Hospitalization rates,length of stay and in-hospital mortality in a cohort of HIV infected patients from Rio de Janeiro,Brazil

In this study, we evaluated trends in hospitalization rates, length of stay and in-hospital mortality in a cohort of HIV-infected patients in Rio de Janeiro, Brazil, from 2007 through 2013. Among the 3991 included patients, 1861 hospitalizations occurred (hospitalization rate of 10.44/100 person-years, 95% confidence interval 9.98–10.93/100 person-years). Hospitalization rates decreased annually (per year incidence rate ratio 0.92, 95% confidence interval 0.89–0.95) as well as length of stay (median of 15 days in 2007 vs. 11 days in 2013, p-value for trend < 0.001), and in-hospital mortality (13.4% in 2007 to 8.1% in 2013, p-value for trend = 0.053). Our results show that, in a middle-income setting, hospitalization rates are decreasing over time and non-AIDS hospitalizations are currently more frequent than those related to AIDS. Notwithstanding, compared with high-income settings, our patients had longer length of stay and higher in-hospital mortality. Further studies addressing these outcomes are needed to provide information that may guide protocols and interventions to further reduce health-care costs and in-hospital mortality.     

Clinical outcomes and length of stay of a co-located psychogeriatric and geriatric unit

To examine the effect of co-location of psychogeriatric and geriatric services on length of stay and changes in patients’ psychosocial characteristics. A retrospective analysis of the performance indices of psychogeriatric patients aged ≥50 years admitted to a co-located psychogeriatric and geriatric unit at Bankstown-Lidcombe Hospital, New South Wales (NSW), Australia from April 2004 to June 2006. Comparisons were made between the performance of the Bankstown-Lidcombe’s unit and the NSW state average (consisting of traditional solitary models of care) with respect to patients’ length of stay (LOS) and changes in psychosocial indices. Bankstown’s patients had a higher burden of psychosocial impairments. The mean LOS for psychogeriatric episodes was significantly shorter at Bankstown-Lidcombe Hospital than the NSW state average (28.3 ± 19.6 days vs. 33.4 ± 22.7 days, p < 0.001). The overall improvement in aspects of mental state and social behaviors for psychogeriatric admissions at Bankstown-Lidcombe Hospital was significantly better than the NSW state average. Co-location of psychogeriatric and geriatric services reduced patients’ LOS and improved psychosocial performance compared to traditional models of care. However, more robust studies are required to fully examine the benefits of this type of service.     

Factors associated with length of stay in hospital for suspected community-acquired pneumonia

OBJECTIVE:

To determine factors associated with the length of stay (LOS) for patients with suspected community-acquired pneumonia (CAP) who required hospitalization for treatment.

STUDY DESIGN:

The authors studied a population-based prospective cohort of 2757 adults with suspected CAP who were admitted over a two-year period. Logistic regression, multiple linear regression, and classification and regression trees were used to determine the factors associated with LOS.

SETTING:

The study was conducted in two community and tertiary care hospitals, two community and secondary care hospitals, and two community hospitals in the Capital Health Region of Edmonton, Alberta.

RESULTS:

Symptoms such as sweats, shaking chills and wheezing were associated with an LOS of seven days or shorter, whereas weight loss, functional impairment, heart, renal or neoplastic diseases and time to first dose of antibiotic were predictive of an LOS greater than seven days. Regression tree analysis indicated that rapid achievement of physiological stability was associated with a shorter LOS. The use of an indwelling urinary catheter was found to be an important determinant of LOS.

CONCLUSIONS:

The present study found several new associations with increased LOS in patients with CAP, including functional status, time to receipt of first dose of antibiotic therapy, use of certain antibiotics, presence of a urinary catheter and the importance of time to physiological stability. An intervention targeting avoidance of urinary catheters may be associated with a shorter LOS.     

