Search

Objective: To investigate the association between prestroke frailty and nonhome discharge, prolonged length of stay as well as functional outcomes. Design: Prospective observational study. Setting: Single urban teaching hospital in Guangzhou, China. Participants: Consecutive sample of 271 older patients admitted with acute stroke. Intervention: N/A. Main measures: A five-item FRAIL scale (0∼5 points) and the stroke severity at onset were measured. The primary outcome of interest was nonhome discharge, with secondary outcomes including prolonged length of stay and worse short-term prognosis. Multivariable logistic regression adjusting for confounding factors was used to determine the association between patient-reported frailty and nonhome discharge, prolonged length of stay, worse short-term prognosis. Results: The population had a median age of 68 [interquartile range (IQR), 64∼74)]years, with 50 individuals (18.5%) identified as frail. After adjusting for age, sex, Barthel index, National Institutes of Health Stroke Scale, and Mini-Mental Status Exam score at admission, patients with self-reported frailty were significantly likely to experience nonhome discharge (Odds Ratio [ OR ] = 4.788; 95% confidence interval [CI] = 1.272∼18.017; p =.021), prolonged length of stay (OR = 4.76; 95% CI = 1.80∼12.56; p =.002), mRS scores at 30 days (OR = 6.72;95% CI = 1.79∼25.20; p =.005) and three months postdischarge and three-month (OR = 8.94; 95% CI = 2.10∼38.08; p =.003). Conclusions: In older adults with stroke, frailty is associated with nonhome discharge, prolonged length of stay, and worse short-term prognosis, regardless of the stroke severity, cognition, and Barthel index score at admission. FRAIL scale can be used as a practical screening tool in acute care setting by multidisciplinary team in supporting discharge process. [ABSTRACT FROM AUTHOR]

As the volume of total joint arthroplasty in the US continues to grow, new challenges surrounding appropriate discharge surface. Arthroplasty literature has demonstrated discharge disposition to postacute care facilities carries major risks regarding the need for revision surgery, patient comorbidities, and financial burden. To quantify, categorize, and mitigate risks, a decision tool that uses preoperative patient variables has previously been published and validated using an urban patient population. The aim of our investigation was to validate the same predictive model using patients in a rural setting undergoing total knee arthroplasty (TKA) and total hip arthroplasty. All TKA and THA procedures that were performed between January 2012 and September 2022 at our institution were collected. A total of 9,477 cases (39.6% TKA, 60.4% THA) were included for the validation analysis. There were 9 preoperative variables that were extracted in an automated fashion from the electronic medical record. Included patients were then run through the predictive model, generating a risk score representing that patient's differential risk of discharge to a skilled nursing facility versus home. Overall accuracy, sensitivity and specificity were calculated after obtaining risk scores. Score cutoff equally maximizing sensitivity and specificity was 0.23, and the proportion of correct classifications by the predictive tool in this study population was found to be 0.723, with an area under the curve of 0.788 — both higher than previously published accuracy levels. With the threshold of 0.23, sensitivity and specificity were found to be 0.720 and 0.723, respectively. The risk calculator showed very good accuracy, sensitivity, and specificity in predicting discharge location for rural patients undergoing TKA and THA, with accuracy even higher than in urban populations. The model provides an easy-to-use interface, with automation representing a viable tool in helping with shared decision-making regarding postoperative discharge plans. [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]

Background/aim: Efficient discharge for stroke patients is crucial but challenging. The study aimed to develop early predictive models to explore which patient characteristics and variables significantly influence the discharge planning of patients, based on the data available within 24 h of admission. Design: Prospective observational study. Methods: A prospective cohort was conducted at a university hospital with 523 patients hospitalised for stroke. We built and trained six different machine learning (ML) models, followed by testing and tuning those models to find the best‐suited predictor for discharge disposition, dichotomized into home and non‐home. To evaluate the accuracy, reliability and interpretability of the best‐performing models, we identified and analysed the features that had the greatest impact on the predictions. Results: In total, 523 patients met the inclusion criteria, with a mean age of 61 years. Of the patients with stroke, 30.01% had non‐home discharge. Our model predicting non‐home discharge achieved an area under the receiver operating characteristic curve of 0.95 and a precision of 0.776. After threshold was moved, the model had a recall of 0.809. Top 10 variables by importance were National Institutes of Health Stroke Scale (NIHSS) score, family income, Barthel index (BI) score, FRAIL score, fall risk, pressure injury risk, feeding method, depression, age and dysphagia. Conclusion: The ML model identified higher NIHSS, BI, and FRAIL, family income, higher fall risk, pressure injury risk, older age, tube feeding, depression and dysphagia as the top 10 strongest risk predictors in identifying patients who required non‐home discharge to higher levels of care. Modern ML techniques can support timely and appropriate clinical decision‐making. Relevance to Clinical Practice: This study illustrates the characteristics and risk factors of non‐home discharge in patients with stroke, potentially contributing to the improvement of the discharge process. Reporting Method: STROBE guidelines. [ABSTRACT FROM AUTHOR]

BACKGROUND: About 3.5 million trauma patients are hospitalized every year, but 35%–40% require further care after discharge. Nurses' ability to affect discharge disposition by minimizing the occurrence of nurse-sensitive indicators (catheter-associated urinary tract infection [CAUTI], central line-associated bloodstream infection [CLABSI], and hospital-acquired pressure injury [HAPI]) is unknown. These indicators may serve as surrogate measures of quality nursing care. OBJECTIVE: The purpose of this study was to determine whether nursing care, as represented by three nurse-sensitive indicators (CAUTI, CLABSI, and HAPI), predicts discharge disposition in trauma patients. METHODS: This study was a secondary analysis of the 2021 National Trauma Data Bank. We performed logistic regression analyses to determine the predictive effects of CAUTI, CLABSI, and HAPI on discharge disposition, controlling for participant characteristics. RESULTS: A total of n = 29,642 patients were included, of which n = 21,469 (72%) were male, n = 16,404 (64%) were White, with a mean (SD) age of 44 (14.5) and mean (SD) Injury Severity Score of 23.2 (12.5). We created four models to test nurse-sensitive indicators, both individually and compositely, as predictors. While CAUTI and HAPI increased the odds of discharge to further care by 1.4–1.5 and 2.1 times, respectively, CLABSI was not a statistically significant predictor. CONCLUSIONS: Both CAUTI and HAPI are statistically significant predictors of discharge to further care for patients after traumatic injury. High-quality nursing care to prevent iatrogenic complications can improve trauma patients' long-term outcomes. [ABSTRACT FROM AUTHOR]

Patients who have bilateral hip arthritis can be treated with bilateral total hip arthroplasty (bTHA) in either a staged or simultaneous fashion. The goal of this study was to determine whether staged and simultaneous posterior bTHA patients differ in regard to (1) patient-reported outcome measures, (2) 90-day complication rates, and (3) discharge dispositions and cumulative lengths of stay. Patients who (1) underwent simultaneous bTHA or staged bTHA (within 12 months) using the posterior approach, and (2) completed preoperative and 1-year postoperative Hip dysfunction and Osteoarthritis Outcome Score for Joint Replacement surveys were included in the study. A total of 266 patients (87 simultaneous bTHA and 179 staged bTHA) were included. Chart review was performed to collect patient-level variables, postoperative complications, discharge dispositions, and lengths of stay. Staged bTHA patients had higher Hip dysfunction and Osteoarthritis Outcome Score for Joint Replacement, Lower Extremity Activity Scale, and Veterans RAND 12-Item Health Survey physical component scores compared to simultaneous bTHA patients at 6 weeks after surgery (P =.019,.006, and.008, respectively), but these differences did not meet the minimal clinically important difference threshold for any questionnaire. Simultaneous bTHA was associated with higher rate of periprosthetic fractures (P =.034) and discharge to a location other than home (P <.001). There were statistically significant, but likely not clinically meaningful differences in patient-reported outcomes for staged and simultaneous bTHA patients at 6 weeks after surgery. Surgeons should be aware of the higher periprosthetic fracture risk and greater likelihood of discharge to a rehabilitation facility associated with simultaneous bTHA. Further research should aim to understand which patients may benefit most from simultaneous bTHA. [ABSTRACT FROM AUTHOR]

Study Design. Retrospective review of a prospective multicenter adult spinal deformity (ASD) study. Objective. The aim of this study was to evaluate 30-day readmissions, 90-day return to surgery, postoperative complications, and patient-reported outcomes (PROs) for matched ASD patients receiving nonhome discharge (NON), including acute rehabilitation (REHAB), and skilled nursing facility (SNF), or home (HOME) discharge following ASD surgery. Summary of Background Data. Postoperative disposition following ASD surgery frequently involves nonhome discharge. Little data exists for longer term outcomes for ASD patients receiving nonhome discharge versus patients discharged to home. Materials and Methods. Surgically treated ASD patients prospectively enrolled into a multicenter study were assessed for NON or HOME disposition following hospital discharge. NON was further divided into REHAB or SNF. Propensity score matching was used to match for patient age, frailty, spine deformity, levels fused, and osteotomies performed at surgery. Thirty-day hospital readmissions, 90-day return to surgery, postoperative complications, and 1-year and minimum 2-year postoperative PROs were evaluated. Results. A total of 241 of 374 patients were eligible for the study. NON patients were identified and matched to HOME patients. Following matching, 158 patients remained for evaluation; NON and HOME had similar preoperative age, frailty, spine deformity magnitude, surgery performed, and duration of hospital stay (P>0.05). Thirty-day readmissions, 90-day return to surgery, and postoperative complications were similar for NON versus HOME and similar for REHAB (N =64) versus SNF (N = 42) versus HOME (P>0.05). At 1-year and minimum 2-year follow-up, HOME demonstrated similar to better PRO scores including Oswestry Disability Index, Short-Form 36v2 questionnaire Mental Component Score and Physical Component Score, and Scoliosis Research Society scores versus NON, REHAB, and SNF (P< 0.05). Conclusions. Acute needs must be considered following ASD surgery, however, matched analysis comparing 30-day hospital readmissions, 90-day return to surgery, postoperative complications, and PROs demonstrated minimal benefit for NON, REHAB, or SNF versus HOME at 1- and 2-year follow-up, questioning the risk and cost/benefits of routine use of nonhome discharge. [ABSTRACT FROM AUTHOR]

