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Factors affecting length of stay according to bronchopulmonary dysplasia severity:a nationwide cohort study in Korea

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World Journal of Pediatrics 2024年第5期20卷 470-480页

作者： Hye Mi Lee Jeongmin Shin Sae Yun Kim So Young Kim Department of Pediatrics College of MedicineThe Catholic University of KoreaSeoulRepublic of Korea Department of Pediatrics Yeouido St.Mary’s HospitalCollege of MedicineThe Catholic University of Korea1063-roYeongdeungpo-guSeoul07345Republic of Korea

Background Longer hospitalizations for preterm infants with bronchopulmonary dysplasia(BPD)delay developmental outcomes,increase the risk for hospital-acquired complications,and exert a substantial socioeconomic burden.This study aimed to identify factors associated with an extended length of stay(LOS)at different levels of severity of BPD.Methods A cohort study was conducted using the Korean Neonatal Network registry of very low birth weight infants with BPD between 2013 and 2017 through retrospective analysis.Results A total of 4263 infants were diagnosed with BPD.For mild BPD,infants requiring surgical treatment for patent ductus arteriosus needed a longer LOS[eadjustedβcoefficients(adjβ)1.041;95%confidence interval(CI):0.01–0.08]and hydrocephalus(eadjβ1.094;95%CI 0.01–0.17).In moderate BPD,infants administered steroids or with intraventricular hemorrhage required a longer LOS(eadjβ1.041;95%CI 0.00–0.07 and eadjβ1.271;95%CI 0.11–0.38,respectively).In severe BPD,infants with comorbidities required a longer LOS:pulmonary hypertension(eadjβ1.174;95%CI 0.09–0.23),administrated steroid for BPD(eadjβ1.116;95%CI 0.07–0.14),sepsis(eadjβ1.062;95%CI 0.01–0.11),patent ductus arteriosus requiring surgical ligation(eadjβ1.041;95%CI 0.00–0.08),and intraventricular hemorrhage(eadjβ1.016;95%CI 0.05–0.26).Additionally,the higher the clinical risk index score,the longer the LOS needed for infants in all groups.Conclusions The factors affecting LOS differed according to the severity of BPD.Individualized approaches to reducing LOS may be devised using knowledge of the various risk factors affecting LOS by BPD severity.

关键词： Bronchopulmonary dysplasia length of stay Very low birth weight

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Prediction of Th17/Treg cell balance on length of stay in intensive care units of patients with sepsis

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Journal of Intensive Medicine 2024年第2期4卷 240-246页

作者： Yu Wu Guosheng Wu Minyu Li Yongqing Chang Miao Yu Yan Meng Xiaojian Wan Department of Intensive Care Medicine Changhai HospitalNaval Medical UniversityShanghaiChina Department of Anesthesiology Bethune International Peace HospitalShijiazhuangHebeiChina Department of Burns Changhai HospitalNaval Medical UniversityShanghaiChina Department of Special Needs Clinic Changhai HospitalNaval Medical UniversityShanghaiChina

Background Prolonged length of stay(LOS)of sepsis can drain a hospital's material and human resources.This study investigated the correlations between T helper type 17(Th17)and regulatory T(Treg)balance with LOS in sepsis.Methods A prospective clinical observational study was designed in Changhai Hospital affiliated to Naval Medical University in Shanghai,China,from January to October 2020.The patients diagnosed with sepsis and who met the inclusion and exclusion criteria were recruited and whether the levels of cytokines,procalcitonin,subtypes,and biomarkers of T cells in the peripheral blood were detected.We analyzed the correlation between these and LOS.Results Sixty septic patients were classified into two groups according to whether their intensive care unit(ICU)stay exceeded 14 days.The patients with LOS≥14 days were older([72.6±7.5]years vs.[63.3±10.4]years,P=0.015)and had higher Sequential Organ Failure Assessment(SOFA)(median[interquartile range]:6.5[5.0–11.0]vs.4.0[3.0–6.0],P=0.001)and higher Acute Physiology and Chronic Health Evaluation(APACHE)II scores(16.0[13.0–21.0]vs.8.5[7.0–14.0],P=0.001).There was no difference in other demographic characteristics and cytokines,interleukin-6,tumor necrosis factor-α,and interleukin-10 between the two groups.The Th17/Treg ratio of sepsis with LOSstay in sepsis,presenting a new option for ICU practitioners to better care for patients with sepsis.

