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Broggi MS, Runge WO, Hurt JT, Dawes AA, Toston RJ, Ojemakinde AA, Cooke HL, Gottschalk MB, Wagner ER. Preoperative Depression Is Associated With Increased Complications Following Distal Radius Fracture Surgery. Hand (N Y) 2023:15589447231207910. [PMID: 37942766 DOI: 10.1177/15589447231207910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
BACKGROUND Depression is a known risk factor for inferior outcomes after orthopedic procedures, but its specific relationship with distal radius fractures remains unknown. This study investigates the relationship between preoperative diagnosed depression and common postoperative complications occurring within the first year after open reduction internal fixation (ORIF) for distal radius fractures. METHODS This retrospective study used Truven MarketScan database and the Current Procedural Terminology (CPT) codes to identify distal radius fracture patients who underwent ORIF in the United States between January 1, 2009, and December 31, 2019. International Classification of Diseases (ICD) codes were used to identify patients with and without a diagnosis of preoperative depression. Univariate, multivariate, t test, and χ2 analyses were performed to determine the association between preoperative depression and postoperative complications following a distal radius fracture surgery. RESULTS Of the 75 098 eligible patients, 9.9% had at least one ICD code associated with preoperative depression. Preoperative depression was associated with increased odds for surgical site infection (odds ratio [OR] 1.25, confidence interval [CI] 1.14-1.37), emergency department visits for postoperative pain (OR 1.28, CI 1.15-1.36), hardware complication (OR 1.18, CI 1.07-1.30), removal of hardware within 1 year (OR 1.16, CI 1.09-1.27), wound complication (OR 1.17, CI 1.08-1.27), and 30-day readmission (OR 1.21, CI 1.07-1.31). CONCLUSIONS Preoperative diagnosed depression is associated with increased complications following distal radius fracture surgery. These results can help guide preoperative and postoperative protocols in these higher risk patients. More research is needed to investigate if depression is a modifiable risk factor, as depression treatment could potentially improve postsurgical outcomes.
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Milton-Cole R, O'Connell MDL, Sheehan KJ, Ayis S. The role of depression in the association between physiotherapy frequency and duration and outcomes after hip fracture surgery: secondary analysis of the physiotherapy hip fracture sprint audit. Eur Geriatr Med 2023; 14:999-1010. [PMID: 37329488 PMCID: PMC10587201 DOI: 10.1007/s41999-023-00808-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 05/29/2023] [Indexed: 06/19/2023]
Abstract
PURPOSE It is not known whether the association between the frequency and duration of physiotherapy and patient outcomes varies for those with and without depression. This study aims to evaluate whether the associations between the frequency and duration of physiotherapy after hip fracture surgery and discharge home, surviving at 30 days post-admission, and being readmitted 30 days post discharge vary by depression diagnosis. METHODS Data were from 5005 adults aged 60 and over included in the UK Physiotherapy Hip Fracture Sprint Audit who had undergone surgery for a nonpathological first hip fracture. Logistic regression models were used to estimate the unadjusted and adjusted odds ratios and their 95% confidence intervals for the associations between physiotherapy frequency and duration and outcomes. RESULTS Physiotherapy frequency and duration were comparable between patients with and without depression (42.1% and 44.6%). The average adjusted odds for a 30-min increase in physiotherapy duration for those with and without depression for discharge home were 1.05 (95% CI 0.85-1.29) vs 1.16 (95% CI 1.05-1.28, interaction p = 0.36), for 30-day survival were 1.26 (95% CI 1.06-1.50) vs 1.11 (95% CI 1.05-1.17, interaction p = 0.45) and for readmission were 0.89 (95% CI 0.81-0.98) vs 0.97 (95% CI 0.93-1.00, interaction p = 0.09). None of the interaction tests reached formal significance, but the readmission models were close (p = 0.09). CONCLUSION Results suggest physiotherapy duration may be negatively associated with readmission in those with depression but not those without depression, while no clear difference in the other outcomes was noted.
