Reduction of Intensive Care Unit Length of Stay

Hunter, Alex; Johnson, Lindsay; Coustasse, Alberto

doi:10.1097/hcm.0000000000000295

Cited by 29 publications

(23 citation statements)

References 19 publications

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“…For example, highvolume hospital admissions were 25% less likely to experience respiratory complications in both databases. Given the well-established importance of shorter ICU stays and earlier mobilization in reducing complications, readmission, and mortality, 21,23,27 this represents another potential benefit of high-volume hospitals. Because trauma volume is a criterion for verification of level I PTCs, these centers are often overrepresented in high-volume hospitals for trauma.…”

Section: Discussionmentioning

confidence: 99%

Volume-outcome relationship in pediatric neurotrauma care: analysis of two national databases

Tang

Yoon

Kimata

et al. 2019

Neurosurgical Focus

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OBJECTIVEPrevious research has demonstrated the association between increased hospital volume and improved outcomes for a wide range of neurosurgical conditions, including adult neurotrauma. The authors aimed to determine if such a relationship was also present in the care of pediatric neurotrauma patients.METHODSThe authors identified 106,146 pediatric admissions for traumatic intracranial hemorrhage (tICH) in the National Inpatient Sample (NIS) for the period 2002–2014 and 34,017 admissions in the National Trauma Data Bank (NTDB) for 2012–2015. Hospitals were stratified as high volume (top 20%) or low volume (bottom 80%) according to their pediatric tICH volume. Then the association between high-volume status and favorable discharge disposition, inpatient mortality, complications, and length of stay (LOS) was assessed. Multivariate regression modeling was used to control for patient demographics, severity metrics, hospital characteristics, and performance of neurosurgical procedures.RESULTSIn each database, high-volume hospitals treated over 60% of pediatric tICH admissions. In the NIS, patients at high-volume hospitals presented with worse severity metrics and more frequently underwent neurosurgical intervention over medical management (all p < 0.001). After multivariate adjustment, admission to a high-volume hospital was associated with increased odds of a favorable discharge (home or short-term facility) in both databases (both p < 0.001). However, there were no significant differences in inpatient mortality (p = 0.208). Moreover, high-volume hospital patients had lower total complications in the NIS and lower respiratory complications in both databases (all p < 0.001). Although patients at high-volume hospitals in the NTDB had longer hospital stays (β-coefficient = 1.17, p < 0.001), they had shorter stays in the intensive care unit (β-coefficient = 0.96, p = 0.024). To determine if these findings were attributable to the trauma center level rather than case volume, an analysis was conducted with only level I pediatric trauma centers (PTCs) in the NTDB. Similarly, treatment at a high-volume level I PTC was associated with increased odds of a favorable discharge (OR 1.28, p = 0.009), lower odds of pneumonia (OR 0.60, p = 0.007), and a shorter total LOS (β-coefficient = 0.92, p = 0.024).CONCLUSIONSPediatric tICH patients admitted to high-volume hospitals exhibited better outcomes, particularly in terms of discharge disposition and complications, in two independent national databases. This trend persisted when examining level I PTCs exclusively, suggesting that volume alone may have an impact on pediatric neurotrauma outcomes. These findings highlight the potential merits of centralizing neurosurgery and pursuing regionalization policies, such as interfacility transport networks and destination protocols, to optimize the care of children affected by traumatic brain injury.

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Section: Discussionmentioning

confidence: 99%

Volume-outcome relationship in pediatric neurotrauma care: analysis of two national databases

Tang

Yoon

Kimata

et al. 2019

Neurosurgical Focus

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“…In addition, obesity has been shown to increase the risk of prolonged hospitalization, critical illness, and need for mechanical ventilation in association with other respiratory infectious diseases such as influenza and pneumonia [ 24 – 28 ]. A prolonged length of stay (LOS) in intensive care reflects a more severe disease with a need for long rehabilitation [ 29 – 31 ].…”

