Predictors of postdischarge complications: role of in-hospital length of stay

Oyetunji, Tolulope A.; Turner, Patricia L.; Onguti, Sharon; Ehanire, Imudia D.; Dorsett, Forrestall O.; Fullum, Terrence M.; Cornwell, Edward E.; Haider, Adil H.

doi:10.1016/j.amjsurg.2012.04.006

Cited by 9 publications

(6 citation statements)

References 14 publications

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“…In an analysis of 12,956 colectomies in NSQIP, Oyetunji et al determined a PDC rate of 8.7%. 12 Similarly, a study of 551,510 patients undergoing general surgery procedures by Kazaure et al reported an overall PDC rate of 6.9%. 8 We found that approximately 40% of complications occurred post discharge, which validates recent findings in general surgery that demonstrated that 33% to 42% of postoperative complications 8,9 and 24% of deaths 9 occurred post discharge.…”

Section: Discussionmentioning

confidence: 94%

“…Prolonged operative time has been shown to be an important predictor of wound complications in laryngectomy 21 and in general surgery. 8,12,14 Since surgical site infections were a common PDC, prolonged operative time may have contributed to PDCs through prolonged exposure of the surgical site and decreased effectiveness of preoperative antibiotics with increased operative time. These results highlight the importance of careful preoperative patient selection and optimization of operative efficiency without compromising thoroughness.…”

Section: Discussionmentioning

confidence: 99%

“…The overall 30‐day PDC rate in our study was 1.2%, which is markedly lower than the PDC rates in general surgery. In an analysis of 12,956 colectomies in NSQIP, Oyetunji et al determined a PDC rate of 8.7% 12 . Similarly, a study of 551,510 patients undergoing general surgery procedures by Kazaure et al reported an overall PDC rate of 6.9% 8 .…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Postdischarge Complications Predict Reoperation and Mortality after Otolaryngologic Surgery

Chen

Roman

Sosa

et al. 2013

Otolaryngol.--head neck surg.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Postdischarge Complications Predict Reoperation and Mortality after Otolaryngologic Surgery

Chen

Roman

Sosa

et al. 2013

Otolaryngol.--head neck surg.

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“…The impact of increased OD on postoperative outcomes has been described in the general surgical literature, 21 , 22 associated with various medical and surgical complications. 18 , 21 , 23 , 24 This relationship has not been extensively explored in the context of spinal deformity procedures. Being able to identify patients at risk for postoperative complications following ASDS and understanding the impact of OD on these risks may useful for optimizing discharge pathways and streamlining postoperative care for such patients.…”

Section: Discussionmentioning

confidence: 99%

Impact of Operation Time on 30-Day Complications After Adult Spinal Deformity Surgery

Phan

Kim

Capua

et al. 2017

Global Spine Journal

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Study Design:Retrospective analysis of prospectively collected data.Objective:There is a paucity of data on the effect of operative duration on postoperative complications during adult spinal deformity surgery (ASDS). The study attempts to explore and quantify the association between increased operation times and postoperative complications.Methods:A retrospective cohort analysis was performed on the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database from 2010 to 2014. Patients (≥18 years of age) from the NSQIP database undergoing ASDS were separated into cohorts based on quartiles of operation duration. Chi-square and multivariate logistic regression models were used to identify risk factors.Results:A total of 5338 patients met the inclusion criteria and were divided per quartiles based on operative duration in minutes (154, 235, 346, and 1156 minutes). Multivariate logistic regressions revealed that in comparison to the lowest quartile of operative duration, the highest quartile group was associated significantly with length of stay ≥5 days (odds ratio [OR] = 5.85), any complication (OR = 9.88), wound complication (OR = 5.95), pulmonary complication (OR = 2.85, P = .001), venous thromboembolism (OR = 12.37), intra-/postoperative transfusion (OR = 12.77), sepsis (OR = 5.27), reoperations (OR = 1.48), and unplanned readmissions (OR = 1.29). The odds ratio was higher when comparing a higher quartile group with the reference group across all associations. P < .001 unless otherwise noted.Conclusion:ASDS operation time is associated with multiple postoperative complications, including, but not limited to, wound and pulmonary complications, venous thromboembolism, postoperative transfusion, length of stay ≥5 days, sepsis, reoperation, and unplanned readmission.

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“…Interestingly, it has been demonstrated that the root cause of prolonged LOS in the patient with trauma is often not related to the severity of the injury or clinical needs, but to system‐related issues (Fakhry, Couillard, Liddy, Adams, & Norcross, 2010; Hwabejire et al, 2013; Jacobs et al, 2009; Kurtz, Cookson, & Mattie, 2008). Because prolonged LOS in this patient population is so often closely associated with state‐wide rather than hospital‐specific system‐related factors, it has been debated whether LOS should be used as a measure of quality (MacKenzie et al, 2012; Oyetunji et al, 2013). However, hospitals acknowledge that a prolonged LOS has an adverse impact on their performance both clinically and financially and thus decreasing LOS became a de facto priority for many institutions interested in maintaining a high level of care quality (Simorov, Bills, Shostrom, Boilesen, & Oleynikov, 2014; Stock & McDermott, 2011).…”

Section: Introductionmentioning

confidence: 99%

A multidisciplinary approach to decreasing length of stay in acute care surgery patients

DePesa

Hechi

McKenzie

et al. 2020

Journal of Advanced Nursing

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Aim:To decrease hospital length of stay in acute care surgery patients.Design: An observational cohort quality improvement project at a single tertiary referral centre. Methods:A multidisciplinary team of physicians, nurses, case managers, and physical and occupational therapists was created to identify patients at risk for prolonged length of stay and implement weekly multidisciplinary rounding, with a systematic method of tracking progress in real time. The main outcome measure was hospital length of stay. The observed/expected ratios for length of stay 2 years before (2012-2014) and after (2014-2016) the intervention were compared.Results: A total of 6,120 patients was analysed. Early identification and action on barriers to discharge created a significant decrease in risk-adjusted acute care surgery patient days per year (96 days) with limited added cost (1-2 hr per week). Patients discharged to home with or without services benefited most. Conclusion:Decreasing length of stay in acute care surgery patients is possible without adding a significant burden to healthcare providers. Impact:We describe a comprehensive, multidisciplinary initiative to decrease the length of stay of acute care surgery patients. Institutions can use existing resources in a sustainable manner to create a significant decrease in patient days per year with limited added cost. Registration: https://osf.io/zfc3t K E Y W O R D S acute care surgery, health resources, length of stay, multidisciplinary, nurse, nursing, quality improvement | 1365 DEPESA Et Al.

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Predictors of postdischarge complications: role of in-hospital length of stay

Cited by 9 publications

References 14 publications

Postdischarge Complications Predict Reoperation and Mortality after Otolaryngologic Surgery

Postdischarge Complications Predict Reoperation and Mortality after Otolaryngologic Surgery

Impact of Operation Time on 30-Day Complications After Adult Spinal Deformity Surgery

A multidisciplinary approach to decreasing length of stay in acute care surgery patients

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