Background: Readmission of patients with kidney disease is a reality in our practice setting. Objectives: To assess the prevalence of readmission and identify factors associated with readmission and death of readmitte...Background: Readmission of patients with kidney disease is a reality in our practice setting. Objectives: To assess the prevalence of readmission and identify factors associated with readmission and death of readmitted patients. Materials and Methods: This was a retrospective study conducted from the 1st of October 2017 to the 31st of December 2019 in the nephrology department of Treichville Teaching Hospital. Results: During the study period, 1142 patients were admitted, of whom 154 patients were readmitted, representing a prevalence of 13.48%. The mean age of the patients was 42.31 [15;77 years] and the sex ratio was 1.35 in favour of men. The unemployed were the most represented (24.78%). The average time between hospitalisations was 28.23 ± 21.83 days [3;123 days]. Patients were readmitted within 30 days of discharge in 65.48% of cases, between 30 and 60 days in 23.90% and after 60 days in 10.62%. The uremic syndrome was the main reason for readmission (68, 14%). The causes of readmission were dominated by dialysis failure (82.30%), followed by complications of vascular access, notably dialysis catheter infection (10.60%). Mortality was 30.97%. Obstructive nephropathy (p = 0.029) and hypocalcaemia (p = 0.030) were associated with the risk of hospital mortality. Severe anaemia was associated with early readmission (p = 0.047) and hypertension with the risk of non-early readmission. Conclusion: The prevalence of readmission at hospitals is high. The causes are dominated by dialysis failure and dialysis catheter infection. Hence, there is an interest in improving accessibility to dialysis for patients and raising awareness on prevention and management of risk factors of chronic kidney disease.展开更多
AIM To reduce readmissions and improve patient outcomes in cirrhotic patients through better understanding of readmission predictors.METHODS We performed a single-center retrospective study of patients admitted with d...AIM To reduce readmissions and improve patient outcomes in cirrhotic patients through better understanding of readmission predictors.METHODS We performed a single-center retrospective study of patients admitted with decompensated cirrhosis from January 1, 2011 to December 31, 2013(n = 222). Primary outcomes were time to first readmission and 30-d readmission rate due to complications of cirrhosis. Clinical and demographic data were collected to help describe predictors of readmission, along with care coordination measures such as post-discharge status and outpatient follow-up. Univariate and multivariateanalyses were performed to describe variables associated with readmission.RESULTS One hundred thirty-two patients(59.4%) were readmitted at least once during the study period. Median time to first and second readmissions were 54 and 93 d, respectively. Thirty and 90-d readmission rates were 20.7 and 30.1 percent, respectively. Predictors of 30-d readmission included education level, hepatic encephalopathy at index, ALT more than upper normal limit and Medicare coverage. There were no statistically significant differences in readmission rates when stratified by discharge disposition, outpatient follow-up provider or time to first outpatient visit.CONCLUSION Readmissions are challenging aspect of care for cirrhotic patients and risk continues beyond 30 d. More initiatives are needed to develop enhanced, longitudinal post-discharge systems.展开更多
ABSTRACT Importance Hospitalizations for heart failure （HHF） represent a major health burden, with high rates of early postdischarge rehospitalization and mortality. Objective To investigate whether aliskiren, a d...ABSTRACT Importance Hospitalizations for heart failure （HHF） represent a major health burden, with high rates of early postdischarge rehospitalization and mortality. Objective To investigate whether aliskiren, a direct renin inhibitor, when added to standard therapy, would reduce the rate of cardiovascular （CV） death or HF rehospitalization among HHF patients. Design, Setting, and Participants International, double-blind, placebo-controlled study that randomized hemodynamically stable HHF patients a median 5 days after admission. Eligible patients were 18 years or older with left ventricular ejection fraction （LVEF） 40% or less,展开更多
BACKGROUND The prevalence of Crohn’s disease(CD)and ulcerative colitis(UC)is on the rise worldwide.This rising prevalence is concerning as patients with CD and UC may frequently relapse leading to recurrent hospitali...BACKGROUND The prevalence of Crohn’s disease(CD)and ulcerative colitis(UC)is on the rise worldwide.This rising prevalence is concerning as patients with CD and UC may frequently relapse leading to recurrent hospitalizations and increased healthcare utilization.AIM To identify trends and adverse outcomes for 30 d readmissions for CD and UC.METHODS This was a retrospective,interrupted trends study involving all adult(≥18 years)30 d readmissions of CD and UC from the National Readmission Database(NRD)between 2008 and 2018.Patients<18 years,elective,and traumatic hospitalizations were excluded from this study.We identified hospitalization characteristics and readmission rates for each calendar year.Trends of inpatient mortality,mean length of hospital stay(LOS)and mean total hospital cost(THC)were calculated using a multivariate logistic trend analysis adjusting for age,gender,insurance status,comorbidity burden and hospital factors.Furthermore,trends between CD and UC readmissions were compared using regression of the interaction coefficient after adjusting for age and gender to determine relative trends between the two populations.Stata®Version 16 software(StataCorp,TX,United States)was used for statistical analysis and P value≤0.05 were considered statistically significant.RESULTS Total number of 30 d readmissions increased from 6202 in 2010 to 7672 in 2018 for CD and from 3272 in 2010 to 4234 in 2018 for UC.We noted increasing trends for 30-day all-cause readmission rate of CD from 14.9%in 2010 to 17.6%in 2018(P-trend<0.001),CD specific readmission rate from 7.1%in 2010 to 8.2%in 2018(P-trend<0.001),30-day all-cause readmission rate of UC from 14.1%in 2010 to 15.7%in 2018(P-trend=0.003),and UC specific readmission rate from 5.2%in 2010 to 5.6%in 2018(P-trend=0.029).There was no change in the risk adjusted trends of inpatient mortality and mean LOS for CD and UC readmissions.However,we found an increasing trend of mean THC for UC readmissions.After comparison,there was no statistical difference in the trends for 30 d all-cause readmission rate,inpatient mortality,and mean LOS between CD and UC readmissions.CONCLUSION There was an increase in total number of 30 d readmissions for CD and UC with a trend towards increasing 30 d all-cause readmission rates.展开更多
It is estimated that more than one million heart failure hospitalizations occur each year.Systolic heart failure and heart failure with preserved ejection fraction contribute equally to heart failure hospitalizations....It is estimated that more than one million heart failure hospitalizations occur each year.Systolic heart failure and heart failure with preserved ejection fraction contribute equally to heart failure hospitalizations.Heart failure readmission rates continue to be about 25%.Strategies to reduce heart failure readmission are key to reducing hospitalization rates.The strategies to reduce heart failure hospitalization are as follows:(1)During hospitalization,diuresis to the euvolemic state is essential.Fifty percent of discharged heart failure patients have minimal weight loss during the hospitalization,representing minimal diuresis,but still fl uid overload.(2)During hospitalization,interrogate the defi brillator or biventricular pacemaker(if applicable)to ensure that there is no right ventricular pacing and there is appropriate biventricular pacing.Interrogation of devices can identify arrhythmia or suboptimal biventricular pacing,which can contribute to decompensation.(3)Before discharge,identify the reason for decompensation,such as atrial fibrillation,infection,pulmonary embolism,or noncompliance.(4)Before discharge a multidisciplinary team is needed to educate the patient on diet,medications,fl uid weight surveillance,and exercise.(5)A postdischarge visit should occur within 10 days and with emphasis on uptitration of neurohormonal blockers and continued congestion management.Such interventions conducted by a multidisciplinary team have the potential to reduce heart failure hospitalization rates.展开更多
