Is it legitimate to use unplanned hospitalizations as a quality indicator for cancer patients? A retrospective French cohort study with special attention to the influence of social deprivation.

PURPOSE: Readmission indicators are used around the world to assess the quality of hospital care. We aimed to assess the relevance of this type of indicator in oncology, especially for socially deprived patients. Our objectives were (1) to assess the proportion of unplanned hospitalizations (UHs) in cancer patients, (2) to assess the proportion of UHs that were avoidable, i.e., related to poor care quality, and (3) to analyze cancer patients the effect of patients' deprivation level on the type of UH (avoidable UHs vs. unavoidable UHs). METHODS: In a French university hospital, we selected all hospitalizations over a year for a random sample of cancer patients. Based on medical records, we identified those among UHs due to avoidable health problems. We assessed the association between social deprivation, home-to-hospital distance, or home-to-general practitioner with the type of UH (avoidable vs. unavoidable) via a multivariate binary logit estimation. RESULTS: Among 2349 hospitalizations (355 patients), there were 383 UHs (16 %), among which 38% were avoidable. Among UHs, the European Deprivation Index was significantly associated with the risk of avoidable UHs, with a lower risk of avoidable UH for patients with medium or high social deprivation. CONCLUSION: Our results suggest that the use of UHs rate as a quality indicator is questionable in oncology. Indeed, the majority of UHs were not avoidable. Furthermore, within UHs, those involving patients with medium or high social deprivation are more often unavoidable in comparison with other patients.

Are patients living far from hospital at higher risk of late adjuvant chemotherapy for colon cancer?

AIMS: Late adjuvant chemotherapy (aCT) administration after colectomy (>56 d) is known to be associated with impaired prognosis. We aim to identify risk factors associated with late aCT, especially the travel time between patients' home and hospital. METHODS: We performed a retrospective monocentre cohort study. Patients included had a colectomy for a stage III or high risk stage II colon cancer between 2009 and 2015 performed at a French university hospital. Risk factors for late aCT were identified using a fractional polynomial logistic regression. RESULTS: Ninety-four patients were included. The risk of late aCT was associated with travel time length, emergent colectomy, the need for scheduled care before aCT, and length of time between colectomy and postoperative multidisciplinary meeting advising aCT. CONCLUSION: Our study suggests that, in patients with colon cancer, factors unrelated to disease severity and complexity could be associated with a higher risk of late aCT.

La douche préopératoire chez les patients obèses : ce qu'en disent les patients et les soignants.

Introduction : At least one preoperative shower is recommended to avoid surgical site infection. Caregivers must explain the showering technique, help the patient if necessary, and assess skin cleanliness after showering.Context : Showering may be more difficult for obese patients because of inadequate equipment and difficulties moving, as well as insufficient explanation regarding the showering technique and an insufficient skin cleanliness assessment from caregivers.Objective : to assess whether patients and/or caregivers report difficulties in the preoperative shower process that could be linked to patient obesity. Methods : pilot qualitative survey with semi-structured interviews conducted with 9 obese surgery patients and 11 surgery caregivers.Results : Patients did not report feelings of discrimination. They described no problem with equipment, but declared having received little explanation on the showering technique and no visual skin cleanliness assessment. Caregivers reported equipment as inadequate, they stated having delivered detailed information, but found the skin cleanliness assessment difficult.Discussion : The lack of skin cleanliness assessment by caregivers after preoperative showering is new information. Limits : preliminary study with a small number of interviews and no non-obese patients.Conclusion : the subject warrants additional work with both quantitative and qualitative surveys to better understand the difficulties with preoperative showering.

Impact of MaxZero™ needle-free connector on the incidence of central venous catheter-related infections in surgical intensive care unit.

