Variation in Adolescent Idiopathic Scoliosis Surgery: Implications for Improving Healthcare Value. Please enable it to take advantage of the complete set of features! 1. This site needs JavaScript to work properly. 7-10 Berg and associates 11 compared 2 time periods (1993-1997 and 2001-2005) and found the overall rate of complications remained unchanged at 28.6%, but the prevalence of … (3)Division of Spine … Prolonged Length-of-stay (PLOS) is associated with increased mortality and other poor outcomes. Increased LOS during the index admission scoliosis surgery is associated with higher costs and an increased risk of 90-day postoperative complications. length of stay increasing by an average of 2.6 days (Emergency Care Intensive Support Team, 2010; Royal College of Physicians, 2012a; Alameda and Suárez, 2009). Increased length of stay; Increased cost of care; Risk of further complications; and; Pain and discomfort. Menger RP, Kalakoti P, Pugely AJ, Nanda A, Sin A. Neurosurg Focus. 2018 Apr;195:213-219.e3. Elective operations evaluated included thyroidectomy, hysterectomy, mastectomy, colectomy, cholecystectomy, amputations, fracture repairs, and total joint replacements, among others. This study investigates the effect of patient-related variables, in-hospital progress and complications on length of stay. There are limited data describing the association of length of stay (LOS) during the index admission with postoperative outcomes. Overall, investigators concluded that diabetes patients incurred greater rates of complications, had higher hospital costs, and had longer lengths of stay than non-diabetes patients following 11 major elective procedures, either common or uncommon.1 In light of these findings, Dr. Figaro stressed the importance of preoperative opportunities for health care professionals to control blood glucose levels more effectively in an effort to decrease elective surgical complications in diabetic patients. Use of this website is Dr. Figaro and colleagues determined that, out of the 13 evaluated elective procedures, results from 11 procedures showed increased cost per patient in the diabetes group. Workman JK, Wilkes J, Presson AP, Xu Y, Heflin JA, Smith JT. Complications of PTCA traditionally considered to be minor also increased length of stay significantly. For each patient, patient and case clinical characteristics, length of stay (LOS), and diagnosis of a nonneurologic complication (including reoperation and readmission) were abstracted. This increases their length of stay.1. J Infect Dis ... they were associated with a median length of stay longer than 6 … Patients with diabetes were more likely to have hypertension prior to surgery (72.7% vs 46.1%) and had more chronic conditions upon admission (mean of 7.6 vs 3.6 diagnoses). Patient and case clinical predictors of any of the reported complications and increased LOS were identified in multivariate logistic and Poisson regression analyses, respectively. length of stay increasing by an average of 2.6 days (Emergency Care Intensive Support Team, 2010; Royal College of Physicians, 2012a; Alameda and Suárez, 2009). Reducing hospital length of stay (LOS), especially as it relates to avoiding unnecessary hospital-acquired conditions (HACs), is a primary indicator of a hospital’s success in achieving these goals. doi: 10.1542/peds.2016-2574. Accelerated Discharge Protocol for Posterior Spinal Fusion Patients With Adolescent Idiopathic Scoliosis Decreases Hospital Postoperative Charges 22. ASPISAFE NG+ . Figaro MK, Jung K, Lim D, BeLue R. The impact of diabetes on length of stay and hospital costs after elective surgical procedures. J Arthroplasty, 2014. For the diabetes group, hospital length of stay (mean, 9.08 vs 4.76 days; p < 0.0001) and cost per patient ($19,547 vs $15,873; p < 0.0001) were also higher. 10. Increased LOS during the index admission scoliosis surgery is associated with higher costs and an increased risk of 90-day postoperative complications. An additional 1 day in the hospital was associated with $11 033 (95% CI=7162-14 904; P<0.001) in insurance charges, $5198 (95% CI=4144-6252; P<0.001) in hospital costs, 28% increased risk (odds ratio=1.28; 95% CI=1.01-1.63; P=0.041) of all-cause 90-day readmission, and a 57% increased risk (odds ratio=1.57; 95% CI=1.13-2.17; P=0.007) of returning to the operating room within 90 days. J Multidiscip Healthc. OBJECTIVETo determine whether a multidisciplinary mobility promotion quality‐improvement (QI) project would increase patient mobility and reduce hospital length of stay (LOS).PATIENTS AND METHODSImplemented using a structured QI model, the project took place between March 1, 2013 and March 1, 2014 on 2 general medicine units in a large academic medical center. Objectives We developed an outcome indicator based on the finding that complications often prolong the patient's hospital stay. J Pediatr. Among the 1286 patients with AIS who underwent spinal fusion, the mean LOS was 4.90 days [95% confidence interval (CI)=4.84-4.97; SD=1.19]. For each patient, patient and case clinical characteristics, length of stay (LOS), and diagnosis of a nonneurologic complication (including reoperation and readmission) were abstracted. After a C-section, you face a higher risk of potentially serious complications in a subsequent pregnancy than you would after a vaginal delivery. Get the latest research from NIH: https://www.nih.gov/coronavirus. Costs and complications of increased length of stay following adolescent idiopathic scoliosis surgery. Health Media & EndocrineWeb do not provide medical advice, diagnosis or treatment.  |  Plast Reconstr Surg. Level of Evidence: Level III, retrospective comparative study. This information is not designed to replace a physician's independent judgment about the appropriateness or Protocols to decrease LOS for this surgery have potential benefits to patients, hospitals, and insurers. Importantly, DMa patients who did not experience any postoperative complication experienced significantly higher rates of prolonged length of stay (23.0% vs. 11.8%, p<0.001), readmissions (10.0% vs. 5.2%, p<0.001), discharges to a facility (13.2% vs. 9.5%, p<0.001), and 30-day mortality (4.7% vs. 0.8%, p<0.001) compared to matched non-DMa patients. Setting We used data of 61 Dutch hospitals. (Farrell & Dempsey 2013) Tool: Wound Care Guide Wound Dehiscence Wound dehiscence is associated with mortality rates as high as 45%. The relationship between length of in-hospital stay (LOS) and quality of care is difficult. Association of Postoperative Complications with Hospital Costs and Length of Stay in a Tertiary Care Center Nadia A. Khan, MD, MSc,1 Hude Quan, MD, PhD,2 Jennifer M. Bugar MD,3 Jane B. Lemaire, MD,3 Rollin Brant, PhD,2 William A. Ghali, MD, MPH2,3 1Department of Medicine, University of British Columbia, BC, Canada; 2Department of Community Health Sciences, University of Calgary, Berry JG, Glotzbecker M, Rodean J, Leahy I, Hall M, Ferrari L. Pediatrics. Vorhies, J.S., et al., Decreased length of stay after TKA is not associated with increased readmission rates in a national Medicare sample. Patient and case clinical predictors of any of the reported complications and increased LOS were identified in multivariate logistic and Poisson regression analyses, respectively. 2017 Oct;43(4):E3. Hyperglycemia has been shown to be associated with increased mortality and morbidity and prolonged hospital stay in inpatients (1–4). There are limited data describing the association of length of stay (LOS) during the index admission with postoperative outcomes. Boylan MR(1), Riesgo AM(1), Chu A(1), Paulino CB(2), Feldman DS(1)(3). The American Association of Clinical Endocrinologists 21st Annual Scientific and Clinical Congress, Endocrine Physicians and Nurses Unaware of Testing Costs, Exercise in Prediabetic Patients Improves Vascular Reactivity to Normal Levels, Gastric Banding Beneficial in Obese Diabetic Patients, Integrated Team Program Improves Diabetes Outcomes, Lowers Drug Costs, Regional Differences Affect Thyroid Cancer Diagnosis, Virtual Endocrine Consultations Can Improve Outcomes for Patients in Rural Settings. USA.gov. Improving perioperative care for adolescent idiopathic scoliosis patients: the impact of a multidisciplinary care approach. We found that the hospital stay increased monotonically with the number of complications. 29(3): p. 510-5. In multivariable model, the length of stay in ED and severity score are independently associated with mortality outcome. We sought to define the economic and clinical implications of an additional 1 day in the hospital for scoliosis surgery. Comorbidities and Complications of Spinal Fusion for Scoliosis. HHS Clipboard, Search History, and several other advanced features are temporarily unavailable. Get the latest public health information from CDC: https://www.coronavirus.gov. We sought to define the economic and clinical implications of an add … Costs and Complications of Increased Length of Stay Following Adolescent Idiopathic Scoliosis Surgery J Pediatr Orthop B. conditional upon your acceptance of our user agreement. Spine (Phila Pa 1976). Vorhies, J.S., et al., Decreased length of stay after TKA is not associated with increased readmission rates in a national Medicare sample. 2017 Mar;139(3):e20162574. El Camino Hospital, a 395-bed multi-specialty community hospital in Mountain View, Calif., places a high priority on keeping patients safe. Failure to wean off of ventilator in 48 hours, urinary tract infection, and pneumonia were associated with length of stay outlier (odds ratios = 3.7, 2.7, and 2.7; all p < 0.001). Source/Disclosures Source: Dawood FS. doi: 10.1016/j.jpeds.2017.12.031. Adolescent idiopathic scoliosis: risk factors for complications and the effect of hospital volume on outcomes. This bias is plausible, since it is likely that the greater the severity of the complications (more hospitalization days) the more thoroughly they were registered. For a five-night stay, this increased to a 5.5 per cent chance of a drug reaction, a 17.6 per cent chance of a hospital-acquired infection and a 3.1 per cent chance of an ulcer. Congestive Heart Failure Predicts Major Complications and Increased Length of Stay in Lower Extremity Pedicled Flap Reconstruction. While the correlation between length of stay following elective surgical procedures and higher health care costs is not new, researchers from Vanderbilt University Medical Center in Nashville, Tennessee, concluded that diabetic patients undergoing such procedures have higher rates of complications due to the vascular conditions and risks of infections that often accompany diabetes. In general, complications are known to prolong LOS following cardiac surgery. There is a large body of