Background: Patient-reported outcome measures (PROMs) are increasingly used to assess patients' perioperative health. The PROM Information System 29 (PROMIS-29) is a well-validated global health assessment instrument for patient physical health, though its utility in cranial neurosurgery is unclear. Objective: To investigate the utility of preoperative PROMIS-29 physical health (PH) summary scores in predicting postoperative outcomes in brain tumor patients. Methods: Adult brain tumor patients undergoing resection at a single institution (January 2018-December 2021) were identified and prospectively received PROMIS-29 surveys during pre-operative visits. PH summary scores were constructed and optimum prediction thresholds for length of stay (LOS), discharge disposition (DD), and 30-day readmission were approximated by finding the Youden index of the associated receiver operating characteristic curves. Bivariate analyses were used to study the distribution of low (z-score≤-1) versus high (z-score>-1) PH scores according to baseline characteristics. Logistic regression models quantified the association between preoperative PH summary scores and post-operative outcomes. Results: A total of 157 brain tumor patients were identified (mean age 55.4±15.4 years; 58.0% female; mean PH score 45.5+10.5). Outcomes included prolonged LOS (24.8%), non-routine discharge disposition (37.6%), and 30-day readmission (19.1%). On bivariate analysis, patients with low PH scores were significantly more likely to be diagnosed with a high-grade tumor (69.6% vs 38.85%, p=0.010) and less likely to have elective surgery (34.8% vs 70.9%, p=0.002). Low PH score was associated with prolonged LOS (26.1% vs 22%, p<0.001), nonroutine discharge (73.9% vs 31.3%, p<0.001) and 30-day readmission (43.5% vs 14.9%, p=0.003). In multivariate analysis, low PH scores predicted greater LOS (odds ratio [OR]=6.09, p=0.003), nonroutine discharge (OR=4.25, p=0.020), and 30-day readmission (OR=3.93, p=0.020). Conclusion: The PROMIS-29 PH summary score predicts short-term postoperative outcomes in brain tumor patients and may be incorporated into prospective clinical workflows. [ABSTRACT FROM AUTHOR]

Background: Total hip (THA) and knee (TKA) discharge disposition is of increasing interest as leaner models are sought, emphasizing the importance of factors affecting discharge disposition. Utilizing the National Surgical and Quality Improvement Program (NSQIP), we hypothesized discharge to home would (1) be more frequent in men, (2) be adversely affected by comorbidities but not by race, and (3) increase in percentage each year. Methods: The NSQIP 2015–2018 database revealed 883,309 orthopedic surgical patients, 413,627 having undergone joint arthroplasty. The primary endpoint was discharge to home. Chi-square tests examined categorical dependent variables, and analysis of variance (ANOVA) assessed continuous variables, with statistical significance accepted for p 0.001) were more likely to be discharged home compared to THA or revision arthroplasty. Race and Ethnicity varied likelihood of going home. Regardless of Ethnicity, Black/African American individuals were least likely to be discharged home. Of patients with reported Ethnicity, Indigenous Non-Hispanics and Indigenous Hispanics had the highest odds of discharge home (OR = 1.94; 1.77, p

Introduction: After adult spinal deformity (ASD) surgery, patients often require postoperative rehabilitation at an inpatient rehabilitation (IPR) center or a skilled nursing facility (SNF). However, home discharge is often preferred by patients and hsas been shown to decrease costs. In a cohort of patients undergoing ASD surgery, we sought to (1) report the incidence of discharge to home, (2) determine the factors significantly associated with discharge to home in the form of a simple scoring system, and (3) evaluate the impact of discharge disposition on patient-reported outcome measures (PROMs). Methods: A single-institution, retrospective cohort study was undertaken for patients undergoing ASD surgery from 2009 to 2021. Inclusion criteria were ≥ 5-level fusion, sagittal/coronal deformity, and at least 2-year follow-up. Exposure variables included preoperative, perioperative, and radiographic data. The primary outcome was discharge status (dichotomized as home vs. IPR/SNF). Secondary outcomes included PROMs, such as the numeric rating scales (NRSs) for back and leg pain, the Oswestry Disability Index (ODI), and EQ-5D. A subanalysis comparing IPR to SNF discharge was conducted. Univariate analysis was performed. Results: Of 221 patients undergoing ASD surgery with a mean age of 63.6 ± 17.6, 112 (50.6%) were discharged home, 71 (32.2%) were discharged to an IPR center, and 38 (17.2%) were discharged to an SNF. Patients discharged home were significantly younger (55.7 ± 20.1 vs. 71.8 ± 9.1, p < 0.001), had lower rate of 2+ comorbidities (38.4% vs. 45.0%, p = 0.001), and had less hypertension (57.1% vs. 75.2%, p = 0.005). Perioperatively, patients who were discharged home had significantly fewer levels instrumented (10.0 ± 3.0 vs. 11.0 ± 3.4 levels, p = 0.030), shorter operative times (381.4 ± 139.9 vs. 461.6 ± 149.8 mins, p < 0.001), less blood loss (1101.0 ± 977.8 vs. 1739.7 ± 1332.9 mL, p < 0.001), and shorter length of stay (5.4 ± 2.8 vs. 9.3 ± 13.9 days, p < 0.001). Radiographically, preoperative SVA (9.1 ± 6.5 vs. 5.2 ± 6.8 cm, p < 0.001), PT (27.5 ± 11.1° vs. 23.4 ± 10.8°, p = 0.031), and T1PA (28.9 ± 12.7° vs. 21.6 ± 13.6°, p < 0.001) were significantly higher in patients who were discharged to an IPR center/SNF. Additionally, the operating surgeon also significantly influenced the disposition status (p < 0.001). A scoring system of the listed factors was proposed and was validated using univariate logistic regression (OR = 1.55, 95%CI = 1.34–1.78, p < 0.001) and ROC analysis, which revealed a cutoff value of > 6 points as a predictor of non-home discharge (AUC = 0.75, 95%CI = 0.68–0.80, p < 0.001, sensitivity = 63.3%, specificity = 74.1%). The factors in the scoring system were age > 56, comorbidities ≥ 2, hypertension, TIL ≥ 10, operative time > 357 mins, EBL > 1200 mL, preop SVA > 6.6 cm, preop PT > 33.6°, and preop T1PA > 15°. When comparing IPR (n = 71) vs. SNF (n = 38), patients discharged to an SNF were significantly older (74.4 ± 8.6 vs. 70.4 ± 9.1, p = 0.029) and were more likely to be female (89.5% vs. 70.4%, p = 0.024). Conclusions: Approximately 50% of patients were discharged home after ASD surgery. A simple scoring system based on age > 56, comorbidities ≥ 2, hypertension, total instrumented levels ≥ 10, operative time > 357 mins, EBL > 1200 mL, preop SVA > 6.6 cm, preop PT > 33.6°, and preop T1PA > 15° was proposed to predict non-home discharge. These findings may help guide postoperative expectations and resource allocation after ASD surgery. [ABSTRACT FROM AUTHOR]

Background: Increasing numbers of patients are undergoing total joint arthroplasty as a treatment for osteoarthritis, which can be an anxiety-provoking experience. Setting expectations through a preoperative physical therapy (pre-op PT) session can alleviate some of these stressors, potentially decrease hospital length of stay (LOS), and promote home discharge. Purpose: We sought to determine whether attending a pre-op PT session is associated with decreased hospital LOS and home discharge in total hip arthroplasty (THA) and total knee arthroplasty (TKA) patients. Methods: A retrospective cohort study was performed of 20,822 patients who underwent THA or TKA between January 2020 and December 2023. Pre-op PT attendance and covariates, including patient demographics and clinical data, were collected and analyzed for association with LOS and discharge disposition. Results: Unadjusted univariate analysis revealed that THA and TKA patients who received pre-op PT had a significantly lower average LOS and were more likely to be discharged home. Our multivariate regression model showed that pre-op PT was not significantly associated with LOS in both groups but was significantly associated with home discharge among THA patients. Conclusions: Our retrospective study of the effect of pre-op PT education on LOS and discharge disposition for elective THA and TKA patients found different results in univariate and multivariate analysis. Further study is needed to confirm the association found on multivariate analysis between pre-op PT and home discharge in THA patients. [ABSTRACT FROM AUTHOR]

Aims: In-hospital length of stay (LOS) and discharge dispositions following arthroplasty could act as surrogate measures for improvement in patient pathways, and have major cost saving implications for healthcare providers. With the ever-growing adoption of robotic technology in arthroplasty, it is imperative to evaluate its impact on LOS. The objectives of this study were to compare LOS and discharge dispositions following robotic arm-assisted total knee arthroplasty (RO TKA) and unicompartmental arthroplasty (RO UKA) versus conventional technique (CO TKA and UKA). Methods: This large-scale, single-institution study included patients of any age undergoing primary TKA (n = 1,375) or UKA (n = 337) for any cause between May 2019 and January 2023. Data extracted included patient demographics, LOS, need for post anaesthesia care unit (PACU) admission, anaesthesia type, readmission within 30 days, and discharge dispositions. Univariate and multivariate logistic regression models were also employed to identify factors and patient characteristics related to delayed discharge. Results: The median LOS in the RO TKA group was 76 hours (interquartile range (IQR) 54 to 104) versus 82.5 (IQR 58 to 127) in the CO TKA group (p < 0.001) and 54 hours (IQR 34 to 77) in the RO UKA versus 58 (IQR 35 to 81) in the CO UKA (p = 0.031). Discharge dispositions were comparable between the two groups. A higher percentage of patients undergoing CO TKA required PACU admission (8% vs 5.2%; p = 0.040). Conclusion: Our study showed that robotic arm assistance was associated with a shorter LOS in patients undergoing primary UKA and TKA, and no difference in the discharge destinations. Our results suggest that robotic arm assistance could be advantageous in partly addressing the upsurge of knee arthroplasty procedures and the concomitant healthcare burden; however, this needs to be corroborated by long-term cost-effectiveness analyses and data from randomized controlled studies. Cite this article: Bone Jt Open 2023;4(10):791–800.