Section: Introductionmentioning

confidence: 99%

Impact of obesity on intensive care outcomes in patients with COVID-19 in Sweden—A cohort study

et al. 2021

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Background Previous studies have shown that a high body mass index (BMI) is a risk factor for severe COVID-19. The aim of the present study was to assess whether a high BMI affects the risk of death or prolonged length of stay (LOS) in patients with COVID-19 during intensive care in Sweden. Methods and findings In this observational, register-based study, we included patients with COVID-19 from the Swedish Intensive Care Registry admitted to intensive care units (ICUs) in Sweden. Outcomes assessed were death during intensive care and ICU LOS ≥14 days. We used logistic regression models to evaluate the association (odds ratio [OR] and 95% confidence interval [CI]) between BMI and the outcomes. Valid weight and height information could be retrieved in 1,649 patients (1,227 (74.4%) males) with COVID-19. We found a significant association between BMI and the risk of the composite outcome death or LOS ≥14 days in survivors (OR per standard deviation [SD] increase 1.30, 95%CI 1.16–1.44, adjusted for sex, age and comorbidities), and this association remained after further adjustment for severity of illness (simplified acute physiology score; SAPS3) at ICU admission (OR 1.30 per SD, 95%CI 1.17–1.45). Individuals with a BMI ≥ 35 kg/m2 had a doubled risk of the composite outcome. A high BMI was also associated with death during intensive care and a prolonged LOS in survivors assessed as separate outcomes. The main limitations were the restriction to the first wave of the pandemic, and the lack of information on socioeconomic status as well as smoking. Conclusions In this large cohort of Swedish ICU patients with COVID-19, a high BMI was associated with increasing risk of death and prolonged length of stay in the ICU. Based on our findings, we suggest that individuals with obesity should be more closely monitored when hospitalized for COVID-19.

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“…This is in contrast to the previously existing standard of care at the institutions included in this analysis of mandatory bed rest for patients who required temporary pacing leads. Early mobilization in critically ill patients has been shown to be associated with decreased rates of delirium, readmission or death, ventilator‐assisted pneumonia, and central line and catheter infections . The Tempo lead's active fixation mechanism may also allow some patients with postprocedure conduction disturbances to recover on general hospital wards rather than in the intensive care unit with reduced in‐hospital costs.…”

Section: Discussionmentioning

confidence: 99%

The initial U.S. experience with the Tempo active fixation temporary pacing lead in structural heart interventions

Nazif

Chen

Codner

et al. 2019

Cathet Cardio Intervent

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Objectives: This multicenter retrospective study of the initial U.S. experience evaluated the safety and efficacy of temporary cardiac pacing with the Tempo ® Temporary Pacing Lead.Background: Despite increasing use of temporary cardiac pacing with the rapid growth of structural heart procedures, temporary pacing leads have not significantly improved. The Tempo lead is a new temporary pacing lead with a soft tip intended to minimize the risk of perforation and a novel active fixation mechanism designed to enhance lead stability.Methods: Data from 269 consecutive structural heart procedures were collected.Outcomes included device safety (absence of clinically significant cardiac perforation, new pericardial effusion, or sustained ventricular arrhythmia) and efficacy (clinically acceptable pacing thresholds with successful pace capture throughout the index procedure). Postprocedure practices and sustained lead performance were also analyzed.Results: The Tempo lead was successfully positioned in the right ventricle and achieved pacing in 264 of 269 patients (98.1%). Two patients (0.8%) experienced loss of pace capture. Procedural mean pace capture threshold (PCT) was 0.7 ± 0.8 mA.There were no clinically significant perforations, pericardial effusions, or sustained device-related arrhythmias. The Tempo lead was left in place postprocedure in 189 patients (71.6%) for mean duration of 43.3 ± 0.7 hr (range 2.5-221.3 hr) with final PCT of 0.84 ± 1.04 mA (n = 80). Of these patients, 84.1% mobilized out of bed with no lead dislodgment.

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Reduction of Intensive Care Unit Length of Stay

Cited by 29 publications

References 19 publications

Volume-outcome relationship in pediatric neurotrauma care: analysis of two national databases

Volume-outcome relationship in pediatric neurotrauma care: analysis of two national databases

Impact of obesity on intensive care outcomes in patients with COVID-19 in Sweden—A cohort study

The initial U.S. experience with the Tempo active fixation temporary pacing lead in structural heart interventions

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