ABSTRACT
OBJECTIVE: We aim to evaluate the cost-saving of the short stay ward (SSW) versus conventional inpatient care following sleeve gastrectomy (LSG). We also compared the readmission rates pre- and post-inception of the intravenous hydration clinic and analyzed the cost-savings. METHODS: Patients who underwent LSG between December 2021 to March 2022 with SSW care were compared with standard inpatient care. Total costs were analyzed using univariate analysis. With a separate cohort of patients, 30-day readmission rates in the 12-months preceding and following implementation of the IV hydration clinic and associated cost-savings were evaluated. RESULTS: After matching on the propensity score to within ± 0.1, 20-subjects pairs were retained. The total cost per SSW-subject was significantly lower at $13,647.81 compared to $15,565.27 for conventional inpatient care (p = 0.0302). Lower average ward charges ($667.76 vs $1371.34, p < 0.0001), lower average daily treatment fee per case ($235.68 vs $836.54, p < 0.0001), and lower average laboratory investigation fee ($612.31 vs $797.21, p < 0.0001) accounted for the difference in costs between the groups. Thirty-day readmission rate reduced from 8.9 to 1.8% after implementation of the hydration clinic (p < 0.01) with decreased 30-day readmission cost (S$96,955.57 vs. S$5910.27, p < 0.01). CONCLUSION: SSW for LSG is cost-effective and should be preferred to inpatient management. Walk-in hydration clinics significantly reduced readmission rates and result in tremendous cost-savings.
Subject(s)
Laparoscopy , Obesity, Morbid , Humans , Length of Stay , Inpatients , Hospitalization , Patient Readmission , Gastrectomy , Postoperative Complications , Retrospective Studies , Obesity, Morbid/surgery , Treatment OutcomeABSTRACT
BACKGROUND AND OBJECTIVE: In patients with COPD, this study evaluated the effect on health-related quality of life (HRQoL) of adding ongoing feedback to a 12-month unsupervised maintenance walking programme. METHODS: Participants were randomized to either an intervention group (IG) or control group (CG). Both groups completed the same 2-month supervised, walking training programme followed by a 12-month unsupervised maintenance walking programme. During the maintenance programme, the IG received ongoing feedback (telephone calls, biofeedback and progressive goal setting) and the CG received no feedback. RESULTS: A total of 75 participants completed the study (mean (SD): age 69 (8) years; forced expiratory volume in 1 s (FEV1 ) 43 (15) % predicted). There was no between-group differences in the magnitude of change in HRQoL when data collected on completion of the 12-month maintenance programme were compared with that collected either before the 2-month supervised programme (mean between-group difference (MD) in total St George's Respiratory Questionnaire change scores: 1 point, 95% CI: -9 to 7) or on completion of the 2-month supervised programme (MD: 4 points, 95% CI -2 to 10). CONCLUSION: Following a 2-month supervised walking training programme, ongoing feedback was no more effective than no feedback in maintaining HRQoL during a 12-month unsupervised walking programme.
Subject(s)
Exercise Therapy/methods , Formative Feedback , Pulmonary Disease, Chronic Obstructive/rehabilitation , Quality of Life , Walking , Aged , Female , Forced Expiratory Volume , Humans , Male , Middle Aged , Pulmonary Disease, Chronic Obstructive/physiopathology , Single-Blind MethodABSTRACT
QUESTION: Is progressive resistance training as effective as aerobic training of similar duration in sedentary older adults with diabetes mellitus? DESIGN: A randomised trial with concealed allocation, assessor blinding and intention-to-treat analysis. PARTICIPANTS: Sixty people with Type 2 diabetes mellitus with glycosylated haemoglobin (HbA1c) between 8% and 10% in the past month. INTERVENTION: One group undertook progressive resistance exercise and the other group undertook aerobic exercise. Both groups completed 18 sessions over 8 weeks. In each session, the progressive resistance exercise group did nine resistive exercises while the aerobic exercise group did 50 minutes of aerobic exercise. OUTCOME MEASURES: HbA1c, blood glucose, lipid profile (total, high- and low-density cholesterol and triglycerides), weight, body mass index, body fat, waist circumference, waist:hip ratio, blood pressure, and peak oxygen consumption. RESULTS: Forty-nine (82%) participants completed the intervention. HbA1c reduced by a similar amount in both groups (MD 0.1%, 95% CI -0.3 to 0.5). However, significant between-group differences occurred in change in waist circumference in favour of progressive resistance exercise (MD -1.8 cm, 95% CI -0.5 to -3.1), and in change in peak oxygen consumption in favour of aerobic exercise (MD 5.2 ml/kg, 95% CI 0.0 to 10.4). CONCLUSIONS: Progressive resistance exercise has similar effects to aerobic exercise and therefore offers a useful alternative for patients unable to participate in aerobic exercise. TRIAL REGISTRATION: NCT01000519.
