Hospital length of stay following first-time elective open posterior lumbar fusion in elderly patients: a retrospective analysis of the associated clinical factors

Zhan, Haibo; Guo, Runsheng; Xu, Huaen; Liu, Xuqiang; Yu, Xiaolong; Xu, Qiang; Chen, Hangjun; Dai, Min; Zhang, Bin

doi:10.1097/md.0000000000017740

Cited by 12 publications

(14 citation statements)

References 28 publications

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“…Our study identified several independent baseline associations with prolonged hospitalization. Other studies have similarly revealed that increasing age [ 12 , 17 , 18 , 20 , 22 , 24 , 25 , 28 , 29 , 30 , 33 , 34 , 36 , 38 , 39 , 40 , 50 ], female gender [ 22 , 24 , 26 , 30 , 36 , 39 , 50 ], not being in a relationship, [ 52 ] being a current smoker [ 39 ], level of co-morbidity [ 11 , 12 , 14 , 15 , 16 , 18 , 22 , 26 , 40 , 42 , 44 ], weekend admissions [ 42 ], and the number of prior admissions [ 25 , 32 , 44 ] were associated with prolonged hospitalization.…”

Section: Discussionmentioning

confidence: 96%

“…Importantly, this cutoff was chosen a priori. Other studies have variably defined prolonged hospitalization as admissions lasting more than seven days [ 19 , 23 , 29 , 37 , 38 ] or above the 75th centile for length of stay [ 11 , 12 , 14 , 15 , 17 , 20 , 26 , 27 , 30 , 40 ].…”

Section: Discussionmentioning

confidence: 99%

“…Several studies have identified factors associated with protracted hospitalization, but many of these have focused on targeted patient populations [ 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 ] or involved data collected at a single centre [ 13 , 18 , 19 , 23 , 24 , 28 , 29 , 31 , 37 , 39 , 40 , 41 , 42 , 43 , 44 , 45 ] Understanding the factors that contribute to prolonged hospitalization in a broader patient cohort may guide the development of interventions that target at risk patients, improve overall care, and reduce resource utilisation.…”

Section: Introductionmentioning

confidence: 99%

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The Frequency of, and Factors Associated with Prolonged Hospitalization: A Multicentre Study in Victoria, Australia

Ofori‐Asenso

Mårtensson

Jones

2020

JCM

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Background: Limited available evidence suggests that a small proportion of inpatients undergo prolonged hospitalization and use a disproportionate number of bed days. Understanding the factors contributing to prolonged hospitalization may improve patient care and reduce the length of stay in such patients. Methods: We undertook a retrospective cohort study of adult (≥20 years) patients admitted for at least 24 h between 14 November 2016 and 14 November 2018 to hospitals in Victoria, Australia. Data including baseline demographics, admitting specialty, survival status and discharge disposition were obtained from the Victorian Admission Episode Dataset. Multivariable logistic regression analysis was used to identify factors independently associated with prolonged hospitalization (≥14 days). Cox proportional hazard regression model was used to examine the association between various factors and in-hospital mortality. Results: There were almost 5 million hospital admissions over two years. After exclusions, 1,696,112 admissions lasting at least 24 h were included. Admissions with prolonged hospitalization comprised only 9.7% of admissions but utilized 44.2% of all hospital bed days. Factors independently associated with prolonged hospitalization included age, female gender, not being in a relationship, being a current smoker, level of co-morbidity, admission from another hospital, admission on the weekend, and the number of admissions in the prior 12 months. The in-hospital mortality rate was 5.0% for those with prolonged hospitalization compared with 1.8% in those without (p < 0.001). Prolonged hospitalization was also independently associated with a decreased likelihood of being discharged to home (OR 0.53, 95% CI 0.52–0.54). Conclusions: Patients experiencing prolonged hospitalization utilize a disproportionate proportion of bed days and are at higher risk of in-hospital death and discharge to destinations other than home. Further studies are required to identify modifiable factors contributing to prolonged hospitalization as well as the quality of end-of-life care in such admissions.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The Frequency of, and Factors Associated with Prolonged Hospitalization: A Multicentre Study in Victoria, Australia

Ofori‐Asenso

Mårtensson

Jones

2020

JCM

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“…Tissue disruption during surgical procedures and trauma leads to bleeding that interferes with visualization of the surgical area and blood loss that may require replacement with blood or blood products. Trauma-induced hemorrhagic shock is a major cause of morbidity and mortality [33], and bleeding-related complications resulting from surgeries and endovascular interventions has been linked to longer length of hospital stays and higher cost of care for a variety of surgical procedures including neurological, vascular, solid organ, thoracic, cardiac, digestive and reproductive organs, and knee/hip replacements [8,[34][35][36][37][38][39]. Pre-hospitalization and inpatient management of bleeding during surgical procedures is crucial to prevent nonfatal and potentially lifethreatening complications [40,41].…”