Nonhome discharge disposition following primary total knee arthroplasty (TKA) is associated with a higher rate of complications and constitutes a socioeconomic burden on the health care system. While existing algorithms predicting nonhome discharge disposition varied in degrees of mathematical complexity and prediction power, their capacity to generalize predictions beyond the development dataset remains limited. Therefore, this study aimed to establish the machine learning model generalizability by performing internal and external validations using nation-scale and institutional cohorts, respectively. Four machine learning models were trained using the national cohort. Recursive feature elimination and hyper-parameter tuning were applied. Internal validation was achieved through five-fold cross-validation during model training. The trained models' performance was externally validated using the institutional cohort and assessed by discrimination, calibration, and clinical utility. The national (424,354 patients) and institutional (10,196 patients) cohorts had non-home discharge rates of 19.4 and 36.4%, respectively. The areas under the receiver operating curve of the model predictions were 0.83 to 0.84 during internal validation and increased to 0.88 to 0.89 during external validation. Artificial neural network and histogram-based gradient boosting elicited the best performance with a mean area under the receiver operating curve of 0.89, calibration slope of 1.39, and Brier score of 0.14, which indicated that the two models were robust in distinguishing non-home discharge and well-calibrated with accurate predictions of the probabilities. The low inter-dataset similarity indicated reliable external validation. Length of stay, age, body mass index, and sex were the strongest predictors of discharge destination after primary TKA. The machine learning models demonstrated excellent predictive performance during both internal and external validations, supporting their generalizability across different patient cohorts and potential applicability in the clinical workflow. [ABSTRACT FROM AUTHOR]

Objectives: By better understanding the long-term effects of COVID-19 and assessing rehabilitation placement among the patients in our study, we hope to determine the predictors of rehabilitation needs in individuals suffering from the long-term sequelae of COVID-19. Methods: A retrospective chart review was performed of adult patients with a positive COVID-19 polymerase chain reaction test among multiple hospitals in a regional health system. The main outcomes measured were discharge disposition, total length of hospital stay, and overall all-cause mortality and readmission rates within 30 and 90 days of discharge. Results: Of the 2502 patients included in the study, we found that 65.2% were discharged to home, while the remaining patients were discharged to home healthcare (33.6%), skilled nursing facilities (31.7%), or long-term acute rehabilitation centers (11.6%). The overall all-cause mortality rate at 30 and 90 days were 2.7% and 4.4%, respectively. The overall all-cause 30-day and 90-day readmission rates were 7.0% and 7.6%, respectively. Conclusion: Younger age and shorter hospitalization stays were the most important predictors of home discharge. Discharge to home was also significantly associated with lower all-cause mortality rates at 30 and 90 days after discharge.

Background: In-hospital mortality and discharge disposition following traumatic hip fractures previously reported in the literature, has mainly focused on a nationwide scale, which may not be reflective of unique populations. Objective: Our aim was to characterize demographics, hospital disposition, and associated outcomes for patients with the most common hip fractures. Methods: A retrospective study utilizing the Trauma Registry from the Texas Department of State Health Services. Patient demographics, injury characteristics, and outcomes, such as in-hospital mortality, and discharge dispositions, were collected. The data were analyzed via univariate analysis and multivariate regressions. Results: There were 17,104 included patients, composed of 45% femoral neck fractures (FN) and 55% intertrochanteric fractures (IT). There were no differences in injury severity score (ISS) (9 ± 1.8) or age (77.4 ± 8 years old) between fracture types. In-hospital mortality risk was low but different among fracture types (intertrochanteric, 1.9% vs femoral neck, 1.3%, P =.004). However, when controlling for age, and ISS, intertrochanteric fractures and Hispanic patients were associated with higher mortality (P <.001, OR 1.5, 95% CI 1.1-2.0). Uninsured, and Black/African American (P =.05, OR 1.2, 95% CI 1.1-1.3) and Hispanic (P <.001, OR 1.2, 95% CI 1.1-1.3) patients were more likely to be discharged home after adjusting for age, ISS, and payment method. Conclusion: Regardless of age, severity of the injury or admission hemodynamics, intertrochanteric fractures and Hispanic/Latino patients had an increased risk of in-hospital mortality. Patients who were uninsured, Hispanic, or Black were discharged home rather than to rehabilitation, regardless of age, ISS, or payment method. [ABSTRACT FROM AUTHOR]

The number of elective spinal fusion procedures performed each year continues to grow, making risk factors for post-operative complications following this procedure increasingly clinically relevant. Nonhome discharge (NHD) is of particular interest due to its associations with increased costs of care and rates of complications. Notably, increased age has been found to influence rates of NHD. To identify aged-adjusted risk factors for nonhome discharge following elective lumbar fusion through the utilization of Machine Learning-generated predictions within stratified age groupings. Retrospective Database Study. The American College of Surgeons National Quality Improvement Program (ACS-NSQIP) database years 2008 to 2018. Postoperative discharge destination. ACS-NSQIP was queried to identify adult patients undergoing elective lumbar spinal fusion from 2008 to 2018. Patients were then stratified into the following age ranges: 30 to 44 years, 45 to 64 years, and ≥65 years. These groups were then analyzed by eight ML algorithms, each tasked with predicting post-operative discharge destination. Prediction of NHD was performed with average AUCs of 0.591, 0.681, and 0.693 for those aged 30 to 44, 45 to 64, and ≥65 years respectively. In patients aged 30 to 44, operative time (p<.001), African American/Black race (p=.003), female sex (p=.002), ASA class three designation (p=.002), and preoperative hematocrit (p=.002) were predictive of NHD. In ages 45 to 64, predictive variables included operative time, age, preoperative hematocrit, ASA class two or class three designation, insulin-dependent diabetes, female sex, BMI, and African American/Black race all with p<.001. In patients ≥65 years, operative time, adult spinal deformity, BMI, insulin-dependent diabetes, female sex, ASA class four designation, inpatient status, age, African American/Black race, and preoperative hematocrit were predictive of NHD with p<.001. Several variables were distinguished as predictive for only one age group including ASA Class two designation in ages 45 to 64 and adult spinal deformity, ASA class four designation, and inpatient status for patients ≥65 years. Application of ML algorithms to the ACS-NSQIP dataset identified a number of highly predictive and age-adjusted variables for NHD. As age is a risk factor for NHD following spinal fusion, our findings may be useful in both guiding perioperative decision-making and recognizing unique predictors of NHD among specific age groups. [ABSTRACT FROM AUTHOR]

Analyze readmission trends of Total Hip Arthroplasty (THA)/Total Knee Arthroplasty (TKA) patients and examine the impact of LOS on the likelihood of hospital readmission, with an emphasis on discharge disposition and patients underlying conditions. Demand and cost of THA/TKA have increased over the years. However, length of stay (LOS) has decreased due to fewer after-surgery complications and advances in pain management. Overall, healthcare cost is on an upward trajectory, and the cost of unplanned readmissions constitutes a large portion of it, so it is vital to examine the relationship between LOS and unplanned readmissions. We use a linear probability model. LOS decreased steadily during the sampled period. Readmitted patients were more likely to be under Medicare/Medicaid and had more significant medical comorbidities. Readmission increases with LOS, but patients with fewer comorbidities are less likely to be readmitted. Patients discharged under 'routine' disposition were less likely to be readmitted, while those discharged against medical advice were more likely to be readmitted. LOS impacts THA/TKA readmission rates; however, patient characteristics such as medical comorbidity and discharge disposition are essential in determining the readmission status and, therefore, necessary inputs in the decision-making processes. [ABSTRACT FROM AUTHOR]

As the obesity epidemic grows, the number of morbidly obese patients undergoing anterior cervical discectomy and fusion (ACDF) continues to increase. Despite the association of obesity with perioperative complications in anterior cervical surgery, the impact of morbid obesity on ACDF complications remains controversial, and studies examining morbidly obese cohorts are limited. A single-institution, retrospective analysis of patients undergoing ACDF from September 2010 to February 2022 was performed. Demographic, intraoperative, and postoperative data were collected via review of the electronic medical record. Patients were categorized as nonobese (body mass index [BMI] <30), obese (BMI 30–39.9), or morbidly obese (BMI ≥40). Associations of BMI class with discharge disposition, length of surgery, and length of stay were assessed using multivariable logistic regression, multivariable linear regression, and negative binomial regression, respectively. The study included 670 patients undergoing single-level or multilevel ACDF: 413 (61.6%) nonobese, 226 (33.7%) obese, and 31 (4.6%) morbidly obese patients. BMI class was associated with prior history of deep venous thrombosis (P < 0.01), pulmonary thromboembolism (P < 0.05), and diabetes mellitus (P < 0.001). In bivariate analysis, there was no significant association between BMI class and reoperation or readmission rates at 30, 60, or 365 days postoperatively. In multivariable analysis, greater BMI class was associated with increased length of surgery (P = 0.03), but not length of stay or discharge disposition. For patients undergoing ACDF, greater BMI class was associated with increased length of surgery, but not reoperation rate, readmission rate, length of stay, or discharge disposition. [ABSTRACT FROM AUTHOR]