BACKGROUND Alcoholic liver cirrhosis(ALC)is a chronic liver disease with varying disease severity.Readmissions of ALC are associated with poor outcomes.AIM To identify and assess trends of readmissions for ALC over an...BACKGROUND Alcoholic liver cirrhosis(ALC)is a chronic liver disease with varying disease severity.Readmissions of ALC are associated with poor outcomes.AIM To identify and assess trends of readmissions for ALC over an eight-year period.METHODS This retrospective interrupted trend study analysed 30-d readmissions of ALC in the United States from 2010 to 2018 using the National Readmissions Database.Hospitalization for ALC was the reason for index admission obtained using the International Classification of Diseases codes(571.2 and K70.3X).Biodemographic characteristics and hospitalization trends were highlighted over time.A multivariate regression analysis model was used to calculate the trend for riskadjusted odds of 30-d all-cause ALC readmissions,ALC specific readmission rate,ALC readmission proportion,inpatient mortality,mean length of stay(LOS)and mean total hospital cost(THC)following adjustments for age,gender,grouped Charlson Comorbidity Index,insurance,mean household income,and hospital characteristics.RESULTS There was a trend towards increasing total 30-d readmissions of ALC from 7660 in 2010 to 15085 in 2018(P<0.001).Patients readmitted for ALC were noted to have an increasing comorbidity burden over time.We noted a rise in the risk-adjusted 30-d all-cause readmission of ALC from 24.9%in 2010 to 29.9%in 2018(P<0.001).ALC-specific readmission rate increased from 6.3%in 2010 to 8.4%in 2018(P<0.001)while ALC readmission proportion increased from 31.4%in 2010 to 36.3%in 2018(P<0.001).Inpatient mortality for 30-d readmissions of ALC declined from 10.5%in 2010 to 8.2%in 2018(P=0.0079).However,there was a trend towards increasing LOS from 5.6 d in 2010 to 6.3 d in 2018(P<0.001)and increasing THC from 13790 dollars in 2010 to 17150 dollars in 2018(P<0.001).The total days of hospital stay attributable to 30-d readmissions of ALC increased by 119.2%while the total attributable hospital costs increased by 149%by the end of 2018.CONCLUSION There was an increase in the 30-d readmission rate and comorbidity burden for ALC;however,inpatient mortality declined.Additionally,there was a trend towards increasing LOS and THC for these readmissions.展开更多
BACKGROUND We previously reported national 30-d readmission rates of 27% in patients with decompensated cirrhosis(DC).AIM To study prospective interventions to reduce early readmissions in DC at our tertiary center.ME...BACKGROUND We previously reported national 30-d readmission rates of 27% in patients with decompensated cirrhosis(DC).AIM To study prospective interventions to reduce early readmissions in DC at our tertiary center.METHODS Adults with DC admitted July 2019 to December 2020 were enrolled and randomized into the intervention(INT) or standard of care(SOC) arms. Weekly phone calls for a month were completed. In the INT arm, case managers ensured outpatient follow-up, paracentesis, and medication compliance. Thirty-day readmission rates and reasons were compared.RESULTS Calculated sample size was not achieved due to coronavirus disease 2019;240 patients were randomized into INT and SOC arms. 30-d readmission rate was 33.75%, 35.83% in the INT vs 31.67% in the SOC arm(P = 0.59). The top reason for 30-d readmission was hepatic encephalopathy(HE, 32.10%). There was a lower rate of 30-d readmissions for HE in the INT(21%) vs SOC arm(45%, P = 0.03). There were fewer 30-d readmissions in patients who attended early outpatient follow-up(n = 17, 23.61% vs n = 55, 76.39%, P = 0.04).CONCLUSION Our 30-d readmission rate was higher than the national rate but reduced by interventions in patients with DC with HE and early outpatient follow-up. Development of interventions to reduce early readmission in patients with DC is needed.展开更多
Reducing inpatient hospital readmissions has been an important component of efforts to improve outcomes and reduce health care costs. This study focused on evaluation of the clinical causes of hospital readmissions of...Reducing inpatient hospital readmissions has been an important component of efforts to improve outcomes and reduce health care costs. This study focused on evaluation of the clinical causes of hospital readmissions of adult medical/surgical patients within 30 days between October 2015 and September 2016. It was based on the principal diagnoses of readmissions, a definition that is used throughout the health care industry in the United States. The study focused on adult medicine and adult surgery readmissions in Syracuse, New York, a small metropolitan area, during a twelve month period. It included almost 4000 individual readmissions. The study data demonstrated that only about 22 percent of inpatient readmissions were for the same diagnoses as the initial admissions that preceded them. The study data also indicated that another 20 percent of hospital readmissions involved a diagnosis different from that of the initial admission but in the same body system. Most importantly, the study demonstrated that a consistent majority of inpatient readmissions were caused by diagnoses in different body systems than the initial. The data suggested that efforts to address the causes of hospital readmissions should be based on management of a broad range of adult medicine conditions, rather than individual diagnoses.展开更多
This study involved evaluation of the impact of drivers of changes in adult medicine readmission rates in the hospitals of Syracuse, New York. The study focused on this population because adult medicine readmissions w...This study involved evaluation of the impact of drivers of changes in adult medicine readmission rates in the hospitals of Syracuse, New York. The study focused on this population because adult medicine readmissions were the largest source of medical-surgical and aggregate inpatient readmissions in the local hospitals. The study focused on identifying and correlating readmission rates for specific indicators over a twenty seven month period. Probably, the most important findings identified in the data were the high readmission rates for patients with high severity of illness and the strong correlations between readmission rates for these patients and total adult medicine readmission rates. Correlations between these readmission rates over the twenty seven month period exceeded 0.7000 for each of the hospitals. The study also identified readmission rates and correlations between rates for specific indicators including patient origin and chronic care diagnoses with readmission rates for all of adult medicine. The results of the study identified challenges facing hospital efforts to reduce readmissions including the need to provide alternative services for patients with high severity of illness and the need to address the impacts of multiple chronic diagnoses.展开更多
