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1.
Bone Joint J ; 102-B(6_Supple_A): 31-35, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32475281

RESUMEN

AIMS: Rates of readmission and reoperation following primary total knee arthroplasty (TKA) are under scrutiny due to new payment models, which penalize these negative outcomes. Some risk factors are more modifiable than others, and some conditions considered modifiable such as obesity may not be as modifiable in the setting of advanced arthritis as many propose. We sought to determine whether controlling for hypoalbuminaemia would mitigate the effect that prior authors had identified in patients with obesity. METHODS: We reviewed the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database for the period of January 2008 to December 2016 to evaluate the rates of reoperation and readmission within 30 days following primary TKA. Multivariate logistic regression modelling controlled for preoperative albumin, age, sex, and comorbidity status. RESULTS: Readmission rates only differed significantly between patients with Normal Weight and Obesity Class II, with a decreased rate of readmission in this group (odds ratio (OR) 0.82; 95% confidence interval (CI) 0.71 to 0.96; p = 0.010). The only group demonstrating association with increased risk of reoperation within 30 days was the Obesity Class III group (OR 1.38; 95% CI 1.05 to 1.82; p = 0.022). Hypoalbuminaemia (preoperative albumin < 35 g/L) was significantly associated with readmission (OR 1.62; 95% CI 1.41 to 1.86; p < 0.001) and reoperation (OR 1.52; 95% CI 1.18 to 1.96; p = 0.001) within 30 days. CONCLUSION: In this study, hypoalbuminaemia appears to be a more significant risk factor for readmission and reoperation than even the highest obesity categories. Future studies may assess whether preoperative albumin restoration or weight loss may improve outcomes for patients with hypoalbuminaemia. The implications of this study may allow surgeons to discuss risk of surgery with obese patients planning to undergo primary TKA procedures if other comorbidities are adequately controlled. Cite this article: Bone Joint J 2020;102-B(6 Supple A):31-35.


Asunto(s)
Hipoalbuminemia/complicaciones , Obesidad/complicaciones , Readmisión del Paciente/estadística & datos numéricos , Reoperación/estadística & datos numéricos , Anciano , Artroplastia de Reemplazo de Rodilla , Femenino , Humanos , Hipoalbuminemia/terapia , Masculino , Persona de Mediana Edad , Obesidad/terapia , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/prevención & control , Estudios Retrospectivos , Factores de Riesgo
2.
South Med J ; 113(6): 305-310, 2020 06.
Artículo en Inglés | MEDLINE | ID: mdl-32483641

RESUMEN

OBJECTIVE: White blood cells (WBCs) play a major role in inflammation, with effects on the vascular wall, the microvascular blood flow, and endothelial cells and endothelial function. Previous studies have shown that a high WBC count may increase the risk of cardiovascular complication rate and mortality after coronary artery bypass graft (CABG) surgery. The aim of the study was to evaluate the association between preoperative WBC count and the post-CABG clinical outcome. METHODS: A retrospective study that was based on 239 patients who underwent CABG surgery in our medical center. Statistical analysis estimated the effect of WBC count in postoperative clinical outcomes, including atrial fibrillation, length of stay, readmission rate, and death. RESULTS: The preoperative WBC count was associated with longer hospitalization length (B = 0.392, P < 0.01). A preoperative WBC count >8150/µL predicted a longer stay (Z = 2.090, P = 0.03). A low lymphocyte count was associated with atrial fibrillation (B = -0.543, P = 0.03). Female patients were older (Z = 2.920, P < 0.01), had impaired renal function (Z = -3.340, P < 0.01), and had a higher rate of postoperative atrial fibrillation (df 2 = 3.780, P = 0.05) and readmission (df 2 = 5.320, P = 0.02). CONCLUSIONS: Preoperative WBC count may have an effect on the postoperative clinical outcome in patients undergoing CABG. Surgeons should pay more attention to patients' WBC count and sex and plan surgery and postoperative management accordingly.