关键词： Sepsis Th17/Treg length of stay Intensive care units

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length of stay and inpatient charges of total knee arthroplasty in China:analysis of a national database

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Chinese Medical Journal 2023年第17期136卷 2050-2057页

作者： Huizhong Long Chao Zeng Ying Shi Haibo Wang Dongxing Xie Guanghua Lei Department of Orthopedics Xiangya HospitalCentral South UniversityChangshaHunan 410008China Hunan Key Laboratory of Joint Degeneration and Injury ChangshaHunan 410008China Hunan Engineering Research Center for Osteoarthritis ChangshaHunan 410008China National Clinical Research Center for Geriatric Disorders Xiangya HospitalCentral South UniversityChangshaHunan 410008China China Standard Medical Information Research Center ShenzhenGuangdong 518054China Clinical Trial Unit First Affiliated Hospital of Sun Yat-Sen UniversityGuangzhouGuangdong 510080China

Background:There are limited data on the resource utilization of total knee arthroplasty(TKA)in China.This study aimed to examine the length of stay(LOS)and inpatient charges of TKA in China,and to investigate their determinants.Methods:We included patients undergoing primary TKA in the Hospital Quality Monitoring System in China between 2013 and 2019.LOS and inpatient charges were obtained,and their associated factors were further assessed using multivariable linear regression.Results:A total of 184,363 TKAs were included.The LOS decreased from 10.8 days in 2013 to 9.3 days in 2019.The admission-to-surgery interval decreased from 4.6 to 4.2 days.The mean inpatient charges were 61,208.3 Chinese Yuan.Inpatient charges reached a peak in 2016,after which a gradual decrease was observed.Implant and material charges accounted for a dominating percentage,but they exhibited a downward trend,whereas labor-related charges gradually increased.Single marital status,non-osteoarthritis indication,and comorbidity were associated with longer LOS and higher inpatient charges.Female sex and younger age were associated with higher inpatient charges.There were apparent varieties of LOS and inpatient charges among provincial or non-provincial hospitals,hospitals with various TKA volume,or in different geographic regions.Conclusions:The LOS following TKA in China appeared to be long,but it was shortened during the time period of 2013 to 2019.The inpatient charges dominated by implant and material charges exhibited a downward trend.However,there were apparent sociodemographic and hospital-related discrepancies of resource utilization.The observed statistics can lead to more efficient resource utilization of TKA in China.

关键词： Total knee arthroplasty China length of stay Inpatient charges

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The impact of emergency department length of stay on the outcomes of trauma patients requiring hospitalization: a retrospective observational study

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World Journal of Emergency Medicine 2023年第2期14卷 96-105页

作者： Ahmed Faidh Ramzee Ayman El-Menyar Mohammad Asim Ahad Kanbar Khalid Ahmed Bahaa Daoud Saji Mathradikkal Ahmad Kloub Hassan Al-Thani Sandro Rizoli Trauma Surgery Section Hamad General Hospital(HGH)Doha P.O Box 3050Qatar Clinical Research Trauma&Vascular Surgery SectionHGHDoha P.O Box 3050Qatar Clinical Medicine Weill Cornell Medical CollegeDoha P.O Box 3050Qatar

BACKGROUND: We aimed to explore the impact of the emergency department length of stay(EDLOS) on the outcome of trauma patients.METHODS: A retrospective study was conducted on all trauma patients requiring hospitalization between 2015 and 2019. Patients were categorized into 4 groups based on the EDLOS(24 h). Data were analyzed using Chi-square test(categorical variables), Student’s t-test(continuous variables), correlation coefficient, analysis of variance and multivariate logistic regression analysis for identifying predictors of short EDLOS and hospital mortality.RESULTS: The study involved 7,026 patients with a mean age of 32.1±15.6 years. Onefifth of patients had a short EDLOS(24 h were older(P=0.001) and had more comorbidities(P=0.001) and fewer deaths(P=0.001). Multivariate regression analysis showed that the predictors of short EDLOS were female gender, GCS, SI, hemoglobin level, ISS, and blood transfusion. The predictors of mortality were TTA-1(odds ratio [OR]=4.081, 95%CI: 2.364–7.045), head injury(OR=3.920, 95%CI: 2.413–6.368), blood transfusion(OR=2.773, 95%CI: 1.668–4.609), SI(OR=2.132, 95%CI: 1.364–3.332), ISS(OR=1.077, 95%CI: 1.057–1.096), and age(OR=1.040, 95%CI: 1.026–1.054). CONCLUSIONS: Patients with shorter EDLOS had different baseline characteristics and hospital outcomes compared with patients with longer EDLOS. Patients with prolonged EDLOS had better outcomes;however, the burden of prolonged boarding in the ED needs further elaboration.