• A total of 65.2% of patients hospitalized for COVID-19 were discharged home. • Younger age and shorter length of stay were predictors of discharge to home. • Male gender, Hispanic ethnicity, and invasive ventilation are associated with lower odds of discharge to home. • Discharge home is associated with lower all-cause mortality rates after hospitalization. • Patients discharged home had longer survival compared to those who were not. By better understanding the long-term effects of COVID-19 and assessing rehabilitation placement among the patients in our study, we hope to determine the predictors of rehabilitation needs in individuals suffering from the long-term sequelae of COVID-19. A retrospective chart review was performed of adult patients with a positive COVID-19 polymerase chain reaction test among multiple hospitals in a regional health system. The main outcomes measured were discharge disposition, total length of hospital stay, and overall all-cause mortality and readmission rates within 30 and 90 days of discharge. Of the 2502 patients included in the study, we found that 65.2% were discharged to home, while the remaining patients were discharged to home healthcare (33.6%), skilled nursing facilities (31.7%), or long-term acute rehabilitation centers (11.6%). The overall all-cause mortality rate at 30 and 90 days were 2.7% and 4.4%, respectively. The overall all-cause 30-day and 90-day readmission rates were 7.0% and 7.6%, respectively. Younger age and shorter hospitalization stays were the most important predictors of home discharge. Discharge to home was also significantly associated with lower all-cause mortality rates at 30 and 90 days after discharge. [ABSTRACT FROM AUTHOR]

Measurement of frailty with the Risk Analysis Index (RAI) has demonstrated improved outcome prediction compared to other frailty indices across the surgical literature. However, the generalizability and clinical utility of preoperative RAI scoring for prediction of postoperative morbidity after adult spinal deformity surgery is presently unknown. Thus, recent studies have called for an RAI analysis of spine deformity outcomes. The present study sought to evaluate the discriminatory accuracy of preoperative frailty, as measured by RAI, for predicting postoperative morbidity among adult spine deformity surgery patients using data queried from a large prospective surgical registry representing over 700 hospitals from 49 US states and 11 countries. Secondary analysis of a prospective surgical registry. American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database (2011–2020). The primary endpoint was "adverse discharge outcome" (ADO) defined as discharge to a non-home, non-rehabilitation nursing/chronic care facility. Adult spine deformity surgeries were queried from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database (2011–2020) using diagnosis and procedure codes. The relationship between increasing preoperative RAI frailty score and increasing rate of primary endpoint (ADO) was assessed with Cochran-Armitage linear trend tests. Discriminatory accuracy was tested by computation of concordance statistics (with 95% confidence interval [CI]) in receiver operating characteristic (ROC) curve analysis. A total of 3104 patients underwent spine deformity surgery and were stratified by RAI score: 0–10: 22%, 11–15: 11%, 16–20: 29%, 21–25: 26%, 26–30: 8.0%, 31–35: 2.4%, and 36+: 1.4%. The rate of ADO was 14% (N=439/3094). The rate of ADO increased significantly with increasing RAI score (p<.0001). RAI demonstrated robust discriminatory accuracy for prediction of ADO in ROC analysis (C-statistic: 0.71, 95% CI: 0.69–0.74, p<.001). In pairwise comparison of ROC curves (DeLong test), RAI demonstrates superior discriminatory accuracy compared to the 5-factor modified frailty index (mFI-5; p<.001). Preoperative frailty, as measured by RAI, is a robust predictor of postoperative morbidity (measured by ADO) after adult spine deformity surgery. The frailty score may be translated directly to the bedside with a user-friendly risk calculator, deployed here: https://nsgyfrailtyoutcomeslab.shinyapps.io/spineDeformity [ABSTRACT FROM AUTHOR]

Introduction: The majority of total hip arthroplasty (THA) patients are discharged home postoperatively, however, many still require continued medical care. We aimed to identify important characteristics that predict nonhome discharge in geriatric patients undergoing THA using machine learning. We hypothesize that our analyses will identify variables associated with decreased functional status and overall health to be predictive of non-home discharge. Materials and Methods: Elective, unilateral, THA patients above 65 years of age were isolated in the NSQIP database from 2018-2020. Demographic, pre-operative, and intraoperative variables were analyzed. After splitting the data into training (75%) and validation (25%) data sets, various machine learning models were used to predict non-home discharge. The model with the best area under the curve (AUC) was further assessed to identify the most important variables. Results: In total, 19,840 geriatric patients undergoing THA were included in the final analyses, of which 5194 (26.2%) were discharged to a non-home setting. The RF model performed the best and identified age above 78 years (OR: 1.08 [1.07, 1.09], P <.0001), as the most important variable when predicting non-home discharge in geriatric patients with THA, followed by severe American Society of Anesthesiologists grade (OR: 1.94 [1.80, 2.10], P <.0001), operation time (OR: 1.01 [1.00, 1.02], P <.0001), anemia (OR: 2.20 [1.87, 2.58], P <.0001), and general anesthesia (OR: 1.64 [1.52, 1.79], P <.0001). Each of these variables was also significant in MLR analysis. The RF model displayed good discrimination with AUC =.831. Discussion: The RF model revealed clinically important variables for assessing discharge disposition in geriatric patients undergoing THA, with the five most important factors being older age, severe ASA grade, longer operation time, anemia, and general anesthesia. Conclusions: With the rising emphasis on patient-centered care, incorporating models such as these may allow for preoperative risk factor mitigation and reductions in healthcare expenditure. [ABSTRACT FROM AUTHOR]

ObjectiveTo examine trends in mental health (MH) visits to pediatric emergency departments (EDs) and identify whether ED disposition varies by presence of a hospital inpatient psychiatric unit (IPU).Study designCross-sectional study of 8,479,311 ED visits to 35 children's hospitals from 2012 to 2016 for patients aged 3 to 21 years with a primary MH or non-MH diagnosis. Multivariable generalized estimating equations and bivariate Rao-Scott chi-square tests were used to examine trends in ED visits and ED disposition by IPU status, adjusted for clustering by hospital.ResultsFrom 2012 to 2016, hospitals experienced a greater increase in ED visits with a primary MH versus non-MH diagnosis (50.7% vs 12.7% cumulative increase, P < .001). MH visits were associated with patients who were older, female, white non-Hispanic, and privately insured compared with patients of non-MH visits (all P < .001). Forty-four percent of MH visits in 2016 had a primary diagnosis of depressive disorders or suicide or self-injury, and the increase in visits was highest for these diagnosis groups (depression: 109.8%; suicide or self-injury: 110.2%). Among MH visits, presence of a hospital IPU was associated with increased hospitalizations (34.6% vs 22.5%, P < .001) and less transfers (9.2% vs 16.2%, P < .001).ConclusionThe increase in ED MH visits from 2012 to 2016 was 4 times greater than non-MH visits at US children's hospitals and was primarily driven by patients diagnosed with depressive disorders and suicide or self-injury. Our findings have implications for strategic planning in tertiary children's hospitals dealing with a rising demand for acute MH care.

Copyright of Canadian Journal of Anaesthesia / Journal Canadien d'Anesthésie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Limited English language proficiency in patients undergoing total shoulder arthroplasty (TSA) may make treatment more challenging. Purpose: We sought to investigate the potential association between TSA patients' use of a language interpreter and 2 outcomes: hospital length of stay (LOS) and discharge disposition. Methods: We conducted a retrospective cohort study comparing LOS and discharge disposition after TSA for patients who required interpreter services and patients who did not at a single institution in an urban setting between 2016 and 2020. Consecutive patients requiring interpreter services who underwent TSA were matched 1:1 to patients who did not require an interpreter by age, body mass index (BMI), sex, and procedure. Multivariate regression models controlling for age, BMI, sex, smoking, opioid use, white or non-white race, procedure, and diagnosis were constructed to determine associations between interpreter use, LOS, and discharge disposition. Results: Forty-one patients were included in each cohort, exceeding the minimum number required per an a priori power analysis. Mean hospital LOS was longer in the interpreter cohort than in the non-interpreter cohort (2.8 ± 2.4 vs 1.8 ± 1.0 days, respectively). Multivariate linear regression demonstrated interpreter use was the strongest predictor of LOS, with the effect estimate indicating an additional 0.88-day LOS per patient. A greater proportion of patients from the interpreter cohort were discharged to an acute/subacute rehabilitation facility than patients from the non-interpreter cohort (n = 8 [19.5%] vs n = 2 [4.9%], respectively). Patients from the interpreter cohort were 454% more likely to be discharged to acute/subacute rehabilitation facilities. Conclusions: Our retrospective analysis of patients undergoing TSA suggests that the need for interpreter services may be associated with increased LOS and discharge to a facility. More rigorous study is needed to identify the factors that influence these outcomes and to avoid disparities in hospital stay and discharge. [ABSTRACT FROM AUTHOR]

Frailty is a common comorbidity associated with worsening outcomes in various medical and surgical fields. The Hospital Frailty Risk Score (HFRS) is a recently developed tool which assesses frailty using 109 International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) comorbidity codes to assess severity of frailty. However, there is a paucity of studies utilizing the HFRS with patients undergoing anterior cervical discectomy and fusion (ACDF) for cervical spondylotic myelopathy (CSM). The aim of this study was to investigate the impact of HFRS on health care resource utilization following ACDF for CSM. A retrospective cohort study was performed using the Nationwide Inpatient Sample (NIS) database from 2016-2019. All adult (≥18 years old) patients undergoing primary, ACDF for CSM were identified using the ICD-10 CM codes. Weighted patient demographics, comorbidities, perioperative complications, LOS, discharge disposition, and total admission costs were assessed. The 109 ICD-10 codes with pre-assigned values from 0.1 to 7.1 pertaining to frailty were queried in each patient, with a cumulative HFRS ≥5 indicating a frail patient. Patients were then categorized as either Low HFRS (HFRS<5) or Moderate to High HFRS (HFRS≥5). A multivariate stepwise logistic regression was used to determine the odds ratio for risk-adjusted extended LOS, non-routine discharge disposition, and increased hospital cost. A total of 29,305 patients were identified, of which 3,135 (10.7%) had a Moderate to High HFRS. Patients with a Moderate to High HFRS had higher rates of 1 or more postoperative complications (Low HFRS: 9.5% vs. Moderate-High HFRS: 38.6%, p≤.001), significantly longer hospital stays (Low HFRS: 1.8±1.7 days vs. Moderate-High HFRS: 4.4 ± 6.0, p≤.001), higher rates of non-routine discharge (Low HFRS: 5.8% vs. Moderate-High HFRS: 28.2%, p≤.001), and increased total cost of admission (Low HFRS: $19,691±9,740 vs. Moderate-High HFRS: $26,935±22,824, p≤.001) than patients in the Low HFRS cohort. On multivariate analysis, Moderate to High HFRS was found to be a significant independent predictor for extended LOS [OR: 3.19, 95% CI: (2.60, 3.91), p≤.001] and non-routine discharge disposition [OR: 3.88, 95% CI: (3.05, 4.95), p≤.001] but not increased cost [OR: 1.10, 95% CI: (0.87, 1.40), p=.418]. Our study suggests that patients with a higher HFRS have increased total hospital costs, a longer LOS, higher complication rates, and more frequent nonroutine discharge compared with patients with a low HFRS following elective ACDF for CSM. Although frail patients should not be precluded from surgical management of cervical spine pathology, these findings highlight the need for peri-operative protocols to medically optimize patients to improve health care quality and decrease costs. [ABSTRACT FROM AUTHOR]

