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Burn injuries remain a significant cause of disability, impacting long term quality-of-life and imposing large costs on our health systems. Readmission is a metric of quality and an important contributor to this economic burden. The association of socioeconomic and insurance status with burn readmission is not well established. The aim of our study is to develop a predictive risk model of factors associated with readmission after burns. Using the Healthcare Cost and Utilization Project's 2018 Nationwide Readmission Database, we identified patients ≥18 y of age with burns admitted between January and October 2018. We excluded patients who died during index admission. Our primary outcome was readmission within 60 d postdischarge. We performed a Lasso regression analysis with adaptive selection to generate a predictive model with least deviance using patients' demographics and socioeconomic status, burn location and severity, past medical history, and hospital characteristics. Weighted multiple logistic regression was performed to obtain population estimates of adjusted odds ratios (ORs) of each element in the model. Our cohort included 11,380 burn patients. Of those, 1625 (14.3%) were readmitted and 67% were males. Readmitted patients were older (55 ± 17 versus 49 ± 18, P = 0.0001). Weighted logistic regression for the selected model showed higher odds of readmission for patients with lowest income quartile (OR: 1.19, 95% confidence interval [CI]: 1.04-1.36), Medicare or Medicaid insurance (OR: 1.35, 95% CI: 1.17-1.55), history of psychiatric illness (OR:1.19, 95% CI: 1.02-1.39), diabetes (OR: 1.46, 95% CI: 1.25-1.69), chronic kidney disease (OR: 1.66, 95% CI: 1.30-2.11), chronic obstructive pulmonary disease (OR: 1.55, 95% CI:1.26-1.89), and alcohol use disorder (OR: 1.33, 95% CI: 1.13-1.58). Third degree burns and foot burns had higher OR of readmission (OR: 1.21, 95% CI: 1.38-1.98 and 1.66, 95% CI: 1.02-1.45, respectively), while face and hand burns had lower OR of readmission (OR: 0.77, 95% CI: 0.66-0.90 and 0.84, 95% CI: 0.72-0.98, respectively). Burn readmissions are multifactorial and directly related to the patient's comorbidities, including markers that reflect barriers to care such as socioeconomic characteristics, as well as the anatomical location of burn injuries. Early identification of these high-risk patients may aid in early intervention, resource allocation, and outreach program development in an attempt to reduce readmission rates and improve outcomes. Future prospective validation of these risk factors is warranted. [ABSTRACT FROM AUTHOR]

Background Patient-reported outcome measures (PROMs) have gained traction in assessing patients' health around surgery. Among these, the 29-item Patient-Reported Outcomes Measurement Information System (PROMIS-29) is a widely accepted tool for evaluating overall health, yet its applicability in cranial neurosurgery remains uncertain. Objective This study aimed to evaluate the predictive value of preoperative PROMIS-29 scores for postoperative outcomes in patients undergoing brain tumor resection. Materials and Methods We identified adult patients undergoing brain tumor resection at a single neurosurgical center between January 2018 and December 2021. We analyzed physical health (PH) summary scores to determine optimal thresholds for predicting length of stay (LOS), discharge disposition (DD), and 30-day readmission. Bivariate analyses were conducted to examine the distribution of PH scores based on patient characteristics. Multivariate logistic regression models were employed to assess the association between preoperative PH scores and short-term postoperative outcomes. Results Among 157 patients (mean age 55.4 years, 58.0% female), 14.6% exhibited low PH summary scores. Additionally, 5.7% experienced prolonged LOS, 37.6% had nonroutine DDs, and 19.1% were readmitted within 30 days. Bivariate analyses indicated that patients with low PH summary scores, indicating poorer baseline PH, were more likely to have malignant tumors, nonelective admissions, and adverse outcomes. In multivariate analysis, low PH summary scores independently predicted increased odds of prolonged LOS (odds ratio [OR] = 6.09, p = 0.003), nonroutine DD (OR = 4.25, p = 0.020), and 30-day readmission (OR = 3.93, p = 0.020). Conclusion The PROMIS-29 PH summary score serves as a valuable predictor of short-term postoperative outcomes in brain tumor patients. Integrating this score into clinical practice can enhance the ability to anticipate meaningful postoperative results. [ABSTRACT FROM AUTHOR]

Objective: To determine whether the rates of readmissions and suicide vary in psychotic unipolar depression based on whether patients receive maintenance electroconvulsive therapy (M‐ECT) following the initial series of ECT, and to examine if there is an age‐dependent association. Methods: We used Swedish national registries to identify hospitalized patients with psychotic unipolar depression, treated 2008–2019 who received ECT during their hospital stay. The patients who received subsequent M‐ECT within 14 days after discharge were compared with those who did not. The primary composite outcome was time to readmission due to a psychiatric disorder, suicide attempt, or suicide within 2 years from discharge. Data were analyzed using Cox regression adjusted for previous psychiatric admissions, age, sex, comorbidity, and pharmacological treatment. We also conducted a within‐individual analysis using the sign‐test, with patients having ≥1 hospital episode followed by M‐ECT and ≥1 hospital episode without M‐ECT. Results: A total of 1873 patients were included, of which 130 received M‐ECT. There was no statistically significant group difference regarding the primary outcome in the whole sample. However, when stratified by age, there was a significant difference in favor of M‐ECT for patients >65 years (adjusted hazard ratio 0.55, 95% confidence interval 0.35–0.87). The within‐individual analysis, including 46 patients, significantly favored M‐ECT. Conclusion: M‐ECT was not associated with a differential risk of the composite of readmission and suicide in psychotic depression. Among patients >65 years, M‐ECT was significantly associated with a decreased risk of the outcome. The possibility of residual confounding cannot be excluded. [ABSTRACT FROM AUTHOR]

Objective: To identify risk factors for readmission following methotrexate treatment for tubal pregnancy. Methods: A retrospective study undertaken in two tertiary medical centers, including all individuals with medically treated tubal pregnancy (N = 511), between December 2009 and June 2021. Individuals with and without readmission following methotrexate treatment were compared. The primary outcome was the readmission rate. Secondary outcomes included the rate of post‐discharge gynecological emergency department visits, tubal rupture rate, and the eventual need for surgical treatment. Results: Readmission following methotrexate treatment occurred in 224/511 patients (43.8%). Most readmissions were due to abdominal pain or suspicion of treatment failure. Readmitted individuals were more likely to have a history of pelvic inflammatory disease and pretreatment serum human chorionic gonadotropin (hCG) >2000 mIU/mL. Both factors remained significantly associated with higher readmission rates in a logistic regression analysis (adjusted odds ratio [OR] 6.28, 95% confidence interval [CI] 1.30–30.45, and adjusted OR 2.73, 95% CI 1.83–4.07, respectively) after adjustment for age, endometriosis, tubal pathology, abdominal pain, and presence of yolk sac or embryo at diagnosis. A dose‐dependent association was observed between pretreatment serum hCG levels and readmission rate (P < 0.001). Pretreatment hCG levels were also associated with tubal rupture and the eventual need for surgical treatment (P < 0.001 for both). A prediction model using hCG was not sufficiently accurate to predict readmission risk. Conclusion: Readmission following methotrexate treatment for tubal pregnancy was independently associated with previous pelvic inflammatory disease and pretreatment serum hCG levels. The latter was also associated with surgical intervention rate. Synopsis: Readmission following methotrexate treatment for tubal pregnancy was associated with previous PID and pretreatment hCG levels. The latter was also associated with surgical intervention rate. [ABSTRACT FROM AUTHOR]