Asunto(s)
Fibrilación Atrial/epidemiología , Puente de Arteria Coronaria , Tiempo de Internación/estadística & datos numéricos , Leucocitosis/epidemiología , Mortalidad , Readmisión del Paciente/estadística & datos numéricos , Complicaciones Posoperatorias/epidemiología , Factores de Edad , Anciano , Femenino , Humanos , Recuento de Leucocitos , Modelos Lineales , Modelos Logísticos , Recuento de Linfocitos , Masculino , Persona de Mediana Edad , Neutrófilos , Pronóstico , Insuficiencia Renal/epidemiología , Estudios Retrospectivos , Factores Sexuales
3.
South Med J ; 113(6): 320-324, 2020 06.
Artículo en Inglés | MEDLINE | ID: mdl-32483643

RESUMEN

OBJECTIVE: To evaluate pharmacist involvement in the inpatient transition of care (TOC) process for patients hospitalized with type 1 diabetes mellitus, type 2 diabetes mellitus, or chronic obstructive pulmonary disease. METHODS: A pharmacist screened patients admitted with one or more of the qualifying conditions within 48 hours of admission to perform medication reconciliation. During medication reconciliation, the pharmacist removed any duplicate or nonindicated medications and added any omitted medications. The pharmacist also reviewed the discharge summary to ensure medication optimization upon discharge. RESULTS: Pharmacist involvement in the admission and discharge reconciliation processes of the 50 identified patients was 100% and 44%, respectively. A medication-related problem was identified in 96% (n = 48) of patients, representing 338 pharmacist-mediated interventions with an average of 6.8 ± 4.0 (range 0-16) interventions per patient. Of those 338 interventions, 298 drug discrepancies were identified and corrected, with an average of 6.0 ± 3.7 (range 0-15) discrepancies per patient. Average time spent was 66 ± 22 (range 30-130) minutes with each patient. Of the 50 patients enrolled, 12 were readmitted within 30 days. CONCLUSIONS: This pilot study demonstrated an improved medication reconciliation process with pharmacist involvement, expanding the body of evidence that pharmacists can enhance TOC management in an inpatient setting. These results highlight the utility of a pharmacist in the implementation and refinement of TOC services and provides impetus for a team-based approach when patients experience a TOC.


Asunto(s)
Diabetes Mellitus Tipo 1/tratamiento farmacológico , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Hospitalización , Conciliación de Medicamentos , Transferencia de Pacientes , Servicio de Farmacia en Hospital , Enfermedad Pulmonar Obstructiva Crónica/tratamiento farmacológico , Adulto , Anciano , Anciano de 80 o más Años , Ahorro de Costo , Registros Electrónicos de Salud , Femenino , Humanos , Ciencia de la Implementación , Masculino , Persona de Mediana Edad , Alta del Paciente , Readmisión del Paciente , Farmacéuticos , Proyectos Piloto , Rol Profesional , Adulto Joven
4.
Arthroscopy ; 36(6): 1584-1586, 2020 06.
Artículo en Inglés | MEDLINE | ID: mdl-32503772

RESUMEN

Hip arthroscopy is known to be a relatively safe procedure with a limited and unique set complications and low hospital readmission rates. Many patients, however, may seek emergency department evaluation after surgery for postoperative pain or complaints unrelated to the most commonly cited complications, such as traction neuropraxia. It is important to recognize and understand the reasons why patients seek medical care after surgery because many of these encounters may be preventable with optimization of perioperative multimodal pain control regimens and proper patient education regarding their expected postoperative course. Patients with barriers to health care access, such as Medicare and Medicaid patients, may be at higher risk for emergency department evaluation of their problems after surgery and clinicians should consider providing additional counseling to these patients regarding when and how to seek medical evaluation after surgery.