Section: Discussionmentioning

confidence: 99%

Hemostatic efficacy of two topical adjunctive hemostats in a porcine spleen biopsy punch model of moderate bleeding

Macdonald

Zhang

Tasse

et al. 2021

J Mater Sci: Mater Med

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Topical hemostatic agents have become essential tools to aid in preventing excessive bleeding in surgical or emergency settings and to mitigate the associated risks of serious complications. In the present study, we compared the hemostatic efficacy of SURGIFLO® Hemostatic Matrix Kit with Thrombin (Surgiflo—flowable gelatin matrix plus human thrombin) to HEMOBLAST™ Bellows Hemostatic Agent (Hemoblast—a combination product consisting of collagen, chondroitin sulfate, and human thrombin). Surgiflo and Hemoblast were randomly tested in experimentally induced bleeding lesions on the spleens of four pigs. Primary endpoints included hemostatic efficacy measured by absolute time to hemostasis (TTH) within 5 min. Secondary endpoints included the number of product applications and the percent of product needed from each device to achieve hemostasis. Surgiflo demonstrated significantly higher hemostatic efficacy and lower TTH (p < 0.01) than Hemoblast. Surgiflo-treated lesion sites achieved hemostasis in 77.4% of cases following a single product application vs. 3.3% of Hemoblast-treated sites. On average, Surgiflo-treated sites required 63% less product applications than Hemoblast-treated sites (1.26 ± 0.0.51 vs. 3.37 ± 1.16). Surgiflo provided more effective and faster hemostasis than Hemoblast. Since both products contain thrombin to activate endogenous fibrinogen and accelerate clot formation, the superior hemostatic efficacy of Surgiflo in the porcine spleen punch biopsy model seems to be due to Surgiflo’s property as a malleable barrier able to adjust to defect topography and to provide an environment for platelets to adhere and aggregate. Surgiflo combines a flowable gelatin matrix and a delivery system well-suited for precise application to bleeding sites where other methods of hemostasis may be impractical or ineffective.

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“…The thicker the edge, the more co‐occurrences of the two connected complications. Five studies were excluded from co‐occurrence network analysis because individual postoperative medical complications were not reported (Baker et al, 2017; Drazin et al, 2017; Passias et al, 2017; Sharma et al, 2019; Zhan et al, 2019).…”

Section: Methodsmentioning

confidence: 99%

In‐hospital medical complication in older people after spine surgery: A scoping review

Strayer

Kuo

King

2022

Int J Older People Nursing

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Objective Worldwide, older people are suffering from lumbar degenerative disease at an annual rate of 266 million. Although spine surgeries restore mobility, reduce pain and resolve neurological damage, these procedures can place older persons at high‐risk for medical complications due to multiple comorbid conditions that are often present in this population. However, the prevalence of complications occurring in older people prior to discharge is unknown. Postoperative medical complications lead to increased healthcare costs as well as pain and potential harm for the patient. Hence, this scoping review aimed to provide an overview of the current knowledge state regarding in‐hospital medical postoperative complications in older people (≥65 years) after elective spine surgery. Method A scoping review was conducted following Arksey and O’Malley's framework. Four databases (PubMed, Cochrane, Scopus and CINAHL) were systematically searched. Inclusion criteria were medical complication(s) after elective spine surgery prior to discharge, age ≥65 years and English language. Co‐occurrence analysis was used to examine how often each complication was examined in the literature and how often the complications co‐occur. Results Twenty‐six studies met inclusion criteria. The most frequently examined postoperative medical complications after spine surgery are delirium and urinary tract infection, followed by gastrointestinal and pulmonary embolus. Despite the list of in‐hospital medical complications, definitions or criteria for measurement of any identified complication were sparse and inconsistent. There is a lack of definition or instruments to comprehensively assess medical complications incurred by older people following spine surgery, including characteristics, classification methodology and temporality. To date, no research has been conducted on how older people experience or perceive a medical complication after elective spine surgery. Conclusion The findings highlight the importance to develop comprehensive instruments to assess co‐occurrence of postoperative medical complications and design interventions to mitigate the negative impacts of medical complications incurred by older people after spine surgery.

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Hospital length of stay following first-time elective open posterior lumbar fusion in elderly patients: a retrospective analysis of the associated clinical factors

Cited by 12 publications

References 28 publications

The Frequency of, and Factors Associated with Prolonged Hospitalization: A Multicentre Study in Victoria, Australia

The Frequency of, and Factors Associated with Prolonged Hospitalization: A Multicentre Study in Victoria, Australia

Hemostatic efficacy of two topical adjunctive hemostats in a porcine spleen biopsy punch model of moderate bleeding

In‐hospital medical complication in older people after spine surgery: A scoping review

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