BACKGROUND: Central venous catheter-related infections (CRIs) are a complication of central venous catheters in intensive care unit (ICU). Some needle-free connectors have been designed to decrease CRI, but there is a lack of data concerning their impact on infection. OBJECTIVES: The objective was to explore the impact of MaxZero™ connectors (BD; Franklin Lakes, US) on CRI in ICU. METHODS: Observational, pre-post design study (2011-2013 and 2014-2016) conducted in the surgical ICU of a tertiary care hospital (18 beds). Patients with a central venous catheter and a length of stay ≥48 h were included. The connectors replaced all disposable caps used on infusion stopcocks and ramps. The primary parameter was to compare the incidence of CRI between the "before" period and the "after" period. RESULTS: A total of 1633 patients were included (789 "before" and 844 "after"). There was no difference between groups concerning the global duration of catheterisation (12.5 ± 11.5 days vs. 12.1 ± 10.9 days). There were 61 CRIs before and 28 CRIs after the introduction of connectors; the incidence of CRI in the "before" group was 20.33 CRI/year (6.18 CRI per 1000 catheter-days) vs. 9.33 CRI/year (2.73 CRI per 1000 catheter-days) in the "after" group (incidence rate ratio = 0.44; 95% confidence interval = 0.28-0.68, p < 0.001). However, after a global analysis of the 6-year period, when adjusting for seasonal effect and pre-existing linear trend, the effect was no longer significant (adjusted incidence rate ratio = 0.57; 95% confidence interval = 0.24-1.35, p = 0.20). CONCLUSIONS: Our results do not allow us to conclude to a potential beneficial effect of MaxZero™ on CRI but are compatible with its prolonged and safe use in ICU. Only future prospective works will be able to confirm the value of these connectors for CRI prevention.

Morbidity-mortality conference for adverse events associated with totally implanted venous access for cancer chemotherapy.

PURPOSE: Although considered safer than central venous catheters for administration of cancer chemotherapy, totally implanted venous access (TIVA) is associated with adverse events that may impair prognosis and quality of life of patients receiving chemotherapy. Our aim was to assess the feasibility and interest of surveillance of cancer chemotherapy TIVA-adverse events (AE), associated with morbidity-mortality conferences (MMCs) on TIVA-AE. METHODS: We performed a prospective interventional study in two hospitals (a university hospital and a comprehensive care center). For each cancer chemotherapy care pathway within each hospital, we set up surveillance of TIVA-AE and MMC on these events. Patients included in surveillance were those with a TIVA either placed or used for chemotherapy cycles in one of the participating wards. Feasibility of MMC was assessed by the number of MMC meetings that actually took place and the number of participants at each meeting. The interest of MMC was assessed by the number of TIVA-AE identified and analyzed, and the number and type of improvement actions selected and actually implemented. RESULTS: We recorded 0.41 adverse events per 1000 TIVA-day. MMCs were implemented in all care pathways, with sustained pluriprofessional attendance throughout the survey; 39 improvement actions were identified during meetings, and 18 were actually implemented. CONCLUSIONS: Surveillance of TIVA-AE associated with MMC is feasible and helps change practices. It could be useful for improving care of patients undergoing cancer chemotherapy.

Natural history of elderly-onset inflammatory bowel disease: a population-based cohort study.

UNLABELLED: Data on the natural history of elderly-onset inflammatory bowel disease (IBD) are scarce. METHODS: In a French population-based cohort we identified 841 IBD patients >60 years of age at diagnosis from 1988 to 2006, including 367 Crohn's disease (CD) and 472 ulcerative colitis (UC). RESULTS: Median age at diagnosis was similar for CD (70 years (IQR: 65-76)) and UC (69 years (64-74)). Median follow-up was 6 years (2-11) for both diseases. At diagnosis, in CD, pure colonic disease (65%) and inflammatory behaviour (78%) were the most frequent phenotype. At maximal follow-up digestive extension and complicated behaviour occurred in 8% and 9%, respectively. In UC, 29% of patients had proctitis, 45% left-sided and 26% extensive colitis without extension during follow-up in 84%. In CD cumulative probabilities of receiving corticosteroids (CSs), immunosuppressants (ISs) and anti tumor necrosis factor therapy were respectively 47%, 27% and 9% at 10 years. In UC cumulative probabilities of receiving CS and IS were 40% and 15%, respectively at 10 years. Cumulative probabilities of surgery at 1 year and 10 years were 18% and 32%, respectively in CD and 4% and 8%, respectively in UC. In CD complicated behaviour at diagnosis (HR: 2.6; 95% CI 1.5 to 4.6) was associated with an increased risk for surgery while CS was associated with a decreased risk (HR: 0.5; 0.3 to 0.8). In UC CS was associated with an increased risk (HR: 2.2; 1.1 to 4.6) for colectomy. CONCLUSIONS: Clinical course is mild in elderly-onset IBD patients. This information would need to be taken into account by physicians when therapeutic strategies are established.

