Causes for 30-day readmissions and accuracy of the LACE index in regional Victoria, Australia.

BACKGROUND: Clinicians and funders continue to search for ways to reduce costs without sacrificing quality of care. Ongoing research should focus on innovative care models that identify patients at high-risk for hospitalisation and thereby reduce healthcare costs. AIMS AND OBJECTIVES: This study examined readmission rates, comorbidity profiles and the performance of the LACEi (Length of stay, Acuity of admission, Charlson Comorbidity Index, ED admissions in the previous 6 months index) to predict the risk of 30-day readmissions in a regional population. Furthermore, we tested a novel clinician-orientated classification for the causes of 30-day readmissions. DESIGN: Using a nested case-control design, data were extracted from administrative health records using 30-day readmission status as the outcome. We defined cases as discharges within 30 days before readmission and controls without a discharge within 30 days before admission between 1 July 2020 and 30 June 2022. SETTING: The study was conducted at South West Healthcare in Victoria, Australia. PARTICIPANTS: All adult medical patients were discharged alive from the facility. We excluded planned readmissions, surgical and obstetric admissions, dialysis, transfers to alternative facilities and discharges against medical advice. MAIN OUTCOME MEASURES: Thirty-day readmission rate, comorbidity profile for all admissions, LACEi for all admissions, the performance of the LACEi in our setting and the causes leading to readmission using a clinician-orientated classification tool. RESULTS: Comorbidity burden, male sex and age > 65 years were associated with increased readmission risk but not length of stay. The LACEi demonstrated modest predictive ability to identify high-risk patients for readmissions (area under the receiver operating characteristic curve = 0.59). Additional variables were needed to increase accuracy. The novel classification identified 42% of readmissions as potentially avoidable. CONCLUSION: Our study identified comorbidity burden, male sex and age ≥ 65 years as critical indicators for readmission risk. Although the LACEi showed moderate predictive ability, additional variables were needed for increased accuracy. Over 40% of readmissions were potentially avoidable, and nearly two thirds occurred within 14 days of discharge from the hospital.

A Delayed Presentation of Late Dumping Syndrome After Ivor Lewis Procedure.

An accurate and timely diagnosis of dumping syndrome after gastric and oesophageal surgery is often difficult. A delay in making this diagnosis and instituting therapy can result in significant morbidity and avoidable complications. As bariatric surgery becomes more prevalent, the importance of a timely diagnosis of dumping syndrome is increasing. We present a case of a 77-year-old man who was admitted into the intensive care unit with a reduced conscious state secondary to hypoglycemia. The patient was subsequently diagnosed with late dumping syndrome in the context of an Ivor Lewis procedure seven years prior. Despite having a history of recurrent neuroglycopenic symptoms, there was a delay in diagnosis as dumping syndrome had not previously been considered until this admission. After confirmation of the diagnosis, the patient was commenced on dietary adjustments and acarbose, with a resolution of post-prandial hypoglycaemia. The authors discuss dietary and pharmacological therapy to manage hypoglycaemia associated with dumping syndrome.

Case report: Disseminated cryptococcus gattii in an immunocompetent patient.

Background: Cryptococcosis is an opportunistic fungal disease, caused by Cryptococcus grubii, C. neoformans, and infrequently by C. gattii. [1], [2] Infection occur in patients with immunosuppression or with intact immunity. Dissemination mostly occurs in the lungs and meninges, but also the skin, bones and the prostate, with very high mortality rates reported for cryptococcal meningitis ranging from 27% to nearly 100%. [2], [3]. Case presentation: We report the case of a healthy, immunocompetent male presenting with a six-month history of weight loss, a chronic cough, recent-onset haemoptysis and a lung mass. The differential diagnosis included pulmonary Tuberculosis, bacterial or fungal pneumonia and lung carcinoma. The patient was subsequently diagnosed with disseminated C. gattii, which remains very rare. Risk factors for this infection included a distant history of cigarette smoking, as well as travel to central Africa for a recreational trip several months prior. Discussion and conclusion: Fungal infections should be considered in any patient presenting with respiratory or neurological symptoms suggestive of Tuberculosis, pneumonia or lung carcinoma, regardless of immunocompetency. Our case highlights the importance of taking a thorough travel history in all patients, as the differential diagnosis would need to include atypical pathogens that could be endemic in the area of travel. It also highlights the significant morbidity associated with cryptococcosis and drug-related toxicities and the methods to prevent complications.

Hyponatremia in COVID-19 Is Not Always Syndrome of Inappropriate Secretion of Antidiuretic Hormone (SIADH): A Case Series.

Hyponatremia is a common complication in COVID-19-positive patients and is associated with significant mortality and morbidity. Several cases of COVID-19-related hyponatremia secondary to the Syndrome of Inappropriate Secretion of Antidiuretic Hormone (SIADH) have been reported in the literature, which might suggest that SIADH is almost always the underlying cause of hyponatremia in COVID-19 infections. However, COVID-19-related hyponatremia can have diverse underlying etiologies, similar to hyponatremia in non-COVID-19 patients, and requires a thorough assessment to reach a correct diagnosis and implement appropriate management.