The Medicare Hospital Readmissions Reduction Program has been implemented in the United States for a five-year period. This study reviewed data associated with Medicare readmissions in the metropolitan area of Syracus...The Medicare Hospital Readmissions Reduction Program has been implemented in the United States for a five-year period. This study reviewed data associated with Medicare readmissions in the metropolitan area of Syracuse, New York during 2015 and 2016, the latest years available. The study data demonstrated that the total number of annual Medicare readmissions for the Syracuse hospitals increased from 2132 to 2202, while chain readmission rates declined from 8.30 to 7.65 as the at-risk population increased. The data also demonstrated that readmissions for diagnosis and procedure categories used in the Medicare program accounted for only 15 - 21 percent of total Medicare readmissions. The study suggested that the program should be expanded by including all Medicare readmissions and that it should employ more current data.展开更多
In a prior practice and policy article published in Healthcare Science,we introduced the deployed application of an artificial intelligence(AI)model to predict longer‐term inpatient readmissions to guide community ca...In a prior practice and policy article published in Healthcare Science,we introduced the deployed application of an artificial intelligence(AI)model to predict longer‐term inpatient readmissions to guide community care interventions for patients with complex conditions in the context of Singapore's Hospital to Home(H2H)program that has been operating since 2017.In this follow on practice and policy article,we further elaborate on Singapore's H2H program and care model,and its supporting AI model for multiple readmission prediction,in the following ways:(1)by providing updates on the AI and supporting information systems,(2)by reporting on customer engagement and related service delivery outcomes including staff‐related time savings and patient benefits in terms of bed days saved,(3)by sharing lessons learned with respect to(i)analytics challenges encountered due to the high degree of heterogeneity and resulting variability of the data set associated with the population of program participants,(ii)balancing competing needs for simpler and stable predictive models versus continuing to further enhance models and add yet more predictive variables,and(iii)the complications of continuing to make model changes when the AI part of the system is highly interlinked with supporting clinical information systems,(4)by highlighting how this H2H effort supported broader Covid‐19 response efforts across Singapore's public healthcare system,and finally(5)by commenting on how the experiences and related capabilities acquired from running this H2H program and related community care model and supporting AI prediction model are expected to contribute to the next wave of Singapore's public healthcare efforts from 2023 onwards.For the convenience of the reader,some content that introduces the H2H program and the multiple readmissions AI prediction model that previously appeared in the prior Healthcare Science publication is repeated at the beginning of this article.展开更多
Objective:Hospital readmission after surgery is one of the major contributors to the increased healthcare cost.Robotic-assisted hysterectomy(RAH)is an innovative surgical procedure most commonly performed within the l...Objective:Hospital readmission after surgery is one of the major contributors to the increased healthcare cost.Robotic-assisted hysterectomy(RAH)is an innovative surgical procedure most commonly performed within the last decade.The purpose of this study was to analyze the effects on hospital readmission patterns and emergency room(ER)visits within 60 days of discharge for women who had RAH versus laparoscopic hysterectomy(LH)in an academic community hospital in Texas.Method:We performed a retrospective study of women with RAH or LH.We used the univariate and multivariate logistic regression to examine the impact of patients'risk factors,the type of surgery,age,number of comorbidities,and duration of surgery on the 60-day hospital readmissions and ER visits.Results:A total of 291 cases with RAH or LH for benign and malignant indications were examined.The number of comorbidities and duration of surgery were similar between the two treatment groups(p>0.05).Patients in the RAH group were younger than the LH group(RAH:45.4±9.9 y,LH:49.8±11.5 y,p<0.05).No significant difference neither in hospital readmission or ER visits between the two groupswas observed(p?0.544 and p=0.109,respectively).Younger age and longer duration of surgery were significantly associated with a higher risk of ER visits(p<0.05).Conclusion:RAH is comparable with LH in hospital readmissions and ER visits.The younger age and longer operation time could lead to ER visits.展开更多
Objectives:Unplanned readmissions severely affect a patient's physical and mental well-being after kidney transplantation(KT),which is also independently associated with morbidity.A retrospective study was conduct...Objectives:Unplanned readmissions severely affect a patient's physical and mental well-being after kidney transplantation(KT),which is also independently associated with morbidity.A retrospective study was conducted to identify the incidence,causes and risk factors for unplanned readmission after KT among Chinese patients.Methods:Patients who underwent KT were admitted to the organ transplant center of the Affiliated Hospital of University of Science and Technology of China(2017-2018).Medical records for these patients were obtained through the hospital information system(HIS).Results:In 518 patients,the incidence of unplanned readmissions within 30 days(n=9)was 1.74%,and 90 days(n=64)was 12.35%.The one-year unplanned readmission rate was 22.59%(n=122).Overall,122 patients were readmitted because of infection,renal events,metabolic disturbances,surgical complications,etc.Hemodialysis(OR=10.462,95%CI:1.355-80.748),peritoneal dialysis(OR=8.746,95%CI:1.074-71.238)and length of stay(OR=1.023,95%CI:1.006-1.040)were independent risk factors for unplanned readmissions.Conclusion:Unplanned readmission rates increased with time after KT.Certain risk factors related to unplanned readmissions should be deeply excavated.Targeted interventions for controllable factors to alleviate the rate of unplanned readmissions should be identified.展开更多
BACKGROUND Factors that are associated with the short-term rehospitalization have been investigated previously in numerous studies.However,the majority of these studies have not produced any conclusive results because...BACKGROUND Factors that are associated with the short-term rehospitalization have been investigated previously in numerous studies.However,the majority of these studies have not produced any conclusive results because of their smaller sample sizes,differences in the definition of pneumonia,joint pooling of the in-hospital and post-discharge deaths and lower generalizability.AIM To estimate the effect of various risk factors on the rate of hospital readmissions in patients with pneumonia.METHODS Systematic search was conducted in PubMed Central,EMBASE,MEDLINE,Cochrane library,ScienceDirect and Google Scholar databases and search engines from inception until July 2021.We used the Newcastle Ottawa(NO)scale to assess the quality of published studies.A meta-analysis was carried out with random-effects model and reported pooled odds ratio(OR)with 95%confidence interval(CI).RESULTS In total,17 studies with over 3 million participants were included.Majority of the studies had good to satisfactory quality as per NO scale.Male gender(pooled OR=1.22;95%CI:1.16-1.27),cancer(pooled OR=1.94;95%CI:1.61-2.34),heart failure(pooled OR=1.28;95%CI:1.20-1.37),chronic respiratory disease(pooled OR=1.37;95%CI:1.19-1.58),chronic kidney disease(pooled OR=1.38;95%CI:1.23- 1.54) and diabetes mellitus (pooled OR = 1.18;95%CI: 1.08-1.28) had statistically significantassociation with the hospital readmission rate among pneumonia patients. Sensitivity analysisshowed that there was no significant variation in the magnitude or direction of outcome,indicating lack of influence of a single study on the overall pooled estimate.CONCLUSIONMale gender and specific chronic comorbid conditions were found to be significant risk factors forhospital readmission among pneumonia patients. These results may allow clinicians and policymakersto develop better intervention strategies for the patients.展开更多