关键词： Emergency department length of stay Trauma Management Outcomes Trauma activation criteria

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Robust length of stay Prediction Model for Indoor Patients

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Computers, Materials & Continua 2022年第3期70卷 5519-5536页

作者： Ayesha Siddiqa Syed Abbas Zilqurnain Naqvi Muhammad Ahsan Allah Ditta Hani Alquhayz M.A.Khan Muhammad Adnan Khan Department of Mechatronics and Control Engineering University of Engineering and TechnologyLahore54000Pakistan Department of Information Sciences Division of Science and TechnologyUniversity of EducationLahore54000Pakistan Department of Computer Science and Information College of Science in ZulfiMajmaah UniversityAl-Majmaah11952Saudi Arabia Riphah School of Computing&Innovation Faculty of ComputingRiphah International UniversityLahore CampusLahore54000Pakistan Pattern Recognition and Machine Learning Lab Department of SoftwareGachon UniversitySeongnam13557Korea

Due to unforeseen climate change,complicated chronic diseases,and mutation of viruses’hospital administration’s top challenge is to know about the length of stay(LOS)of different diseased patients in the hospitals.Hospital management does not exactly know when the existing patient leaves the hospital;this information could be crucial for hospital management.It could allow them to take more patients for admission.As a result,hospitals face many problems managing available resources and new patients in getting entries for their prompt treatment.Therefore,a robust model needs to be designed to help hospital administration predict patients’LOS to resolve these issues.For this purpose,a very large-sized data(more than 2.3 million patients’data)related to New-York Hospitals patients and containing information about a wide range of diseases including Bone-Marrow,Tuberculosis,Intestinal Transplant,Mental illness,Leukaemia,Spinal cord injury,Trauma,Rehabilitation,Kidney and Alcoholic Patients,HIV Patients,Malignant Breast disorder,Asthma,Respiratory distress syndrome,etc.have been analyzed to predict the LOS.We selected six Machine learning(ML)models named:Multiple linear regression(MLR),Lasso regression(LR),Ridge regression(RR),Decision tree regression(DTR),Extreme gradient boosting regression(XGBR),and Random Forest regression(RFR).The selected models’predictive performance was checked using R square andMean square error(MSE)as the performance evaluation criteria.Our results revealed the superior predictive performance of the RFRmodel,both in terms of RS score(92%)and MSE score(5),among all selected models.By Exploratory data analysis(EDA),we conclude that maximumstay was between 0 to 5 days with the meantime of each patient 5.3 days and more than 50 years old patients spent more days in the hospital.Based on the average LOS,results revealed that the patients with diagnoses related to birth complications spent more days in the hospital than other diseases.This finding could help predict the future length of hospital sta

关键词： length of stay machine learning robust model random forest regression

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The impact of daylight and window views on length of stay among patients with heart disease:A retrospective study in a cardiac intensive care unit

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Journal of Intensive Medicine 2023年第2期3卷 155-164页

作者： Roxana Jafarifiroozabadi Anjali Joseph William Bridges Andrea Franks College of Architecture and Design Lawrence Technological UniversitySouthfieldMI 48075USA Spartanburg Regional Healthcare System Endowed Chair in Architecture+Health Design Clemson UniversityClemsonSC 29634USA Center for Health Facilities Design and Testing Clemson UniversityClemsonSC 29634USA School of Architecture Clemson UniversityClemsonSC 29634USA Industrial Engineering Clemson UniversityClemsonSC 29634USA School of Mathematical and Statistical Sciences Clemson UniversityClemsonSC 29634USA Clinical and Nursing Research AnMed HealthAndersonSC 29621USA