Background: This article evaluates the predictive accuracy of the CareMOSAIC Risk Assessment for discharge disposition in Medicare patients undergoing total joint arthroplasty. Methods: Retrospectively collected data from a single institution on 499 consecutive Medicare patients who underwent primary total hip arthroplasty or total knee arthroplasty were reviewed. The CareMOSAIC Risk Assessment was completed by each patient during the preoperative period. The CareMOSAIC Risk Assessment scores were calculated via the CareMOSAIC software, and the scores indicate a risk category for each patient as it relates to post–acute care discharge needs. Results: The CareMOSAIC Risk Assessment with a binary logistic regression area under the receiver operating characteristic curve of 0.798 appears to be a reliable tool for predicting discharge disposition. The assessment had a positive predictive value of 90.0% and negative predictive value of 76.3% for discharge disposition. Conclusions: The CareMOSAIC Risk Assessment effectively predicts the discharge disposition for Medicare patients undergoing total hip or total knee arthroplasty.

Background: Black patients receiving outpatient care for skin ulcers are less likely to see a physician and are at risk for higher stage pressure injuries. While racial/ethnic differences in outpatient treatment of skin ulcers have been described, this study aims to elucidate potential differences in the inpatient setting using publicly available data. Methods: We conducted a retrospective cohort study of the Statewide Planning and Research Cooperative System database, a de-identified, patient-level dataset for inpatient visits in New York between 2009 and 2021. Admissions were filtered by diagnosis-related group (APR-DRG) code 380 (skin ulcers). Results: Compared to non-Hispanic white patients, non-Hispanic black patients demonstrated longer mean LOS (8.15 vs. 7.48 days, p = 0.009), higher mean charges ($44,400 vs. $37,600, p < 0.001), and were more frequently discharged home without services (38.1% vs. 32.4%, p < 0.001). Black Hispanic patients had similar mean LOS (7.22 vs. 6.36 days, p = 0.133), similarly discharged home without services, and had higher mean charges ($45,800 vs. $36,700, p = 0.031). After adjusting for patient factors, non-Hispanic black patients had a longer LOS by 0.26 days (p = 0.028) with $2331 higher inpatient charges (p = 0.001) compared to non-Hispanic white patients. Conclusions: The findings suggest racial and ethnic differences in hospitalizations for skin ulcers, with black patients experiencing greater LOS and charges. The reasons for these differences merit investigation, yet could be related to delays in outpatient care, more severe disease, presence of comorbid conditions, or complications requiring intensive inpatient services. [ABSTRACT FROM AUTHOR]

Simple Summary: Radical cystectomy is a surgical procedure used in the treatment of bladder cancer. It can potentially cure a patient of their disease, but it is associated with risks including long hospital stays and high complication rates. Here, we evaluated how certain factors related to a patient and/or their surgery may impact their discharge to home versus to a rehabilitation facility after surgery. This study found that patients that are older, living alone prior to surgery, and/or have a major post-operative complication are more likely to be discharged to a rehabilitation facility. Recognizing these factors prior to surgery may help identify which patients may require discharge to a rehabilitation facility and can help patients and urologists better plan for the postoperative course. Radical cystectomy (RC) is a complex procedure associated with lengthy hospital stays and high complication and readmission rates. We evaluated the impact of patient, surgical, and perioperative factors on discharge disposition following RC at a tertiary referral center. From 2012 to 2019, all bladder cancer patients undergoing RC at our institution were identified (n = 1153). Patients were classified based on discharge disposition: to home or to continued facility-based rehabilitation centers (CFRs, n = 180 (15.61%) patients). On multivariate analysis of patient factors only, age [Risk Ratio (RR): 1.07, p < 0.001)], single marital status (RR: 1.09, p < 0.001), and living alone prior to surgery (RR: 2.55, p = 0.004) were significant predictors of discharge to CFRs. Multivariate analysis of patient, surgical, and perioperative factors indicated age (RR: 1.09, p < 0.001), single marital status (RR: 3.9, p < 0.001), living alone prior to surgery (RR: 2.42, p = 0.01), and major post-operative (Clavien > 3) complications (RR: 3.44, p < 0.001) were significant independent predictors of discharge to CFRs. Of note, ERAS did not significantly impact discharge disposition. Specific patient and perioperative factors significantly impact discharge disposition. Patients who are older, living alone prior to surgery, and/or have a major post-operative complication are more likely to be discharged to CFRs after RC. [ABSTRACT FROM AUTHOR]

Simple Summary: Our study analyzed 138,151 radical cystectomy patient encounters to determine which patient and facility characteristics are associated with discharge home and discharge to continued rehabilitation facilities. We used multivariate logistic regression to statistically analyze these datapoints while controlling for other variables. We found that older age, single/widowed marital status, female gender, increased Charlson Comorbidity Index, Medicaid, and Medicare insurance and open surgery are associated with Continued Rehabilitation Facility (CRF) discharge. Objective: To assess predictors of discharge disposition—either home or to a CRF—after undergoing RC for bladder cancer in the United States. Methods: In this retrospective, cohort study, patients were divided into two cohorts: those discharged home and those discharged to CRF. We examined patient, surgical, and hospital characteristics. Multivariable logistic regression models were used to control for selected variables. All statistical tests were two-sided. Patients were derived from the Premier Healthcare Database. International classification of disease (ICD)-9 (<2014), ICD-10 (≥2015), and Current Procedural Terminology (CPT) codes were used to identify patient diagnoses and encounters. The population consisted of 138,151 patients who underwent RC for bladder cancer between 1 January 2000 and 31 December 2019. Results: Of 138,151 patients, 24,922 (18.0%) were admitted to CRFs. Multivariate analysis revealed that older age, single/widowed marital status, female gender, increased Charlson Comorbidity Index, Medicaid, and Medicare insurance are associated with CRF discharge. Rural hospital location, self-pay status, increased annual surgeon case, and robotic surgical approach are associated with home discharge. Conclusions: Several specific patient, surgical, and facility characteristics were identified that may significantly impact discharge disposition after RC for bladder cancer. [ABSTRACT FROM AUTHOR]

Background: Community deprivation has been linked to poor health outcomes following primary total knee arthroplasty (pTKA), but few studies have explored revision TKA (rTKA). The present study analyzed implications of neighborhood deprivation on rTKA outcomes by characterizing relationships between Area Deprivation Index (ADI) and (1) non-home discharge disposition (DD), (2) hospital length of stay (LOS), (3) 90-day emergency department (ED) visits, (4) 90-day hospital readmissions, and (5) the effect of race on these healthcare outcomes., Methods: A total of 1,434 patients who underwent rTKA between January 2016 and June 2022 were analyzed. Associations between the ADI and postoperative healthcare resource utilization outcomes were evaluated using multivariate logistic regression. Mediation effect was estimated using a nonparametric bootstrap resampling method., Results: Greater ADI was associated with non-home DD (p < 0.001), LOS ≥ 3 days (p < 0.001), 90-day ED visits (p = 0.015), and 90-day hospital readmission (p = 0.002). Although there was no significant difference in ADI between septic and aseptic patients, septic patients undergoing rTKA were more likely to experience non-home discharge (p < 0.001), prolonged LOS (p < 0.001), and 90-day hospital readmission (p = 0.001). The effect of race on non-home DD was found to be mediated via ADI (p = 0.038). Similarly, results showed the effect of race on prolonged LOS was mediated via ADI (p = 0.01)., Conclusion: A higher ADI was associated with non-home discharge, prolonged LOS, 90-day ED visits, and 90-day hospital readmissions. The impacts of patient race on both non-home discharge and prolonged LOS were mediated by ADI. This index allows clinicians to better understand and address disparities in rTKA outcomes., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: Discharge to acute rehabilitation is strongly correlated with functional recovery after traumatic injury, including spinal cord injury (SCI). However, services such as acute care rehabilitation and Skilled Nursing Facilities (SNF) are expensive. Our objective was to understand if high-cost, resource-intensive post-discharge rehabilitation or alternative care facilities are utilized at disparate rates across socioeconomic groups after SCI. Methods: We performed a cohort analysis using the National Trauma Data Bank® tabulated from 2012-2016. Eligible patients had a diagnosis of cervical or thoracic spine fracture with spinal cord injury (SCI) and were treated surgically. We evaluated associations of sociodemographic and psychosocial variables with non-home discharge (e.g., discharge to SNF, other healthcare facility, or intermediate care facility) via multivariable logistic regression while correcting for injury severity and hospital characteristics. Results: We identified 3933 eligible patients. Patients who were older, male (OR=1.29 95% Confidence Interval [1.07-1.56], p=.007), insured by Medicare (OR=1.45 [1.08-1.96], p=.015), diagnosed with a major psychiatric disorder (OR=1.40 [1.03-1.90], p=.034), had a higher Injury Severity Score (OR=5.21 [2.96-9.18], p