AIM To determine the incidence of readmission after cholecystectomy using 90 d as a time limit. METHODS We retrospectively reviewed all patients undergoing cholecystectomy at the General Surgery and Digestive System S...AIM To determine the incidence of readmission after cholecystectomy using 90 d as a time limit. METHODS We retrospectively reviewed all patients undergoing cholecystectomy at the General Surgery and Digestive System Service of the University Hospital of Guadalajara, Spain. We included all patients undergoing cholecystectomy for biliary pathology who were readmitted to hospital within 90 d. We considered readmission to any hospital service as cholecystectomyrelated complications. We excluded ambulatory cholecystectomy, cholecystectomy combined with other procedures, oncologic disease active at the time of cholecystectomy, finding of malignancy in the resection specimen, and scheduled re-admissions for other unrelated pathologies. RESULTS We analyzed 1423 patients. There were 71 readmissions in the 90 d after discharge, with a readmission rate of4.99%. Sixty-four point seven nine percent occurred after elective surgery(cholelithiasis or vesicular polyps) and 35.21% after emergency surgery(acute cholecystitis or acute pancreatitis). Surgical non-biliary causes were the most frequent reasons for readmission, representing 46.48%; among them, intra-abdominal abscesses were the most common. In second place were non-surgical reasons, at 29.58%, and finally, surgical biliary reasons, at 23.94%. Regarding time for readmission, almost 50% of patients were readmitted in the first week and most second readmissions occurred during the second month. Redefining the readmissions rate to 90 d resulted in an increase in re-hospitalization, from 3.51% at 30 d to 4.99% at 90 d. CONCLUSION The use of 30-d cutoff point may underestimate the incidence of complications. The current tendency is to use 90 d as a limit to measure complications associated with any surgical procedure.展开更多
Objective: Admissions to acute care hospitals represent a significant portion of healthcare utilization. Little is known regarding hospitalization in the first postpartum year beyond the traditional 6 weeks of the pue...Objective: Admissions to acute care hospitals represent a significant portion of healthcare utilization. Little is known regarding hospitalization in the first postpartum year beyond the traditional 6 weeks of the puerperium. We sought to investigate whether there are identifiable risk factors for hospital readmission during this time period. Study Design: We conducted a retrospective population-based study using all California birth records between 1999 and 2003. These records were linked with hospital discharge data for all admissions to California hospitals in the first 365 days after delivery. For women with a first birth during the study period, we assessed the likelihood of readmission to an acute care hospital between 42 and 365 days post-delivery. Univariate and multivariable logistic regression were used to determine risk factors for these “late postpartum” admissions. Results: Of 951,570 maternal birth admissions during the time period, 15,727 (1.7%) women were admitted in the late postpartum period. Women with an early postpartum readmission, antepartum admission, extremes of maternal age, black race, diabetes, hypertension, early preterm delivery and cesarean delivery had higher rates of late postpartum readmission. Of women with an antepartum admission for gestational diabetes or pre-existing diabetes, 6.6% and 18.5% of these women experienced a late postpartum admission for a diabetes-related diagnosis. Conclusion: Hospital readmission rates in the first year postpartum, remote from delivery, are significant. Women are at a higher risk of requiring hospital admission in the first year postpartum with select demographics and pregnancy-related diagnoses.展开更多
Background: Daily paediatric asthma readmissions within 28 days are a good example of a low count time series and not easily amenable to common time series methods used in studies of asthma seasonality and time trends...Background: Daily paediatric asthma readmissions within 28 days are a good example of a low count time series and not easily amenable to common time series methods used in studies of asthma seasonality and time trends. We sought to model and predict daily trends of childhood asthma readmissions over time inVictoria,Australia. Methods: We used a database of 75,000 childhood asthma admissions from the Department ofHealth,Victoria,Australiain 1997-2009. Daily admissions over time were modeled using a semi parametric Generalized Additive Model (GAM) and by sex and age group. Predictions were also estimated by using these models. Results: N = 2401 asthma readmissions within 28 days occurred during study period. Of these, n = 1358 (57%) were boys. Overall, seasonal peaks occurred in winter (30.5%) followed by autumn (28.6%) and then spring (24.6%) (p展开更多
Particularly commendable is the important work of Calvo,et al.[1]in comparing geriatric assessment tools to predict mortality and readmissions in elderly patients undergoing transcatheter aortic valve implantation(TAV...Particularly commendable is the important work of Calvo,et al.[1]in comparing geriatric assessment tools to predict mortality and readmissions in elderly patients undergoing transcatheter aortic valve implantation(TAVI).Their efforts underscore the growing importance of frailty assessment in cardiovascular risk stratification.We would like to respectfully highlight several areas that,if addressed in future studies(Figure 1),could further enhance the utility and inclusivity of these assessments.展开更多
Background:Current guidelines recommend cholecystectomy for patients with mild acute biliary pancreatitis(MABP)during the index admission because it is associated with better outcomes.In this study,we aimed to assess ...Background:Current guidelines recommend cholecystectomy for patients with mild acute biliary pancreatitis(MABP)during the index admission because it is associated with better outcomes.In this study,we aimed to assess national trends in cholecystectomy during index admissions for MABP and to identify factors associated with cholecystectomy completion and 30-day readmission.Methods:Using diagnostic codes and the National Readmissions Database,we identified patients admitted with MABP between 2010 and 2014.Differences in cholecystectomy rates were computed on the basis of various characteristics.We conducted a multivariable analysis to identify factors associated with 30-day readmission and cholecystectomy during the same admission.Results:We identified 255,695 unique index MABP cases(41.3%male)and the 30-day readmission rate was 12.6%.Overall,43.8%underwent cholecystectomy and 25%underwent endoscopic retrograde cholangiopancreatography(ERCP)with sphincterotomy.We observed a decreasing trend in both procedures during the study period(P<0.001).In multivariate analysis,odds of 30-day readmission were reduced for patients undergoing ERCP with sphincterotomy(odds ratio,0.78;95%confidence interval,0.74–0.84)or cholecystectomy(odds ratio,0.37;95%confidence interval,0.35–0.39).Conclusions:For patients with MABP,cholecystectomy or ERCP with sphincterotomy during the index admission decreased the risk of 30-day readmission.Despite this benefit and national guidelines recommending cholecystectomy during the index MABP admission,the rate of cholecystectomies performed nationally decreased during the study period.Further research is needed to understand the implications and reasons underlying this deviation from guidelines.展开更多
