Citations

109 Background: Hospital readmissions following surgery are a focus of quality improvement efforts nationwide. Although some reflect appropriate care, others are potentially preventable readmissions (PPRs). We aim to describe the burden, timing, and factors associated with PPRs after complex cancer surgery. Methods: The National Readmissions Dataset (2013) was used to select patients undergoing a complex oncologic resection (defined as esophagectomy/gastrectomy, hepatectomy, pancreatectomy, colorectal resection, lung resection, and cystectomy). All Readmissions occurring within 30 days from discharge were analyzed. Causes for readmissions were categorized in eleven diagnostic groups and tabulated. ICD-9 primary diagnosis codes were reviewed to identify PPRs. Logistic regression analyses were used to identify demographic, clinical and hospital factors associated with PPRs. Results: We analyzed 60,970 patients with 92,260 admissions. A 30 day readmission occurred in 14% of patients, and was highest following cystectomy (25%) and lowest for lung resections (9%). Of all readmissions 82% were deemed to be PPRs. Half of PPRs occurred within the first 10 days of discharge. Infections, gastrointestinal complications and respiratory conditions accounted for 59% of PPRs. Other common causes included dehydration/electrolyte deficiencies (11%), exacerbation of comorbidity (9.2%), bleeding (5%), thromboembolism (3.5%), and wound complications (3.2%). Factors associated with an increased likelihood of PPRs include Medicaid compared with private insurance (OR 1.24, 95%CI 0.8-1.7), higher comorbid conditions (OR 1.44, 95%CI 1.32, 1.59), and discharge to a facility (OR 1.9, 95%CI 1.7-2.1). Patients with a prolonged hospital stay or a major complication during the index admission had a 34% (OR 1.34, 95%CI 1.3-1.4), and 64% (OR 1.64, 95%CI 1.5-1.7) higher likelihood of a PPR respectively. Conclusions: Most 30 day readmissions after complex cancer surgery are potentially preventable and occur within 10 days of discharge. We identify common causes of readmission and high risk populations to help physicians, administrators and policy makers develop strategies to decrease PPRs.

Objective To evaluate the association between renal tumour complexity and outcomes in a large cohort of patients undergoing percutaneous cryoablation ( PCA ). Patients and Methods Patients with renal tumours treated with PCA were identified using our prospectively maintained ablation registry (2003–2015). Salvage procedures and inherited tumour syndromes were excluded. The associations between R.E.N.A.L. nephrometry score ( NS ) and risk of complications, renal function impairment, local failure and cancer‐specific mortality ( CSM ) were evaluated using univariate and multivariable logistic, linear and Cox regression models. Results The cohort included 618 tumours treated during 580 procedures in 565 patients. The median (interquartile range [ IQR ]) follow‐up was 34 (14.66) months. Complications (any grade) during a procedure ( n [total] = 87, 15%) were more frequent with higher NS ( NS 4–6: 10%; NS 7–9: 14%; NS 10–12: 36%; P < 0.001). Higher NS was independently associated with risk of complications (odds ratio [ OR ; per 1 point] = 1.3; 95% confidence interval [ CI ] 1.2–1.5; P < 0.001). Of all the NS components, tumour size was the most strongly associated with complication risk ( OR 3.4; 95% CI 2.2–5.2; P < 0.001). The median ( IQR ) decline in glomerular filtration rate ( GFR ) from baseline was 9% (0, 22) at last follow‐up. Each additional point in NS was associated with a 1.3% (95% CI 0.4–2.1; P = 0.005) greater GFR decline from baseline. NS was not significantly associated with local failure ( n [total] = 14, 2%; NS 4–6: 2%; NS 7–9: 3%; NS 10–12: 5%; P = 0.32) or CSM ( n [total] = 8, 2%; NS 4–6: 2%; NS 7–9: 3%; NS 10–12: 2%; P = 0.88). Conclusion In high‐complexity tumours PCA was associated with a tumour size‐driven increased risk of post‐procedural complications. Higher NS was associated with a small, clinically minor additional decline in renal function. Risks for local failure and CSM were low, regardless of tumour complexity.

Workload experienced by health care workers continues to be a challenge to define and quantify. The purpose of the current study is to present descriptive data on the application of sociometers in an emergency care environment during simulated hand-off scenarios and discuss their potential and limitations for quantifying individual’s workload in health care settings. Sociometer devices, worn by nine actors, collected body movement, interactions, and speech data during four simulated hand-off scenarios in the emergency department wards. Results found that sociometers distinguished body movement differences between sitting, standing, lying, and walking individuals. Interactions quantified by the devices were limited by obstructions, distance, and angles between the sociometer devices. The data collected by these devices show promise in providing human factors researchers a tool for quantifying the dynamic exposures experienced by health care workers over time.