Revision total hip arthroplasty (THA) and total knee arthroplasty (TKA) tremendously burden hospital resources. This study evaluated factors influencing perioperative costs, including emergency department (ED) visits, readmissions, and total costs-of-care within 90 days following revision surgery. A retrospective analysis of 772 revision TKAs and THAs performed on 630 subjects at a single center between January 2007 and December 2019 was conducted. Cost data were available from January 2015 to December 2019 for 277 patients. Factors examined included comorbidities, demographic information, preoperative Anesthesia Society of Anesthesiologists score, implant selection, and operative indication using mixed-effects linear regression models. Among 772 revisions (425 THAs and 347 TKAs), 213 patients required an ED visit, and 90 required hospital readmission within 90 days. There were 22.6% of patients who underwent a second procedure after their initial revision. Liver disease was a significant predictor of ED readmission for THA patients (multivariable odds ratio [OR]: 3.473, P =.001), while aseptic loosening, osteolysis, or instability significantly reduced the odds of readmission for TKA patients (OR: 0.368, P =.014). In terms of ED visits, liver disease increased the odds for THA patients (OR: 1.845, P =.100), and aseptic loosening, osteolysis, or instability decreased the odds for TKA patients (OR: 0.223, P <.001). Increased age was associated with increased costs in both THA and TKA patients, with significant cost factors including congestive heart failure for TKA patients (OR: $7,308.17, P =.004) and kidney disease for THA patients. Revision surgeries took longer than primary ones, with TKA averaging 3.0 hours (1.6 times longer) and THA 2.8 hours (1.5 times longer). Liver disease increases ED readmission risk in revision THA, while aseptic loosening, osteolysis, or instability decreases it in revision TKA. Increased age and congestive heart failure are associated with increased costs. These findings inform postoperative care and resource allocation in revision arthroplasty. Economic and Decision Analysis, Level IV. [ABSTRACT FROM AUTHOR]

Background: Heart failure (HF) is a complex problem characterized by frequent hospitalizations and high 30-day readmission rates. Researchers studying HF readmission report that patients and clinicians have different perspectives on readmission and preventability when unadjusted for disease severity. Objective: The aim of this study was to gather patient, caregiver, nurse, and physician subjective reason(s) for 30-day HF readmission and perceptions of preventability with contextual factors to evaluate differences. Methods: A convergent, parallel, mixed-methods design was used with interviews and chart reviews to evaluate contextual factors from the current and index hospital stay. Adults readmitted within 30 days of a previous inpatient stay with a coded HF diagnosis were enrolled and interviewed, followed by interviews with associated caregivers, attending physicians, and assigned nurses. Results: Interviews were conducted with patients (n = 44), caregivers (n = 6), physicians (n = 24), and nurses (n = 44). Readmissions were emergent/urgent (95%) and occurred within 14.9 days (SD, 8.1; 2-28 days) on average after discharge. Index stay coding revealed that most patients (73%) had a high severity of illness (73%) and risk of mortality (68%). Heart failure stage was inconsistently documented. Patients reported acute symptomatic reasons, with only 32% describing readmission as preventable. Physicians reported diagnostic reasons, 38% of which were preventable. Nurses reported behavioral reasons, with 59% being preventable. Patient/clinician agreement on readmission reason was low(30%). Conclusions: Patient/clinician perspectives on readmission varied among the patients with complex HF. Care planning based on HF stage and other contextual factors is needed to ensure a shared understanding of disease severity and a tailored symptom management approach to prevent readmission. [ABSTRACT FROM AUTHOR]

With increasing survivorship following cerebrovascular accidents (CVAs), more patients with a history of CVA are undergoing total shoulder arthroplasty (TSA). The purpose of this study is to determine the impact of prior CVA on the perioperative outcomes following TSA. The Nationwide Readmissions Database was queried from 2010 to 2019 to identify all patients with a history of CVA undergoing TSA. Eight hundred seventeen cases were identified and case matched on a 1:2 ratio for age, sex, obesity status, and year of procedure. Patient demographic characteristics were collected and analyzed for differences between the 2 groups. Data on length of stay, 180-day complications, 180-day readmissions, and 180-day mortality were collected and analyzed for differences between the 2 groups. Eight hundred seventeen cases of patients with a history of CVA were matched with 1634 patients without a history of CVA undergoing TSA. The average age was 71. Fifty six percent of patients were female, and 23% of patients were obese. Patients with CVA had higher incidence of tobacco use (P <.001), deficiency anemia (P <.001), electrolyte disorders (P <.001), paralysis (P <.001), coagulopathy (P <.001), heart valve disorders (P <.001), history of myocardial infarction (P <.001), and higher rates of chronic diseases, such as hypertension (P <.001), diabetes (P <.001), liver disease (P <.001), congestive heart failure (P <.001), renal failure (P <.001), and peripheral vascular disease (P <.001). Patients with a history of CVA had higher rates of complications, readmissions, and revisions within 180 days (P <.001). One hundred eighty–day mortality was similar between the 2 groups. The average length of stay was 3.2 days in patients with a history of CVA compared to 1.4 days in those without a history of CVA (P <.001). Patients with a history of CVA have a higher rate of medical comorbidities than those without. These patients have higher rates of complications within 180 days of procedure, 180-day readmissions, and 180-day revisions. One hundred eighty–day mortality was similar between the 2 groups. Surgeons should take care to ensure thorough preoperative optimization and risk discussions to try and minimize postoperative adverse outcomes. [ABSTRACT FROM AUTHOR]

To develop and externally validate a prognostic model built on important factors predisposing multimorbid patients to all-cause readmission and/or death. In addition to identify patients who may benefit most from a comprehensive clinical pharmacist intervention. A multivariable prognostic model was developed based on data from a randomised controlled trial investigating the effect of pharmacist-led medicines management on readmission rate in multimorbid, hospitalised patients. The derivation set comprised 386 patients randomised in a 1:1 manner to the intervention group, i.e. with a pharmacist included in their multidisciplinary treatment team, or the control group receiving standard care at the ward. External validation of the model was performed using data from an independent cohort, in which 100 patients were randomised to the same intervention, or standard care. The setting was an internal medicines ward at a university hospital in Norway. The number of patients who were readmitted or had died within 18 months after discharge was 297 (76.9 %) in the derivation set, i.e. the randomized controlled trial, and 69 (71.1 %) in the validation set, i.e. the independent cohort. Charlson comorbidity index (CCI; low, moderate or high), previous hospital admissions within the previous six months and heart failure were the strongest prognostic factors and were included in the final model. The efficacy of the pharmaceutical intervention did not prove significant in the model. A prognostic index (PI) was constructed to estimate the hazard of readmission or death (low, intermediate or high-risk groups). Overall, the external validation replicated the result. We were unable to identify a subgroup of the multimorbid patients with better efficacy of the intervention. A prognostic model including CCI, previous admissions and heart failure can be used to obtain valid estimates of risk of readmission and death in patients with multimorbidity. • A prognostic risk model for readmission/death in multimorbid patients was developed. • Prognostic factors: Charlson comorbidity index, heart failure and previous admission. • A subgroup with better efficacy of the intervention could not be identified. [ABSTRACT FROM AUTHOR]

Acute diarrhea represents a major public health issue, and the management of adult patients admitted to the emergency department (ED) for this problem is still challenging. In a retrospective analysis on more than 20,000 patients visiting a tertiary ED for acute diarrhea and then being discharged home, we found that age > 65 years, onset of symptoms > 24 h since ED admission, refusal of hospitalization, and a history of chronic renal and liver diseases were independently associated with ED readmission for abdominal symptoms within 7 days. In the younger group, the presence of comorbidities significantly impacted on ED readmission, while fever and alteration of serum creatinine were the main determinants in the older group. Antibiotics were prescribed in about 25% of patients, although diarrhea etiology (viral or bacterial) was usually not available. According to international guidelines, fluoroquinolones were the most prescribed class, showing an inverse correlation to ED readmission. However, β-lactams and probiotics were also commonly prescribed; the latter were independently correlated to ED readmission in the elderly group. A comprehensive, guideline-based approach, including a detailed clinical history and laboratory and comorbidity assessment, should be encouraged to support physicians in the management of different age subgroups of adults admitted to the ED for acute diarrhea. [ABSTRACT FROM AUTHOR]

Tonsillectomy is a common surgical procedure but carries a high risk of readmission for secondary bleeding and pain. This study evaluated the feasibility and effectiveness of using the hemostatic self-assembling peptide hydrogel RADA16 (PuraBond, 3-D Matrix SAS; Caluire et Cuire, France) to control bleeding from the tonsillectomy wound bed. Readmission/re-operation rates were compared between a prospective case series of 21 primarily adult tonsillectomy patients treated with topical RADA16 and an untreated historical Control group of 164 patients who underwent tonsillectomy by 10 surgeons at a single tertiary hospital in the UK between March 2019 and June 2022. Cumulative readmission rates for any reason were 2-fold elevated in Control subjects (18.9%; n = 31/164 subjects) compared to patients treated intra-operatively with RADA16 hemostatic hydrogel (9.5%; n = 2/21) (p = 0.378). Readmission rates for postoperative bleeding were 3-fold higher in Controls (14.6%; n = 24/164 subjects) than in the RADA16-treated group (4.8%; n = 1/21) (p = 0.317). A similar rate of retreatment for pain was recorded in the Control (4.3%; n = 7/164) and RADA16 (4.8%; n = 1/21) groups (p = 0.999). Two Control subjects (1.2%) required re-operation for recalcitrant bleeding; no RADA16 subject (0.0%) required re-operation for any reason. No device-related adverse events occurred in the RADA16 group. Surgeons were pleased with the easy learning curve and technical feasibility associated with intra-operatively administering RADA16 hemostatic hydrogel. Intra-operative hemostasis using RADA16 peptide hydrogel was straightforward and was associated with a trend of 3-fold lower rates of readmission for postoperative bleeding events than untreated Control subjects. [ABSTRACT FROM AUTHOR]