Patients' Experience and Satisfaction Regarding the Pre-Operative Shower: The PRODOUCH Multicenter Descriptive Survey.

Background: Patients' experience of the pre-operative shower remains poorly assessed in the literature although it is an essential step in the prevention of surgical site infection. For obese patients, a pre-operative shower could be challenging. The goal was to assess patient satisfaction and experience with the process of pre-operative shower, and the effect of obesity status. Patients and Methods: This study was a multicenter prospective survey of consecutive surgical patients from nine hospitals. Data on the pre-operative shower were collected via telephone interview two to four weeks after surgery, and included the place (hospital, home), time, information received, difficulties experienced, the presence or absence of a visual assessment of skin cleanliness by a healthcare professional after the pre-operative shower, and overall patient satisfaction with the pre-operative shower technique. Data on the surgical procedure and patients' characteristics were collected from patients' records, and included age, gender, and body mass index. Factors associated with patient satisfaction were assessed. Results: Among 430 patients, 91.6% declared having received information on the pre-operative shower and 94.8% were very or rather satisfied with the pre-operative shower. Two factors were independently associated with satisfaction: showering at home and having received information on the pre-operative shower, but not obesity status. Only 17% of patients reported a visual assessment of skin cleanliness by a healthcare professional after the pre-operative shower. Discussion: Overall, regardless of obesity status, patients were satisfied with the pre-operative shower and reported no difficulties. However, this survey highlights the fact that skin cleanliness was seldom assessed by healthcare professionals, which may represent an unidentified weakness in skin preparation before surgery.

Prevalence of End Stage Kidney Disease and distribution of treatment modalities / Prévalence de l'IRCT et part des différentes modalités de traitement

On the occasion of the 20th anniversary of the REIN (French Renal Epidemiology and Information Network), a summary work on the contributions of the national French ESKD register was carried out. On the issue of ESKD prevalence, the following key messages were retained. While chronic kidney disease affects all age groups, there always are more patients to treat in the older age groups, with a median age of 71.1 years (IIQ 60.3-80.0) under dialysis and 58.7 years (IIQ 47.4-68.3) under renal transplant. Despite an increase in transplant activity and improved survival of grafts, the gap between the number of dialysis patients and transplant patients at the end of each year is only moderately reduced. There has been a moderate decrease in the proportion of in-centre haemodialysis that is explained by a significant increase in medicalised dialysis units (out-centre haemodialysis) and a decrease in self-care haemodialysis. Finally, a stable home-based care has been observed despite the ministerial incentives and the recommendations of the French-speaking scientific society (SFNDT-white paper).

À l'occasion des 20 ans du REIN (Réseau Epidémiologie et Information en Néphrologie), un travail de synthèse sur les apports du registre a été mené. Sur la question de la prévalence de la maladie rénale stade 5, les messages clés suivants ont été retenus. Si la maladie rénale chronique touche toutes les tranches d'âge, il y a toujours plus de patients à prendre en charge dans les tranches d'âge les plus élevées, avec un âge médian de 71,1 ans (Intervalle Inter Quartile (IIQ) 60,3-80,0) en dialyse et 58,7 ans (IIQ 47,4-68,3) en transplantation rénale. Malgré une augmentation de l'activité de greffe et une meilleure survie des greffons, l'écart entre le nombre de patients dialysés et greffés à la fin de chaque année ne diminue que de façon modérée. On observe une baisse modérée de la part de l'hémodialyse en centre expliquée par une hausse importante des unités de dialyse médicalisée (UDM) et une baisse de l'autodialyse. Enfin, on note une prise en charge à domicile stable malgré les incitations ministérielles et les recommandations de la société savante (SFNDT-livre blanc).

