scholarly journals Factors associated with delay in trauma team activation and impact on patient outcomes

CJEM ◽  
2017 ◽  
Vol 20 (4) ◽  
pp. 606-613 ◽  
Author(s):  
Rory Connolly ◽  
Michael Y. Woo ◽  
Jacinthe Lampron ◽  
Jeffrey J. Perry
Keyword(s):  
Length Of Stay ◽  
Multiple Logistic Regression Analysis ◽  
Univariate Analysis ◽  
Group Versus ◽  
Trauma Team ◽  
Operative Management ◽  
Trauma Team Activation ◽  
Factors Associated ◽  
Significant Difference ◽  
Delayed Group

AbstractObjectiveTrauma code activation is initiated by emergency physicians using physiological and anatomical criteria, mechanism of injury, and patient demographic factors. Our objective was to identify factors associated with delayed trauma team activation.MethodsWe assessed consecutive cases from a regional trauma database from January 2008 to March 2014. We defined a delay in trauma code activation as a time greater than 30 minutes from the time of arrival. We conducted univariate analysis for factors potentially influencing trauma team activation, and we subsequently used multiple logistic regression analysis models for delayed activation in relation to mortality, length of stay, and time to operative management.ResultsPatients totalling 846 were included for our analysis; 4.1% (35/846) of trauma codes were activated after 30 minutes. Mean age was 40.8 years in the early group versus 49.2 in the delayed group (p=0.01). Patients were over age 70 years in 7.6% in the early activation group versus 17.1% in the delayed group (p=0.04). There was no significant difference in sex, type of injury, injury severity, or time from injury between the two groups. There was no significant difference in mortality, median length of stay, or median time to operative management.ConclusionsDelayed activation is linked with increasing age with no clear link to increased mortality. Given the severe injuries in the delayed cohort that required activation of the trauma team, further emphasis on the older trauma patient and interventions to recognize this vulnerable population should be made.

scholarly journals LO89: Factors associated with delay in trauma team activation and impact on patient outcomes

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S58-S59
Author(s):  
R. Connolly ◽  
M. Woo ◽  
J. Lampron ◽  
J.J. Perry
Keyword(s):  
Length Of Stay ◽  
Trauma Team ◽  
Operative Management ◽  
Trauma Patients ◽  
Early Group ◽  
Emergency Physicians ◽  
Trauma Team Activation ◽  
Factors Associated ◽  
Significant Difference ◽  
Delayed Group

Introduction: Trauma code activation is initiated by emergency physicians using physiologic and anatomic criteria, mechanism of injury and patient demographic factors in conjunction with data obtained from emergency medical service personnel. This enables rapid definitive treatment of trauma patients. Our objective was to identify factors associated with delayed trauma team activation. Methods: We conducted a health records review to supplement data from a regional trauma center database. We assessed consecutive cases from the trauma database from January 2008 to March 2014 including all cases in which a trauma code was activated by an emergency physician. We defined a delay in trauma code activation as a time greater than 30 minutes from time to arrival to trauma team activation. Data were collected in Microsoft Excel and analyzed in Statistical Analysis System (SAS). We conducted univariate analysis for factors potentially influencing trauma team activation and we subsequently used multiple logistic regression analysis models for delayed activation in relation to mortality, length of stay and time to operative management. Results: 1020 patients were screened from which 174 patients were excluded, as they were seen directly by the trauma team. 846 patients were included for our analysis. 4.1% (35/846) of trauma codes were activated after 30 minutes. Mean age was 40.8 years in the early group versus 49.2 in the delayed group p=0.01. There was no significant difference in type of injury, injury severity or time from injury between the two groups. Patients were over 70 years in 7.6% in the early activation group vs 17.1% in the delayed group (p=0.04). 77.7% of the early group were male vs 71.4% in the delayed group (p=0.39). There was no significant difference in mortality (15.2% vs 11.4% p=0.10), median length of stay (10 days in both groups p=0.94) or median time to operative management (331 minutes vs 277 minutes p=0.52). Conclusion: Delayed activation is linked with increasing age with no clear link with increased mortality. Given the severe injuries in the delayed cohort which required activation of the trauma team further emphasis on the older trauma patient and interventions to recognize this vulnerable population should be made. When assessing elderly trauma patients emergency physicians should have a low threshold to activate trauma teams.

scholarly journals Prevalence and associated factors for Pterygium in Han and Mongolian adults: across-sectional study in inner Mongolian, China

