDINGS: The ICER of DES vs. BMS was NT$ 663,000 per cardiovascular death averted and NT$ 238,394 per cardiovascular death or coronary event averted in five years from the insurer perspective. CONCLUSION: Percutaneous coronary intervention (PCI) with DES was a more cost-effective strategy than PCI with BMS for CHD patients during the five-year follow-up.