Malnutrition in postacute geriatric care: Basic ESPEN diagnosis and etiology based diagnoses analyzed by length of stay,in-hospital mortality,and functional rehabilitation indexes

ObjectiveTo determine the relationships between malnutrition and nutrition-related conditions according to the European Society of Clinical Nutrition and Metabolism (ESPEN) consensus and guidelines and clinical outcomes in postacute rehabilitation.MethodsOf 102 eligible inpatients, 95 (84.5 years old, 63.2% women) fulfilled inclusion criteria: aged ≥70 years, body mass index <30 kg/m², admission for rehabilitation. Mini-Nutritional Assessment-Short Form (MNA-SF≤11) identified patients “at risk” and ESPEN basic and etiology based definitions were applied. Nutrition-related conditions (sarcopenia, frailty, overweight/obesity, micronutrient abnormalities) were determined. We assessed the relationship between these conditions and the clinical and rehabilitation outcomes (relative functional gain, rehabilitation efficiency) during hospitalization.ResultsAll patients were “at risk” by MNA-SF criteria and 31 reported unintentional weight loss >5% in the last year or 2–3 kg in the last 6 months. Nineteen fulfilled the ESPEN basic definition, of which 10 had disease-related malnutrition with inflammation and 9 without inflammation, and 20 had cachexia. Sarcopenia (n = 44), frailty (n = 94), overweight/obesity (n = 59), and micronutrient abnormalities (n = 70) were frequent. Unintentional weight loss impaired all functional outcomes and increased length of stay [OR = 6.04 (2.87–9.22); p < 0.001]. In multivariate analysis, relationships between rehabilitation impact indices and the ESPEN basic and etiology-based definitions observed in univariate analysis persisted only (and marginally) for relative functional gain [OR = 13.24 (0.96–181.95); p = 0.005]. Infrequent in-hospital mortality prevented meaningful analysis of this outcome.ConclusionsESPEN basic and etiology-based definitions and nutrition related disorders were determined in postacute care. Malnutrition was associated with poor rehabilitation outcomes, mainly due to unintentional weight loss.     

慢性阻塞性肺疾病急性加重期住院时间延长的因素分析

目的探讨引起慢性阻塞性肺疾病急性加重(AECOPD)住院患者的住院时间延长的危险因素。方法选取在2017至2018年因AECOPD入住上海市浦东医院综合内科及呼吸内科的661例患者,分析比较患者的基线特点、COPD稳定期的治疗措施以及住院期间的实验室检查、治疗经过。结果在661例患者中76.6%为男性,平均年龄74.5岁,平均住院时间11.9 d,有24%的患者出现住院时间延长,2.57%的患者需入住重症监护病房(ICU),14.67%的患者需使用无创机械通气(NIV)。AECOPD患者住院时间延长与多种因素有关,首先,患者自身条件包括年龄、低血红蛋白血症、合并慢性肾脏病;其次还与入住的科室、AECOPD的严重程度、住ICU时间以及对NIV的需求相关,差异均具有统计学意义(P值均<0.05)。结论导致AECOPD患者住院时间延长的因素主要与住院科室以及对ICU、NIV的需求相关。     

Declining length of hospital stay for pneumonia and postdischarge outcomes

Objective

This study was designed to assess 8-year trends in the duration of hospitalization for community-acquired pneumonia and to evaluate the impact of declining length of stay on postdischarge short-term readmission and mortality.

Methods

We conducted a prospective observational cohort study of 1886 patients with community-acquired pneumonia who were discharged from a single hospital between March 1, 2000, and June 30, 2007. The main outcomes measured were all-cause mortality and hospital readmission during the 30-day period after discharge. Regression models were used to identify risk factors associated with hospital length of stay and the adjusted associations between length of stay and mortality and readmission.