2019 ◽  
Author(s):  
Yuhan Wang ◽  
Guangliang Shan ◽  
Linyang Gan ◽  
Yonggang Qian ◽  
Ting Chen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Protective Factors ◽  
Rural Areas ◽  
Inner Mongolia ◽  
Univariate Analysis ◽  
Education Level ◽  
Study Cohort ◽  
Sectional Study ◽  
Factors Associated ◽  
Significant Difference

Abstract Background: To investigate the prevalence of and factors associated with pterygium in Han and Mongolian adults at four survey sites in Inner Mongolia, China. Methods: A population-based, cross-sectional study was conducted. Using a stratified sampling method, we eventually included 2,651 participants of at least30 years of age from a total of 3,468 eligible residents. Factors associated with pterygium were analysed using univariate analysis and logistic regression models. Results: There were 1,910 Han adults and 741 Mongolian adults included in this study. The mean± standard deviation of age for individuals in the study cohort was 48.93±11.06 years. The overall prevalence of pterygium was 6.4% (n=169), and the prevalences of bilateral and unilateral pterygium were 1.4% (n=38) and 4.8% (n=128), respectively. The most common grade of pterygium was Grade 2. After univariate analysis, eleven factors were considered in a multivariate analysis. The results indicated that age (P<0.001), education level (P<0.001), outdoor occupation (P=0.026), and time spent in rural areas (P<0.001) were significantly associated with pterygium, whereas gender and ethnicity were not risk factors. In subgroup analysis, BMI≥28 was a protective factor for Han individuals (OR 0.42, 95% CI 0.21-0.81, P=0.01), but a risk factor for Mongolian individuals (OR 2.39, 95% CI 1.02-5.58, P=0.044). The BF% in Han and Mongolian individuals had significant difference (P<0.001). Conclusions: Our results indicated that an outdoor occupation, old age and time spent in rural areas are risk factors for pterygium in Inner Mongolia. Living near an urban survey site (Hohhot and Tsining District) and having a higher education level are protective factors for pterygium. Ethnicity, gender, smoking, diabetes and high blood pressure are not associated with pterygium. Different dietary structures in Han and Mongolian adults may lead to different fat content of body and therefore contributes to the prevalence of pterygium. Keywords: Pterygium, prevalence, Han and Mongolian, risk factors, protective factors

Balanced Crystalloid Versus Normal Saline as Resuscitative Fluid in Diabetic Ketoacidosis

2022 ◽  
pp. 106002802110636
Author(s):  
Adriana R. Carrillo ◽  
Kirsten Elwood ◽  
Chris Werth ◽  
Jessica Mitchell ◽  
Preeyaporn Sarangarm
Keyword(s):  
Length Of Stay ◽  
Serum Creatinine ◽  
Diabetic Ketoacidosis ◽  
Fluid Resuscitation ◽  
Normal Saline ◽  
Group Versus ◽  
Hospital Length Of Stay ◽  
Maximum Serum ◽  
Significant Difference ◽  
Balanced Crystalloid

Background: Large volume resuscitation with normal saline (NS) may be associated with iatrogenic hyperchloremia and renal injury. Objective: The purpose of this study was to assess clinical outcomes associated with the use of Lactated Ringer’s (LR) compared to NS as resuscitative fluid in diabetic ketoacidosis (DKA). Methods: Single-center, retrospective analysis of patients admitted for DKA. The primary objective of this study was to evaluate the incidence of iatrogenic hyperchloremia associated with fluid resuscitation using balanced crystalloid compared to NS. Results Iatrogenic hyperchloremia occurred more frequently in the NS group compared to the LR group (74.4% vs 64.2%; P = 0.05). Mean maximum serum chloride was higher in the NS group (115.7 mmol/L vs 113.7 mmol/L; P = 0.004). Incidence of hypernatremia was higher in the NS group (18.3% vs 9.3%; P = 0.02). There was no significant difference in the incidence of AKI; however, mean change in serum creatinine at 48 hours showed a significantly greater decrease in the LR group (-0.15 mg/dL vs -0.04 mg/dL; P = 0.002). No significant differences were found in intensive care unit (ICU) length of stay or total hospital length of stay. Conclusion and Relevance This study found a statistically significant reduction in the incidence of iatrogenic hyperchloremia with the use of LR compared to NS as fluid resuscitation in DKA. Serum creatinine was more improved in the LR group versus NS group at 48 hours. Preferential use of balanced crystalloid for fluid resuscitation in DKA may reduce incidence of hyperchloremia and support renal recovery in this population.