evidence supporting the fact that prolonged hospitalizations are associated with increased risk for in-hospital complications including infections and deep venous thrombosis [1, 2].However, most of the published data deal with pre-specified populations and the prolonged hospital stay is considered as an outcome rather than a causative factor for complications … Across the board, results showed variations between the 2 patient cohorts. COVID-19 is an emerging, rapidly evolving situation. Presented at the American Association of Clinical Endocrinologists 21st Annual Scientific and Clinical Congress; May 23-27, 2012; Philadelphia, Pennsylvania:Abstract 232. Sanders AE, Andras LM, Sousa T, Kissinger C, Cucchiaro G, Skaggs DL. The Statewide Planning and Research Cooperative System database was used to identify patients with adolescent idiopathic scoliosis who underwent spinal fusion from 1 October 2007 to 30 September 2012 at high-volume institutions (>20 cases/year) in the state of New York. 2016 Sep 14;9:435-445. doi: 10.2147/JMDH.S95319. A higher percentage of patients with an unexpectedly long length of stay (UL-LOS) compared to the national average may indicate shortcomings in patient safety. 2019 Jan;28(1):27-31. doi: 10.1097/BPB.0000000000000543. Level of Evidence: Level III, retrospective comparative study. Increased risks during future pregnancies. eCollection 2016. J Arthroplasty, 2014. Similar biases have been demonstrated in the MBDS with the registration of comorbidity Major complications such as emergency bypass surgery increased the length of stay after PTCA by 7.8±1.0 days (P<.001), and myocardial infarction increased length of stay by 3.4±0.9 days (P<.001). Prolonged length of stay in ED is independently associated with increased risk of hospital mortality in patients with critical illness with sepsis. Prolonged Length-of-stay (PLOS) is associated with increased mortality and other poor outcomes. 9. Intra- and inter-hospital transfers of older people at night can also increase the risk of delirium and, as a result, increase length of stay (Royal College of Physicians, 2012b). Epub 2017 Feb 2. Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. In the perioperative period, 605 (47.05%) underwent transfusion and 202 (15.71%) had problems with pain control. Increased length of stay; Increased cost of care; Risk of further complications; and; Pain and discomfort. Additionally, these patients represent a significant economic problem on public health systems and their families. In one study 53.6% of the germs identified were gram-negative bacteria, 39.3% gram-positive bacteria, and 7.1% were fungi . OBJECTIVETo determine whether a multidisciplinary mobility promotion quality‐improvement (QI) project would increase patient mobility and reduce hospital length of stay (LOS).PATIENTS AND METHODSImplemented using a structured QI model, the project took place between March 1, 2013 and March 1, 2014 on 2 general medicine units in a large academic medical center. Summary of Background Data: Previous work has associated an increased incidence of complications and length of stay following surgery in patients with increased preoperative narcotic use. Other problems inherent in a study of this nature are associated with the limitations of the ICD9CM itself, and with the aspect of obtaining data retrospectively. Busl KM (1), Ouyang B, Boland TA, Pollandt S, Temes RE. Drug Demonstrates Sustained Efficacy for Weight Loss in Obese Patients, © 2020 Remedy Health Media, LLC ALL RIGHTS RESERVED. Remedy However, the degree to which extended LOS represents complications, patient illness, or inefficient practice style is unclear. We explored the utility of the UL-LOS indicator. In multivariable model, the length of stay in ED and severity score are independently associated with mortality outcome. Results. (2)Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, New York. 9. Good glycemic control has been shown to decrease length of stay (LOS) and …  |  Prolonged air leak may be associated with an increased complication rate and certainly may increase length of stay. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. LOS is determined by a complex interweaving network of multiple supply and demand factors which operate at macro-, meso-, and micro-levels. NIH Influenza complications increased length of hospital stay. Overall, investigators concluded that diabetes patients incurred greater rates of complications, had higher hospital costs, and had longer lengths of stay than non-diabetes patients following 11 major elective procedures, either common or uncommon.1 In light of these findings, Dr. Figaro stressed the importance of preoperative opportunities for health care professionals to control … Regression models were adjusted for age, sex, race, insurance, comorbidity score, and perioperative complications during the index admission. This study may be particularly affected if the complications were registered more often with increased length of the stay. Influenza complications increased length of hospital stay. doi: 10.3171/2017.6.FOCUS17300. 