Results

Factors associated with a longer hospital stay included the number of comorbid conditions, high risk classification on the Pneumonia Severity Index, bilateral or multilobe radiographic involvement, and treatment failure. Patients treated with an appropriate antibiotic were less likely to have an increased length of stay. The mean length of stay was significantly shorter during the 2006 to 2007 period (3.6 days) than during the 2000 to 2001 period (5.6 days, P <.001). Despite the reduction in length of stay, there were no significant differences in the likelihood of death or readmission at 30 days between the 2 time periods. Adjusted multivariate analysis showed that patients with hospital stays less than 3 days did not have significant increases in postdischarge outcomes.

Conclusion

The marked decreased in the length of stay for patients hospitalized with community-acquired pneumonia since 2000 has not been accompanied by an increase in short-term mortality or hospital readmission.     

南阳地区某医院急性ST段抬高型心肌梗死住院时长研究

目的探索影响南阳地区急性ST段抬高型心肌梗死(STEMI)住院时长的因素。方法应用南阳市中心医院心血管内科参加的中国冠心病医疗结果评价和临床转化研究(简称China PEACE)回顾性急性心肌梗死(AMI)注册登记研究的数据,从中随机抽取2001年、2006年、2011年及2016年四个年份STEMI的病例共计462例。按照患者住院时长进行排序,分为高住院时长组147例(n=147),中住院时长组166例(n=166)及低住院时长组149例(n=149)。分析住院时长的影响因素。结果与低住院时长组相比,高住院时长组中女性、心率>100次/min、收缩压<100 mmHg(1 mmHg=0.133kPa)的比例高,差异有统计学意义(P<0.05)。与低住院时长组相比,中、高住院时长组中合并糖尿病的比例高,差异有统计学意义(P<0.05)。与低住院时长组相比,中、高住院时长组中择期经皮冠状动脉介入治疗(PCI)的比例高,差异有统计学意义(P<0.05)。与低住院时长组相比,中住院时长组中β-受体阻滞剂的应用比例高,差异有统计学意义(P<0.05)。结论该院STEMI患者的住院时长受性别、糖尿病病史、血压、心率、择期PCI等多种因素的影响,进一步提高临床诊疗能力来减少影响因素,从而缩短住院时长是改善该院STEMI患者诊疗效率的关键。     

Determinants of postoperative stay in patients with colorectal cancer

The easiest way to reduce the cost of hospital care for patients is to reduce the length of hospital stay. Multivariate analysis was used to identify potentially alterable factors affecting postoperative length of stay for 320 consecutive colorectal cancer patients undergoing elective surgery during a three-year period. Prolonged postoperative stays were noted for patients over age 69. Significantly longer stays were seen for men than for women (13.9vs. 11.9 days,P=.012). Operative procedure significantly influenced postoperative stay: left hemicolectomies, anterior resections with colostomy, abdominoperineal resections, and subtotal coloectomies were associated with significantly longer stays than right, transverse, sigmoid, and anterior resections without colostomy (P<.001). Complications increased the mean postoperative stay from 11.4 to 19.7 days (P<.001) and stay increased progressively with the number of blood transfusions received from 11.1 days for no blood to 21.6 days for more than four units (P<.001). Severity of disease, as reflected by Dukes' stage, tumor differentiation, and tumor size, was not related to postoperative stay. In the latter half of the study, postoperative stay declined, accompanied by a decline in the use of blood and a shift in the procedures performed for rectal carcinoma away from abdominoperineal resection toward anterior resection without colostomy. Diagnosis-related group (DRG) relative weights for procedure, age, and complications are at variance with these findings. Supported in part by NCI-NIH Grant 1 R01-CA-35558-01 and The Frieda and George Zinberg Foundation.     