scholarly journals Retrospective analysis of alcohol testing in trauma team activation patients at a Canadian tertiary trauma centre

BMJ Open ◽  
2018 ◽  
Vol 8 (11) ◽  
pp. e024190 ◽  
Author(s):  
Mete Erdogan ◽  
Nelofar Kureshi ◽  
Saleema A Karim ◽  
John M Tallon ◽  
Mark Asbridge ◽  
...  
Keyword(s):  
Primary Outcome ◽  
Trauma Team ◽  
Trauma Centre ◽  
System Level ◽  
Trauma Patients ◽  
Blood Alcohol ◽  
Trauma Team Activation ◽  
Factors Associated ◽  
Patient Level ◽  
Alcohol Testing

ObjectivesAlthough alcohol screening is an essential requirement of level I trauma centre accreditation, actual rates of compliance with mandatory alcohol testing in trauma patients are seldom reported. Our objective was to determine the prevalence of blood alcohol concentration (BAC) testing in patients requiring trauma team activation (TTA) for whom blood alcohol testing was mandatory, and to elucidate patient-level, injury-level and system-level factors associated with BAC testing.DesignRetrospective cohort study.SettingTertiary trauma centre in Halifax, Canada.Participants2306 trauma patients who required activation of the trauma team.Primary outcome measureThe primary outcome was the rate of BAC testing among TTA patients. Trends in BAC testing over time and across patient and injury characteristics were described. Multivariable logistic regression examined patient-level, injury-level and system-level factors associated with testing.ResultsOverall, 61% of TTA patients received BAC testing despite existence of a mandatory testing protocol. Rates of BAC testing rose steadily over the study period from 33% in 2000 to 85% in 2010. Testing varied considerably across patient-level, injury-level and system-level characteristics. Key factors associated with testing were male gender, younger age, lower Injury Severity Score, scene Glasgow Coma Scale score <9, direct transport to hospital and presentation between midnight and 09:00 hours, or on the weekend.ConclusionsAt this tertiary trauma centre with a policy of empirical alcohol testing for TTA patients, BAC testing rates varied significantly over the 11-year study period and distinct factors were associated with alcohol testing in TTA patients.

Weekly paclitaxel (WP) +/- bevacizumab (B) in angiosarcoma (AS) patients (pts): Analysis of prognostic/predictive factors from a randomized phase 2 trial.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 11024-11024
Author(s):  
Loic Lebellec ◽  
Francois Bertucci ◽  
Emmanuelle Tresch-Bruneel ◽  
Isabelle Laure Ray-Coquard ◽  
Axel Le Cesne ◽  
...  
Keyword(s):  
Predictive Factors ◽  
De Novo ◽  
Cox Model ◽  
Univariate Analysis ◽  
Continuous Variables ◽  
Phase 2 ◽  
Factors Associated ◽  
Phase 2 Trial ◽  
Significant Difference ◽  
Radiation Induced

11024 Background: WP is an active regimen for treatment of AS pts (Ray-Coquard JCO 2015). We report here the correlative analysis conducted during a phase 2 trial assessing WP +/- B. Methods: Circulating pro/anti-angiogenic factors (FGF, PlGF, SCF, Selectin, thrombospondin, VEGF, VEGF-C) were collected at D1 and D8. Prognostic value for PFS was assessed using Cox model (biomarkers as continuous variables). We attempt to identify subgroups of pts benefiting from adding B using interaction tests (predictive factors). Results: Among the 51 pts enrolled in this trial, 45 were analyzable: 20 in Arm A (WP without B) and 25 in Arm B (with B). Median PFS was 5.5 and 6.1 months, respectively (p = 0.84). Samples were collected in 45 pts at D1 and 42 pts at D1 and 8. Baseline biomarkers were similar in both arms (excluding Selectin, significantly lower in arm A: median of 25 vs. 35 ng/mL, p = 0.03). In arm A, there was no significant difference between values at D1 and D8. In arm B, there were a significant decrease in VEGF (from a median of 0.49 to 0.08 ng/mL; p < 0.01) and selectin (from a median of 35.3 to 31.7 ng/mL; p < 0.01), and a significant increase in PlGF (from a median of 16.1 to 30.0 pg/mL; p < 0.01). In univariate analysis, factors associated with PFS were: de novo vs. radiation-induced AS (HR = 2.39 (p < 0.01), visceral vs. superficial AS (HR = 2.04; p < 0.03), VEGF-C at D1 (HR = 0.77; p < 0.03), FGF at D8 (HR = 1.17; p < 0.01), difference in FGF D8-D1 (HR = 1.24; p < 0.01), and PlGF value at D1 (HR = 1.02; p < 0.05). In multivariate analysis, factors associated with PFS were: de novo AS (HR = 2.39; p = 0.03), VEGF-C at D1 (HR = 0.73; p < 0.02) and FGF difference between D8 and D1 (HR = 1.16; p < 0.02). None of these factors were associated with benefit of adding B. Conclusions: Baseline VEGF-C levels and change in FGF were independent prognostic factors in pts with or without B. Addition of B significantly decreased the level of circulating VEGF and selectin and increased the level of circulating PlGF in AS patients. We did not identify subgroup of pts benefiting from adding of B to WP. Clinical trial information: NCT01303497.

