Safe Transitions and Congregate Living in the Age of COVID-19: A Retrospective Cohort Study

2021 ◽  
Author(s):  
Christopher A Boyle ◽  
Urmila Ravichandran ◽  
Valerie Hankamp ◽  
Nadim Ilbawi ◽  
Coleen Conway-Svec ◽  
...  
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Negative Impact ◽  
Relative Reduction ◽  
Nursing Facilities ◽  
Post Intervention ◽  
Or Efficiency ◽  
Skilled Nursing ◽  
Value Based Care

BACKGROUND: COVID-19 represents a grave risk to residents in skilled nursing facilities (SNFs). OBJECTIVE: To determine whether establishment of an appropriate-use committee was associated with a reduction in SNF utilization. DESIGNS, SETTING, AND PARTICIPANTS: Retrospective cohort study at NorthShore University HealthSystem, a multihospital integrated health system in northern Illinois. Participants were patients hospitalized from March 19, 2019, to July 16, 2020. INTERVENTION: Creation of a multidisciplinary committee to assess appropriateness of discharge to SNF following hospitalization. MAIN OUTCOME AND MEASURES: Primary outcome was total discharges to SNFs. Secondary outcomes were new discharges to SNFs, readmissions, length of stay (LOS), and COVID-19 incidence following discharge. RESULTS: Matched populations pre and post intervention were each 4424 patients. Post intervention, there was a relative reduction in total SNF discharges of 49.7% (odds ratio [OR], 0.42; 95% CI, 0.38-0.47) and in new SNF discharges of 66.9% (OR, 0.29; 95% CI, 0.25-0.34). Differences in readmissions and LOS were not statistically significant. For patients discharged to a SNF, 2.99% (95% CI, 1.59%-4.39%) developed COVID-19 within 30 days, compared with 0.26% (95% CI, 0.29%-0.93%) of patients discharged to other settings (P < .001). CONCLUSION: Implementing a review committee to assess for appropriateness of SNF use after a hospitalization during the COVID-19 pandemic is highly effective. There was no negative impact on safety or efficiency of hospital care, and reduced SNF use likely prevented several cases of COVID-19. This model could serve as a template for other hospitals to reduce the risks of COVID-19 in SNFs and as part of a value-based care strategy.

scholarly journals Influence of Comorbidities on Functional Outcomes in Patients With Surgically Treated Fragility Hip Fractures: a Retrospective Cohort Study

2021 ◽  
Author(s):  
Soo Hoon Yoon ◽  
Bo Ryun Kim ◽  
Sang Yoon Lee ◽  
Jaewon Beom ◽  
Jun Hwan Choi ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Cohort Study ◽  
Hip Fractures ◽  
Retrospective Cohort Study ◽  
Cerebrovascular Accident ◽  
Functional Outcomes ◽  
Retrospective Cohort ◽  
Negative Impact ◽  
Korean Version ◽  
Significant Negative Impact