REIN: a tool to highlight inequalities in health / REIN : un outil au service de l'éclairage des inégalités en santé

On the occasion of the 20th anniversary of the REIN (French Renal Epidemiology and Information Network), a summary work on the contributions of the national French ESKD register was carried out. On the issue of Social Inequalities in Health, the following key messages were retained. Social inequalities in health exist throughout the journey of a patient with chronic kidney disease and manifest as territorial inequalities in access to home-based or independent dialysis treatment and to transplant, whether preemptive or otherwise. SIH are observed in adults as well as in the paediatric population. The female gender appears to be associated with a disparity in access to kidney transplant.

À l'occasion des 20 ans du REIN (Réseau Epidémiologie et Information en Néphrologie), un travail de synthèse sur les apports du registre a été mené. Sur la question des inégalités sociales de santé, les messages clés suivants ont été retenus. Les inégalités sociales de santé existent tout au long du parcours du patient atteint d'une maladie rénale chronique et se traduisent par des inégalités territoriales d'accès au traitement par dialyse au domicile ou autonome, à la greffe qu'elle soit préemptive ou non. Les ISS sont retrouvées chez l'adulte mais aussi dans la population pédiatrique. Le genre féminin semble associé à une disparité d'accès à la greffe rénale.

Knowledge, attitudes and practices of French university students towards COVID-19 prevention-are health students better?

During the COVID-19 outbreak in 2020, public health measures (PHM) were implemented to prevent the spread of SARS-CoV-2. At university, we wondered whether health students would be more likely to comply with these safety measures against infectious disease transmission compared to other students. Thus, we collected 1 426 university students' responses to an online anonymous survey to describe their knowledge, attitudes and practices (KAP) of COVID-19 prevention measures and to compare the opinions and practices of health students and science students at the same university of Rouen Normandy (France). A higher proportion of science students (84.6%) compared to health students (73.9%) reported knowledge of the university's COVID-19 protocol, p<0.001. However, the health students compared to science students reported a higher compliance with PHM at home (91.4% vs 88.0%) and at university (94.1% vs 91.1%). In a multiple regression analysis, after adjustment for age, sex and university department, factors associated with higher compliance with PHM were knowledge of the university's COVID-19 protocol and a high perceived efficacy of PHM. A SARS-CoV-2 PCR result was not predictive of compliance with PHM. The results of this online survey in French students show a high level of knowledge and practices of COVID-19 prevention Although their performances could still be improved by training, the good results of health students regarding knowledge, attitudes and practices are encouraging as these students could be an added backup force to fight against viral pandemics.

Does an information leaflet about surgical site infection (SSI) improve recollection of information and satisfaction of patients? A randomized trial in patients scheduled for digestive surgery.

BACKGROUND: A previous study suggested that most surgical patients do not remember having received information about surgical site infection (SSI). In other fields, written information has been suggested to improve patient satisfaction and recollection of information. Our objective was to assess if providing patients with written information about SSI, in addition to oral information, could influence patient satisfaction, recall of information, and opinion regarding SSI. METHODS: A total of 207 patients scheduled for digestive surgery at a university hospital were randomized between usual oral information about SSI, plus an information leaflet about SSI (group O/L), or usual oral information alone (group O). Patients were interviewed 5 weeks after surgery to assess their recall and satisfaction regarding information, opinion regarding SSI, and declared intention of seeking legal action in case of SSI. Surgeons and interviewer were blinded to patients' group allocation. Recruitment occurred between October 2005 and August 2006. RESULTS: Of the original 207 patients, 161 patients (O/L=87, O=74) underwent operation and were interviewed as scheduled. Satisfaction was higher in group O/L (67% vs. O: 43%; P=0.003). The recall of having received information (O/L: 39% vs. O: 31%; P=0.29), was similar between the two groups. Judging SSI as always preventable was more frequent in group O/L (28% vs. O: 9%; P=0.004) with a trend toward a more frequent intention of seeking legal action (O/L: 10% vs. O: 3%; P=0.055). CONCLUSIONS: The leaflet did not improve patient recall of information about SSI, but it was associated with an increased level of satisfaction. The association between the leaflet and judging SSI as always preventable was unexpected.