Relationship between dementia and length of stay of general medical patients admitted to acute care

Objective: To determine the contributing factors that lead to increased length of stay (LOS) of patients with dementia. Methods: A case‐controlled study in a tertiary metropolitan hospital general medical unit was conducted. Patients were aged 65 and over, 26 cases with dementia were identified and 26 controls without dementia were randomly selected. Results: The mean (± SD) LOS for patients with dementia was significantly longer than for those without dementia (20.59 ± 15.38 days vs. 9.6 ± 6.45 days, P = 0.02). In addition to dementia, severity of illness, referral to the aged care assessment team, and day of week admitted were also significant independent predictors of increased LOS. Conclusion: Reasons for increased LOS of patients with dementia remain unclear. Cognitive impairment due to dementia is likely to increase within the context of an increasing and ageing population. Specific strategies may be required within in‐hospital clinical pathways to assist the needs of this group.     

Glucose dysregulation and its association with COVID-19 mortality and hospital length of stay

Background and aimsWe investigate the impact of blood glucose on mortality and hospital length of stay (HLOS) among COVID-19 patients.MethodsRetrospective study of 456 patients with confirmed COVID-19 and glycemic dysregulation in the New York City area.ResultsWe found that impaired glucose adjusted for other organs systems involved (OR:1.87; 95% CI:1.36–2.57, p < 0.001), increased glucose nadir (OR:34.28; 95% CI:3.97–296.05, p < 0.01) and abnormal blood glucose levels at discharge (OR:5.07; 95% CI:2.31–11.14, p < 0.001) were each significantly associated with increased odds for mortality. New or higher from baseline insulin requirement during hospitalization (OR:0.34; 95% CI:0.15–0.78; p < 0.05) was significantly associated with decreased odds for mortality. Increased glucose peak (B = 0.001, SE=<0.001, p < 0.001), new or higher from baseline insulin requirement during hospitalization (B = 0.11, SE = 0.03, p < 0.001), and increased days to dysglycemia (B = 0.15, SE = 0.04, p < 0.001) were each significantly associated with increased HLOS. Increased glucose nadir (B = ?0.67, SE = 0.07, p < 0.001), insulin intravenous drip (B = ?0.10, SE = 0.05, p < 0.05), and increased proportion days endocrine system involved (B = ?0.25, SE = 0.06, p < 0.001) were each significantly associated with decreased HLOS.ConclusionGlucose dysregulation adversely affects mortality and HLOS in COVID-19. These data can help clinicians to guide patient treatment and management in COVID-19 patients.     

The impact of glycemic variability on length of stay and mortality in diabetic patients admitted with community-acquired pneumonia or chronic obstructive pulmonary disease

AimTo investigate the influence of glycemic variability (GV) on length of stay and in-hospital mortality in non-critical diabetic patients.MethodsA observation retrospective study was performed. Diabetic patients admitted between January and June 2016 with the diagnosis of community-acquire pneumonia (CAP) and/or acute exacerbation of chronic obstructive pulmonary disease (COPD) were enrolled and glycemic control (persistent hyperglycemia, hypoglycemia, mean glucose level (MGL) and respective standard deviation (SD) and coefficient of variation (CV)) were evaluated. Primary outcomes were length of stay and in-hospital mortality.ResultsData from 242 patients were analyzed. Fifty-eight percent of the patients were male, with a median age of 77 years (min-max, 29–98). Patients had on average 2.1 glucose readings-day and the MGL was 193.3 mg/dl (min-max, 84.3–436.6). Hypoglycemia was documented in 13.4% of the patients and 55.4% had persistent hyperglycemia. The median length of hospital stay was 10 days (min-max, 1–66) and in-hospital mortality was 7.4%. We found a significant higher in-hospital mortality in older patients, with history of cancer and with nosocomial infections. We did not find any correlation between MGL, SD, CV, hypoglycemia or persist hyperglycemia and in-hospital mortality. A longer length of stay was observed in patients with heavy alcohol consumption and nosocomial infections. The length of stay was negatively correlated with the mean glucose level (r²-0.147; p < 0.05) and positively correlated with the coefficient of variation (p 0.162; p < 0.05).ConclusionThis study confirmed the negative impact of the glycemic variability in the outcomes of diabetic patients admitted with CAP or acute exacerbation of COPD.