Introduction: Mortality benefit of digoxin prescription in patients suffering from heart failure has been questioned many time. We evaluated these effects among admitted symptomatic heart failure patients. Methods: We retrospectively divided our patients into two groups: group A (n=205) were digoxin prescribed, and group B (n=96) were digoxin naïve patients. Both groups' medical records were gathered for one year, and the study endpoints were compared between the two groups. Results: The mean age was 62.3±12.1 years and 54.8 % were male. All-cause mortality and readmission occurred in 26.7% and 31.7% of individuals, respectively, without significant differences between the two groups. However, in subgroup analysis, there was a significant relationship between in-hospital mortality and the presence of cardiovascular risk factors. Conclusion: Digoxin might increase in-hospital mortality in patients with underlying cardiovascular risk factors. [ABSTRACT FROM AUTHOR]

Hospital readmissions among older adults pose a significant risk to society. Continued interprofessional efforts are needed to identify older adults at risk for readmission to improve patient health outcomes after hospitalization. This study investigated the factors associated with 30-day hospital readmissions among older adults. Method: This study used secondary data analysis from individual patient electronic health records, covering all the admissions data of older adults within one year (January 1 - December 31, 2022) at one general hospital in Pekalongan, Central Java, Indonesia. The study comprised a sample of 930 older adult patients, of which 48 (5.2%) experienced 30-day readmissions, while 882 (94.8%) did not. Binary logistic regression was used to test the relationship between independent variables and dependent variable in bivariate and multivariate analysis. Results: The prevalence of 30-day readmission among older adults was 5.2%. More than half of the 30-day readmissions occurred in males, and married older adults. The average length of hospitalization at initial admission was 3.44 + 2.377 days. The top three main medical diagnoses at initial admissions were cataracts (22.9%), cardiovascular diseases (16.7%), and renal diseases (14.6%). Based on multivariate analysis, the factors significantly associated with 30-day readmission were marital status (AOR: 3.161, 95% CI = 1.577 - 6.337) and kidney disease-related diagnosis (AOR: 4.090, 95% CI = 1.664 - 10.052). Conclusion: Kidney diseases may play a crucial role in screening for 30-day readmission risk. The hospital should evaluate the care process of patients with kidney disease, to reduce the number of preventable readmissions. Furthermore, the presence of a primary caregiver for older adults should be part of discharge planning in the hospital. [ABSTRACT FROM AUTHOR]

Introduction: The choice between simultaneous and staged bilateral total knee arthroplasty (BTKA) remains controversial. Age-adjusted Charlson Comorbidity Index(CCI) is a promising tool for risk-stratification. We aimed to compare the outcomes between patients who underwent simultaneous and staged BTKA, stratified by age-adjusted CCI scores. Materials and methods: We conducted this retrospective, single-surgeon case series from 2010 to 2020. This study consisted of 1558 simultaneous BTKA and 786 staged BTKA procedures. The outcome domains included 30-day and 90-day readmission and 1-year reoperation events. We performed multivariate regression analysis to compare the risk of readmission and reoperation following simultaneous and staged BTKA. Other factors included age, sex, body mass index, diabetes mellitus, rheumatoid arthritis, smoking, receiving thromboprophylaxis and blood transfusion. Results: The rates of 30-day, 90-day readmission and 1-year reoperation following simultaneous BTKA was 1.99%, 2.70% and 0.71%, respectively. The rates of 30-day, 90-day readmission and 1-year reoperation following staged BTKA was 0.89%, 1.78% and 0.89%, respectively. For patients with age-adjusted CCI ≥ 4 points, simultaneous BTKA was associated with a higher risk of 30-day (aOR:3.369, 95% CI:0.990-11.466) and 90-day readmission (aOR:2.310, 95% CI:0.942–5.668). In patients with age-adjusted CCI ≤ 3 points, the risk of readmission and reoperation was not different between simultaneous or staged BTKA. Conclusion: Simultaneous BTKA was associated with an increased risk of short-term readmissions in patients with age-adjusted CCI ≥ 4 points but not in those with age-adjusted CCI ≤ 3 points. Age-adjusted CCI can be an effective index for the choice between simultaneous and staged BTKA procedures. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to determine the rates of compartment syndrome and other early complications following outpatient open reduction and internal fixation (ORIF) of tibial plateau fractures. Methods: This was a retrospective cohort at a single US level I academic trauma centre of patients with tibial plateau fractures managed operatively. Inpatients received their definitive ORIF during their index hospital stay and were admitted post-operatively following ORIF. Outpatients were scheduled for ambulatory surgery during definitive ORIF. Exclusion criteria for outpatient surgery included compartment syndrome, polytrauma, open types IIIb/IIIc, and patients who received any internal fixation during index presentation. The primary outcome measure was post-operative compartment syndrome. Secondary outcomes were return to the 90-day return to the ED, 90-day readmission, surgical wound infection, thromboembolism, and 90-day mortality. An intention-to-treat (ITT) and as-treated (AT) analyses were performed. Results: Totally, 71 inpatients and 47 outpatients were included. There were no cases of post-operative compartment syndrome. In the ITT analysis, there were no differences for inpatients vs outpatients for 90-day re-admission (22.5% vs 12.8%, p = 0.275), 90-day return to the ED (35.2% vs 17.0%, p = 0.052), infection (12.7% vs 2.1%, p = 0.094), DVT (7% vs 4.3%, p = 0.819), or PE 1.4% vs 0.0%, p = 1.000). The AT analysis showed a significantly higher 90-day re-admission (26.9% vs 2.5%, p = 0.003) and 90-day ED visit (38.5% vs 7.5%, p = 0.001) rate in the inpatient group. Conclusions: Appropriately selected patients with isolated tibial plateau fractures can have non-inferior rates of compartment syndrome and post-operative complications when compared to inpatients. [ABSTRACT FROM AUTHOR]

Currently, high hospital readmission rates have become a problem for mental health services, because it is directly associated with the quality of patient care. The development of predictive models with machine learning algorithms allows the assessment of readmission risk in hospitals. The main objective of this paper is to predict the readmission risk of patients with schizophrenia in a region of Spain, using machine learning algorithms. In this study, we used a dataset with 6089 electronic admission records corresponding to 3065 patients with schizophrenia disorders. Data were collected in the period 2005–2015 from acute units of 11 public hospitals in a Spain region. The Random Forest classifier obtained the best results in predicting the readmission risk, in the metrics accuracy = 0.817, recall = 0.887, F1-score = 0.877, and AUC = 0.879. This paper shows the algorithm with highest accuracy value and determines the factors associated with readmission risk of patients with schizophrenia in this population. It also shows that the development of predictive models with a machine learning approach can help improve patient care quality and develop preventive treatments. [ABSTRACT FROM AUTHOR]

Background: A significant number of young individuals are readmitted one or more times shortly after their first episode of psychosis. Readmission may represent a marker of psychopathological vulnerability. Our primary aim was to evaluate the impact of clinical and socio-demographic variables on readmission at 12-month follow-up. Secondly, our goal was to determine whether the use of Long-Acting Injection (LAI) antipsychotics provides notable benefits compared to oral medications in preventing subsequent readmissions. Subjects and methods: 80 patients hospitalised for the first time with a diagnosis of psychotic disorder (ICD-10 criteria) were retrospectively assessed through clinical records. The mean age was 21.7 years. Patients were predominantly male (n = 62, 77.5%), and 55 subjects had at least 8 years of education. 50% of the sample was "NEET" (not in education, employment, or training). Results: 35 patients (43.8%) were discharged with a LAI antipsychotic, while 45 (56.2%) recieved oral antipsychotic therapy. Substance use (p = 0.04) and oral antipsychotics at discharge (p = 0.003) were significantly associated with readmission at 1 year. We did not find any significant predictors of being discharged with LAI therapy. Conclusion: Our findings underlined the importance of identifying patients at risk of readmission in order to prevent future rehospitalization and promote appropriate prevention strategies. LAIs should be considered as a first-choice treatment for patients hospitalised for FEP since they proved to be effective in preventing relapse. [ABSTRACT FROM AUTHOR]