Deprived social status is associated with decreased use of oral chemotherapy in patients with metastatic colorectal cancer: A retrospective cohort study on administrative databases in a French University Hospital.

Factors associated with the choice of oral versus intravenous CT are not clearly established. Our purpose was to evaluate the influence of social status and home distance to hospital on the use of oral CT in patients with metastatic colorectal cancer (mCRC). This retrospective single-center study included mCRC patients between 2011 and 2017. Patient social status was assessed by European Deprivation Index (EDI) and home distance to the hospital was calculated. Univariable and multivariable logistic regression analyses were performed. One hundred and seventy-five mCRC patients were included, with 71 receiving oral CT. Most deprived patients received less oral CT (OR 0.5 [0.26, 0.96], p = .039). No association was found for road distance. Previous use of adjuvant oral CT was associated with oral CT in mCRC (OR 2.65 [1.06, 6.66], p = .038). Our results suggest that deprived social status is a factor associated with decreased use of oral CT in patients with mCRC. Clinical trial registration: no registration.

General Practitioners' Practice premises and Risk of Viral Cross-Transmission: A French Observational Multicenter Study.

BACKGROUND: The common areas of general practitioners' practices (eg, reception, secretariat, waiting room, toilets) are places at risk of cross-transmission of viral diseases such as COVID-19, however risk is poorly documented. AIM: To evaluate the risks of viral cross-transmission in general practitioners' practices based on the organization of the common areas of the premises. DESIGN AND SETTING: Cross-sectional multicenter observational study in randomly selected general practitioners' practices in a French department (Seine-Maritime). The practices were included in 4 strata (1, 2, 3-5, or ≥6 general practitioners). METHOD: Each practice was visited and a questionnaire describing practice organization, cleaning of the premises, screening of high-risk patients was completed on site and observation of the premises). RESULTS: Data collection started in December 2019 and was discontinued due to the national lockdown related to the global SARS-CoV-2 pandemic. Eighty-two practices were analyzed. A hydroalcoholic solution was available in 7.3% of practices and surgical masks in 1.2%. In a majority of waiting rooms, the minimum distance between chairs facing each other was >2 m (78.0%), but was more frequently 1 m for chairs at 90° (53.7%). Overall, 79.3% of waiting rooms could be properly ventilated and waste bins were present in 23.9% of cases. A cleaning protocol was reported in 39.2% of practices. CONCLUSION: The COVID-19 epidemic allowed the national dissemination of standard precautions. It will be interesting to monitor over the next few years whether the renewed consideration of standard precautions to prevent viral cross-contamination will be maintained over time.

Nutritional status and growth in pediatric Crohn's disease: a population-based study.

OBJECTIVES: Growth retardation and malnutrition are major features of pediatric Crohn's disease (CD). We examined nutritional and growth parameters from diagnosis to maximal follow-up in a population-based pediatric cohort, and we determined predictive factors. METHODS: A total of 261 patients (156 boys, 105 girls) with onset of CD before the age of 17 were identified from 1988 to 2004 through the EPIMAD registry (Registre des Maladies Inflammatoires Chroniques de l'Intestin) in northern France. Median age at diagnosis was 13 years (11.2-15.4) and median follow-up was 73 months (46-114). Z-scores of height/age, weight/age, and body mass index (BMI)/age were determined. Multivariate stepwise regression analysis identified predictive factors for malnutrition and growth retardation at maximal follow-up. RESULTS: At diagnosis, 25 children (9.5%) showed height less than -2 s.d., 70 (27%) weight less than -2 s.d., and 84 (32%) BMI less than -2 s.d. At maximal follow-up, growth retardation was present in 18 children (6.9%), whereas 40 (15%) had malnutrition. Nutritional status was more severely impaired in children with stricturing disease. Growth and nutritional retardation at diagnosis, young age, male gender, and extraintestinal manifestations at diagnosis were indicators of poor prognosis. A significant compensation was observed for weight and BMI in both genders and for height in girls. No treatment was associated with height, weight, or BMI at maximal follow-up. CONCLUSIONS: In our pediatric population-based study, growth retardation and severe malnutrition were still present at maximal follow-up in 6.9 and 15% of CD children, respectively. Young boys with substantial inflammatory manifestations of CD have a higher risk of subsequent growth failure, especially when growth retardation is present at diagnosis.