Asunto(s)
Artroscopía , Manejo del Dolor , Servicio de Urgencia en Hospital , Humanos , Medicare , Readmisión del Paciente , Estados Unidos
5.
JAMA ; 323(21): 2170-2184, 2020 06 02.
Artículo en Inglés | MEDLINE | ID: mdl-32484532

RESUMEN

Importance: Earlier administration of intravenous tissue plasminogen activator (tPA) in acute ischemic stroke is associated with reduced mortality by the time of hospital discharge and better functional outcomes at 3 months. However, it remains unclear whether shorter door-to-needle times translate into better long-term outcomes. Objective: To examine whether shorter door-to-needle times with intravenous tPA for acute ischemic stroke are associated with improved long-term outcomes. Design, Setting, and Participants: This retrospective cohort study included Medicare beneficiaries aged 65 years or older who were treated for acute ischemic stroke with intravenous tPA within 4.5 hours from the time they were last known to be well at Get With The Guidelines-Stroke participating hospitals between January 1, 2006, and December 31, 2016, with 1-year follow-up through December 31, 2017. Exposures: Door-to-needle times for intravenous tPA. Main Outcomes and Measures: The primary outcomes were 1-year all-cause mortality, all-cause readmission, and the composite of all-cause mortality or readmission. Results: Among the 61 426 patients treated with tPA within 4.5 hours, the median age was 80 years and 43.5% were male. The median door-to-needle time was 65 minutes (interquartile range, 49-88 minutes). The 48 666 patients (79.2%) who were treated with tPA and had door-to-needle times of longer than 45 minutes, compared with those treated within 45 minutes, had significantly higher all-cause mortality (35.0% vs 30.8%, respectively; adjusted HR, 1.13 [95% CI, 1.09-1.18]), higher all-cause readmission (40.8% vs 38.4%; adjusted HR, 1.08 [95% CI, 1.05-1.12]), and higher all-cause mortality or readmission (56.0% vs 52.1%; adjusted HR, 1.09 [95% CI, 1.06-1.12]). The 34 367 patients (55.9%) who were treated with tPA and had door-to-needle times of longer than 60 minutes, compared with those treated within 60 minutes, had significantly higher all-cause mortality (35.8% vs 32.1%, respectively; adjusted hazard ratio [HR], 1.11 [95% CI, 1.07-1.14]), higher all-cause readmission (41.3% vs 39.1%; adjusted HR, 1.07 [95% CI, 1.04-1.10]), and higher all-cause mortality or readmission (56.8% vs 53.1%; adjusted HR, 1.08 [95% CI, 1.05-1.10]). Every 15-minute increase in door-to-needle times was significantly associated with higher all-cause mortality (adjusted HR, 1.04 [95% CI, 1.02-1.05]) within 90 minutes after hospital arrival, but not after 90 minutes (adjusted HR, 1.01 [95% CI, 0.99-1.03]), higher all-cause readmission (adjusted HR, 1.02; 95% CI, 1.01-1.03), and higher all-cause mortality or readmission (adjusted HR, 1.02 [95% CI, 1.01-1.03]). Conclusions and Relevance: Among patients aged 65 years or older with acute ischemic stroke who were treated with tissue plasminogen activator, shorter door-to-needle times were associated with lower all-cause mortality and lower all-cause readmission at 1 year. These findings support efforts to shorten time to thrombolytic therapy.


Asunto(s)
Fibrinolíticos/administración & dosificación , Readmisión del Paciente/estadística & datos numéricos , Accidente Cerebrovascular/tratamiento farmacológico , Accidente Cerebrovascular/mortalidad , Tiempo de Tratamiento , Activador de Tejido Plasminógeno/administración & dosificación , Anciano , Anciano de 80 o más Años , Isquemia Encefálica/tratamiento farmacológico , Isquemia Encefálica/etiología , Causas de Muerte , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Infusiones Intravenosas , Masculino , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Terapia Trombolítica
6.
Medicine (Baltimore) ; 99(21): e20233, 2020 May 22.
Artículo en Inglés | MEDLINE | ID: mdl-32481297