Summary: Background: Understanding how patients' frailty and the physiological stress of surgical procedures affect postoperative outcomes may inform risk stratification of older patients undergoing surgery. The objective of the study was to examine the association of peri‐operative frailty with mortality, 30‐day readmission and days at home after non‐cardiac surgical procedures of different physiological stress. Methods: This retrospective study used Medicare claims data from a 7.125% random sample of Medicare fee‐for‐service beneficiaries from 2015 to 2019 who were aged ≥ 65 years and underwent non‐cardiac surgical procedure listed in the Operative Stress Score categories. The exposure of the study was claims‐based frailty index (robust, < 0.15; pre‐frail, 0.15 to < 0.25; mildly frail, 0.25 to < 0.35; and moderate‐to‐severely frail, ≥ 0.35) with Operative Stress Score categories being 1, very low stress to 5, very high stress. The primary outcome was all‐cause mortality at 30 days and 365 days after the surgical procedure. Results: In total, 1,019,938 patients (mean (SD) age of 76.1 (7.3) years; 52.3% female; 16.8% frail) were included. The cumulative incidence of mortality generally increased with Operative Stress Score category, ranging from 5.0% (Operative Stress Score 2) to 24.9% (Operative Stress Score 4) at 365 days. Within each category, increasing frailty was associated with mortality at 30 days (hazard ratio comparing moderate‐to‐severe frailty vs. robust ranged from 1.59–3.91) and at 365 days (hazard ratio 1.30–4.04). The variation in postoperative outcomes by patients' frailty level was much greater than the variation by the operative stress category. Conclusions: These results emphasise routine frailty screening before major and minor non‐cardiac procedures and the need for greater clinician awareness of postoperative outcomes beyond 30 days in shared decision‐making with older adults with frailty. [ABSTRACT FROM AUTHOR]

Background: Health‐related quality of life (HRQoL) is a multidimensional concept used to examine the impact of patient‐perceived health status on quality of life. Patients' perception of illness affects outcomes in both medical and elective surgical patients; however, not much is known about how HRQoL effects outcomes in the emergency surgical setting. This study aimed to examine if patient‐reported HRQoL was a predictor of unplanned readmission after emergency laparotomy. Methods: This study included 215 patients who underwent emergency laparotomy at the Copenhagen University Hospital, Herlev, between August 1, 2021, and July 31, 2022. Patient‐reported HRQoL was assessed with the EuroQol group EQ5D index (EQ5D5L descriptive system and EQ‐VAS). The population was followed from 0 to 180 days after discharge, and readmissions and days alive and out of hospital were registered. A Cox proportional hazard model was used to examine HRQoL and the risk of readmission within 30 and 180 days. Results: Within 30 days, 28.4% of patients were readmitted; within 180 days, the number accumulated to 45.1%. Low self‐evaluated HRQoL predicted 180‐day readmission and was significantly associated with fewer days out of hospital within both 90 and 180 days. Low HRQoL and discharge with rehabilitation were independent risk factors for short‐ (30‐day) and long‐term (180‐day) emergency readmission. Conclusion: Patient‐perceived quality of life is an independent predictor of 180‐day readmission, and the number of days out of hospital was correlated to self‐reported HRQoL. [ABSTRACT FROM AUTHOR]

Background: Previous research into outcomes after treatment in medium secure psychiatric hospitals has mostly relied on pre‐millennium data. Aims: To examine patient and inpatient service‐related factors associated with readmission within 2 years following discharge to the community or open conditions from conditions of medium security. Methods: A retrospective cohort study of 137 patients discharged either to the community or to open conditions from one 64‐bed South Wales Regional Medium Secure Hospital Unit between July 1999 and November 2017 was completed using data from healthcare records to document demographics, diagnosis and nature of index offences together with researcher‐completed ratings of inpatient progress using the Dangerousness Understanding Recovery and Urgency Manual (DUNDRUM) Programme Completion and DUNDRUM Recovery scales. Binary logistic regression analyses were used to identify independent associations between inpatient progress according to these measures and readmission. Results: Forty‐three patients (31%) were readmitted within 2 years of discharge and 23 (17%) in breach of legal conditions on discharge. Most readmitted patients (n = 29, 67%) returned directly to medium secure care. There were significant binary level associations between readmission and severity of the index offences (lower), number of adverse childhood experiences (higher), history of drug misuse (more likely) and number of previous psychiatric admissions (higher). Binary logistic regression confirmed that these relationships were not independent. No inpatient service‐related variables, according to DUNDRUM scale scores, showed an independent association with readmission within 2 years post‐discharge. Conclusions: The proportion of medium security hospital patients who were readmitted within 2 years of discharge aligns with estimates found in earlier national research using the same follow‐up period. Since levels of inpatient progress bore little if any relationship to longer term outcomes, our findings highlight the need for investigating factors in the discharge environment that are linked to readmission. It is possible that readmission may indicate effective monitoring and responsive care to the changing needs of patients, but a better understanding of this is essential. [ABSTRACT FROM AUTHOR]

General surgery procedures place stress on geriatric patients, and postdischarge care options should be evaluated. We compared the association of discharge to a skilled nursing facility (SNF) versus home on patient readmission. We retrospectively reviewed the Nationwide Readmission Database (2016-2019) and included patients ≥65 y who underwent a general surgery procedure between January and September. Our primary outcome was 30-d readmissions. Our secondary outcome was predictors of readmission after discharge to an SNF. We performed a 1:1 propensity-matched analysis adjusting for patient demographics and hospital course to compare patients discharged to an SNF with patients discharged home. We performed a sensitivity analysis on patients undergoing emergency procedures and a stepwise regression to identify predictors of readmission. Among 140,056 included patients, 33,916 (24.2%) were discharged to an SNF. In the matched population of 19,763 pairs, 30-d readmission was higher in patients discharged to an SNF. The most common diagnosis at readmission was sepsis, and a greater proportion of patients discharged to an SNF were readmitted for sepsis. In the sensitivity analysis, emergency surgery patients discharged to an SNF had higher 30-d readmission. Higher illness severity during the index admission and living in a small or fringe county of a large metropolitan area were among the predictors of readmission in patients discharged to an SNF, while high household income was protective. Discharge to an SNF compared to patients discharged home was associated with a higher readmission. Future studies need to identify the patient and facility factors responsible for this disparity. [ABSTRACT FROM AUTHOR]

Background: Caring for patients after a neurovascular incident is common for advanced practice registered nurses (APRNs). Most neurological readmission studies focus on a small subset of neurovascular incident groups, but advanced practice nurses in primary care attend to a diverse neurovascular population and lack time to adequately search hospital records. Purpose: The aim of this study was to determine readmission risk factors after a neurovascular incident to guide APRNs in the primary care setting. Methodology: The study is a retrospective observational study that used a crude single predictor model to determine potential risks for readmission. Results: A total of 876 neurovascular participants were studied. Of these, only 317 experienced at least one hospital readmission, with 703 readmissions within 1 year, indicating some were readmitted more than once. Risks for readmission varied across neurovascular events. The main reasons for readmission were because of neurological, cardiovascular, and musculoskeletal complications. Conclusions: Stroke readmission rates are high and require intervention by APRNs. To prevent readmission includes timely follow-up within 30 days and should also include longitudinal follow-up beyond 90 days to prevent hospital readmission. Implications: Future studies are needed to create guidelines for APRNs that implement rehabilitation strategies to decrease hospital readmission for the neurovascular population that focus on interdisciplinary communication. [ABSTRACT FROM AUTHOR]