Natural history of pediatric Crohn's disease: a population-based cohort study.

BACKGROUND & AIMS: The natural history of pediatric Crohn's disease and risk factors necessitating surgery have not been thoroughly described. METHODS: In a geographically derived incidence cohort diagnosed from 1988 to 2002, we identified 404 Crohn's disease patients (ages, 0-17 years at diagnosis) with a follow-up time >or=2 years. RESULTS: Median follow-up time was 84 months (range, 52-124 months). The most frequent disease location at diagnosis was the terminal ileum/colon (63%). Follow-up was characterized by disease extension in 31% of children. Complicated behavior was observed in 29% of children at diagnosis and 59% at follow-up. Kaplan-Meier survival estimates of the cumulative incidence of surgery were 20% at 3 years and 34% at 5 years from diagnosis. Multivariate Cox models showed that both structuring behavior at diagnosis (hazard ratio [HR], 2.54; 95% confidence interval [CI]: 1.58-4.01) and treatment with corticosteroids (HR, 2.98; 95% CI: 1.64-5.41) were associated with increased risk for surgery, whereas treatment with azathioprine (HR, 0.51; 95% CI: 0.33-0.78) was associated with decreased risk. Azathioprine was introduced earlier in the course of disease in patients not undergoing surgery than in patients requiring surgery. CONCLUSIONS: Pediatric Crohn's disease was characterized by frequent occurrence, with time, of a severe phenotype with extensive, complicated disease. Immunosuppressive therapy may improve the natural history of this disease and decrease the need for performing surgery.

The natural history of pediatric ulcerative colitis: a population-based cohort study.

OBJECTIVES: The natural history of ulcerative colitis (UC) has been poorly described in children. METHODS: In a geographically derived incidence cohort diagnosed from 1988 to 2002, we identified 113 UC patients (age 0-17 years at diagnosis) with a follow-up of at least 2 years. The cumulative risk of colectomy was estimated by the Kaplan-Meier method. Risk factors for disease extension were assessed with logistic regression models, and risk factors for colectomy with Cox hazards proportional models. RESULTS: Median follow-up time was 77 months (46-125). At diagnosis, 28% of patients had proctitis, 35% left-sided colitis, and 37% extensive colitis. Disease course was characterized by disease extension in 49% of patients. A delay in diagnosis of more than 6 months and a family history of inflammatory bowel disease were associated with an increased risk of disease extension, with odds ratios of 5.0 (1.2-21.5) and 11.8 (1.3-111.3), respectively. The cumulative rate of colectomy was 8% at 1 year, 15% at 3 years, and 20% at 5 years. The presence of extra-intestinal manifestations (EIMS) at diagnosis was associated with an increased risk of colectomy (hazard ratio (HR)=3.5 (1.2-10.5)). Among the patients with limited disease at diagnosis, the risk of colectomy was higher in those who experienced disease extension than in those who did not (HR=13.3 1.7-101.7). CONCLUSIONS: Pediatric UC was characterized by widespread localization at diagnosis and a high rate of disease extension. Twenty percent of children had their colon removed after 5 years. The colectomy rate was influenced by disease extension and was associated with the presence of EIMS at diagnosis.

Does comparison of performance lead to better care? A pilot observational study in patients admitted for hip fracture in three French public hospitals.