RESUMEN

BACKGROUND: Sepsis-induced myopathy (SIM) is a disease that causes motor dysfunction in patients with sepsis. There is currently no targeted treatment for this disease. Acupuncture has shown considerable efficacy in the treatment of sepsis and muscle weakness. Therefore, our research aims to explore the effects of acupuncture on the improvement of muscle structure and function in SIM patients and on activities of daily living. METHODS: The ACU-SIM pilot study is a single-center, propensity-score stratified, assessor-blinded, prospective pragmatic controlled trial (pCT) with a 1-year follow-up period. This study will be deployed in a multi-professional critical care department at a tertiary teaching hospital in Guangzhou, China. Ninety-eight intensive care unit subjects will be recruited and assigned to either the control group or the acupuncture group. Both groups will receive basic treatment for sepsis, and the acupuncture group will additionally receive acupuncture treatment. The primary outcomes will be the rectus femoris cross-sectional area, the Medical Research Council sum-score and time-to-event (defined as all-cause mortality or unplanned readmission to the intensive care unit due to invasive ventilation). The activities of daily living will be accessed by the motor item of the Functional Independence Measure. Recruitment will last for 2 years, and each patient will have a 1-year follow-up after the intervention. DISCUSSION: There is currently no research on the therapeutic effects of acupuncture on SIM. The results of this study may contribute to new knowledge regarding early muscle atrophy and the treatment effect of acupuncture in SIM patients, and the results may also direct new approaches and interventions in these patients. This trial will serve as a pilot study for an upcoming multicenter real-world study. TRIAL REGISTRATION: Chinese Clinical Trials Registry: ChiCTR-1900026308, registered on September 29th, 2019.


Asunto(s)
Terapia por Acupuntura/métodos , Debilidad Muscular/terapia , Atrofia Muscular/terapia , Enfermedades Musculares/terapia , Sepsis/terapia , Actividades Cotidianas , Terapia por Acupuntura/efectos adversos , China/epidemiología , Cuidados Críticos/organización & administración , Estudios de Seguimiento , Humanos , Unidades de Cuidados Intensivos/estadística & datos numéricos , Mortalidad/tendencias , Debilidad Muscular/etiología , Debilidad Muscular/patología , Atrofia Muscular/etiología , Atrofia Muscular/patología , Enfermedades Musculares/etiología , Readmisión del Paciente/tendencias , Proyectos Piloto , Puntaje de Propensión , Estudios Prospectivos , Respiración Artificial/métodos , Respiración Artificial/estadística & datos numéricos , Sepsis/complicaciones , Centros de Atención Terciaria/organización & administración , Resultado del Tratamiento
8.
Medicine (Baltimore) ; 99(23): e20636, 2020 Jun 05.
Artículo en Inglés | MEDLINE | ID: mdl-32502045

RESUMEN

ABSTRACTS: To examine the impact of increased managed care activity on 30-day readmission and mortality for acute myocardial infarctions and congestive heart failure in U.S. hospitals following the managed care backlash against managed care cost containment practices.The Centers for Medicare and Medicaid Services (CMS) Hospital Compare files, CMS Hospital Cost Report, CMS Medicare Advantage Enrollment files, and Health Resources and Services Administration Area Resource File data for the period 2008 to 2011 were used to construct the study sample. Multivariate fixed effects regression with robust standard errors, hospital fixed effects, and year fixed effects were used to estimate the impact of managed care penetration on adverse cardiovascular outcomes. Our primary outcome measures were readmission and mortality for patients discharged with acute myocardial infarction and congestive heart failure for acute, non-federal hospitals with emergency rooms. To examine effects of hospital ownership status, not-for-profit hospitals were compared to proprietary hospitals.The main analysis revealed that an increase in managed care penetration was associated with a decline in both 30-day readmission and mortality for acute myocardial infarction and congestive heart failure. In the hospital ownership analysis, only the acute myocardial infarction results for proprietary hospitals was statistically significant. All hospital types reported similar congestive heart failure trends as the full sample; however, proprietary hospitals reported greater declines in readmission and mortality.Increased managed care activity is associated with reductions in hospital readmission and mortality following the legislative and consumer backlash against managed care, with differential impacts across hospital ownership type. These finding highlights the important role of managed care in creating quality improvements in the delivery of care in the hospital setting.