29(3): p. 510-5. This association has been established for several conditions including cardiac surgery, acute myocardial infarction, stroke, trauma, burns, pneumonia, and critical illness (5–10). Background Hospital length-of-Stay has been traditionally used as a surrogate to evaluate healthcare efficiency, as well as hospital resource utilization. NLM Endocrine Web is a Remedy Health Media, LLC web property. Intra- and inter-hospital transfers of older people at night can also increase the risk of delirium and, as a result, increase length of stay (Royal College of Physicians, 2012b). 2017 Jan 15;42(2):92-97. doi: 10.1097/BRS.0000000000001666. Prolonged mechanical ventilation is associated with pulmonary complications, increased length of stay, and unfavorable discharge destination among patients with subdural hematoma. For each patient, patient and case clinical characteristics, length of stay (LOS), and diagnosis of a nonneurologic complication (including reoperation and readmission) were abstracted. The number of high-risk pregnancies due to maternal comorbidities and complications has significantly increased, leading to an increased number of adverse maternal health outcomes postdelivery requiring increased length of stay. Consecutive patients undergoing conventional balloon angioplasty at nine medical centers in North America between February 1, 1992, and April 30, 1992, were prospectively enrolled in this study, which was denoted the Heparin Registry and performed as a pilot study for the Hirulog Angioplasty Study to id… BACKGROUND: Congestive heart failure affects 6.2 million people in the United States. All the eight bloodstream infections increased the length of stay in the ICU, with longer stays for the patients who eventually died (mean increase 0.7–6.0 days) compared with those who were discharged (mean increase: 0.4–3.1 days). Prolonged mechanical ventilation is associated with pulmonary complications, increased length of stay, and unfavorable discharge destination among patients with subdural hematoma. For example, new onset of atrial fibrillation, 25–27 renal dysfunction 28 and deep sternal wound infection 29 were associated with increased ICU and postoperative LOS. Significant differences in patients with diabetes versus those without were seen in mortality rate (1.42% vs 0.93%), myocardial infarction (1.6% vs 0.59%), pneumonia (2.88% vs 0.32%), and acute kidney injury (11.2% vs 2.53%) (p >0.0001 for all). Materials And … (Farrell & Dempsey 2013) Tool: Wound Care Guide Wound Dehiscence Wound dehiscence is associated with mortality rates as high as 45%. Always consult your doctor about your medical conditions. Additionally, these patients represent a significant economic problem on public health systems and their families. Lovald, S.T., et al., Complications, mortality, and costs for outpatient and short-stay total knee arthroplasty patients in comparison to standard-stay patients. Admissions for HF have increased over the last decade while length of stay has decreased; the reasons for this change in length of stay are uncertain. J Infect Dis ... they were associated with a median length of stay … risks of a procedure for a given patient. J Neurosurg Anesthesiol. Author information: (1)Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York. The objective of this study was to identify patient and hospital factors associated with prolonged length of stay (LOS) or complications during pediatric hospitalizations for asthma or lower respiratory infection (LRI). Patients inadvertently pull feeding tubes out, leading to complications such as malnutrition, increase length of stay, increased unnecessary sedation, restraints and nursing time with patient. Protocols to decrease LOS for this surgery have potential benefits to patients, hospitals, and insurers. This study may be particularly affected if the complications were registered more often with increased length of the stay. 10. Ensuring the delivery of appropriate care and treatment is crucial for quality of care; length of stay in hospital may be irrelevant to this process. They are responsible for increased hospital mortality to up to 19% as well as increased costs and length of hospital stay. 2015 Jan;27(1):31-6. doi: 10.1097/ANA.0000000000000085. Accelerated discharge protocols for scoliosis surgery have recently been described in the literature. Source/Disclosures Source: Dawood FS. Importance With the health policy focus on shifting risk to hospitals and physicians, hospital leaders are increasing efforts to reduce excessive resource use, such as patients with extended length of stay (LOS) after surgery. Lovald, S.T., et al., Complications, mortality, and costs for outpatient and short-stay total knee arthroplasty patients in comparison to standard-stay patients. Despite this and recent national attention highlighting the negative effects of narcotics, they remain commonly used for the management of pain in patients undergoing spine surgery. 2020; 146(6):790e-795e (ISSN: 1529-4242) Levy-Lambert D; Ramly EP; Kantar RS; Alfonso AR; Levine JP. Prolonged length of stay in ED is independently associated with increased risk of hospital mortality in patients with critical illness with sepsis.  |  M. Kathleen Figaro, MD, et al, evaluated data from the 2008 Healthcare Cost and Utilization Project Nationwide Inpatient Sample (29,589 patients with diabetes and 793,827 patients without diabetes), specifically looking at comorbidities and perioperative complications as they related to length of stay for diabetic patients in 13 procedures.

increased length of stay complications

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