To examine the association between applied cognition scores and discharge disposition using the Activity Measure for Post-Acute Care Applied Cognitive Inpatient Short Form (AM-PAC ACISF). Retrospective analysis of electronic medical records. Johns Hopkins Hospital (JHH). Adult patients admitted between 07/01/2020–11/02/2021, excluding those in psychiatric and labor and delivery units. The AM-PAC ACISF was integrated into the daily operations of occupational therapy and speech-language pathology staff at JHH in every patient encounter during treatment session. First recorded AM-PAC ACISF score was the primary predictor variable. The outcome variable was discharge disposition, dichotomized between discharge home or post-acute care (PAC) facility. Other patient-and health-related characteristics were included as secondary predictor variables. The applied cognitive t-scale scores assessed within 72 hours of admission were 9.3 points lower in patients who required PAC than those discharged home. The median A t-scale score of patients discharged home was 39.8 points (30.5, 62.2), while those who required PAC was 30.5 (19.3, 41.8). The odds of PAC needs for patients with AM-PAC ACISF t-scale scores in the lowest tertile (7.7-28.8) were almost four times greater than patients in the highest tertile (47.8-62.2; OR=3.7, 95%CI 3.1,4.3; p< 0.0001). The odds of PAC for patients in the middle tertile (30.5-44.3) were two times greater than patients in the highest tertile (OR=2.0, 95% CI=1.7, 2.3; p< 0.001). The AM-PAC ACISF score, male gender, living alone, prior residence outside of home, and admission for general surgery, neurology or orthopedic services all increase the odds of PAC needs (OR 1.2–4.4, p=< 0.001). This study provides empirical evidence on the importance of understanding the role of applied cognitive assessment in discharge planning, including the identification of at-risk patients who will are more likely to require PAC. Dr. Carla Enriquez received funding from the Learning Health Systems Rehabilitation Research Network (LeaRRn) Scholar Program, supported by the National Institutes of Health under award number 1P2CHD101895-01. The authors confirm that there are no financial conflicts of interest to report. [ABSTRACT FROM AUTHOR]

Patients hospitalized for acute heart failure (HF) tend to experience declines in physical function and activities of daily living (ADL) due to bed rest and restricted mobilization. This could result in some patients being transferred to rehabilitation hospitals. This study aims to examine the relationship between discharge disposition and 1-year readmission and mortality rates in HF patients. Nine hundred fifty six consecutive HF patients who were hospitalized for acute decompensated HF and underwent rehabilitation were divided into two groups: home (returned home) or transfer (transferred to rehabilitative or long-term care hospital units due to decline in physical function and/or ADL) groups. The primary and secondary outcomes were 1-year readmission and mortality rates after discharge, respectively. Of the 956 patients, 8.6% (n = 82) were transferred to rehabilitative or long-term care hospital units. Over a 1-year follow-up period, all-cause and HF readmission rates were 50.1% (n = 479) and 27.2% (n = 260), respectively. The transfer group had significantly lower readmission rates compared to home group after adjusting for the pre-existing risk factors (hazard ratio for all-cause and HF readmission: 0.600 and 0.552, 95% CI 0.401–0.897 and 0.314–0.969; P = 0.013 and P = 0.038, respectively). There was no significant relationship between discharge disposition and all-cause mortality rate. Low ADL defined as Barthel index < 60 points was identified as a predictor of all-cause and HF readmission among the home group (odds ratio for all-cause and HF readmission rates: 2.156 and 1.847, 95% CI 1.026–4.531 and 1.036–2.931; P = 0.043 and P = 0.037, respectively). This multi-center study demonstrated that HF patients transferred to rehabilitative or long-term care hospital units after an acute hospitalization had a significantly decreased 1-year all-cause and HF readmission rates compared to patients who returned to their home. These findings may help in selecting a discharge disposition for older HF patients with ADL decline. [ABSTRACT FROM AUTHOR]

Introduction: The purpose of this study is to report on the association between the number of stairs to enter home and length of stay (LOS), discharge disposition, and patient reported outcome measures (PROMs) among patients who underwent primary total joint arthroplasty (TJA). Materials and methods: We retrospectively reviewed patients who underwent primary total hip or knee arthroplasty between January 2016 and March 2020. Only patients with documentation of the number of stairs to enter their homes were included in the study. The two cohorts were separated into four groups: none, 1–10, 11–20, and > 20 stairs. Collected variables included demographic data, LOS, discharge disposition, and PROMs. Chi-square and ANOVA were utilized to determine significance. Results: Of the 1116 patients included, 510 underwent THA, and 606 underwent TKA. There was no statistical difference in LOS (THA: p = 0.308; TKA: p = 0.701) and discharge disposition (THA: p = 0.371; TKA: p = 0.484) in both cohorts regardless the number of stairs. There was no statistical difference in FJS-12 scores at 3 months (THA: p = 0.590; TKA: p = 0.206), 12 months (THA: p = 0.217; TKA: p = 0.845), and 21 months (THA: p = 0.782; TKA: p = 0.296) postoperatively for both cohorts. There was no statistical difference in HOOS, JR scores preoperatively (p = 0.278) and at 3 months postoperatively (p = 0.527) for the THA cohort, as well as KOOS, JR scores preoperatively and at 3 and 12 months postoperatively (p = 0.557; p = 0.522; p = 0.747) for the TKA cohort. Conclusion: We found no statistical differences in LOS, discharge disposition, and PROMs in patients who underwent TJA, irrespective of the number of stairs negotiated to enter their home. These findings can aid surgeons to provide preoperative education and reassurance to patients who have concerns with their discharge planning due to the walk-up stairway at their residence. [ABSTRACT FROM AUTHOR]

Balanced crystalloids may improve outcomes compared with saline for some critically ill adults. Lower tonicity of balanced crystalloids could worsen cerebral edema in patients with intracranial pathology. The effect of balanced crystalloids versus saline on clinical outcomes in patients with traumatic brain injury (TBI) requires further study. We planned an a priori subgroup analysis of TBI patients enrolled in the pragmatic, cluster-randomized, multiple-crossover Isotonic Solutions and Major Adverse Renal Events Trial (SMART) (ClinicalTrials.gov: NCT02444988, NCT02547779). Primary outcome was 30-day in-hospital mortality. Secondary outcomes included hospital discharge disposition (home, facility, death). Regression models adjusted for pre-specified baseline covariates compared outcomes. TBI patients assigned to balanced crystalloids (n = 588) and saline (n = 569) had similar baseline characteristics including Injury Severity Score 19 (10); mean maximum head/neck Abbreviated Injury Score, 3.4 (1.0). Isotonic crystalloid volume administered between intensive care unit admission and first of hospital discharge or 30 days was 2037 (3470) mL and 1723 (2923) mL in the balanced crystalloids and saline groups, respectively (p = 0.18). During the study period, 94 (16%) and 82 (14%) patients (16%) died in the balanced crystalloid and saline groups, respectively (adjusted odds ratio [aOR], 1.03; 95% confidence interval [CI], 0.60 to 1.75; p = 0.913). Patients in the balanced crystalloid group were more likely to die or be discharged to another medical facility (aOR 1.38 [1.02-1.86]; p = 0.04). Overall, balanced crystalloids were associated with worse discharge disposition in critically injured patients with TBI compared with saline. The confidence intervals cannot exclude a clinically relevant increase in mortality when balanced crystalloids are used for patients with TBI. [ABSTRACT FROM AUTHOR]

Purpose: Based on the rising incidence of revision total knee arthroplasty (TKA), bundled payment models may be applied to revision TKA in the near future. Facility discharge represents a significant cost factor for those bundled payment models; however, accurately predicting discharge disposition remains a clinical challenge. The purpose of this study was to develop and validate artificial intelligence algorithms to predict discharge disposition following revision total knee arthroplasty. Methods: A retrospective review of electronic patient records was conducted to identify patients who underwent revision total knee arthroplasty. Discharge disposition was defined as either home discharge or non-home discharge, which included rehabilitation and skilled nursing facilities. Four artificial intelligence algorithms were developed to predict this outcome and were assessed by discrimination, calibration and decision curve analysis. Results: A total of 2228 patients underwent revision TKA, of which 1405 patients (63.1%) were discharged home, whereas 823 patients (36.9%) were discharged to a non-home facility. The strongest predictors for non-home discharge following revision TKA were American Society of Anesthesiologist (ASA) score, Medicare insurance type and revision surgery for peri-prosthetic joint infection, non-white ethnicity and social status (living alone). The best performing artificial intelligence algorithm was the neural network model which achieved excellent performance across discrimination (AUC = 0.87), calibration and decision curve analysis. Conclusion: This study developed four artificial intelligence algorithms for the prediction of non-home discharge disposition for patients following revision total knee arthroplasty. The study findings show excellent performance on discrimination, calibration and decision curve analysis for all four candidate algorithms. Therefore, these models have the potential to guide preoperative patient counselling and improve the value (clinical and functional outcomes divided by costs) of revision total knee arthroplasty patients. Level of evidence: IV. [ABSTRACT FROM AUTHOR]