Asunto(s)
Insuficiencia Cardíaca/mortalidad , Programas Controlados de Atención en Salud/normas , Infarto del Miocardio/mortalidad , Readmisión del Paciente/estadística & datos numéricos , Centers for Medicare and Medicaid Services, U.S. , Femenino , Hospitales/clasificación , Hospitales/estadística & datos numéricos , Humanos , Incidencia , Masculino , Programas Controlados de Atención en Salud/economía , Programas Controlados de Atención en Salud/estadística & datos numéricos , Medicare Part C/estadística & datos numéricos , Indicadores de Calidad de la Atención de Salud , Estados Unidos
11.
Int J Infect Dis ; 95: 433-435, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32353545

RESUMEN

The current reports of COVID-19 focus on the respiratory system, however, intestinal infections caused by SARS-CoV-2 are also worthy of attention. This paper reported persistence of intestinal SARS-CoV-2 infection leads to re-admission after pneumonia resolved in three cases with COVID-19.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/complicaciones , Diarrea/etiología , Neumonía Viral/etiología , Adulto , Betacoronavirus/aislamiento & purificación , Heces/virología , Femenino , Humanos , Pandemias , Readmisión del Paciente , Neumonía Viral/complicaciones
12.
South Med J ; 113(5): 254-260, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32358621

RESUMEN

OBJECTIVES: Hospitalized patients with acute and chronic pancreatitis (AP and CP) are prone to frequent readmissions to different hospitals. The rate of care fragmentation and its impact on important outcomes are unknown. The aims of this study were to evaluate the rate and predictors of care fragmentation in patients hospitalized with AP and CP using a nationally representative sample, and to analyze the impact of care fragmentation on mortality, cost, and hospital readmissions. METHODS: We identified all adult hospitalizations with a primary diagnosis of AP or CP in the 2010-2014 National Readmissions Database, which captures statewide readmissions. We calculated 30- and 90-day readmission and care fragmentation rates. Readmission to a nonindex hospital was considered care fragmentation. Logistic regression was used to determine hospital and patient factors independently associated with 30-day care fragmentation. Patients readmitted within 30 days were followed for 60 days postdischarge from the first readmission. Mortality during the first readmission, hospitalization costs, and rates of 60-day readmission were compared between those with and without care fragmentation. RESULTS: There were 479,427 admissions with AP and 25,513 with CP. The rates of 30- and 90-day readmissions were 13.5% and 22.9% for AP and 26.9% and 44.7%% for CP. The rates of 30- and 90-day care fragmentation were 28% and 32% for AP and 33% and 38% for CP. Younger age (younger than 45 y), male patients, length of stay <5 days, ≥4 Elixhauser comorbidities, and self-pay or Medicaid insurance were associated with increased risk of 30-day care fragmentation. Large hospital size, routine discharge, and metropolitan location were associated with lower risk. Patients who had the first readmission to a nonindex hospital had a higher mortality (2% vs 1.6%, P = 0.005), length of stay (6.5 vs 5.6 days, P < 0.0001), mean hospitalization cost ($16,731 vs $13,368, P < 0.0001), and 60-day readmission (48.4% vs 42.9%) compared with those readmitted to the index hospital. CONCLUSIONS: In patients with AP and CP, one-third of 90-day readmissions occur at a nonindex hospital. Care fragmentation is associated with increased mortality, readmissions, and cost of care.


Asunto(s)
Continuidad de la Atención al Paciente/estadística & datos numéricos , Mortalidad Hospitalaria , Tiempo de Internación/estadística & datos numéricos , Pancreatitis Crónica/terapia , Pancreatitis/terapia , Readmisión del Paciente/estadística & datos numéricos , Adulto , Factores de Edad , Anciano , Comorbilidad , Femenino , Tamaño de las Instituciones de Salud , Hospitalización , Hospitales Urbanos , Humanos , Modelos Logísticos , Masculino , Medicaid , Pacientes no Asegurados , Persona de Mediana Edad , Factores Sexuales , Estados Unidos , Adulto Joven
13.
Int Heart J ; 61(3): 571-578, 2020 May 30.
Artículo en Inglés | MEDLINE | ID: mdl-32418965