scholarly journals Newly Modified Descemetopexy Method in Descemet’s Membrane Detachment and Prognostic Analysis: A Systematic Review

2020 ◽  
Author(s):  
Zhan Shen ◽  
Rongmei Peng ◽  
Gege Xiao ◽  
Jing Hong
Keyword(s):  
Logistic Regression ◽  
Multiple Logistic Regression Analysis ◽  
Univariate Analysis ◽  
Dominant Factor ◽  
Prognostic Analysis ◽  
Descemet’S Membrane Detachment ◽  
Significant Difference ◽  
Descemet's Membrane ◽  
Descemet’S Membrane ◽  
Donor Characteristics

Abstract BackgroundTo present a newly modified descemetopexy method and investigate the most determinative factor in the prognosis of Descemet’s membrane detachment (DMD). MethodsThis was a retrospective review of 37 patients (38 eyes) treated with the newly modified descemetopexy method. This surgical method was combined with the vacuum technique to pump supra-Descemet’s fluid. After reviewing and screening, we enrolled 31 patients (32eyes). We evaluated outcomes using the anatomical reattachment of DM [anatomical success (AS)] and the resolution of corneal oedema [functional success (FS)]. Donor characteristics, including sex, age, the presence of diabetes, ocular history, DMD duration, DMD grade, were analysed. Patients were divided into two groups according to whether FS was achieved. Univariate and multi-factor logistic regression analyses were adopted to evaluate factors contributing to the prognosis of DMD. ResultsAS was achieved in 31 eyes (96.9%), and FS was achieved in 21 eyes (65.6%). The univariate analysis showed that both the DMD grade (P=0.029) and DMD duration (P=0.004) affect the prognosis of DMD. The multiple logistic regression analysis indicated that the DMD duration was the dominant factor (P=0.006). No significant difference was found in the DMD grade, sex, age, presence of diabetes, presence of glaucoma or DMD-originating surgery between the two groups.ConclusionsDescemetopexy combined with the vacuum technique can be used to deal with DMD. The DMD duration is the dominant factor affecting the activity of endothelial cells and the final prognosis.

scholarly journals Fusion and Opioid-Sparing With the Use of Ketorolac in Posterior Thoracolumbar Spinal Fusions: A Prospective Double-Blinded Randomized Placebo-Controlled Trial

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Evan J Lytle ◽  
Chad F Claus ◽  
Doris Tong ◽  
Diana Sigler R.Ph ◽  
Dominick Lago ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Perioperative Complications ◽  
Controlled Trial ◽  
Univariate Analysis ◽  
Opioid Use ◽  
Allocation Mechanism ◽  
Opioid Sparing ◽  
Analgesic Regimen ◽  
Significant Difference ◽  
Double Blinded