Background: Studies indicate one in three hospitalized patients are malnourished on admission; however, the documented malnutrition rate in acute care hospitals is often lower. This study measured prevalence of malnutrition on admission and correlated the relationship among malnutrition status, length of stay (LOS), discharge disposition, and readmission rate. Methods: A prospective observational cohort study was performed across nine tertiary care hospitals in Houston, Texas. Registered dietitians screened patients aged ≥18 years within 24 h of admission for two consecutive days per hospital. Malnourished patients were diagnosed using a modified version of the 2012 Consensus Statement from the Academy of Nutrition and Dietetics (AND)/American Society for Parenteral and Enteral Nutrition (ASPEN). Data collected included demographics, LOS, discharge disposition, and 30‐day readmission status. Results: In 416 patients, 31.7% were malnourished on admission. Malnourished patients were significantly older (67.8 vs 57.6 years; P < 0.001) and had a lower body mass index (26.2 vs 32.4; P < 0.001) than nonmalnourished patients. Malnourished patients had higher odds of having a LOS of ≥3 days (2.38 [95% CI, 1.45 to 3.88]; P < 0.001) and higher odds of readmitting within 30 days (2.28 [95% CI, 1.26 to 4.12]; P < 0.006) when compared with nonmalnourished patients. There were no significantly different clinical outcomes between moderately and severely malnourished groups. Conclusion: The study successfully utilized the modified AND‐ASPEN criteria to show that approximately one in three patients presented with malnutrition on admission. Malnourished patients were more likely to have a longer LOS and more likely to be readmitted within 30 days. [ABSTRACT FROM AUTHOR]

Purpose: The research questions for this study were as follows: (1) is the Parker Mobility Score (PMS) associated with discharge disposition and hospital length of stay (HLOS) of geriatric traumatic hip fracture patients? (2) Can the PMS be incorporated in a decision tree for the prediction of discharge disposition of geriatric traumatic hip fracture patients upon admittance. Methods: A dual-center retrospective cohort study was conducted at two level II trauma centers. All patients aged 70 years and older with traumatic hip fractures undergoing surgery in 2018 and 2019 were included consecutively (n = 649). A χ2 automatic interaction detection analysis was performed to determine the association of the PMS (and other variables) with discharge disposition and HLOS and predict discharge destination. Results: The decision tree for discharge disposition classified patients with an overall accuracy of 82.1% and a positive predictive value of 91% for discharge to a rehabilitation facility. The PMS had the second most significant effect on discharge disposition (χ2 = 22.409, p < 0.001) after age (χ2 = 79.094, p < 0.001). Regarding the tree analysis of HLOS, of all variables in the analysis, PMS had the most significant association with HLOS (F = 14.891, p < 0.001). Patients who were discharged home had a mean HLOS of 6.5 days (SD 8.0), whereas patients who were discharged to an institutional care facility had a mean HLOS of 9.7 days (SD 6.4; p < 0.001). Conclusion: This study shows that the PMS was strongly associated with discharge disposition and HLOS. The decision tree for the discharge disposition of geriatric traumatic hip fracture patients offers a practical solution to start discharge planning upon admittance which could potentially reduce HLOS. Level of evidence: Level III, diagnostic. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study was to determine whether stroke patients who receive physical medicine and rehabilitation consultation in acute care setting are more likely to discharge from inpatient rehabilitation facility to a community setting compared with those who do not. Design: This was a retrospective analysis of consecutive patients admitted with stroke to inpatient rehabilitation facility between June and October 2018. The primary outcome measure was discharge disposition. Other variables measured included functional independence measures and length of stay. Analysis of baseline covariates was conducted with t tests and analysis of primary outcome measured with Fisher exact test. Results: We identified 184 consecutive patients, with 62 (33.7%) having and 122 (66.3%) not having a physical medicine and rehabilitation consult; 35 (56.5%) patients versus 51 (41.8%) in physical medicine and rehabilitation consult versus non–physical medicine and rehabilitation group were discharged home (P = 0.042). Between both groups, there were no differences in baseline admission/discharge cognitive or motor functional independence measure scores, total admission/discharge functional independence measure scores, functional independence measure efficiency, or length of stay. However, in both the groups, admission versus discharge overall functional independence measure scores were significantly improved, 71.34 vs. 94.76 and 66.52 vs. 89.94 (P < 0.0001). Conclusions: Despite no difference in baseline functional scores or length of stay, physical medicine and rehabilitation consultation of poststroke patients in hospital may be associated with discharge home after inpatient rehabilitation facility. [ABSTRACT FROM AUTHOR]

Identify sociodemographic, injury, and hospital-level factors associated with acute hospital discharge dispositions following acute hospitalization for moderate-to-severe traumatic brain injury (TBI) in the United States. The 2011–2014 National Trauma Data Bank data was used, including 466 acute care hospitals and 114,736 patients ≥16 years old who survived moderate-to-severe TBI. Outcome was acute hospital discharge dispositions: home with/without care (HC), skilled nursing home/other care facility (SNF/ICF) and inpatient rehabilitation/long-term care facility (IRF). Independent variables were patients' sociodemographic, injury, and hospital-level factors. Multilevel modeling was used to assess associations and compare likelihood of discharges. Of all patients, 74.5%, 14.6% ,and 10.9% were discharged to HC, SNF/ICF ,and IRF, respectively. Intraclass correlation coefficients indicated that hospitals explained 14.3% and 14.8% of variations in probabilities of institution dispositions. Sociodemographic factors including older age, females, Non-Hispanic Whites, recipients of commercial insurance, and Medicare/Medicaid were significantly associated with higher institution discharges. Hospital-related factors including bed size, teaching status, trauma accreditations, and hospital locations were significantly associated with discharge dispositions. Identifying factors associated with discharge dispositions after acute hospitalization of TBI is pertinent to ensure quality of care and optimal patient outcomes. Further research into hospital-related variations in acute care discharge dispositions is recommended. [ABSTRACT FROM AUTHOR]

Lymphopenia contributes to the immune suppression observed in critical illness. However, its role in the immunologic response to trauma remains unclear. Herein, we assessed whether admission lymphopenia is associated with poor outcomes in patients with blunt chest wall trauma (BCWT). All adult patients with a Chest Abbreviated Injury Score (CAIS) ≥ 2 admitted to our Level I Trauma center between May 2009 and December 2018 were identified in our institution Trauma Registry. Patients with absolute lymphocyte counts (ALC) collected within 24 H of admission were included. Patients who died within 24 H of admission, had bowel perforation on admission, penetrating trauma, and burns were excluded. Demographics, injury characteristics, comorbidities, ALC, complications, and outcomes were collected. Lymphopenia was defined as an ALC ≤ 1000/µL. Association between lymphopenia and clinical outcomes of BCWT was assessed using multivariate analyses. P < 0.05 was considered significant. A total of 1394 patients were included; 69.7% were male; 44.3% were lymphopenic. On univariate analysis, lymphopenia was associated with longer in-hospital stay (11.6±10.2 versus 10.1±11.4, P = 0.009), in-hospital death (9.7% versus 5.8%, P = 0.006), and discharge to a healthcare facility (60.9% versus 46.4%, P < 0.001). Controlling for Injury Severity Score, age, gender, and comorbidities, the association between lymphopenia and discharge to another facility (SNF/rehabilitation facility/ACH) (OR = 1.380 [1.041-1.830], P = 0.025) remained significant. Lymphopenia on admission is associated with discharge requiring increased healthcare support. Routine lymphocyte count monitoring on admission may provide important prognostic information for BCWT patients. [ABSTRACT FROM AUTHOR]

Purpose: Despite the increase in outpatient total knee arthroplasty (TKA) procedures, many patients are still discharged to non-home locations following index surgery. The ability to accurately predict non-home discharge (NHD) following TKAs has the potential to promote a reduction in associated adverse events and excess healthcare costs. This study aimed to evaluate whether a machine learning (ML) model could outperform the American College of Surgeons (ACS) Risk Calculator in predicting NHD following TKA, using the same set of clinical variables. We hypothesised that the ML model would outperform the ACS Risk Calculator., Methods: Data from 365,240 patients who underwent a primary TKA between 2013 and 2020 were extracted from the ACS-National Surgical Quality Improvement Program database and used to develop an artificial neural network (ANN) to predict discharge disposition following primary TKA. The ANN and ACS calculator were assessed and compared using discrimination, calibration and decision curve analysis., Results: Age (>68 years), BMI (>35.5 kg/m 2 ) and ASA Class (≥2) were found to be the most important variables in predicting NHD following TKA. When compared to the ACS calculator, the ANN model demonstrated a significantly superior ability to distinguish the area under the receiver operating characteristic curve (AUC) among NHD patients and provided probability predictions well aligned with the true outcomes (AUC ANN  = 0.69, AUC ACS  = 0.50, p = 0.002, slope ANN  = 0.85, slope ACS  = 4.46, intercept ANN  = 0.04, and intercept ACS  = 0.06)., Conclusion: Our findings support the hypothesis that machine learning models outperform the ACS Risk Calculator in predicting non-home discharge after TKA, even when constrained to the same clinical variables. Our findings underscore the potential benefits of integrating machine learning models into clinical practice for improving preoperative patient risk identification, optimisation, counselling and clinical decision-making., Level of Evidence: III., (© 2024 European Society of Sports Traumatology, Knee Surgery and Arthroscopy.)