Unplanned intensive care unit(ICU)admissions(UP-ICU)following initial general ward placement are associated with poor patient outcomes and represent a key quality indicator for healthcare facilities.Healthcare facilit...Unplanned intensive care unit(ICU)admissions(UP-ICU)following initial general ward placement are associated with poor patient outcomes and represent a key quality indicator for healthcare facilities.Healthcare facilities have employed numerous predictive models,such as physiological scores(e.g.,Acute Physiology and Chronic Health Evaluation II,Revised Trauma Score,and Mortality Probability Model II at 24 hours)and anatomical scores(Injury Severity Score and New Injury Severity Score),to identify high-risk patients.Although physiological scores frequently surpass anatomical scores in predicting mortality,their specificity for trauma patients is limited,and their clinical applicability may be limited.Initially proposed for ICU readmission prediction,the stability and workload index for the transfer score has demonstrated inconsistent validity.Machine learning offers a promising alternative.Several studies have shown that machine learning models,including those that use electronic health records(EHR)data,can more accurately predict trauma patients’deaths and admissions to the ICU than traditional scoring systems.These models identify unique predictors that are not captured by existing methods.However,challenges remain,including integration with EHR systems and data entry complexities.Critical care outreach programs and telemedicine can help reduce UP-ICU admissions;however,their effectiveness remains unclear because of costs and implementation challenges,respectively.Strategies to reduce UP-ICU admissions include improving triage systems,implementing evidence-based protocols for ICU patient management,and prioritizing prehospital intervention and stabilization to optimize the“golden hour”of trauma care.To improve patient outcomes and reduce the burden of UPICU admissions,further studies are required to validate and implement these strategies and refine machine learning models.展开更多
文摘Background: Readmission of patients with kidney disease is a reality in our practice setting. Objectives: To assess the prevalence of readmission and identify factors associated with readmission and death of readmitted patients. Materials and Methods: This was a retrospective study conducted from the 1st of October 2017 to the 31st of December 2019 in the nephrology department of Treichville Teaching Hospital. Results: During the study period, 1142 patients were admitted, of whom 154 patients were readmitted, representing a prevalence of 13.48%. The mean age of the patients was 42.31 [15;77 years] and the sex ratio was 1.35 in favour of men. The unemployed were the most represented (24.78%). The average time between hospitalisations was 28.23 ± 21.83 days [3;123 days]. Patients were readmitted within 30 days of discharge in 65.48% of cases, between 30 and 60 days in 23.90% and after 60 days in 10.62%. The uremic syndrome was the main reason for readmission (68, 14%). The causes of readmission were dominated by dialysis failure (82.30%), followed by complications of vascular access, notably dialysis catheter infection (10.60%). Mortality was 30.97%. Obstructive nephropathy (p = 0.029) and hypocalcaemia (p = 0.030) were associated with the risk of hospital mortality. Severe anaemia was associated with early readmission (p = 0.047) and hypertension with the risk of non-early readmission. Conclusion: The prevalence of readmission at hospitals is high. The causes are dominated by dialysis failure and dialysis catheter infection. Hence, there is an interest in improving accessibility to dialysis for patients and raising awareness on prevention and management of risk factors of chronic kidney disease.
文摘AIM To reduce readmissions and improve patient outcomes in cirrhotic patients through better understanding of readmission predictors.METHODS We performed a single-center retrospective study of patients admitted with decompensated cirrhosis from January 1, 2011 to December 31, 2013(n = 222). Primary outcomes were time to first readmission and 30-d readmission rate due to complications of cirrhosis. Clinical and demographic data were collected to help describe predictors of readmission, along with care coordination measures such as post-discharge status and outpatient follow-up. Univariate and multivariateanalyses were performed to describe variables associated with readmission.RESULTS One hundred thirty-two patients(59.4%) were readmitted at least once during the study period. Median time to first and second readmissions were 54 and 93 d, respectively. Thirty and 90-d readmission rates were 20.7 and 30.1 percent, respectively. Predictors of 30-d readmission included education level, hepatic encephalopathy at index, ALT more than upper normal limit and Medicare coverage. There were no statistically significant differences in readmission rates when stratified by discharge disposition, outpatient follow-up provider or time to first outpatient visit.CONCLUSION Readmissions are challenging aspect of care for cirrhotic patients and risk continues beyond 30 d. More initiatives are needed to develop enhanced, longitudinal post-discharge systems.
文摘ABSTRACT Importance Hospitalizations for heart failure （HHF） represent a major health burden, with high rates of early postdischarge rehospitalization and mortality. Objective To investigate whether aliskiren, a direct renin inhibitor, when added to standard therapy, would reduce the rate of cardiovascular （CV） death or HF rehospitalization among HHF patients. Design, Setting, and Participants International, double-blind, placebo-controlled study that randomized hemodynamically stable HHF patients a median 5 days after admission. Eligible patients were 18 years or older with left ventricular ejection fraction （LVEF） 40% or less,
文摘BACKGROUND The prevalence of Crohn’s disease(CD)and ulcerative colitis(UC)is on the rise worldwide.This rising prevalence is concerning as patients with CD and UC may frequently relapse leading to recurrent hospitalizations and increased healthcare utilization.AIM To identify trends and adverse outcomes for 30 d readmissions for CD and UC.METHODS This was a retrospective,interrupted trends study involving all adult(≥18 years)30 d readmissions of CD and UC from the National Readmission Database(NRD)between 2008 and 2018.Patients<18 years,elective,and traumatic hospitalizations were excluded from this study.We identified hospitalization characteristics and readmission rates for each calendar year.Trends of inpatient mortality,mean length of hospital stay(LOS)and mean total hospital cost(THC)were calculated using a multivariate logistic trend analysis adjusting for age,gender,insurance status,comorbidity burden and hospital factors.Furthermore,trends between CD and UC readmissions were compared using regression of the interaction coefficient after adjusting for age and gender to determine relative trends between the two populations.Stata®Version 16 software(StataCorp,TX,United States)was used for statistical analysis and P value≤0.05 were considered statistically significant.RESULTS Total number of 30 d readmissions increased from 6202 in 2010 to 7672 in 2018 for CD and from 3272 in 2010 to 4234 in 2018 for UC.We noted increasing trends for 30-day all-cause readmission rate of CD from 14.9%in 2010 to 17.6%in 2018(P-trend<0.001),CD specific readmission rate from 7.1%in 2010 to 8.2%in 2018(P-trend<0.001),30-day all-cause readmission rate of UC from 14.1%in 2010 to 15.7%in 2018(P-trend=0.003),and UC specific readmission rate from 5.2%in 2010 to 5.6%in 2018(P-trend=0.029).There was no change in the risk adjusted trends of inpatient mortality and mean LOS for CD and UC readmissions.However,we found an increasing trend of mean THC for UC readmissions.After comparison,there was no statistical difference in the trends for 30 d all-cause readmission rate,inpatient mortality,and mean LOS between CD and UC readmissions.CONCLUSION There was an increase in total number of 30 d readmissions for CD and UC with a trend towards increasing 30 d all-cause readmission rates.