RESUMEN

The simplified frailty scale is a simple frailty assessment tool modified from Fried's phenotypic frailty criteria, which is easy to administer in hospitalized patients. The applicability of the simplified frailty scale to indicate prognosis in elderly hospitalized patients with cardiovascular disease (CVD) was examined.This cohort study was performed in 895 admitted patients ≥ 65 years (interquartile range, 71.0-81.0, 541 men) with CVD. Patients were classified as robust, prefrail, or frail based on the five components of the simplified frailty scale: weakness, slowness, exhaustion, low activity, and weight loss. The primary endpoint was the composite outcome of all-cause mortality and unplanned readmission for CVD.Patients positive for greater numbers of frailty components showed higher risk of all-cause mortality or unplanned CVD-related readmission (P for trend < 0.001). Classification as both frail (adjusted HR: 3.27, 95% confidence interval [CI]: 1.49-7.21, P = 0.003) and prefrail (adjusted HR: 2.19, 95% CI: 1.00-4.79, P = 0.049) independently predicted the composite endpoint compared with robust after adjusting for potential confounding factors. The inclusion of prefrail, frail, and number of components of frailty increased both continuous net reclassification improvement (0.113, P = 0.049; 0.426, P < 0.001; and 0.321, P < 0.001) and integrated discrimination improvement (0.007, P = 0.037; 0.009, P = 0.038; and 0.018, P = 0.002) for the composite endpoint.Higher scores on the simplified frailty scale were associated with increased risk of mortality or readmission in elderly patients hospitalized for CVD.


Asunto(s)
Enfermedades Cardiovasculares/mortalidad , Fragilidad/complicaciones , Evaluación Geriátrica/métodos , Índice de Severidad de la Enfermedad , Anciano , Anciano de 80 o más Años , Enfermedades Cardiovasculares/complicaciones , Femenino , Humanos , Japón/epidemiología , Masculino , Readmisión del Paciente/estadística & datos numéricos , Estudios Retrospectivos
14.
Medicine (Baltimore) ; 99(19): e19969, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32384446

RESUMEN

Although previous clinical trials demonstrated that ticagrelor could reduce cardiovascular events and mortality versus clopidogrel in patients with acute coronary syndrome (ACS), the real-world evidence of its clinical impacts on East Asian Diabetic population has rarely been investigated.Between November 2013 and June 2015, 1534 patients were recruited into the Acute Coronary Syndrome-Diabetes Mellitus Registry of the Taiwan Society of Cardiology (TSOC ACS-DM registry). After propensity score matching, a total of 730 patients undergoing successful revascularization and discharged on ticagrelor (N = 365) or clopidogrel (N = 365) were analyzed. The primary and secondary endpoints were all-cause mortality and re-hospitalization, respectively. The all-cause death associated with ticagrelor vs clopidogrel was 3.6% vs 7.4% (adjusted hazard ratio (HR) 0.34 [0.15-0.80]; P = .0138) at 24 months. The re-hospitalization rate at 24 months was 38.9% vs 39.2% (P = .3258).For diabetic patients with ACS, ticagrelor provided better survival benefit than clopidogrel without an increase of re-hospitalization in 24 months after successful percutaneous coronary intervention. This study in real-world circumstance provided valuable complementary data to externally validate platelet inhibition and patient outcomes (PLATO) finding especially in Asian diabetic population.


Asunto(s)
Síndrome Coronario Agudo , Clopidogrel , Diabetes Mellitus/epidemiología , Intervención Coronaria Percutánea , Ticagrelor , Síndrome Coronario Agudo/epidemiología , Síndrome Coronario Agudo/terapia , Clopidogrel/administración & dosificación , Clopidogrel/efectos adversos , Comorbilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Mortalidad , Readmisión del Paciente/estadística & datos numéricos , Intervención Coronaria Percutánea/efectos adversos , Intervención Coronaria Percutánea/métodos , Inhibidores de Agregación Plaquetaria/administración & dosificación , Inhibidores de Agregación Plaquetaria/efectos adversos , Puntaje de Propensión , Sistema de Registros , Prevención Secundaria/métodos , Prevención Secundaria/estadística & datos numéricos , Taiwán/epidemiología , Ticagrelor/administración & dosificación , Ticagrelor/efectos adversos , Resultado del Tratamiento
15.
Medicine (Baltimore) ; 99(19): e19982, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32384450