Background: A greater area deprivation index (ADI), a tool that gauges socioeconomic disadvantage at the neighborhood level, is associated with worse health care outcomes following primary total hip arthroplasty. However, its association with revision total hip arthroplasty (rTHA) is unknown. This study aimed to determine the association between ADI and rates of postoperative health care resource utilization following rTHA., Methods: A total of 996 patients who underwent rTHA between 2016 and 2022 were enrolled in a prospective study. The primary outcomes assessed were nonhome discharge disposition (DD), length of stay (LOS) ≥ three days, 90-day emergency department (ED) visits, and 90-day hospital readmissions. The ADI was calculated using the patient's home address at the time of surgery, with greater ADI indicating greater socioeconomic disadvantage. We evaluated the mediation effect of patient race on ADI and postoperative health care utilization using a multivariable logistic regression model., Results: A higher median ADI was revealed for patients who experienced nonhome discharge (P = 0.001), extended LOS (P < 0.001), and ED readmission within 90 days of surgery (P = 0.045). When comparing septic versus aseptic rTHA patients, there were significant differences in health care resource utilization but no difference in ADI between the two groups. For aseptic rTHA, ADI significantly mediated the effect of race on both nonhome DD and LOS ≥ 3 (41 and 46% mediation, respectively). In septic rTHA, ADI mediated 31.1% of the effect of race on nonhome DD, but showed minimal mediation effect on LOS. The mediation effect of ADI on ED admission and hospital readmission was minimal for both groups., Conclusions: Higher ADI scores are associated with increased health care utilization after rTHA, including longer hospital stays and more nonhome discharges. The ADI significantly mediates the effect of race on these outcomes, particularly in aseptic rTHA cases, suggesting that neighborhood socioeconomic factors play a crucial role in previously observed racial disparities., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Purpose: This study aims to examine the relationship between insurance status, hospital ownership type, and children's hospital designation with outcomes for pediatric patients undergoing neurosurgical treatment for spasticity. Methods: This retrospective cohort study utilized the Healthcare Cost and Utilization Project Kids' Inpatient Database and included 11,916 pediatric patients (≤ 17 years of age) who underwent neurosurgical treatment for spasticity between 2006 and 2012 using ICD-9-CM procedure codes. Results: Uninsured patients had a significantly shorter hospital length of stay compared to Medicaid patients (−1.42 days, P = 0.030) as did privately insured patients (−0.74 days; P = 0.035). Discharge disposition and inpatient mortality rate were not associated with insurance status. There were no significant associations with hospital ownership type. Free-standing children's hospitals retained patients significantly longer compared to non-children's hospitals (+1.48 days; P = 0.012) and had a significantly higher likelihood of favorable discharge disposition (P = 0.004). Mortality rate was not associated with children's hospital designation. Conclusion: Pediatric patients undergoing neurosurgical treatment for spasticity were more likely to stay in the hospital longer if they were insured by Medicaid or treated in a free-standing children's hospital. In addition, patients in free standing children's hospitals were more likely to be discharged with a favorable disposition. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the burden of illness––length of stay (LOS), total charges, and discharge disposition––among cancers of the lip, oral cavity and pharynx (CLOP) patients with and without palliative care (PC) referral. Methods: This cross-sectional study utilized the 2017 National inpatient sample database to identify hospitalizations with a primary diagnosis of CLOP. Generalized linear models were used to assess the association between PC referral status and the outcomes—LOS, total charges, and discharge disposition while controlling for patients' characteristics. Results: There were 4165 PC referral among 52, 524 CLOP patients. The geometric mean of LOS for non-PC referral patients was 3.7 days, and for PC referral was 5.02 days, P < 0.001. In the adjusted analysis, CLOP patients with PC referral were more likely to have a higher LOS (Coefficient:1.16; 95% CI, 1.01–1.25) compared to those without PC referral. The geometric mean of total charge among non-PC referral group was 48,308 USD, and CLOP-PC referral was 48,983 USD, P = 0.72. After adjusting for covariates, there was still no significant difference between the PC and non-PC referral groups. Discharge disposition were considerably different across the non-PC vs. PC referral groups. Compared to non-PC referral patients, PC referral patients were more likely to be discharge to skilled nursing facility, intermediate care, and another type of facility (aOR = 7.10; CIs, 5.51–9.12), or home health care (aOR = 4.13; CIs, 3.31–5.15). Conclusion: During primary hospitalization, total charges was not different between patient non-PC and PC referral groups; however, the LOS and discharge dispositions were significantly different. [ABSTRACT FROM AUTHOR]

Study Design: Retrospective review.Objective: The primary aim was to compare length of stay (LOS) and discharge disposition of adult spinal deformity (ASD) patients undergoing surgery before and during the pandemic. Secondary aims were to compare the rates of 30-day complications, reoperations, readmissions, and unplanned emergency department (ED) visits.Summary Of Background Data: ASD patients often require extended LOS and non-routine discharge. Given resource limitations during the COVID-19 pandemic and caution regarding hospital stays, surgeons modified standard postoperative protocols to minimize patient exposure.Methods: We identified all patients who underwent elective thoracolumbar ASD surgery with ≥5 levels fusion at a tertiary care center during two distinct time intervals: Jul-Dec 2019 (Pre-COVID, N = 60) and Jul-Dec 2020 (During-COVID, N = 57). Outcome measures included LOS and discharge disposition (home vs. non-home), as well as 30-day major complications, reoperations, readmissions, and ED visits. Regression analyses controlled for demographic and surgical factors.Results: Patients who underwent ASD surgery during the pandemic were younger (61 vs. 67 years) and had longer fusion constructs (9 vs. 8 levels) compared to before the pandemic (p < 0.05 for both). On bivariate analysis, patients undergoing surgery during the pandemic had shorter LOS (6 vs. 9 days) and were more likely to be discharged home (70% vs. 28%) (p < 0.05 for both). After controlling for age and levels fused on multivariable regression, patients who had surgery during the pandemic had shorter LOS (IRR = 0.83, p = 0.015) and greater odds of home discharge (OR = 7.2, p < 0.001). Notably, there were no differences in major complications, reoperations, readmissions, or ED visits between the two groups.Conclusions: During the COVID-19 pandemic, LOS for patients undergoing thoracolumbar ASD surgery decreased, and more patients were discharged home without adversely affecting complication or readmission rates. Lessons learned during the pandemic may help improve resource utilization without negatively influencing short-term outcomes.Level of Evidence: 3. [ABSTRACT FROM AUTHOR]

Background: Post-acute care (PAC) services can include home healthcare, long-term care hospitals, and skilled nursing facilities. We sought to define factors associated with PAC discharge disposition among Medicare beneficiaries who underwent hepatectomy for hepatocellular carcinoma (HCC). Methods: Data for Medicare beneficiaries with a diagnosis of HCC and who underwent a hepatectomy between 2004 and 2015 were retrieved from the SEER-Medicare database. Discharge disposition was defined as routine (HSC: discharged to home) or non-routine (SNF/ICF, discharged to skilled nursing/intermediate care facilities, or HHA, discharge to home with home health agency). The Cochran-Mantel-Haenszel test and multivariable logistic regression were used to assess trends in discharge disposition. Results: Among 1305 patients, the median patient age at diagnosis was 72 years (IQR: 68–76). Approximately 4 in 5 patients were discharged to HSC (77.4%; n = 1010). The odds of a non-routine discharge decreased by 7.0% annually from 2004 to 2015 (ORtrend, 0.93; 95%CI, 0.89–0.97; ptrend = 0.001). Several factors were associated with non-routine discharge, including patient age (OR 1.06, 95%CI 1.04–1.09) and longer LOS (OR 1.07, 95%CI 1.05–1.10). In contrast, patients who had a minor hepatectomy (OR 0.69, 95%CI 0.52–0.93) at a teaching hospital (OR 0.63, 95%CI 0.45–0.89) had lower odds of a non-routine discharge (all P < 0.05). HSC discharge increased over time (2004–2007 (n = 205, 68.1%) vs. 2008–2011 (n = 330, 77.8%) vs. 2012–2015 (n = 475, 81.9%); ptrend < 0.001). Over the same time period, there was a decreasing trend in 90-day readmission (2004–2007 (n = 91, 30.2%) vs. 2008–2011 (n = 107, 25.2%) vs. 2012–2015 (n = 129, 22.2%); ptrend = 0.03). Conclusion: Utilization of PAC services following hepatic resection of HCC decreased by 57.0% between 2004 and 2015. These data highlight that decreased PAC utilization was not generally associated with higher readmission rates following resection of HCC. [ABSTRACT FROM AUTHOR]

Malnutrition is associated with poor postoperative outcomes after knee, hip, and spine surgery. However, whether albumin labs should be part of the routine preoperative workup for shoulder arthroplasty remains understudied. This study investigated the role of preoperative albumin levels in predicting common postoperative adverse outcomes in patients undergoing shoulder arthroplasty. All shoulder arthroplasty cases performed at 2 tertiary referral centers between July 2013 and May 2019 (institution 1) and between June 2007 and Feb 2020 (institution 2) were reviewed. A total of 421 primary and 71 revision elective shoulder arthroplasty cases had preoperative albumin levels recorded. Common demographic variables and relevant Elixhauser comorbidities were pulled. Outcomes gathered included extended (>3 days) postoperative inpatient length of stay (eLOS), 90-day readmission, and discharge to rehab or skilled nursing facility (SNF). The prevalence of malnutrition (albumin <3.5 g/dL) was higher in the revision group compared with the primary group (36.6% vs. 19.5%, P =.001). Reverse shoulder arthroplasty (P =.013) and increasing American Society of Anesthesiologists score (P =.016) were identified as independent risk factors for malnutrition in the primary group. In the revision group, liver disease was associated with malnutrition (P =.046). Malnourished primary shoulder arthroplasty patients had an increased incidence of eLOS (26.8% vs. 13.6%, P =.003) and discharge to rehab/SNF (18.3% vs. 10.3%, P =.045). On univariable analysis, low albumin had an odds ratio (OR) of 2.34 for eLOS (P =.004), which retained significance in a multivariable model including age, American Society of Anesthesiologists score, sex, and body mass index (OR 2.11, P =.03). On univariable analysis, low albumin had an OR of 1.94 for discharge to SNF/rehab (P =.048), but this did not reach significance in the multivariable model. Among revisions, malnourished patients had an increased incidence of eLOS (30.8% vs. 6.7%, P =.014) and discharge to rehab/SNF (26.9% vs. 4.4%, P =.010). In both the primary and revision groups, there was no difference in 90-day readmission rate between patients with low or normal albumin. Malnutrition is more prevalent among revision shoulder arthroplasty patients compared with those undergoing a primary procedure. Primary shoulder arthroplasty patients with low preoperative albumin levels have an increased risk of eLOS and may have an increased need for postacute care. Low albumin was not associated with a risk of 90-day readmissions. Albumin level merits further investigation in large, prospective cohorts to clearly define its role in preoperative risk stratification. [ABSTRACT FROM AUTHOR]