文摘It is estimated that more than one million heart failure hospitalizations occur each year.Systolic heart failure and heart failure with preserved ejection fraction contribute equally to heart failure hospitalizations.Heart failure readmission rates continue to be about 25%.Strategies to reduce heart failure readmission are key to reducing hospitalization rates.The strategies to reduce heart failure hospitalization are as follows:(1)During hospitalization,diuresis to the euvolemic state is essential.Fifty percent of discharged heart failure patients have minimal weight loss during the hospitalization,representing minimal diuresis,but still fl uid overload.(2)During hospitalization,interrogate the defi brillator or biventricular pacemaker(if applicable)to ensure that there is no right ventricular pacing and there is appropriate biventricular pacing.Interrogation of devices can identify arrhythmia or suboptimal biventricular pacing,which can contribute to decompensation.(3)Before discharge,identify the reason for decompensation,such as atrial fibrillation,infection,pulmonary embolism,or noncompliance.(4)Before discharge a multidisciplinary team is needed to educate the patient on diet,medications,fl uid weight surveillance,and exercise.(5)A postdischarge visit should occur within 10 days and with emphasis on uptitration of neurohormonal blockers and continued congestion management.Such interventions conducted by a multidisciplinary team have the potential to reduce heart failure hospitalization rates.
文摘BACKGROUND Alcoholic liver cirrhosis(ALC)is a chronic liver disease with varying disease severity.Readmissions of ALC are associated with poor outcomes.AIM To identify and assess trends of readmissions for ALC over an eight-year period.METHODS This retrospective interrupted trend study analysed 30-d readmissions of ALC in the United States from 2010 to 2018 using the National Readmissions Database.Hospitalization for ALC was the reason for index admission obtained using the International Classification of Diseases codes(571.2 and K70.3X).Biodemographic characteristics and hospitalization trends were highlighted over time.A multivariate regression analysis model was used to calculate the trend for riskadjusted odds of 30-d all-cause ALC readmissions,ALC specific readmission rate,ALC readmission proportion,inpatient mortality,mean length of stay(LOS)and mean total hospital cost(THC)following adjustments for age,gender,grouped Charlson Comorbidity Index,insurance,mean household income,and hospital characteristics.RESULTS There was a trend towards increasing total 30-d readmissions of ALC from 7660 in 2010 to 15085 in 2018(P<0.001).Patients readmitted for ALC were noted to have an increasing comorbidity burden over time.We noted a rise in the risk-adjusted 30-d all-cause readmission of ALC from 24.9%in 2010 to 29.9%in 2018(P<0.001).ALC-specific readmission rate increased from 6.3%in 2010 to 8.4%in 2018(P<0.001)while ALC readmission proportion increased from 31.4%in 2010 to 36.3%in 2018(P<0.001).Inpatient mortality for 30-d readmissions of ALC declined from 10.5%in 2010 to 8.2%in 2018(P=0.0079).However,there was a trend towards increasing LOS from 5.6 d in 2010 to 6.3 d in 2018(P<0.001)and increasing THC from 13790 dollars in 2010 to 17150 dollars in 2018(P<0.001).The total days of hospital stay attributable to 30-d readmissions of ALC increased by 119.2%while the total attributable hospital costs increased by 149%by the end of 2018.CONCLUSION There was an increase in the 30-d readmission rate and comorbidity burden for ALC;however,inpatient mortality declined.Additionally,there was a trend towards increasing LOS and THC for these readmissions.
基金GASTR29:Prospective validation of readmission risk score and interventions to prevent readmission in patients with decompensated cirrhosis(CCTS ID#:6018).
文摘BACKGROUND We previously reported national 30-d readmission rates of 27% in patients with decompensated cirrhosis(DC).AIM To study prospective interventions to reduce early readmissions in DC at our tertiary center.METHODS Adults with DC admitted July 2019 to December 2020 were enrolled and randomized into the intervention(INT) or standard of care(SOC) arms. Weekly phone calls for a month were completed. In the INT arm, case managers ensured outpatient follow-up, paracentesis, and medication compliance. Thirty-day readmission rates and reasons were compared.RESULTS Calculated sample size was not achieved due to coronavirus disease 2019;240 patients were randomized into INT and SOC arms. 30-d readmission rate was 33.75%, 35.83% in the INT vs 31.67% in the SOC arm(P = 0.59). The top reason for 30-d readmission was hepatic encephalopathy(HE, 32.10%). There was a lower rate of 30-d readmissions for HE in the INT(21%) vs SOC arm(45%, P = 0.03). There were fewer 30-d readmissions in patients who attended early outpatient follow-up(n = 17, 23.61% vs n = 55, 76.39%, P = 0.04).CONCLUSION Our 30-d readmission rate was higher than the national rate but reduced by interventions in patients with DC with HE and early outpatient follow-up. Development of interventions to reduce early readmission in patients with DC is needed.
文摘Reducing inpatient hospital readmissions has been an important component of efforts to improve outcomes and reduce health care costs. This study focused on evaluation of the clinical causes of hospital readmissions of adult medical/surgical patients within 30 days between October 2015 and September 2016. It was based on the principal diagnoses of readmissions, a definition that is used throughout the health care industry in the United States. The study focused on adult medicine and adult surgery readmissions in Syracuse, New York, a small metropolitan area, during a twelve month period. It included almost 4000 individual readmissions. The study data demonstrated that only about 22 percent of inpatient readmissions were for the same diagnoses as the initial admissions that preceded them. The study data also indicated that another 20 percent of hospital readmissions involved a diagnosis different from that of the initial admission but in the same body system. Most importantly, the study demonstrated that a consistent majority of inpatient readmissions were caused by diagnoses in different body systems than the initial. The data suggested that efforts to address the causes of hospital readmissions should be based on management of a broad range of adult medicine conditions, rather than individual diagnoses.
文摘This study involved evaluation of the impact of drivers of changes in adult medicine readmission rates in the hospitals of Syracuse, New York. The study focused on this population because adult medicine readmissions were the largest source of medical-surgical and aggregate inpatient readmissions in the local hospitals. The study focused on identifying and correlating readmission rates for specific indicators over a twenty seven month period. Probably, the most important findings identified in the data were the high readmission rates for patients with high severity of illness and the strong correlations between readmission rates for these patients and total adult medicine readmission rates. Correlations between these readmission rates over the twenty seven month period exceeded 0.7000 for each of the hospitals. The study also identified readmission rates and correlations between rates for specific indicators including patient origin and chronic care diagnoses with readmission rates for all of adult medicine. The results of the study identified challenges facing hospital efforts to reduce readmissions including the need to provide alternative services for patients with high severity of illness and the need to address the impacts of multiple chronic diagnoses.