RESUMEN

Unplanned reoperations have not been studied extensively in pediatric patients, especially concerning risk factors. We aim to estimate the rate of unplanned reoperations and to determine the associated factors in pediatric general surgical specialties.This analysis included a retrospective case-control study of unplanned reoperations from July 1, 2010 to June 30, 2017 in the general surgical specialties. For each case, we identified approximately 2 randomly selected controls who underwent the same type of operation. The factors involved in the unplanned reoperations were investigated using univariate and multivariate analysis.Of the 3263 patients who underwent surgery, unplanned reoperations were performed in 139 patients (4.3%). The main indications for unplanned reoperations were wound complications (n = 52, 42.6%), followed by postoperative ileus (n = 12, 9.8%), postoperative bleeding (n = 8, 6.6%), and intraabdominal infection (n = 13, 10.7%). Following multivariate analysis, 2 factors remained significantly associated with unplanned reoperation: higher initial surgery-related risk level (P = .007, risk ratio (RR) = 0.48; 95% confidence interval (CI) = 0.27-0.82) and operation performed outside working hours (P = .031, RR = 0.52; 95% CI = 0.30-0.89).Various patient- and procedure-related factors were associated with unplanned reoperations. This information might be helpful for the optimization of treatment planning and resource allocation.


Asunto(s)
Complicaciones Posoperatorias/cirugía , Indicadores de Calidad de la Atención de Salud , Reoperación , Procedimientos Quirúrgicos Operativos/efectos adversos , Estudios de Casos y Controles , Preescolar , China/epidemiología , Femenino , Humanos , Masculino , Evaluación de Procesos y Resultados en Atención de Salud , Readmisión del Paciente/estadística & datos numéricos , Complicaciones Posoperatorias/epidemiología , Mejoramiento de la Calidad , Reoperación/métodos , Reoperación/estadística & datos numéricos , Procedimientos Quirúrgicos Operativos/estadística & datos numéricos
17.
Pediatr Infect Dis J ; 39(6): e69-e70, 2020 06.
Artículo en Inglés | MEDLINE | ID: mdl-32282658

RESUMEN

Since December 2019, novel coronavirus-infected pneumonia (coronavirus disease 19) occurred in Wuhan and rapidly spread throughout China and beyond. During this period, increasing of reports found that several recovered patients from different hospitals showed positive results of nucleic acid test again soon after discharge. However, little attention has been paid to recovered children. Herein, we reported a case of 8-year-old recovered child, who was rehospitalized again because of unexplained fever.


Asunto(s)
Infecciones por Coronavirus/diagnóstico , Readmisión del Paciente , Neumonía Viral/diagnóstico , Betacoronavirus , Niño , China , Fiebre , Humanos , Masculino , Pandemias , ARN Viral/aislamiento & purificación
18.
BMJ ; 369: m958, 2020 04 08.
Artículo en Inglés | MEDLINE | ID: mdl-32269037

RESUMEN

OBJECTIVE: To provide focused evaluation of predictive modeling of electronic medical record (EMR) data to predict 30 day hospital readmission. DESIGN: Systematic review. DATA SOURCE: Ovid Medline, Ovid Embase, CINAHL, Web of Science, and Scopus from January 2015 to January 2019. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: All studies of predictive models for 28 day or 30 day hospital readmission that used EMR data. OUTCOME MEASURES: Characteristics of included studies, methods of prediction, predictive features, and performance of predictive models. RESULTS: Of 4442 citations reviewed, 41 studies met the inclusion criteria. Seventeen models predicted risk of readmission for all patients and 24 developed predictions for patient specific populations, with 13 of those being developed for patients with heart conditions. Except for two studies from the UK and Israel, all were from the US. The total sample size for each model ranged between 349 and 1 195 640. Twenty five models used a split sample validation technique. Seventeen of 41 studies reported C statistics of 0.75 or greater. Fifteen models used calibration techniques to further refine the model. Using EMR data enabled final predictive models to use a wide variety of clinical measures such as laboratory results and vital signs; however, use of socioeconomic features or functional status was rare. Using natural language processing, three models were able to extract relevant psychosocial features, which substantially improved their predictions. Twenty six studies used logistic or Cox regression models, and the rest used machine learning methods. No statistically significant difference (difference 0.03, 95% confidence interval -0.0 to 0.07) was found between average C statistics of models developed using regression methods (0.71, 0.68 to 0.73) and machine learning (0.74, 0.71 to 0.77). CONCLUSIONS: On average, prediction models using EMR data have better predictive performance than those using administrative data. However, this improvement remains modest. Most of the studies examined lacked inclusion of socioeconomic features, failed to calibrate the models, neglected to conduct rigorous diagnostic testing, and did not discuss clinical impact.