Abstract INTRODUCTION Use of Ketorolac in spinal fusion is limited due to the risk of pseudarthrosis. Recent literature suggested that such an effect could be type and dose-related. We sought to demonstrate that Ketorolac use was safe with significant opioid-sparing effect and non-inferior fusion rate. METHODS This is a prospective, double-blinded, randomized placebo-controlled trial designed according to the 2013 SPIRIT Guidelines. It is a 2-arm parallel design with a 1:1 randomization. Over a 2- period under 6 surgeons at 2 sites, consecutive patients who underwent elective 1 to 3 level minimally invasive thoracolumbar fusion were screened for inclusion/exclusion. Patients with fusion confounders were excluded. A centralized treatment allocation mechanism and Excel-generated block randomization were used. Patients received a 48-hr scheduled treatment of intravenous Ketorolac (15 mg IV Q6H) or saline. We implemented a standardized analgesia regimen using a standardized order set. The primary outcome was fusion as evaluated XR/CT using the Suk criteria at 6/12 mo by a blinded neuroradiologist. The secondary outcomes were morphine-equivalence (MME) in the first 48 hr postop and during the hospital stay, NSAIDs-specific perioperative complications, VAS, length of stay, and quality-of-life outcomes at 6/12 mo. Univariate analysis was used, P < .05 considered significant. The sample size was estimated to be 600. This is an interim analysis to evaluate the safety and MME reduction. RESULTS A total of 142 patients were analyzed. Patient characteristics and operative data were comparable between the groups except EBL. No significant difference in fusion was found at 6-mo. There was a significant reduction in total/48-hr MME and length of stay (LOS) for the ketorolac group. The only complication was a superficial hematoma in a ketorolac-assigned patient requiring evacuation. CONCLUSION Ketorolac demonstrated safety, a significant reduction in postoperative opioid use and length of stay when used as part of a multi-modal analgesic regimen after thoracolumbar fusion.

scholarly journals Risk Factors and Mortality in Pediatric Patients with Stenotrophomonas maltophilia Bacteremia

2020 ◽  
Vol 41 (S1) ◽  
pp. s374-s375
Author(s):  
Mohammed Alsuhaibani ◽  
Alanoud Aljarboua ◽  
Sahar Althawadi ◽  
Abdurahman Alsweed ◽  
Sami Al-Hajjar
Keyword(s):  
Risk Factors ◽  
Stenotrophomonas Maltophilia ◽  
Pediatric Patients ◽  
Heart Diseases ◽  
Univariate Analysis ◽  
Bloodstream Infections ◽  
Factors Associated ◽  
Icu Admission ◽  
Significant Difference ◽  
The Impact

Background:Stenotrophomonas maltophilia (S. maltophilia) is an opportunistic and nosocomial pathogen that can cause an invasive and fatal infection, particularly in hospitalized and immunocompromised patients. However, little is known about the impact of S. maltophilia bacteremia in pediatric patients. Therefore, we aimed to identify risk factors for mortality, antibiotic susceptibility of S. maltophilia, and mortality rates in pediatric patients with S. maltophilia bacteremia. Methods: We conducted a retrospective cohort study by identifying all S. maltophilia–positive blood cultures in the microbiology laboratory database between January 2007 and December 2018 from hospitalized pediatric patients (age, 1–14 years) at King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia. After identifying patients with S. maltophilia bacteremia, medical charts were reviewed for demographics, clinical data, and outcome within 7 days of bacteremia diagnosis. Risk factors associated with mortality in S. maltophilia bacteremia patients were determined using univariate and multivariate analyses. Results: Overall, 68% of pediatric patients with S. maltophilia bacteremia were identified. The most common underlying primary diagnoses were malignancy (29.4%), congenital heart diseases (16.2%), anemia (14.7%), and primary immunodeficiency (11.8%). All infections were nosocomial infections, and (88.2%) bacteremia cases were central-line–associated bloodstream infections. The risk factors associated with mortality as determined by univariate analysis were ICU admission (P < .001), intubation (P = .001), neutropenia (P = .008), prior use of carbapenem (P = .002), thrombocytopenia (P = .006), and respiratory colonization (P < .001). On multivariate analysis, ICU admission (P = .007; 95% CI, 0.003–0.406) and neutropenia (P = .009; 95% CI, 0.013–0.537) were the major risk factors associated with mortality. S. maltophilia was the most susceptible to trimethoprim and sulfamethoxazole (TMP/SMX, 94.1%), followed by levofloxacin (85.7%). In addition, 36 patients received TMP/SMX as monotherapy, and 11 patients received it in combination with other antibiotics (fluoroquinolone, ceftazidime, or aminoglycoside). Hence, no statistically significant difference was observed in patient mortality. The overall mortality rate within 7 days of S. maltophilia bacteremia diagnosis was 33.8%. Conclusions:S. maltophilia bacteremia is a devastating emerging infection associated with high mortality among hospitalized children. Therefore, early diagnosis and prompt management based on local susceptibility data are crucial. Various risk factors, especially ICU admission and neutropenia, are associated with S. maltophilia bacteremia mortality.Funding: NoneDisclosures: None

scholarly journals Outcomes following operative vs. non-operative management of blunt traumatic pancreatic injuries: a retrospective multi-institutional study