Background: Repair of an umbilical hernia is most often considered the less important condition when concomitant with other abdominal surgery. Despite this, the evidence for a concomitant umbilical hernia repair is sparse. The aim of this nationwide cohort study is to compare the short- and long-term outcomes of primary umbilical hernia repair and umbilical hernia repair concomitant with other abdominal surgery. Method: Data from the Danish Hernia Database and the National Patients Registry from January 2007 to December 2018 was merged, resulting in identification of patients receiving umbilical hernia concomitant to another abdominal surgery (laparoscopic inguinal hernia repair, laparoscopic cholecystectomy, and laparoscopic appendectomy). This group was propensity score matched with patients undergoing umbilical hernia repair as a primary procedure. Outcome data included 90-day readmission, 90-day reoperation, and operation for recurrence. Results: A total of 3365 primary umbilical hernia repairs and 2418 umbilical hernia repairs concomitant to other abdominal surgery were included. Readmission (10.5%, 255/2418) and reoperation (3.8%, 93/2418) rates within 90 days were decreased for umbilical hernia repairs concomitant to other abdominal surgery, compared with primary umbilical hernia repairs (22.7%, 765/3365) and (10.5%, 255/3365), P < 0.001 and P < 0.001, respectively. The rate of operation for recurrence was significantly increased for primary repairs (4.2%, 141/3365), compared with repairs concomitant to other abdominal surgery (3.2%, 77/2418), P = 0.014. Conclusion: Outcome in umbilical hernia repair performed concomitant to laparoscopic inguinal hernia repair, elective or emergency laparoscopic cholecystectomy, or laparoscopic appendectomy is comparable to umbilical hernia repair without concomitant surgery. [ABSTRACT FROM AUTHOR]

Background: Approximately 50% of patients with congenital scoliosis will require surgical treatment to prevent further progression. Outcomes following congenital scoliosis are sparse in the literature. The purpose of this study was to identify independent risk factors associated with unplanned readmission and prolonged length of stay (LOS) in patients undergoing primary surgical treatment for congenital scoliosis. Methods: The National Surgical Quality Improvement Database-Pediatric was queried for database years 2016–2018 to identify patients with congenital scoliosis who underwent primary posterior fusion of the spine. Patient demographics, comorbidities, and operative variables, such as the number of levels fused and the American Society of Anesthesiologists (ASA) classificaiton, were collected. Univariate and multivariate analyses of patient factors were performed to test for association with readmission within 30 days and prolonged LOS (>4 days). Results: Eight hundred sixteen patients were identified. The average age was 11.3 ± 4.02 years, and the mean postoperative LOS was 4.64 ± 3.71 days. Forty-three patients (5.40%) were readmitted, and 73 patients (8.96%) had prolonged LOS. Independent risk factors associated with prolonged LOS included chronic lung disease (P < 0.001), presence of a tracheostomy (P < 0.001), structural central nervous system abnormality (P = 0.039), oxygen support (P < 0.001), and number of levels fused (P = 0.008). The factors independently associated with unplanned readmission were fusion to the pelvis (P = 0.004) and LOS >4 days (P = 0.008). Conclusions: Prolonged LOS and readmission are widely being used as quality and performance metrics for hospitals. Congenital scoliosis, which often progresses rapidly resulting in significant deformity, frequently requires surgery at an earlier age than idiopathic and neuromuscular deformity. Nevertheless, 30-day outcomes for surgical intervention have not been thoroughly studied. The present study identifies risk factors for prolonged LOS and readmission, which can facilitate preoperative planning, patient/family counseling, and postoperative care. Clinical Relevance: Congenital scoliosis management poses certain challenges that may be mitigated by understanding the risk factors for adverse outcomes following primary fusion surgery. [ABSTRACT FROM AUTHOR]

Same-day discharge (SDD) after total joint arthroplasty (TJA) is safe and cost effective. However, benefits may be offset by the potential cost of emergency department (ED) visits and readmissions. We identified risk factors for return to the ED and readmission in patients who underwent SDD and inpatient (IP) stays after TJA. We performed a retrospective review of patients who underwent primary TJA at an academic institution over the course of one year. There were 1,708 consecutive TJAs (721 THA [total hip arthroplasty] and 987 TKA [total knee arthroplasty]) included. A SDD occurred after 1,199 (70%) TJAs, 523 THAs, and 676 TKAs. We compared the demographics and comorbidities of patients who have SDD or IP who stayed following TJA. We documented rates of return to the ED or readmission within 90 days of surgery. Cohorts were compared using the Student's t -test or Chi -square test. Significant findings were those with P value <.05. The SDD cohort had a significantly higher rate of young, non-White men who had a lower body mass index and fewer comorbidities than the IP cohort. Rates of return to ED and readmission were similar between SDD and IP cohorts after TJA and similar between THA and TKA. Factors that significantly influenced return to ED included a higher American Society of Anaesthesiologists score (SDD, IP), a higher Charlson Comorbidity Index score (SDD, IP), a lower body mass index (IP), and a psychological diagnosis (SDD, IP). Factors that significantly influenced readmission rates included a higher American Society of Anaesthesiologists score (SDD), older age (SDD), and psychological diagnosis (SDD, IP). Patients who discharged the same day after primary TJA have similar rates of return to the ED and readmission as those admitted as an IP. Patients who had a psychological diagnosis, and particularly a diagnosis of depression, are at higher risk for return to the ED and readmission after primary TJA, regardless of discharge the same-day or IP admission. Improved measures that attempt to further treat and optimize this patient population could reduce unnecessary postoperative ED visits. [ABSTRACT FROM AUTHOR]

Tracheostomized children have higher mortality compared to adults due to smaller airway anatomy and greater medical complexity and are at high risk for life-threatening complications. Following new tracheostomy placement, caregivers are required to successfully complete extensive training before discharge home. Training for tracheostomy emergencies such as tube obstruction and accidental decannulation is challenging without real-life, hands-on experience, but simulation training has shown promising effects on improving caregiver knowledge and comfort in preparing for emergency situations. Readmissions and emergency department visits are common following discharge, with many due to respiratory illness. Inhaled antibiotics are frequently prescribed to treat bacterial respiratory infection. However, guidelines for standardized management of tracheostomy-related respiratory illness are not available. Although standardized decannulation protocols are utilized, evidence-based guidelines are lacking, and the role of routine polysomnogram prior to decannulation is unresolved. Several knowledge gaps in management of pediatric tracheostomy present the opportunity for future research to improve patient outcomes. [ABSTRACT FROM AUTHOR]

Aims: The predictive value of the lactate/albumin ratio (LAR) in mortality is established in various conditions, yet its relevance to 3‐month readmission risk in Chinese adults with heart failure (HF) remains unclear. Method and results: Analysing data from 957 patients with HF at Zigong Fourth People's Hospital, Sichuan, China (December 2016 to June 2019), we assessed baseline characteristics, vital signs, comorbidities, and prescriptions. LAR demonstrated a linear correlation with 3‐month readmission risk (HR = 1.60, 95% CI: 1.19–2.16). Tertile 3 (≥−0.48) exhibited higher risk than tertile 1 (<−0.83) and tertile 2 [−0.83, −0.48), with HRs and 95% CI of 1.49 (1.06–2.10), 1.43 (1.01–2.02), 1.48 (1.03–2.12), respectively. Subgroup and sensitivity analyses affirmed consistent influence of LAR on 3‐month readmission risk for HF. Conclusions: Higher LAR significantly correlates with increased 3‐month readmission risk in Chinese adult patients with HF, suggesting LAR is a valuable predictor for early readmission. [ABSTRACT FROM AUTHOR]

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PURPOSE: To evaluate the 30-day complication rates after arthroscopic meniscus repair and meniscectomy using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database, with subgroup analysis of patients aged > 40 years. METHODS: NSQIP registries between 2006 and 2019 were queried using Current Procedural Terminology codes to identify patients undergoing arthroscopic meniscus repair (CPT 29882, 29883) and meniscectomy (29880, 29881). The following 30-day complications were assessed: pulmonary embolism (PE), venous thromboembolism (VTE), surgical site infection (SSI), reoperation, and readmission. Complications rates between treatment groups were compared using multivariate logistic regression analyses adjusted for sex, age, steroid use, and smoking/dyspnoea/COPD. A subgroup analysis was performed for patients aged > 40 years. RESULTS: A total 6354 meniscus repairs and 99,372 meniscectomies were identified. Complication rates were  40 years, complication rates were  40 years undergoing meniscus repair versus meniscectomy: PE (0.38% vs 0.12%, p  40 years. These findings support meniscus repair whenever feasible in the setting of preserved articular cartilage. Understanding of the short-term complication rates after arthroscopic meniscus repair and meniscectomy can aid surgeons in providing comprehensive preoperative counselling to patients considering such treatments, specifically when discussing the risks and benefits of meniscus repair. LEVEL OF EVIDENCE: III.