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Affiliation(s)
- Rhian Milton-Cole
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King's College London, 4th Floor Addison House, Guy's Campus, London, SE1 1UL, UK.
| | - Matthew D L O'Connell
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King's College London, 4th Floor Addison House, Guy's Campus, London, SE1 1UL, UK
| | - Katie Jane Sheehan
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King's College London, 4th Floor Addison House, Guy's Campus, London, SE1 1UL, UK
| | - Salma Ayis
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King's College London, 4th Floor Addison House, Guy's Campus, London, SE1 1UL, UK
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Crutchley RD, Keuler N. Sub-Analysis of CYP-GUIDES Data: Assessing the Prevalence and Impact of Drug-Gene Interactions in an Ethnically Diverse Cohort of Depressed Individuals. Front Pharmacol 2022; 13:884213. [PMID: 35496293 PMCID: PMC9039251 DOI: 10.3389/fphar.2022.884213] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 03/23/2022] [Indexed: 12/02/2022] Open
Abstract
Introduction: Minority groups are underrepresented in pharmacogenomics (PGx) research. Recent sub-analysis of CYP-GUIDES showed reduced length of stay (LOS) in depressed patients with CYP2D6 sub-functional status. Our primary objective was to determine whether PGx guided (G) versus standard treatment (S) influenced LOS among different race/ethnic groups. Secondary objectives included prevalence of drug-gene interactions (DGIs) and readmission rates (RAR). Methods: Retrospective sub-analysis of CYP-GUIDES data comprising CYP2D6 phenotypes was reclassified using standardized CYP2D6 genotype to phenotype recommendations from the Clinical Pharmacogenetics Implementation Consortium (CPIC) and Dutch Pharmacogenetics Working Group (DPWG). The Mann-Whitney test was used to determine differences in LOS between groups G and S and Kruskal Wallis test to compare LOS among different race/ethnic groups. Logistic regression was used to determine covariates associated with RAR. Results: This study included 1,459 patients with 67.3% in G group (n = 982). The majority of patients were White (57.5%), followed by Latinos (25.6%) and Blacks (12.3%). Although there were no differences in LOS between G and S groups, Latinos had significant shorter LOS than Whites (p = 0.002). LOS was significantly reduced by 5.6 days in poor metabolizers in group G compared to S (p = 0.002). The proportion of supra functional and ultra-rapid metabolizers (UMs) were 6 and 20.3% using CYP-GUIDES and CPIC/DPWG definitions, respectively. Prevalence of DGIs was 40% with significantly fewer DGIs in Blacks (p < 0.001). Race/ethnicity was significantly associated with RAR (aOR 1.30; p = 0.003). Conclusion: A greater number of patients were classified as CYP2D6 UMs using CPIC/DPWG definitions as compared to CYP-GUIDES definitions. This finding may have clinical implications for using psychotropics metabolized by CYP2D6.
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Affiliation(s)
- Rustin D. Crutchley
- Department of Pharmacotherapy, College of Pharmacy and Pharmaceutical Sciences, Washington State University, Yakima, WA, United States
- *Correspondence: Rustin D. Crutchley,
| | - Nicole Keuler
- School of Pharmacy, University of the Western Cape, Cape Town, South Africa
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Lazarides AL, Flamant EM, Cullen MM, Ferlauto HR, Cochrane N, Gao J, Jung SH, Visgauss JD, Brigman BE, Eward WC. Investigating readmission rates for patients undergoing oncologic resection and endoprosthetic reconstruction for primary sarcomas and tumors involving bone. J Surg Oncol 2022; 126:356-364. [PMID: 35319106 DOI: 10.1002/jso.26864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 02/21/2022] [Accepted: 03/10/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Little is known about the drivers of readmission in patients undergoing Orthopaedic oncologic resection. The goal of this study was to identify factors independently associated with 90-day readmission for patients undergoing oncologic resection and subsequent prosthetic reconstruction for primary tumors involving bone. METHODS This was a retrospective comparative cohort study of patients treated from 2008 to 2019 who underwent endoprosthetic reconstruction for a primary bone tumor or soft tissue tumor involving bone, as well as those who underwent a revision endoprosthetic reconstruction if the primary endoprosthetic reconstruction was performed for an oncologic resection. The primary outcome measure was unplanned 90-day readmission. RESULTS A total of 149 patients were identified who underwent 191 surgeries were for a primary bone or soft tissue tumor. The 90-day readmission rate was 28.3%. Female gender, depression, higher tumor grade, vascular reconstruction, longer procedure duration, longer length of stay (LOS), multiple surgeries during an admission and disposition to a Skilled Nursing Facility were associated with readmission (p < 0.05). In a multivariate analysis, female sex, higher tumor grade and longer procedure duration were independently associated with risk of readmission (p < 0.05). CONCLUSIONS Readmission rates are high following endoprosthetic reconstruction for Orthopaedic oncologic resections. Further work is necessary to help minimize unplanned readmissions.