文摘The Medicare Hospital Readmissions Reduction Program has been implemented in the United States for a five-year period. This study reviewed data associated with Medicare readmissions in the metropolitan area of Syracuse, New York during 2015 and 2016, the latest years available. The study data demonstrated that the total number of annual Medicare readmissions for the Syracuse hospitals increased from 2132 to 2202, while chain readmission rates declined from 8.30 to 7.65 as the at-risk population increased. The data also demonstrated that readmissions for diagnosis and procedure categories used in the Medicare program accounted for only 15 - 21 percent of total Medicare readmissions. The study suggested that the program should be expanded by including all Medicare readmissions and that it should employ more current data.
文摘In a prior practice and policy article published in Healthcare Science,we introduced the deployed application of an artificial intelligence(AI)model to predict longer‐term inpatient readmissions to guide community care interventions for patients with complex conditions in the context of Singapore's Hospital to Home(H2H)program that has been operating since 2017.In this follow on practice and policy article,we further elaborate on Singapore's H2H program and care model,and its supporting AI model for multiple readmission prediction,in the following ways:(1)by providing updates on the AI and supporting information systems,(2)by reporting on customer engagement and related service delivery outcomes including staff‐related time savings and patient benefits in terms of bed days saved,(3)by sharing lessons learned with respect to(i)analytics challenges encountered due to the high degree of heterogeneity and resulting variability of the data set associated with the population of program participants,(ii)balancing competing needs for simpler and stable predictive models versus continuing to further enhance models and add yet more predictive variables,and(iii)the complications of continuing to make model changes when the AI part of the system is highly interlinked with supporting clinical information systems,(4)by highlighting how this H2H effort supported broader Covid‐19 response efforts across Singapore's public healthcare system,and finally(5)by commenting on how the experiences and related capabilities acquired from running this H2H program and related community care model and supporting AI prediction model are expected to contribute to the next wave of Singapore's public healthcare efforts from 2023 onwards.For the convenience of the reader,some content that introduces the H2H program and the multiple readmissions AI prediction model that previously appeared in the prior Healthcare Science publication is repeated at the beginning of this article.
文摘Objective:Hospital readmission after surgery is one of the major contributors to the increased healthcare cost.Robotic-assisted hysterectomy(RAH)is an innovative surgical procedure most commonly performed within the last decade.The purpose of this study was to analyze the effects on hospital readmission patterns and emergency room(ER)visits within 60 days of discharge for women who had RAH versus laparoscopic hysterectomy(LH)in an academic community hospital in Texas.Method:We performed a retrospective study of women with RAH or LH.We used the univariate and multivariate logistic regression to examine the impact of patients'risk factors,the type of surgery,age,number of comorbidities,and duration of surgery on the 60-day hospital readmissions and ER visits.Results:A total of 291 cases with RAH or LH for benign and malignant indications were examined.The number of comorbidities and duration of surgery were similar between the two treatment groups(p>0.05).Patients in the RAH group were younger than the LH group(RAH:45.4±9.9 y,LH:49.8±11.5 y,p<0.05).No significant difference neither in hospital readmission or ER visits between the two groupswas observed(p?0.544 and p=0.109,respectively).Younger age and longer duration of surgery were significantly associated with a higher risk of ER visits(p<0.05).Conclusion:RAH is comparable with LH in hospital readmissions and ER visits.The younger age and longer operation time could lead to ER visits.
基金This work was supported by the National Key Clinical Specialist Construction Projects of China[No.(2018)292]
文摘Objectives:Unplanned readmissions severely affect a patient's physical and mental well-being after kidney transplantation(KT),which is also independently associated with morbidity.A retrospective study was conducted to identify the incidence,causes and risk factors for unplanned readmission after KT among Chinese patients.Methods:Patients who underwent KT were admitted to the organ transplant center of the Affiliated Hospital of University of Science and Technology of China(2017-2018).Medical records for these patients were obtained through the hospital information system(HIS).Results:In 518 patients,the incidence of unplanned readmissions within 30 days(n=9)was 1.74%,and 90 days(n=64)was 12.35%.The one-year unplanned readmission rate was 22.59%(n=122).Overall,122 patients were readmitted because of infection,renal events,metabolic disturbances,surgical complications,etc.Hemodialysis(OR=10.462,95%CI:1.355-80.748),peritoneal dialysis(OR=8.746,95%CI:1.074-71.238)and length of stay(OR=1.023,95%CI:1.006-1.040)were independent risk factors for unplanned readmissions.Conclusion:Unplanned readmission rates increased with time after KT.Certain risk factors related to unplanned readmissions should be deeply excavated.Targeted interventions for controllable factors to alleviate the rate of unplanned readmissions should be identified.
文摘BACKGROUND Factors that are associated with the short-term rehospitalization have been investigated previously in numerous studies.However,the majority of these studies have not produced any conclusive results because of their smaller sample sizes,differences in the definition of pneumonia,joint pooling of the in-hospital and post-discharge deaths and lower generalizability.AIM To estimate the effect of various risk factors on the rate of hospital readmissions in patients with pneumonia.METHODS Systematic search was conducted in PubMed Central,EMBASE,MEDLINE,Cochrane library,ScienceDirect and Google Scholar databases and search engines from inception until July 2021.We used the Newcastle Ottawa(NO)scale to assess the quality of published studies.A meta-analysis was carried out with random-effects model and reported pooled odds ratio(OR)with 95%confidence interval(CI).RESULTS In total,17 studies with over 3 million participants were included.Majority of the studies had good to satisfactory quality as per NO scale.Male gender(pooled OR=1.22;95%CI:1.16-1.27),cancer(pooled OR=1.94;95%CI:1.61-2.34),heart failure(pooled OR=1.28;95%CI:1.20-1.37),chronic respiratory disease(pooled OR=1.37;95%CI:1.19-1.58),chronic kidney disease(pooled OR=1.38;95%CI:1.23- 1.54) and diabetes mellitus (pooled OR = 1.18;95%CI: 1.08-1.28) had statistically significantassociation with the hospital readmission rate among pneumonia patients. Sensitivity analysisshowed that there was no significant variation in the magnitude or direction of outcome,indicating lack of influence of a single study on the overall pooled estimate.CONCLUSIONMale gender and specific chronic comorbid conditions were found to be significant risk factors forhospital readmission among pneumonia patients. These results may allow clinicians and policymakersto develop better intervention strategies for the patients.