Background and purpose: Major lower extremity amputation (MLEA) is associated with complications that may prolong length of hospital stay (LOS) and increase the risk of readmission. We primarily aimed to examine the LOS and risk of readmissions after MLEA in Denmark. Secondarily we investigated the time trends. Methods: Using Danish National Patient Registry data, this observational study analyzed 11,205 first-time MLEAs (35% transtibial amputations, 65% transfemoral amputations) performed between January 1, 2010 and December 31, 2021. Total LOS included pre- and postoperative nights. The first readmission within 30 days and 90 days post-discharge was analyzed. Results: The median total LOS after a transtibial amputation was 19 days (interquartile range [IQR] 11–30), and decreased from 28 days (IQR 17–41) in 2010 to 14 days (IQR 9–23) in 2021. The median total LOS after a transfemoral amputation was 13 days (IQR 8–22) and decreased from 16 days (IQR 9–27) in 2010 to 11 days (IQR 7–18) in 2021. Post-discharge readmission risks within 30 days were 27% (95% confidence interval [CI] 24–28) for transtibial amputations and 23% (CI 22–24) for transfemoral amputations, with corresponding 90-day risks of 40% (CI 39–42) and 35% (CI 34–36), respectively. The 30-day risk of readmission increased in both groups. Conclusion: We observed that MLEA patients’ hospital admissions lasted 2–3 weeks and decreased over the study period. A readmission risk of 23–27% within 30 days and 35–40 % within 90 days post-discharge was observed. Readmissions risk increased for both initial transtibial and transfemoral amputations over the study period.

Background: A desire to control cost and improve patient outcomes following arthroplasty led to the introduction of the Center for Medicare and Medicaid Service Comprehensive Care for Joint Replacement Program. Hemi and total hip arthroplasty for femoral neck fracture has been shown to have worse outcomes than those for osteoarthritis. However, little has been studied about the effect of comorbidities on costs associated with arthroplasty for femoral neck fracture. This study investigates how the number of comorbidities influence 90-day outcomes and cost following hemi or total hip arthroplasty for displaced femoral neck fracture in patients covered by the Comprehensive Care for Joint Replacement bundle. Methods: We reviewed all Medicare hip fracture patients undergoing hemi or total hip arthroplasty at our institution between April 2016 and November 2020. Basic demographic and perioperative information was collected. The primary outcome was hospital readmission within 90 days. The data set captured 90-day readmission to any institution, not just within our system. Secondary outcomes included 90-day reoperation and outpatient complications. Multiple logistic regression was used to examine the influence of number of comorbidities on the primary and secondary outcomes while controlling for other variables. Results: The cohort comprised 378 patients (72% female), mean age 82 (±9) years, mean body mass index 23.4 (±4.7) kg/m2. For every additional comorbidity, the odds of related readmission without reoperation increased by 1.261 (95% confidence interval [1.055-1.507], P = .011). Odds of reoperation and odds of outpatient complication did not show statistical significance with the available numbers. Conclusions: Increasing preoperative comorbidities results in a higher odd of readmission within 90 days following arthroplasty for femoral neck fracture in this Medicare population.

BackgroundTo investigate the risk factors for readmission of elderly patients with coronary artery disease, and to construct and validate a predictive model for readmission risk of elderly patients with coronary artery disease within 3 years by applying machine learning method.MethodsWe selected 575 elderly patients with CHD admitted to the Affiliated Lu’an Hospital of Anhui Medical University from January 2020 to January 2023. Based on whether patients were readmitted within 3 years, they were divided into two groups: those readmitted within 3 years (215 patients) and those not readmitted within 3 years (360 patients). Lasso regression and multivariate logistic regression were used to compare the predictive value of these models. XGBoost, LR, RF, KNN and DT algorithms were used to build prediction models for readmission risk. ROC curves and calibration plots were used to evaluate the prediction performance of the model. For external validation, 143 patients who were admitted between February and June 2023 from a different associated hospital in Lu'an City were also used.ResultsThe XGBoost model demonstrated the most accurate prediction performance out of the five machine learning techniques. Diabetes, Red blood cell distribution width (RDW), and Triglyceride glucose-body mass index (TyG-BMI), as determined by Lasso regression and multivariate logistic regression. Calibration plot analysis demonstrated that the XGBoost model maintained strong calibration performance across both training and testing datasets, with calibration curves closely aligning with the ideal curve. This alignment signifies a high level of concordance between predicted probabilities and observed event rates. Additionally, decision curve analysis highlighted that both decision trees and XGBoost models achieved higher net benefits within the majority of threshold ranges, emphasizing their significant potential in clinical decision-making processes. The XGBoost model's area under the ROC curve (AUC) reached 0.903, while the external validation dataset yielded an AUC of 0.891, further validating the model's predictive accuracy and its ability to generalize across different datasets.ConclusionTyG-BMI, RDW, and diabetes mellitus at the time of admission are the factors affecting readmission of elderly patients with coronary artery disease, and the model constructed based on the XGBoost algorithm for readmission risk prediction has good predictive efficacy, which can provide guidance for identifying high-risk patients and timely intervention strategies.

Background Despite robust evidence supporting an association with improved outcomes in eligible patients, cardiac rehabilitation (CR) remains underused, with a minority of eligible patients participating. Virtual cardiac rehabilitation (VCR) has been proposed as an alternative to traditional center‐based CR (CBCR) to improve usage rates. However, data supporting the efficacy and cost‐effectiveness of VCR are limited. In the present study, we compared the outcomes and cost of a VCR versus traditional CBCR program. Methods and Results In a retrospective cohort study comparing VCR versus CBCR, CBCR data were collected from a period of January 2018 to September 2023. VCR data were collected from program initiation in July 2021 to September 2023. Primary health outcomes measured were 1‐year mortality rates, recurrent myocardial infarction, all‐cause hospital readmission, and emergency department visits. Primary cost outcomes were analyzed as cost ratios related to VCR versus CBCR assessing total medical costs allowed, pharmacy costs, and total costs of care over the 12 months post‐CR enrollment. VCR was associated with a significant reduction in 1‐year all‐cause hospital readmission (incident rate ratio [IRR], 0.616 [95% CI, 0.489–0.777], P

Providing the highest quality care with no biases is the goal of every healthcare system. As a part of that goal hospital readmission has been investigated due to its impact on healthcare cost and case fatality rate in patient outcome. Patient’s demographics, substance use and insurance barriers have been investigated as factors for readmission rate but the impact of COVID-19 pandemic on those biases and barriers have not been studied extensively yet. In our retrospective cross-sectional study, we placed the scope on readmission rate with the intention to investigate any relation with patient’s demographics including ethnicity, gender, language, substance use and insurance barriers and if there has been any change in the area pre and post COVID-19 pandemic. Total of 1713 readmitted patients were identified and split into 893 pre-COVID-19 and 820 post COVID-19 pandemic. Our multivariable analysis showed that the rate of readmissions during the COVID-19 pandemic was statistically higher among substance users (p = 0.003) and Medicaid insured (p = 0.038), and less likely among Spanish speakers p = 0.003. This study is limited due to small sample size and does not accurately represent the full population of the United States. Our hope is to further investigate the impact of COVID-19 pandemic on the readmission rate and to identify any influencing factors, biases, and barriers that contributed to the increased rate of readmission to learn and avoid future readmissions during straining times in medicine such as during COVID-19 pandemic.

[This corrects the article on p. 1001 in vol. 12, PMID: 35036342.].

Abstract Background Postpartum readmissions (PPRs) are an important indicator of maternal postpartum complications and the quality of medical services and are important for reducing medical costs. The present study aimed to investigate the risk factors affecting readmission after delivery in Imam Ali Hospital in Amol, Iran. Methods This retrospective cohort study was conducted on the mothers who were readmitted after delivery within 30 days, at Imam Ali Hospital (2019–2023). The demographic and obstetrics characteristics were identified through the registry system. Univariate and multivariate logistic regressions with odds ratios (ORs) and 95% CIs were carried out. To identify the most important variables by machine learning methods, a random forest model was used. The data were analyzed using SPSS 22 software and R (4.1.3) at a significant level of 0.05. Results Among 13,983 deliveries 164 (1.2%) had readmission after delivery. The most prevalent cause of readmission after delivery was infection (59.7%). The chance of readmission for women who underwent elective cesarean section and women who experienced labor pain onset by induction of labor was twice and 1.5 times greater than that among women who experienced spontaneous labor pain, respectively. Women with pregnancy complications had more than 2 times the chance of readmission. Cesarean section increased the chance of readmission by 2.69 times compared to normal vaginal delivery. Conclusion The method of labor pain onset, mode of delivery, and complications during pregnancy were the most important factors related to readmission after childbirth.

