National Study of Immediate and Delayed Readmissions After Colostomy Creation.

BACKGROUND: Readmissions after colorectal operations adversely impact patient recovery and are associated with about $300 million in additional health care expenditure in the United States alone. The present study aimed to characterize nonelective, short-term readmissions of colorectal surgery patients who underwent colostomy. METHODS: The Nationwide Readmissions Database was used to identify patients who received a colostomy from 2010 to 2015. Patients were stratified by discharge-to-readmission interval: immediate (within 7 d) and delayed (7-30 d). Nonparametric trend analysis and multivariable regression were performed to identify predictors of immediate and delayed readmission. RESULTS: Of an estimated 376,693 operations requiring colostomies during the study, in-hospital survival was 92.3%, with higher rates after elective compared with nonelective operations (96.5 versus 90.8%, P < 0.001). Overall, 15.3% patients undergoing elective and nonelective colostomy creation returned to the hospital within 30 d, with 41.6% of these readmissions occurring by the first week of discharge (immediate). Readmission rates and proportion of immediate and delayed groups did not significantly change over the 6-year study period. Nonhome discharge increased the odds of immediate (AOR 1.25, 95% CI 1.17-1.34) and delayed readmission (AOR 1.44, 95% CI 1.35-1.54). Annually, immediate and delayed rehospitalizations after colostomy creation were responsible for $64 and 82 million in excess costs, respectively. CONCLUSIONS: Colostomy creation is associated with a steady and high rate of rehospitalization. Nonhome discharge, in addition to several patient comorbidities, is associated with higher odds of readmission. Programs aimed at reduction of immediate readmission are warranted.

Abdominal Operations After Left Ventricular Assist Device Implantation and Heart Transplantation.

BACKGROUND: Left ventricular assist devices (LVADs) are increasingly used to supplant the limited number of orthotopic heart transplantation (OHT). The present study aimed to perform a contemporary analysis of emergency abdominal operations after LVAD and OHT at a national level. METHODS: The 2005-2015 National Impatient Sample, the largest all-payer hospitalization database in the United States, was used to identify all adult patients who had received LVAD or OHT. The primary outcome of interest was the rate of emergency general surgery (EGS), which included laparotomy, small or large bowel resection, peptic ulcer operation, adhesiolysis, and cholecystectomy, during the same hospitalization as LVAD or OHT. Logistic regression was used to determine risk factors for EGS as well as the association between EGS and mortality in both the LVAD and OHT populations. RESULTS: Of the estimated 19,395 OHT and 23,441 LVAD performed, 445 (2.3%) OHT and 719 (3.1%) LVAD patients required EGS. The incidence of EGS in LVAD decreased from 5.4 to 3.3%, whereas it increased among OHT patients from 1.9 to 3.7%, P = 0.003. Occurrence of EGS after OHT and LVAD was associated with significantly higher inpatient risk-adjusted mortality (OHT adjusted odds ratio, 3.0; P = 0.004; LVAD adjusted odds ratio, 2.5; P < 0.001), incremental hospitalization costs (OHT, $106,778; P < 0.001; LVAD, $61,965; P < 0.001), and length of stay (OHT, 27.9 d; P < 0.001; LVAD, 20.8 d; P < 0.001). CONCLUSIONS: EGS remains an infrequent but high mortality and cost complication of OHT and LVAD. Further investigation of the impact of immunosuppression, anticoagulation, and perfusion strategies on incidence of abdominal complications is warranted.

Developing and testing a high-fidelity simulation scenario for an uncommon life-threatening disease: severe malaria.

Background. Severe malaria is prevalent globally, yet it is an uncommon disease posing a challenge to education in nonendemic countries. High-fidelity simulation (sim) may be well suited to teaching its management. Objective. To develop and evaluate a teaching tool for severe malaria, using sim. Methods. A severe malaria sim scenario was developed based on 5 learning objectives. Sim sessions, conducted at an academic center, utilized METI ECS mannequin. After sim, participants received standardized debriefing and completed a test assessing learning and a survey assessing views on sim efficacy. Results. 29 participants included 3rd year medical students (65%), 3rd year EM residents (28%), and EM nurses (7%). Participants scored average 85% on questions related to learning objectives. 93% felt that sim was effective or very effective in teaching severe malaria, and 83% rated it most effective. All respondents felt that sim increased their knowledge on malaria. Conclusion. Sim is an effective tool for teaching severe malaria in and may be superior to other modalities.