Hospital Length of Stay Reduction Over Time and Patient Readmission for Severe Adverse Events Following Surgery

Pascal, Léa; Polazzi, Stéphanie; Piriou, Vincent; Cotte, Eddy; Wegrzyn, Julien; Carty, Matthew J.; Chollet, François; Sanchez, Stéphane; Lifante, Jean-Christophe; Duclos, Antoine

doi:10.1097/sla.0000000000003206

Cited by 21 publications

(14 citation statements)

References 39 publications

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“… 2015 ; Pascal et al . 2020 ), and by critically ill patients (Puthucheary et al . 2013 ), the investigation of the possible determinants of the disproportionate reduction in muscle force compared with that of muscle size is of considerable relevance.…”

Section: Introductionmentioning

confidence: 99%

Neuromuscular junction instability and altered intracellular calcium handling as early determinants of force loss during unloading in humans

Monti

Reggiani

Franchi

et al. 2021

The Journal of Physiology

133

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Few days of unloading are sufficient to induce a decline of skeletal muscle mass and function; notably, contractile force is lost at a faster rate than muscle mass.r The reasons behind this disproportionate loss of muscle force are still poorly understood. r We provide strong evidence of two mechanisms only hypothesized until now for the rapid muscle force loss in only 10 days of bed rest.r Our results show that an initial neuromuscular junction instability, accompanied by alterations in the innervation status and impairment of single fibre sarcoplasmic reticulum function contribute to the loss of contractile force in front of a preserved myofibrillar function and central activation capacity.r Early onset of neuromuscular junction instability and impairment in calcium dynamics involved in excitation-contraction coupling are proposed as eligible determinants to the greater decline in muscle force than in muscle size during unloading.

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Section: Introductionmentioning

confidence: 99%

Neuromuscular junction instability and altered intracellular calcium handling as early determinants of force loss during unloading in humans

Monti

Reggiani

Franchi

et al. 2021

The Journal of Physiology

133

View full text Add to dashboard Cite

show abstract

“…Patient demographics, comorbidities, complications grade, surgical details, were abstracted from the database and charts. Tumor clinical and pathology staging was categorized according to the 7th Edition of the American Joint Committee on Cancer Staging Manual ( 21 ).…”

Section: Methodsmentioning

confidence: 99%

The Effect of Major and Minor Complications After Lung Surgery on Length of Stay and Readmission

Finley

Begum

Pearce

et al. 2022

Journal of Patient Experience

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The effect of post-operative adverse events (AEs) on patient outcomes such as length of stay (LOS) and readmissions to hospital is not completely understood. This study examined the severity of AEs from a high-volume thoracic surgery center and its effect on the patient postoperative LOS and readmissions to hospital. This study includes patients who underwent an elective lung resection between September 2018 and January 2020. The AEs were grouped as no AEs, 1 or more minor AEs, and 1 or more major AEs. The effects of the AEs on patient LOS and readmissions were examined using a survival analysis and logistic regression, respectively, while adjusting for the other demographic or clinical variables. Among 488 patients who underwent lung surgery, (Wedge resection [n = 100], Segmentectomy [n = 51], Lobectomy [n = 310], Bilobectomy [n = 10], or Pneumonectomy [n = 17]) for either primary (n = 440) or secondary (n = 48) lung cancers, 179 (36.7%) patients had no AEs, 264 (54.1%) patients had 1 or more minor AEs, and 45 (9.2%) patients had 1 or more major AEs. Overall, the median of LOS was 3 days which varied significantly between AE groups; 2, 4, and 8 days among the no, minor, and major AE groups, respectively. In addition, type of surgery, renal disease (urinary tract infection [UTI], urinary retention, or acute kidney injury), and ASA (American Society of Anesthesiology) score were significant predictors of LOS. Finally, 58 (11.9%) patients were readmitted. Readmission was significantly associated with AE group ( P = 0.016). No other variable could significantly predict patient readmission. Overall, postoperative AEs significantly affect the postoperative LOS and readmission rates.

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“…However, length of stay does not necessarily correlate with postoperative outcomes [11]. In fact, there is concern that shortening length of stay for certain surgeries may increase adverse events once the patient returns home [29]. A barrier to implementation will be the heterogeneity in sensor types [30,31].…”

Section: Summary Of Findingsmentioning

confidence: 99%

Relationship Between Mobile Digital Sensor Monitoring and Perioperative Outcomes: Systematic Review

et al. 2021

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Background Monitoring surgical recovery has traditionally been confined to metrics measurable within the hospital and clinic setting. However, commercially available mobile sensors are now capable of extending measurements into a patient’s home. As these sensors were developed for nonmedical applications, their clinical role has yet to be established. The aim of this systematic review is to evaluate the relationship between data generated by mobile sensors and postoperative outcomes. Objective The objective of this study is to describe the current use of mobile sensors in the perioperative setting and the correlation between their data and clinical outcomes. Methods A systematic search of EMBASE, MEDLINE, and Cochrane Library from inception until April 2019 was performed to identify studies of surgical patients monitored with mobile sensors. Sensors were considered if they collected patient metrics such as step count, temperature, or heart rate. Studies were included if patients underwent major surgery (≥1 inpatient postoperative day), patients were monitored using mobile sensors in the perioperative period, and the study reported postoperative outcomes (ie, complications and hospital readmission). For studies including step count, a pooled analysis of the step count per postoperative day was calculated for the complication and noncomplication cohorts using mean and a random-effects linear model. The Grading of Recommendations, Assessment, Development, and Evaluation tool was used to assess study quality. Results From 2209 abstracts, we identified 11 studies for review. Reviewed studies consisted of either prospective observational cohorts (n=10) or randomized controlled trials (n=1). Activity monitors were the most widely used sensors (n=10), with an additional study measuring temperature, respiratory rate, and heart rate (n=1). Low step count was associated with worse postoperative outcomes. A median step count of around 1000 steps per postoperative day was associated with adverse surgical outcomes. Within the studies, there was heterogeneity between the type of surgery and type of reported postoperative outcome. Conclusions Despite significant heterogeneity in the type of surgery and sensors, low step count was associated with worse postoperative outcomes across surgical specialties. Further studies and standardization are needed to assess the role of mobile sensors in postoperative care, but a threshold of approximately 1000 steps per postoperative day warrants further investigation.

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Hospital Length of Stay Reduction Over Time and Patient Readmission for Severe Adverse Events Following Surgery

Cited by 21 publications

References 39 publications

Neuromuscular junction instability and altered intracellular calcium handling as early determinants of force loss during unloading in humans

Neuromuscular junction instability and altered intracellular calcium handling as early determinants of force loss during unloading in humans

The Effect of Major and Minor Complications After Lung Surgery on Length of Stay and Readmission

Relationship Between Mobile Digital Sensor Monitoring and Perioperative Outcomes: Systematic Review

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