文摘AIM To determine the incidence of readmission after cholecystectomy using 90 d as a time limit. METHODS We retrospectively reviewed all patients undergoing cholecystectomy at the General Surgery and Digestive System Service of the University Hospital of Guadalajara, Spain. We included all patients undergoing cholecystectomy for biliary pathology who were readmitted to hospital within 90 d. We considered readmission to any hospital service as cholecystectomyrelated complications. We excluded ambulatory cholecystectomy, cholecystectomy combined with other procedures, oncologic disease active at the time of cholecystectomy, finding of malignancy in the resection specimen, and scheduled re-admissions for other unrelated pathologies. RESULTS We analyzed 1423 patients. There were 71 readmissions in the 90 d after discharge, with a readmission rate of4.99%. Sixty-four point seven nine percent occurred after elective surgery(cholelithiasis or vesicular polyps) and 35.21% after emergency surgery(acute cholecystitis or acute pancreatitis). Surgical non-biliary causes were the most frequent reasons for readmission, representing 46.48%; among them, intra-abdominal abscesses were the most common. In second place were non-surgical reasons, at 29.58%, and finally, surgical biliary reasons, at 23.94%. Regarding time for readmission, almost 50% of patients were readmitted in the first week and most second readmissions occurred during the second month. Redefining the readmissions rate to 90 d resulted in an increase in re-hospitalization, from 3.51% at 30 d to 4.99% at 90 d. CONCLUSION The use of 30-d cutoff point may underestimate the incidence of complications. The current tendency is to use 90 d as a limit to measure complications associated with any surgical procedure.
文摘Objective: Admissions to acute care hospitals represent a significant portion of healthcare utilization. Little is known regarding hospitalization in the first postpartum year beyond the traditional 6 weeks of the puerperium. We sought to investigate whether there are identifiable risk factors for hospital readmission during this time period. Study Design: We conducted a retrospective population-based study using all California birth records between 1999 and 2003. These records were linked with hospital discharge data for all admissions to California hospitals in the first 365 days after delivery. For women with a first birth during the study period, we assessed the likelihood of readmission to an acute care hospital between 42 and 365 days post-delivery. Univariate and multivariable logistic regression were used to determine risk factors for these “late postpartum” admissions. Results: Of 951,570 maternal birth admissions during the time period, 15,727 (1.7%) women were admitted in the late postpartum period. Women with an early postpartum readmission, antepartum admission, extremes of maternal age, black race, diabetes, hypertension, early preterm delivery and cesarean delivery had higher rates of late postpartum readmission. Of women with an antepartum admission for gestational diabetes or pre-existing diabetes, 6.6% and 18.5% of these women experienced a late postpartum admission for a diabetes-related diagnosis. Conclusion: Hospital readmission rates in the first year postpartum, remote from delivery, are significant. Women are at a higher risk of requiring hospital admission in the first year postpartum with select demographics and pregnancy-related diagnoses.
文摘Background: Daily paediatric asthma readmissions within 28 days are a good example of a low count time series and not easily amenable to common time series methods used in studies of asthma seasonality and time trends. We sought to model and predict daily trends of childhood asthma readmissions over time inVictoria,Australia. Methods: We used a database of 75,000 childhood asthma admissions from the Department ofHealth,Victoria,Australiain 1997-2009. Daily admissions over time were modeled using a semi parametric Generalized Additive Model (GAM) and by sex and age group. Predictions were also estimated by using these models. Results: N = 2401 asthma readmissions within 28 days occurred during study period. Of these, n = 1358 (57%) were boys. Overall, seasonal peaks occurred in winter (30.5%) followed by autumn (28.6%) and then spring (24.6%) (p
文摘Particularly commendable is the important work of Calvo,et al.[1]in comparing geriatric assessment tools to predict mortality and readmissions in elderly patients undergoing transcatheter aortic valve implantation(TAVI).Their efforts underscore the growing importance of frailty assessment in cardiovascular risk stratification.We would like to respectfully highlight several areas that,if addressed in future studies(Figure 1),could further enhance the utility and inclusivity of these assessments.
文摘Background:Current guidelines recommend cholecystectomy for patients with mild acute biliary pancreatitis(MABP)during the index admission because it is associated with better outcomes.In this study,we aimed to assess national trends in cholecystectomy during index admissions for MABP and to identify factors associated with cholecystectomy completion and 30-day readmission.Methods:Using diagnostic codes and the National Readmissions Database,we identified patients admitted with MABP between 2010 and 2014.Differences in cholecystectomy rates were computed on the basis of various characteristics.We conducted a multivariable analysis to identify factors associated with 30-day readmission and cholecystectomy during the same admission.Results:We identified 255,695 unique index MABP cases(41.3%male)and the 30-day readmission rate was 12.6%.Overall,43.8%underwent cholecystectomy and 25%underwent endoscopic retrograde cholangiopancreatography(ERCP)with sphincterotomy.We observed a decreasing trend in both procedures during the study period(P<0.001).In multivariate analysis,odds of 30-day readmission were reduced for patients undergoing ERCP with sphincterotomy(odds ratio,0.78;95%confidence interval,0.74–0.84)or cholecystectomy(odds ratio,0.37;95%confidence interval,0.35–0.39).Conclusions:For patients with MABP,cholecystectomy or ERCP with sphincterotomy during the index admission decreased the risk of 30-day readmission.Despite this benefit and national guidelines recommending cholecystectomy during the index MABP admission,the rate of cholecystectomies performed nationally decreased during the study period.Further research is needed to understand the implications and reasons underlying this deviation from guidelines.
文摘Unplanned intensive care unit(ICU)admissions(UP-ICU)following initial general ward placement are associated with poor patient outcomes and represent a key quality indicator for healthcare facilities.Healthcare facilities have employed numerous predictive models,such as physiological scores(e.g.,Acute Physiology and Chronic Health Evaluation II,Revised Trauma Score,and Mortality Probability Model II at 24 hours)and anatomical scores(Injury Severity Score and New Injury Severity Score),to identify high-risk patients.Although physiological scores frequently surpass anatomical scores in predicting mortality,their specificity for trauma patients is limited,and their clinical applicability may be limited.Initially proposed for ICU readmission prediction,the stability and workload index for the transfer score has demonstrated inconsistent validity.Machine learning offers a promising alternative.Several studies have shown that machine learning models,including those that use electronic health records(EHR)data,can more accurately predict trauma patients’deaths and admissions to the ICU than traditional scoring systems.These models identify unique predictors that are not captured by existing methods.However,challenges remain,including integration with EHR systems and data entry complexities.Critical care outreach programs and telemedicine can help reduce UP-ICU admissions;however,their effectiveness remains unclear because of costs and implementation challenges,respectively.Strategies to reduce UP-ICU admissions include improving triage systems,implementing evidence-based protocols for ICU patient management,and prioritizing prehospital intervention and stabilization to optimize the“golden hour”of trauma care.To improve patient outcomes and reduce the burden of UPICU admissions,further studies are required to validate and implement these strategies and refine machine learning models.