Abstract Background: The incidence and number of fragility hip fractures are gradually increasing, resulting in a wide consumption of medical resources. Various factors affecting functional recovery in patients with fragility hip fractures are known, and comorbid diseases are one of them. The purpose of this study is to determine the effect of comorbidities on functional outcomes in patients surgically treated for fragility hip fractures, thereby contributing to the efficient distribution of medical resources.Methods: This was a retrospective cohort study performed in the three tertiary rehabilitation facilities. A total of 211 patients (50 men and 161 women; average age 81.6±6.7 years) who had undergone surgery for fragility hip fractures were followed up from immediately after transfer to the Department of Rehabilitation Medicine to 6 months postoperatively. Comorbidities referred to a summary of the following conditions: hypertension, diabetes mellitus, chronic liver disease, dementia, cerebrovascular accident, and osteoporosis. Functional outcomes included Koval’s grade, functional ambulatory category (FAC), functional independence measure (FIM)-locomotion, modified Rivermead mobility index, Berg balance scale (BBS), 4-meter walking speed test, the Korean version of the Mini-Mental State Examination, Geriatric Depression Scale (GDS), EuroQol five-dimension (EQ-5D) questionnaire, the Korean version of the Modified Barthel Index, the Korean version of the instrumental activities of daily living (K-IADL), and Korean version of fatigue, resistance, ambulation, illnesses, and loss of weight scale (K-FRAIL). For all tests, each patient was assessed immediately after transfer and 6 months post-surgery.Results: Multivariate linear regression analyses adjusted for age, sex, the initial variable of the functional outcomes, and comorbidities revealed that dementia had a significant negative impact on Koval’s grade and K-FRAIL 6 months postoperatively. Diabetes mellitus had a significant negative impact on the FAC, GDS, EQ-5D, K-IADL, and K-FRAIL 6 months postoperatively. Patients with osteoporosis showed a significant negative outcome of FIM-locomotion 6 months postoperatively. A cerebrovascular accident revealed a significant negative impact on the BBS 6 months postoperatively. In addition, hypertension led to significantly less favorable outcomes of the K-FRAIL 6 months postoperatively. Conclusions: This study confirmed that comorbidities, particularly dementia and diabetes mellitus, significantly influence functional outcomes 6 months after fragility hip fracture surgeries.

1622 Peri-Operative Blood Use in Upper GI Surgery

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
A Mercer
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Baseline Data ◽  
Post Intervention ◽  
Upper Gi ◽  
Number Of Patients ◽  
Made In

Abstract Aim One group and hold sample costs approximately £18 to process while it costs £170 to prepare and administer 1 unit of cross matched blood. We aimed to quantify the amount of blood cross-matched for elective oesophagectomy and gastrectomy cases and compare this to the number of units transfused. Method Retrospective cohort study comparing number of crossmatched blood units requested. Baseline data collected over a 10-week period (08/07/19-16/09/19). A new blood ordering protocol made in agreement with oesophago-gastric and anaesthetic consultants with criteria for blood ordering. Blood was only to be requested if: antibodies on group and hold, pre-op Hb &lt; 120g/l, operative team concerns or previous radiotherapy. Data recollected using the same parameters post -intervention over a 10-week period (23/12/19-08/03/20). Results Pre-intervention 24 patients were included, mean age 67. 47 units were requested with only 1 transfused. Post intervention 27 patients were included, mean age 69. 36 units were ordered and 3 transfused. The new protocol was correctly implemented in 19 patients (70%) therefore saving a potential of 24 units and approximately £4080. Conclusions Patients were cross matched far in excess of their transfusion needs. There was significant reduction in the number of patients being cross-matched post intervention. Rationalising this is important to reduce waste, reduce cost and cut down on delays to maximise theatre time.

scholarly journals How the COVID-19 pandemic changed postoperative infections in urology wards: A retrospective cohort study from two urology departments

2021 ◽  
Vol 16 (5) ◽  
Author(s):  
Bernardo L. Teixeira ◽  
João Cabral ◽  
André Marques-Pinto ◽  
Fernando Vila ◽  
Joaquim Lindoro ◽  
...  
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Postoperative Infection ◽  
Elective Surgery ◽  
Resistant Organism ◽  
Relative Reduction ◽  
Drug Resistant ◽  
Postoperative Infections ◽  
Elective Surgical Procedures

Introduction: We aimed to compare the rate of postoperative infection and drug-resistant organism (DRO) before and during the COVID-19 pandemic in urology departments. Methods: A retrospective cohort study was carried out. Data from all elective surgical procedures carried out in two urology departments between April and June 2018 and the homologous period in 2020 were collected. Main outcomes were the number of postoperative infections during the pandemic, and the number of DROs. Sample size was calculated based on a 50% relative reduction of infections during the pandemic. Variables were compared by Chi-squared test, and multivariable logistic regression was used to estimate predictors. Results: A total of 698 patients undergoing elective surgery were included. The postoperative infection rate during the pre-pandemic period was of 14.1% compared to 12.1% during the pandemic (p=0.494). DROs were lower during the pandemic (92.3% vs. 52.4%, p=0.002). The pandemic period was the main predictor for reduced multi-drug-resistant isolates, with an odds ratio of 0.10 (p=0.010, 95% confidence interval 0.016–0.57). Conclusions: Postoperative infection rates were not significantly reduced during the COVID-19 pandemic, despite the adoption of enhanced infection preventive measures. There was, however, a decrease in the rate of DROs during this period, suggesting a secondary benefit to enhanced infection prevention practices adopted during the COVID-19 era.