Background:Heart disease is the leading cause of death in the United States.The length of stay(LOS)is a well-established parameter used to evaluate health outcomes among critically ill patients with heart disease in cardiac intensive care units(CICUs).While evidence suggests that the presence of daylight and window views can positively influence patients’LOS,no studies to date have differentiated the impact of daylight from window views on heart disease patients.Also,existing research studies on the impact of daylight and window views have failed to account for key clinical and demographic variables that can impact the benefit of such interventions in CICUs.Methods:This retrospective study investigated the impact of access to daylight vs.window views on CICU patients'LOS.The study CICU is located in a hospital in the southeast United States and has rooms of the same size with different types of access to daylight and window views,including rooms with daylight and window views(with the patient bed located parallel to full-height,south-facing windows),rooms with daylight and no window views(with the patient bed located perpendicular to the windows),and windowless rooms.Data from electronic health records(EHRs)for the time-period September 2015 to September 2019(n=2936)were analyzed to investigate the impact of room type on patients’CICU LOS.Linear regression models were developed for the outcome of interest,controlling for potential confounding variables.Results:Ultimately,2319 patients were finally included in the study analysis.Findings indicated that patients receiving mechanical ventilation in rooms with access to daylight and window views had shorter LOS durations(16.8 h)than those in windowless rooms.Sensitivity analysis for a subset of patients with LOS≤3 days revealed that parallel bed placement to the windows and providing access to both daylight and window views significantly reduced their LOS compared to windowless rooms in the unit(P=0.007).Also,parallel bed placement to the window significantly reduced

关键词： Heart disease Daylight Window views length of stay Cardiac intensive care unit

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What factors affect length of hospital stay among trauma patients? A single-center study, Southwestern Iran

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Chinese Journal of Traumatology 2020年第3期23卷 176-180页

作者： Ali Kashkooe Mahnaz Yadollahi Forough Pazhuheian Trauma Research Center Shiraz University of Medical SciencesShirazIran

Purpose: Trauma is a major health concern. length of hospital stay (LOS) has been targeted as an important metric to assess trauma care. This study aims to evaluate the risk factors that affect LOS among trauma patients in a trauma center in Southwestern Iran.Methods: This cross-sectional study was conducted on patients admitted to Rajaee Trauma Center, Shiraz, Iran between January 1, 2018 and December 30, 2018. The inclusion criteria were age above 15 years and having traffic accident injuries, including car, motorcycle and pedestrian injury mechanisms. The exclusion criteria were existing diseases including cardiovascular, cerebral, renal, and pulmonary diseases prior to this study, dead upon arrival or within 48 h after admission, and stay at the hospital for less than 6 h. The risk variables analyzed for prolonged LOS were age, gender, mechanism of traffic accident injury, infection during hospital stay, type of injury, injury severity score, surgery during hospitalization, and survival. Poisson regression was performed to evaluate the partial effects of each co- variate on trauma hospitalization (≥3 days as longer stay).Results: This study was conducted on 14,054 patients with traffic accident injury and the mean age was (33.89 ± 15.78) years. Additionally, 74.35% of the patients were male, with male to female ratio of 2.90. The result of Poisson regression indicated that male patients, higher age, combination of thoracic injuries, onset of infected sites, and surgery patients were more susceptible to have a longer LOS. Considering the site of injury, patients with face injuries followed by those with thorax injuries had the highest means of LOS (3.74 days and 3.36 days, respectively). Simultaneous existence of surgical inter- vention and infection in a patient had the greatest impact on prolonged LOS.Conclusion: This study identified that age, gender, mechanism of injury, infection, type of injury, survival, and ISS could lead to prolongation of LOS, but the affect can be reduced by eliminating modifiable r

关键词： length of stay Trauma Accidents,traffic Risk factors

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Factors influencing the length of emergency room stay and hospital stay in non-fatal bicycle accidents:A retrospective analysis

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Chinese Journal of Traumatology 2021年第3期24卷 148-152页

作者： Satoru Beppu Masahito Hitosugi Tadahiro Ueda Mirae Koh Kei Nishiyama Department of Emergency and Critical Care Medicine National Hospital OrganizationKyoto Medical CenterKyoto612-0861Japan Department of Legal Medicine Shiga University of Medical ScienceShiga520-2192Japan

Purpose:lengthy hospitalization places a burden on patients and healthcare resources.However,the factors affecting the length of hospital stay(LHoS)and length of emergency room stay(LERS)in non-fatal bicycle accidents are currently unclear.We investigated these factors to inform efforts to minimize hospitalization.Methods:We performed a retrospective analysis of data from non-fatal injured bicyclists admitted to the Emergency and Critical Care Center at Kyoto Medical Center between January 2012 and December 2016.We measured LHoS,LERS,mechanism of injury,head injury prevalence,polytrauma,operations performed,injury severity score(ISS),abbreviated injury scale(AIS)score,maximum AIS score,and trauma and injury severity score probability of survival.We conducted multiple regression analysis to determine predictors of LHoS and LERS.Results:Within the study period,82 victims met the inclusion and exclusion criteria and were included.Mean age was(46.0±24.7)years.Overall mean LHoS was(16.8±25.2)days,mean LERS was(10.6±14.7)days,median ISS was 9(interquartile range(IQR):3-16),median maximum AIS was 3(IQR:1-4),and median trauma and injury severity score probability of survival was 98.0%(IQR:95.5%-99.6%).Age,maximum AIS,ISS,and prevalence of surgery were significantly greater in long LHoS and LERS group compared with short LHoS and LERS group(pstays and ISS was associated with long emergency room stays.To improve the quality life of the bicyclists,preventive measures for reducing injury severity or avoiding injuries needing operation are required.