OBJECTIVE: To assess whether comparison of quality of hip fracture care among three teams located in different hospitals is associated with improvement in process and outcomes. DESIGN: A baseline assessment was performed using quality indicators selected by professionals. RESULTS: were discussed among the three teams followed by a post-comparison assessment of the same indicators. SETTING: Three hospitals in North Western France. PARTICIPANTS: Professionals caring for patients operated on for a low-impact hip fracture. INTERVENTION: Review and discussion of comparative performance results by three teams followed by implementation of quality improvement as deemed necessary by each team. MAIN OUTCOME MEASURES: Fifteen quality indicators of health care during orthopedic and rehabilitation stay, mobility, dependence and place of residence before hip fracture and 3 months after discharge, 3 month post-surgery mortality and readmission rates. RESULTS: Major differences were observed among hospitals throughout the care process during baseline period. Comparison of performance and discussion among the three teams were followed by corrective action in 11 areas. After comparison, a significant improvement was observed in 10 areas, seven of which corresponded to quality improvement areas chosen for improvement action by professionals. A significant decrease in readmission rate (6.7% vs. 15.7%, P < 0.001) was observed but there was no change in mortality, functional outcome or length of stay. CONCLUSIONS: Comparison of performance among voluntary teams, on fields selected by health-care professionals, was associated with improvement in the care process and with improvement of some related outcomes.

The impact of a patient's social status on the cost of vaginal deliveries: an observational study in a French university hospital.

INTRODUCTION: We aimed to assess the association between a patient's social status and the cost of stay for a single uncomplicated vaginal delivery. Currently, few data have been reported. MATERIAL AND METHODS: We conducted an observational study with data retrieved from the medical and administrative databases of a university hospital in North-West France. We included all patients admitted in 2014 and classified in either Diagnosis-Related Group (DRG) « Single uncomplicated vaginal deliveries in a primiparous patient ¼ or DRG « Single uncomplicated vaginal deliveries in a multiparous patient ¼. Criteria defining poor social status were: a specific healthcare benefit in relation to low income or for foreign undocumented patients, and/or a consultation with a social worker during the hospital stay except if no social problem was diagnosed. We compared the cost of stay between patients with poor social status and patients with good social status using a multivariate median regression stratified on parity, and adjusted for age, gestational age and neonatal hospitalization. RESULTS: Among 686 primiparous patients, 21% had poor social status, which was associated with an increase in the median cost of stay (+€475; 95% CI [+334 to +616]), mostly explained by a 1-day increase in the median length of stay.Among 899 multiparous patients, 29% had poor social status, which was not associated with the cost of stay. DISCUSSION: Social status had an impact on the cost of vaginal deliveries in primiparous patients. Our findings suggest a need to redefine the DRG classification according to patients' social status.

Surgical Site Infection in Endometriosis Surgery Is a Rare Complication: Results of a Single Center's Prospective Surveillance of Eight Hundred Ninety-Six Procedures.

Background: There are no studies reporting the rate of surgical site infection (SSI) after surgery for endometriosis, although this information is valuable when discussing the most appropriate treatment strategy with the patient. Methods: We conducted a prospective cohort study in a university hospital and regional reference center for endometriosis. We sought to measure the rate of SSI after endometriosis surgery using prospective SSI post-discharge surveillance data and the hospital information system via an ad hoc algorithm using both diagnosis and procedure code classifications. Results: Among 896 consecutive endometriosis surgical procedures, we identified 365 procedures with involvement of the gastrointestinal tract, defined as the deep invasive procedure (DIP) group, 107 procedures with involvement of an ovary, and 424 other procedures. Twelve SSI (all organ/space infections) were observed, all in the DIP group, corresponding to an overall SSI incidence of 1.3% 95% confidence interval (CI) 0.7-2.3, and an SSI incidence in the DIP group of 2.8%, 95% CI 1.5-4.9. The median delay between the procedure and the SSI was 6.5 days (range, 3-23). At least one micro-organism was found in 10 patients (four Escherichia coli, four Enterobacter cloacae, three Enteroccus faecalis, two Bacteroides fragilis, one Pseudomonas aeruginosa, one Candida albicans). Conclusion: A low overall rate of SSI after surgery for endometriosis was observed. Nevertheless, procedures with involvement of the intestinal tract were at risk of SSI.