2016 ◽  
Vol 4 ◽  
pp. 1-7 ◽  
Author(s):  
Poppy Addison ◽  
Toni Iurcotta ◽  
Leo I. Amodu ◽  
Geoffrey Crandall ◽  
Meredith Akerman ◽  
...  
Keyword(s):  
Retrospective Review ◽  
Injury Severity ◽  
Univariate Analysis ◽  
Operative Management ◽  
Morbidity And Mortality ◽  
Categorical Variables ◽  
P Value ◽  
Continuous Variables ◽  
Pancreatic Injuries ◽  
Significant Difference

Abstract Background Traumatic pancreatic injuries are rare, and guidelines specifying management are controversial and difficult to apply in the acute clinical setting. Due to sparse data on these injuries, we carried out a retrospective review to determine outcomes following surgical or non-surgical management of traumatic pancreatic injuries. We hypothesize a higher morbidity and mortality rate in patients treated surgically when compared to patients treated non-surgically. Methods We performed a retrospective review of data from four trauma centers in New York from 1990–2014, comparing patients who had blunt traumatic pancreatic injuries who were managed operatively to those managed non-operatively. We compared continuous variables using the Mann-Whitney U test and categorical variables using the chi-square and Fisher’s exact tests. Univariate analysis was performed to determine the possible confounding factors associated with mortality in both treatment groups. Results Twenty nine patients were managed operatively and 32 non-operatively. There was a significant difference between the operative and non-operative groups in median age (37.0 vs. 16.2 years, P = 0.016), grade of pancreatic injury (grade I; 30.8 vs. 85.2%, P value for all comparisons &lt;0.0001), median injury severity score (ISS) (16.0 vs. 4.0, P = 0.002), blood transfusion (55.2 vs. 15.6%, P = 0.0012), other abdominal injuries (79.3 vs. 38.7%, P = 0.0014), pelvic fractures (17.2 vs. 0.00%, P = 0.020), intensive care unit (ICU) admission (86.2 vs. 50.0%, P = 0.003), median length of stay (LOS) (16.0 vs. 4.0 days, P &lt;0.0001), and mortality (27.6 vs. 3.1%, P = 0.010). Conclusions Patients with traumatic pancreatic injuries treated operatively were more severely injured and suffered greater complications than those treated non-operatively. The greater morbidity and mortality associated with these patients warrants further study to determine optimal triage strategies and which subset of patients is likely to benefit from surgery.

scholarly journals P.225 Factors Contributing to Prolonged Length of Stay in Adults Undergoing Spine Surgery: Results from a Quaternary Spinal Care Center

2021 ◽  
Vol 48 (s3) ◽  
pp. S85-S85
Author(s):  
MN Hindi ◽  
C Dandurand ◽  
S Paquette ◽  
B Kwon ◽  
T Ailon ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Multivariate Analyses ◽  
Care Center ◽  
Diagnostic Category ◽  
Emergency Admission ◽  
Operative Management ◽  
Care Quality ◽  
Prolonged Length ◽  
Factors Associated ◽  
Asia Score

Background: Prolonged length of stay (LOS) is associated with increased resource utilization and worse outcomes. The goal of this study is identifying patient, surgical and systemic factors associated with prolonged LOS overall and per diagnostic category for adults admitted to a quaternary spinal care center. Methods: We performed a retrospective analysis on 13,493 admissions from 2006 to 2019. Factors analyzed included patient age, sex, emergency vs elective admission, diagnostic category (degenerative, deformity, oncology, trauma), presence of neurological deficits in trauma patients, ASIA score, operative management and duration, blood loss, and adverse events (AEs). Univariate and multivariate analyses determined factors associated with prolonged LOS. Results: Overall mean LOS (±SD) was 15.80 (±34.03) days. Through multivariate analyses, predictors of prolonged LOS were advanced age (p<0.001), emergency admission (p<0.001), advanced ASIA score (p<0.001), operative management (p=0.043), and presence of AEs (p<0.001), including SSI (p=0.001), other infections (systemic and UTI) (p<0.001), delirium (p=0.006), and pneumonia (p<0.001). The effects of age, emergency admission, and AEs on LOS differed by diagnostic category. Conclusions: Understanding patient and disease factors that affect LOS provides opportunities for QI intervention and allows for an informed preoperative discussion with patients. Future interventions can be targeted to maximize patient outcomes, optimize care quality, and decrease costs.

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