Asunto(s)
Registros Electrónicos de Salud/estadística & datos numéricos , Readmisión del Paciente/estadística & datos numéricos , Adulto , Femenino , Humanos , Israel , Aprendizaje Automático , Masculino , Persona de Mediana Edad , Modelos Estadísticos , Medición de Riesgo
19.
Am Surg ; 86(3): 200-207, 2020 Mar 01.
Artículo en Inglés | MEDLINE | ID: mdl-32223798

RESUMEN

The nascent robotic approach for hepatic resections is gaining momentum in the United States because it offers solutions to the known limitations of laparoscopic approach. Herein, we report our initial experience and short-term outcomes of the first 100 robotic hepatectomies. With Institutional Review Board approval, all patients undergoing robotic hepatectomy were prospectively followed up. Patient demographics, operative outcomes, complications, and 30-day readmissions were collected and analyzed. Data are presented as median (mean ± SD). One hundred consecutive patients underwent robotic hepatectomy. Patients were aged 62 (63 ± 13.6) years, 66 per cent were women, and BMI was 29 (29 ± 6.4) kg/m². In all, 76 per cent of the hepatectomies were undertaken for malignancy [metastatic colorectal cancer (28%), hepatocellular carcinoma (21%), and intrahepatic cholangiocarcinoma (15%)], and 20 per cent for benign lesions; 66 per cent of patients underwent nonanatomical partial hepatectomies, 17 per cent right hepatectomies, 16 per cent left hepatectomies, and 1 per cent trisegmentectomy. Operative time was 233 (268 ± 109.3) minutes, and the estimated blood loss was 123 (269 ± 322.1) mL. Conversion to "open" approach was necessary in one patient. The length of stay was 3 (5 ± 4.6) days. There were no intraoperative complications. Twelve patients experienced postoperative complications. Six patients required readmission to the hospital within 30 days of discharge. Robotic hepatectomy is safe and feasible with favorable short-term outcomes. The robotic system enhances application of minimally invasive surgery for complex hepatobiliary operations.


Asunto(s)
Carcinoma Hepatocelular/cirugía , Hepatectomía/métodos , Mortalidad Hospitalaria/tendencias , Neoplasias Hepáticas/cirugía , Readmisión del Paciente/estadística & datos numéricos , Procedimientos Quirúrgicos Robotizados/métodos , Anciano , Pérdida de Sangre Quirúrgica/fisiopatología , Carcinoma Hepatocelular/mortalidad , Carcinoma Hepatocelular/parasitología , Estudios de Cohortes , Femenino , Hepatectomía/mortalidad , Humanos , Tiempo de Internación , Neoplasias Hepáticas/mortalidad , Neoplasias Hepáticas/patología , Masculino , Persona de Mediana Edad , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Procedimientos Quirúrgicos Mínimamente Invasivos/mortalidad , Seguridad del Paciente , Estudios Retrospectivos , Medición de Riesgo , Procedimientos Quirúrgicos Robotizados/efectos adversos , Resultado del Tratamiento
20.
J Thorac Cardiovasc Surg ; 160(1): 256-257, 2020 07.
Artículo en Inglés | MEDLINE | ID: mdl-32340808
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