scholarly journals Influence of comorbidities on functional outcomes in patients with surgically treated fragility hip fractures: a retrospective cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Soo Hoon Yoon ◽  
Bo Ryun Kim ◽  
Sang Yoon Lee ◽  
Jaewon Beom ◽  
Jun Hwan Choi ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Cohort Study ◽  
Hip Fractures ◽  
Retrospective Cohort Study ◽  
Cerebrovascular Accident ◽  
Functional Outcomes ◽  
Retrospective Cohort ◽  
Negative Impact ◽  
Korean Version ◽  
Significant Negative Impact

Abstract Background The incidence and number of fragility hip fractures are gradually increasing, resulting in a wide consumption of medical resources. Various factors affecting functional recovery in patients with fragility hip fractures are known, and comorbid diseases are one of them. The purpose of this study is to determine the effect of comorbidities on functional outcomes in patients surgically treated for fragility hip fractures, thereby contributing to the efficient distribution of medical resources. Methods This was a retrospective cohort study performed in the three tertiary rehabilitation facilities. A total of 211 patients (50 men and 161 women; average age 81.6 ± 6.7 years) who had undergone surgery for fragility hip fractures were followed up from immediately after transfer to the Department of Rehabilitation Medicine to 6 months postoperatively. Comorbidities referred to a summary of the following conditions: hypertension, diabetes mellitus, chronic liver disease, dementia, cerebrovascular accident, and osteoporosis. Functional outcomes included Koval’s grade, Functional Ambulatory Category (FAC), Functional Independence Measure (FIM)-locomotion, Modified Rivermead Mobility Index, Berg Balance Scale (BBS), 4-Meter Walking speed Test (4MWT), the Korean version of the Mini-Mental State Examination(K-MMSE), Geriatric Depression Scale (GDS), EuroQol Five-Dimension (EQ-5D) questionnaire, the Korean version of the Modified Barthel Index (K-MBI), the Korean version of the Instrumental Activities of Daily Living (K-IADL), and Korean version of Fatigue, Resistance, Ambulation, Illnesses, and Loss of weight scale (K-FRAIL). For all tests, each patient was assessed immediately after transfer and 6 months post-surgery. Results Multivariate linear regression analyses adjusted for age, sex, the initial variable of the functional outcomes, and comorbidities revealed that dementia had a significant negative impact on Koval’s grade and K-FRAIL 6 months postoperatively. Diabetes mellitus had a significant negative impact on the FAC, GDS, EQ-5D, K-IADL, and K-FRAIL 6 months postoperatively. Patients with osteoporosis showed a significant negative outcome of FIM-locomotion 6 months postoperatively. A cerebrovascular accident revealed a significant negative impact on the BBS 6 months postoperatively. In addition, hypertension led to significantly less favorable outcomes of the K-FRAIL 6 months postoperatively. Conclusions This study confirmed that comorbidities, particularly dementia and diabetes mellitus, significantly influence functional outcomes 6 months after fragility hip fracture surgeries.

Tu1788 CLINICAL CHARACTERISTICS AND TREATMENT DIFFERENCES BETWEEN YOUNGER AND OLDER ONSET MICROSCOPIC COLITIS: A MULTICENTER RETROSPECTIVE COHORT STUDY

2020 ◽  
Vol 158 (6) ◽  
pp. S-1161
Author(s):  
Amrit K. Kamboj ◽  
Amandeep Gujral ◽  
Elida Voth ◽  
Daniel Penrice ◽  
Jessica McGoldrick ◽  
...  
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Clinical Characteristics ◽  
Microscopic Colitis
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