Abstract Context Critically ill patients, especially those with respiratory failure associated with multiple comorbidities, are at risk of recurrent ICU admission and consuming a significant portion of medical resources. Aim To study the risk factors and common etiologies of readmission among surviving patients with acute respiratory failure in Mansoura University’s respiratory intensive care unit during the year 2023. Settings and design This was a retrospective cohort study. Patients and methods This study included all patients with acute respiratory failure who were admitted to Mansoura University’s respiratory intensive care unit (RICU), from January 2023 to December 2023. Deceased patients after initial admission or those with incomplete data were not included in the study. All data related to patient’s demographics, type of respiratory failure, type of respiratory support, associated comorbidities, length of ICU stay, and causes of readmission were collected from the registration system database. Results Eight-hundred-thirty (830) cases that were admitted to the Mansoura University’s RICU with respiratory failure in the year 2023 were enrolled in the study, and 84 cases (10.1%) of them were readmitted. COPD exacerbation was the most common cause of readmission (35.7%) followed by pneumonia (21.4%) and OSA exacerbation (20.2%). Results showed that the significant independent predictors of readmission were being male [AOR (95% CI): 1.8 (1.01–3.1), p: 0.046], having organ failure (renal/liver) [AOR (95% CI): 29.9 (7.9–113.4), p ≤ 0.001], and length of ICU stay more than 12 days [AOR (95% CI): 4.8 (2.6–8.6), p ≤ 0.001]. Also, the type of respiratory failure and the type of respiratory support received were significantly associated with readmission in the univariate analysis; however, they were insignificant in the multivariate analysis. Conclusion The rate of readmission was not high (only 10.3%). The most common causes of readmission were COPD exacerbation, followed by pneumonia and OSA exacerbation, respectively. Type of respiratory failure, male gender, the presence of other organ failure, and length of ICU stay are significant independent predictors of readmission in Mansoura University’s RICU during the year 2023. Therefore, higher-risk individuals should receive attention and careful assessment before discharge from the ICU to reduce the rate of readmission. Trial registration ClinicalTrials.gov identifier: NCT06291636.

Abstract The purpose of this study was to develop a machine learning model for predicting 30-day readmission after bariatric surgery based on laboratory tests. Data were collected from patients who underwent bariatric surgery between 2018 and 2023. Laboratory test indicators from the preoperative stage, one day postoperatively, and three days postoperatively were analyzed. Least absolute shrinkage and selection operator regression was used to select the most relevant features. Models constructed included support vector machine (SVM), generalized linear model, multi-layer perceptron, random forest, and extreme gradient boosting. Model performance was evaluated and compared using the area under the receiver operating characteristic curve (AUROC). A total of 1262 patients were included, of which 7.69% of cases were readmitted. The SVM model achieved the highest AUROC (0.784; 95% CI 0.696–0.872), outperforming other models. This suggests that machine learning models based on laboratory test data can effectively identify patients at high risk of readmission after bariatric surgery.

Background Acute medical unit (AMU) is a dedicated facility to treat patients with acute medical conditions requiring a short hospital stay (< 72 hours) with the support of a multidisciplinary team led by a medical consultant. We aim to present a study of the AMU model of care from Qatar to provide insight into its effects on patient care and management.

Abstract Background Early post-discharge assessments for newborns are recommended. Virtual care has become more prevalent during the pandemic, providing an opportunity to better understand its impact on the quality of post-discharge newborn care. The objective of this study was to understand whether primary care visit modality (in-person vs. virtual) is associated with early newborn hospital readmissions and emergency department (ED) visits. Methods We conducted a population-based, case-control study using linked health administrative databases between September 1, 2020 and March 31, 2022 in Ontario, Canada. We compared the modality of primary care visits among cases (hospital readmission within 14 days of life) and controls (newborns without a readmission), matched on infant sex, gestational age, and maternal parity. We included an alternative definition of cases as a composite of either a newborn hospital readmission or emergency department (ED) visit or in-hospital death within the first 14 days of life. Conditional logistic regression models were used to model odds ratios (ORs), comparing those exposed to a virtual visit versus in-person visit, adjusting for infant birth weight, birth hospitalization length of stay, neighbourhood level material deprivation, rurality and presence of active maternal comorbidities. Results Among 73,324 eligible newborns, 2,220 experienced a hospital readmission within 14 days of life and were matched to 8,880 controls. Jaundice was the primary reason for readmission (75% of readmissions). Compared to newborns who were seen in-person post-discharge, newborns who were seen virtually had higher odds of hospital readmission (adjusted odds ratio [aOR] 1.41 (95% CI 1.09, 1.83); the magnitude of effect was not different using the composite outcome (aOR 1.35, 95% CI 1.05, 1.75). Conclusions Newborns who receive a virtual post-discharge visit are more likely than those who receive an in-person visit to require hospital readmission.

Objective Readmission rates after posterior cervical fusion (PCF) significantly impact patients and healthcare, with complication rates at 15%–25% and up to 12% 90-day readmission rates. In this study, we aim to test whether machine learning (ML) models that capture interfactorial interactions outperform traditional logistic regression (LR) in identifying readmission-associated factors. Methods The Optum Clinformatics Data Mart database was used to identify patients who underwent PCF between 2004–2017. To determine factors associated with 30-day readmissions, 5 ML models were generated and evaluated, including a multivariate LR (MLR) model. Then, the best-performing model, Gradient Boosting Machine (GBM), was compared to the LACE (Length patient stay in the hospital, Acuity of admission of patient in the hospital, Comorbidity, and Emergency visit) index regarding potential cost savings from algorithm implementation. Results This study included 4,130 patients, 874 of which were readmitted within 30 days. When analyzed and scaled, we found that patient discharge status, comorbidities, and number of procedure codes were factors that influenced MLR, while patient discharge status, billed admission charge, and length of stay influenced the GBM model. The GBM model significantly outperformed MLR in predicting unplanned readmissions (mean area under the receiver operating characteristic curve, 0.846 vs. 0.829; p < 0.001), while also projecting an average cost savings of 50% more than the LACE index. Conclusion Five models (GBM, XGBoost [extreme gradient boosting], RF [random forest], LASSO [least absolute shrinkage and selection operator], and MLR) were evaluated, among which, the GBM model exhibited superior predictive performance, robustness, and accuracy. Factors associated with readmissions impact LR and GBM models differently, suggesting that these models can be used complementarily. When analyzing PCF procedures, the GBM model resulted in greater predictive performance and was associated with higher theoretical cost savings for readmissions associated with PCF complications.

Abstract Background The transition of patients between care contexts poses patient safety risks. Discharges to home from inpatient care can be associated with adverse patient outcomes. Quality in discharge processes is essential in ensuring safe transitions for patients. Current evidence relies on bivariate analyses and neglects contextual factors such as treatment and patient characteristics and the interactions of potential outcomes. This study aimed to investigate the associations between the quality and safety of the discharge process, patient safety incidents, and health-related outcomes after discharge, considering the treatments’ and patients’ contextual factors in one comprehensive model. Methods Patients at least 18 years old and discharged home after at least three days of inpatient treatment received a self-report questionnaire. A total of N = 825 patients participated. The assessment contained items to assess the quality and safety of the discharge process from the patient’s perspective with the care transitions measure (CTM), a self-report on the incidence of unplanned readmissions and medication complications, health status, and sociodemographic and treatment-related characteristics. Statistical analyses included structural equation modeling (SEM) and additional analyses using logistic regressions. Results Higher quality of care transition was related to a lower incidence of medication complications (B = -0.35, p