关键词： Emergency room length of stay Injury severity score Safety Non-fatal Bicyclist

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Hospital length of stay and healthcare costs among African American women due to obesity and diabetic conditions in United States: A model for correlation studies comparing ethnicity, co-morbidities and hospital resources

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慢性疾病与转化医学(英文) 2018年第4期4卷 244-253页

作者： Moss Terris R. Rutgers BioPharma Educational Initiative School of Health Professions Rutgers The State University of New Jersey 65 Bergen Street Newark NJ 07101-1709 USA.

Objective: To examine obesity and diabetes associations with United States hospital use and healthcare costs for African American women, to explore the relationship between co-morbidities of interest (obesity and diabetes) and hospital resources [length of stay (LOS) and costs].Methods: A retrospective, correlation, quantitative analysis for lengths of hospital stay and cost among adult African American women categorized according to their weight status with type 2 diabetes. Healthcare Cost and Utilization Project (HCUP) data which contains the Nationwide Inpatient Sample was used. Focused on 803,163 African American, female inpatients between the ages of 21 and 55 in the United States from 2008 to 2010. Researcher explored the relationship between individual health factors of interest (obesity and diabetes) and the effects on hospital LOS and healthcare costs. All statistical analysis will be performed using Stata v12. All inferential tests will be two-sided and will utilize a 95% significance level. Two separate multiple regressions will be used.Results: A total of 758,874 records were retained for analysis. The patients in the weighted population ranged in age from 21 to 55 years. The patient LOS ranged from 0 to 333 days. The patients had approximately 2 procedures on average, and presented with approximately 3 chronic conditions on average. The total charges (Cost) ranged from 106 to over 1 million US dollars. The size and direction of the relationship between LOS, healthcare costs and the independent variables of diabetes and obesity suggests that both LOS and health care cost decreased for African American female patients with diabetes or obesity. There is a statistically significant relationship between at least one of the individual health factors of interest (obesity and diabetes) and hospital LOS (F = 13,394.00,P < 0.0005,R2 = 0.440) and hospital costs (F = 10,171.23,P < 0.0005,R2 = 0.502).Conclusions: There is evidence of racial and ethnic disparities in health care quality in hospital treatment of Af

关键词： Diabetes Obesity African American length of stay Hospital costs

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Concept Analysis: Emergency Department Crowding and length of stay before and after an Increase in Catchment Area

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Open Journal of Nursing 2023年第8期13卷 500-511页

作者： Ali M. Al Yasin General Nursing Administration Security Forces Hospital Riyadh Saudi Arabia

Several notable issues arise from overcrowding in an emergency department (ED) for both patients and staff. Longer wait times, higher ambulance diversion rates, longer stays, higher incidence of medical errors, higher rates of patient mortality, and greater harm to hospitals due to financial losses are some of these problems. Collaboration is crucial in the healthcare industry since it determines the team’s hourly performance in managing patient care. By using Walker and Avant’s (2011) concept analysis method, the author reviewed the literature to better understand ED crowding, to ensure that patients receive safe treatment in a timely manner, and to highlight best practices that can be identified through concept analysis and practice evaluations. In conducting this concept analysis, Walker and Avant’s framework was applied to examine the nature of the findings selected for the advancement of the concept. Everyone working in the ED, from those who determine policy to those on the front lines continually encounter new obstacles, but has little or no time to formulate fresh concepts or reconsider how ED treatment is provided. Overcrowding occurs when the number of patients requiring attention, awaiting transfer, or undergoing diagnosis and treatment exceeds the physical capacity of ED staff. If a clear plan is not in place to increase and improve services in proportion to a growing population, this situation will persist.

关键词： Overcrowding Increasing Population Emergency Room length of stay Input Throughput Output

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