Adolescent Peer and Parent Relationships Into Emerging Adulthood.

Threats to adolescent and young adult health and well-being come primarily from behavior and life choices. The purpose of this study was to understand the role that peer and parent relationships have on reckless and deviant behaviors during the transition from adolescence to emerging adulthood. Select Wave I and Wave III variables from the Add Health database were studied. Adolescent reckless behavior was significantly associated with emerging adult deviant behavior, Wald χ2(1, N = 4,615) = 105, p < .001, ß = 0.152, SE(ß) = 0.015 Adolescent reckless behavior increases the probability of emerging adult deviant behavior among adolescents having lower scores on the quality of peer relationships, Wald χ2(1, N = 4,615) = 56, p < .001, ß = 0.062, SE(ß) = 0.008, and the quality of parent relationships, Wald χ2(1, N = 4,545) = 36, p < .001 ß = 0.052, SE(ß) = 0.009.

Day of Discharge Does Not Impact Hospital Readmission After Major Cardiac Surgery.

BACKGROUND: Because the rate of rehospitalization after major cardiac surgery has been reported up to 22%, an investigation of potential modifiable elements in the discharge process has led our group to evaluate whether the day of discharge affects readmission performance. METHODS: Our institutional Society of Thoracic Surgeons registry was used to identify all adult patients undergoing elective cardiac operations from 2008 to 2016. Emergency, transplant, and mechanical assist patients were excluded. The primary outcome was all-cause readmission within 30 days of operation. Multivariable logistic regression was used to develop a risk-adjusted predictive model of readmission risk. RESULTS: Of 4,877 patients discharged from our institution, 20% were discharged on a weekend or holiday. The overall rehospitalization rate was 11.3%, with comparable readmission rates for weekday and weekend and holiday discharges (11.4 vs 10.9, p = 0.73). A greater proportion of patients are discharged to facilities on weekdays than on weekends and holidays (15.0% vs 5.7%, p < 0.001). Discharge to a facility is associated with a higher all-cause, unadjusted readmission rate (16.7% vs 12.7%, p = 0.01). After adjusting for patient comorbidities, operative performance, and postoperative complications, weekend or holiday discharge is not associated with worse readmission performance (adjusted odds ratio, 1.0; 95% confidence interval, 0.77 to 1.32). CONCLUSIONS: Cardiac surgical patients in the weekend and holiday discharge cohort did not have significantly higher odds of readmission regardless of operative type and discharge disposition. Allocation of resources to changing weekend staffing may be better allocated to surgical site infection prevention and outpatient intervention programs.

Are nonemergent cardiac operations performed during off-time associated with worse outcome?

BACKGROUND: With the implementation of value-based health care, it is of increasing interest to understand whether performing elective surgeries during off-time impacts surgical outcomes. The objective of this study was to evaluate the impact of start times on nonemergent cardiac operations. METHODS: The institutional Society of Thoracic Surgeons was used to identify all adult nonemergent cardiac operations performed between January 2008 and December 2015 at our institution. "Off-time" is defined as either operation "late starts," that is, an incision time after 3 PM and before 7 AM, or procedures occurring during the weekends. Univariate and multivariate logistic regression analyses were performed to examine its impact on in-hospital mortality and major adverse events. Available cost data were directly obtained from the departmental BIOME database. RESULTS: Of the 3406 cardiac operations included in the study, 2933 (86.1%) were normal-start and 473 (13.9%) were off-time-start operations. After adjusting for patient and operative characteristics, late operating room start times were not associated with increased in-hospital mortality (P = 0.28, confidence interval [CI] 95% = 0.99-1.03), readmissions (P = 0.21, CI 95% = 0.99-1.07), or major adverse events (P = 0.07, CI 95% = 1.00-1.12). In addition, there was no significant impact on total hospital cost (9.0% increase, P = 0.07). CONCLUSIONS: These findings suggest that late operating room start times are not associated with increased mortality or other complications in a tertiary-care academic medical center. Our findings should be considered during operative scheduling to optimize resource distribution and patient care strategies.

Does Travel Distance Affect Readmission Rates after Cardiac Surgery?

With emphasis on value-based health care, empiric models are used to estimate expected readmission rates for individual institutions. The aim of this study was to determine the relationship between distance traveled to seek surgical care and likelihood of readmission in adult patients undergoing cardiac operations at a single medical center. All adults undergoing major cardiac surgeries from 2008 to 2015 were included. Patients were stratified by travel distance into regional and distant travel groups. Multivariable logistic regression models were developed to assess the impact of distance traveled on odds of readmission. Of the 4232 patients analyzed, 29 per cent were in the regional group and 71 per cent in the distant. Baseline characteristics between the two groups were comparable except mean age (62 vs 61 years, P < 0.01) and Caucasian race (59 vs 73%, P < 0.01). Distant travel was associated with a significantly longer hospital length of stay (11.8 vs 10.5 days, P < 0.01) and lower risk of readmission (9.5 vs 13.4%, P < 0.01). Odds of readmission was inversely associated with logarithm of distance traveled (odds ratio 0.75). Travel distance in patients undergoing major cardiac surgeries was inversely associated with odds of readmission.