Abdulmajeed Alshabanat, Maha Alrabiah, Amerah Bin Zuair, Sheikhah Aldossari, Rand Abdullah Alhumaidi Department of Medicine, College of Medicine, King Saud University (KSU) and King Saud University Medical City (KSUMC), Riyadh, Saudi ArabiaCorrespondence: Amerah Bin Zuair, Department of Medicine, College of Medicine, King Saud University Medical City, Riyadh, Saudi Arabia, Tel +966558765609, Email Amerah.zuair@gmail.comBackground: SCD poses a significant healthcare burden. Understanding the factors contributing to high healthcare utilization and readmissions is crucial for improving the quality of care provided.Methods: This retrospective comparative observational study was conducted at King Saud University Medical City and included 160 SCD patients. A comparison was made between patients with no readmission and patients with at least one 30-day readmission. Another comparison was done between high healthcare-utilizing patients and low healthcare-utilizing patients. A regression model for 30-day readmission prediction was created.Results: Readmission was significantly higher in patients using opioids, following up with pain clinics, and having a history of AVN (p= 0.002, p=0.028 and p=0.025 respectively). Higher healthcare utilization was associated with older age, smoking, use of opioids and GABA analogs, and psychiatric illnesses, including depression, substance use disorder, and anxiety. Predictors of 30-day readmission were hydroxyurea use (odds ratio, 2.819 [95% CI,1.082 to 7.34], p = 0.034), follow-up with pain management clinics (odds ratio, 2.248 [95% CI,1.547 to 3.266], p = 0.001), and SCD genotype (SS genotype) (odds ratio, 1.754 [95% CI,1.012 to 3.042], p = 0.045). Using the Paracetamol/Codeine combination significantly reduced the likelihood of readmission within 30 days of discharge.Conclusion: This study identified factors associated with 30-day readmission rate and high healthcare utilization among SCD patients. Strategies to reduce readmissions may include specialized SCD clinics, educational programs for patients, improved physician awareness of mental health screening, and further research on the impact of opioid use. Limitations include retrospective nature, single-center design, reliance on self-reported data, and exclusion of critically ill patients. However, despite the limitations, this study could lay a foundation for future projects aiming to optimize care and outcomes for patients living with SCD.Keywords: sickle cell disease, readmission, healthcare utilization, pain management

Zhihao Zhao,1,&ast; Diya Qi,1,&ast; Zeqing Zhang,2,&ast; Xin Du,3 Fengyun Zhang,2 Ruicong Ma,4 Yi Liang,1 Yuewu Zhao,1 Ying Gao,1 Yu Yang2 1Department of Cardiology, the Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, Xuzhou First People’s Hospital, Xuzhou, People’s Republic of China; 2Department of Cardiology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, People’s Republic of China; 3Department of Neurology, the Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, Xuzhou First People’s Hospital, Xuzhou, People’s Republic of China; 4Graduate School, Dalian Medical University, Dalian, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Ying Gao, Department of Cardiology, the Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, Xuzhou First People’s Hospital, Xuzhou, People’s Republic of China, Tel +86-13951461302, Email xzyygaoying@163.com Yu Yang, Department of Cardiology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, People’s Republic of China, Tel +86-15651359875, Email xuzhouyangyu@163.comPurpose: The aim of this study was to explore the relationship between inflammatory cytokines and the risk of heart failure (HF) readmission in patients with heart failure with preserved ejection fraction (HFpEF).Patients and Methods: We enrolled 429 patients with HFpEF admitted to the cardiology department in our hospital from January 2020 to July 2022. The patients were divided into the readmission or non-readmission groups according to whether they were readmitted for heart failure within 1 year of discharge. The clinical features and laboratory date of the subjects were collected and analyzed. Multivariate cox regression analysis was used to identify predictors of HF readmission. In addition, receiver operating characteristic (ROC) curves were used to determine the prognostic value of each factor.Results: The levels of IL-1β, IL-6, IL-10, IL-17, TNF-α, NT-proBNP, heart rate, total cholesterol and NYHA class were significantly higher in the readmission group than in the non-readmission group (p < 0.05). IL-1β, IL-6, IL-17, TNF-α, NT-proBNP, heart rate and NYHA class were identified as independent predictors of HF readmission.Conclusion: Inflammatory markers, including IL-1β, IL-6, IL-17 and TNF-α were related to the HF readmission in patients with HFpEF.Keywords: heart failure with preserved ejection fraction, inflammation, cytokine, readmission, risk assessment

Introduction: There has been a substantial shift in the number of outpatient total joint arthroplasty performed over the last decade. Furthermore, use of ambulatory surgical centers (ASC) has increased, which has led to improved access to operating rooms and increased efficiency for many arthroplasty surgeons. However, there remains uncertainty as to the safety of this rapid transition from inpatient to outpatient surgery especially at major medical centers usually associated with a more morbid population. Methods: Utilizing the total joint registry at our institution, we identified all total hip and knee arthroplasties from2018–2022 (n = 5000). Surgeries were grouped by timing of surgery, location and by admission status. Patient demographics and clinical outcomes were collected and compared with a focus on readmission and reoperation rates. Results: There was a significant increase in the percentage of same day surgery (SDS) total joint arthroplasty after the transition to an ASC. We identified no significant change in reoperation rate or 30-day readmission amongst SDS patients with our rapid transition to outpatient. Furthermore, the post-transition cohort had a higher incidence of diabetes were more medically complex and the patients were generally older. Conclusion: Within one year of the COVID-19 pandemic onset, we transitioned approximately half of our surgical volume from an inpatient hospital setting to a stand-alone ASC. Furthermore, we did not identify any statistical difference in reoperations, readmissions, or complications even amongst a higher risk population. Therefore, we found a rapid transition to ASC outpatient surgery to be a safe option.

Background: Reducing unnecessary emergency department (ED) visits following joint arthroplasty is an important goal. Literature suggests 30-day visit rates range between 4% and 15%, with only 20%-25% of these admitted for care. Low admissions suggest an opportunity to reduce unnecessary postarthroplasty ED visits. This study examined whether a wristband would encourage patients to call the care team with concerns prior to going to the ED. Methods: A wristband displaying a contact phone number was placed on patients at discharge. ED visit rates (30 and 90 days) and readmissions (90 days) were tabulated for 2 years prior to and up to 3 years after the implementation of the wristband program. Residents who responded to calls and call logs were also reviewed. Results: At 2 years after implementation, a total of 1023 joint replacements produced 273 calls or 1 call per 3.75 patients. Nearly half (48.1%) of the calls were received during weekday work hours when the patients had been directed to call the office. While ED visits declined after the implementation of the wristband at both 2 and 3 years, these reductions were not statistically significant (30 days: 5.1% before, 4.1% after; 90 days: 8.1% before, 7.1% after). There was a significant reduction in 90-day readmissions (6.4% before, 4.0% after). Conclusions: Patients utilized the wristband number, but this did not significantly reduce the number of ED visits within 3 years. Future studies should track ED visits and identify decision-making factors behind ED use in order to find ways to improve the intervention.

Introduction: Limited information exists on patients with suspected coronavirus disease 2019 (COVID-19) who return to the emergency department (ED) during the first wave. In this study we aimed to identify predictors of ED return within 72 hours for patients with suspected COVID-19.Methods: Incorporating data from 14 EDs within an integrated healthcare network in the New York metropolitan region from March 2–April 27, 2020, we analyzed this data on predictors for a return ED visit—including demographics, comorbidities, vital signs, and laboratory results.Results: In total, 18,599 patients were included in the study. The median age was 46 years old [interquartile range 34-58]), 50.74% were female, and 49.26% were male. Overall, 532 (2.86%) returned to the ED within 72 hours, and 95.49% were admitted at the return visit. Of those tested for COVID-19, 59.24% (4704/ 7941) tested positive. Patients with chief complaints of “fever” or “flu” or a history of diabetes or renal disease were more likely to return at 72 hours. Risk of return increased with persistently abnormal temperature (odds ratio [OR] 2.43, 95% CI 1.8-3.2), respiratory rate (2.17, 95% CI 1.6-3.0), and chest radiograph (OR 2.54, 95% CI 2.0-3.2). Abnormally high neutrophil counts, low platelet counts, high bicarbonate values, and high aspartate aminotransferase levels were associated with a higher rate of return. Risk of return decreased when discharged on antibiotics (OR 0.12, 95% CI 0.0-0.3) or corticosteroids (OR 0.12, 95% CI 0.0-0.9).Conclusion: The low overall return rate of patients during the first COVID-19 wave indicates that physicians’ clinical decision-making successfully identified those acceptable for discharge.