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Affiliation(s)
- Alexander L Lazarides
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Etienne M Flamant
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Mark M Cullen
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Harrison R Ferlauto
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Niall Cochrane
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Junheng Gao
- Department of Biostatistics & Bioinformatics, Duke University Medical Center, Durham, North Carolina, USA
| | - Sin-Ho Jung
- Department of Biostatistics & Bioinformatics, Duke University Medical Center, Durham, North Carolina, USA
| | - Julia D Visgauss
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Brian E Brigman
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - William C Eward
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, USA
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Abrams LR, Hoffman GJ. Skilled Nursing Facilities Modify the Relationship Between Depressive Symptoms and Hospital Readmissions but Not Health Outcomes Among Older Adults. J Aging Health 2021; 33:817-827. [PMID: 33929271 DOI: 10.1177/08982643211013127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: Despite detrimental effects of depressive symptoms on self-care and health, hospital discharge practices and the benefits of different discharge settings are poorly understood in the context of depression. Methods: This retrospective cohort study comprised 23,485 hospitalizations from Medicare claims linked to the Health and Retirement Study (2000-2014). Results: Respondents with depressive symptoms were no more likely to be referred to home health, whereas the probability of discharge to skilled nursing facilities (SNFs) went up a half percentage point with each increasing symptom, even after adjusting for family support and health. Rehabilitation in SNFs, compared to routine discharges home, reduced the positive association between depressive symptoms and 30-day hospital readmissions (OR = 0.95, p = 0.029) but did not prevent 30-day falls, 1-year falls, or 1-year mortality associated with depressive symptoms. Discussion: Depressive symptoms were associated with discharges to SNFs, but SNFs do not appear to address depressive symptoms to enhance functioning and survival.
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Affiliation(s)
- Leah R Abrams
- Harvard Center for Population and Development Studies, 1857Harvard T.H. Chan School of Public Health, Cambridge, MA, USA
| | - Geoffrey J Hoffman
- Department of Systems, Populations and Leadership, University of Michigan School of Nursing, Ann Arbor, MI, USA
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Malnutrition and depression as predictors for 30-day unplanned readmission in older patient: a prospective cohort study to develop 7-point scoring system. BMC Geriatr 2021; 21:256. [PMID: 33865312 PMCID: PMC8052844 DOI: 10.1186/s12877-021-02198-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 03/24/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Readmission is related to high cost, high burden, and high risk for mortality in geriatric patients. A scoring system can be developed to predict the readmission of older inpatients to perform earlier interventions and prevent readmission. METHODS We followed prospectively inpatients aged 60 years and older for 30 days, with initial comprehensive geriatric assessment (CGA) on admission in a tertiary referral centre. Patients were assessed with CGA tools consisting of FRAIL scale (fatigue, resistance, ambulation, illness, loss of weight), the 15-item Geriatric Depression Scale, Mini Nutritional Assessment short-form (MNA-SF), the Barthel index for activities of daily living (ADL), Charlson Comorbidity Index (CCI), caregiver burden based on 4-item Zarit Burden Index (ZBI), and cognitive problem with Abbreviated Mental Test (AMT). Demographic data, malignancy diagnosis, and number of drugs were also recorded. We excluded data of deceased patients and patients transferred to other hospitals. We conducted stepwise multivariate regression analysis to develop the scoring system. RESULTS Thirty-day unplanned readmission rate was 37.6 %. Among 266 patients, 64.7 % of them were malnourished, and 46.5 % of them were readmitted. About 24 % were at risk for depression or having depressed mood, and 53.1 % of them were readmitted. In multivariate analysis, nutritional status (OR 2.152, 95 %CI 1.151-4.024), depression status (OR 1.884, 95 %CI 1.071-3.314), malignancy (OR 1.863 95 %CI 1.005-3.451), and functional status (OR 1.584, 95 %CI 0.885-2.835) were included in derivation of 7 score system. The scoring system had maximum score of 7 and incorporated malnutrition (2 points), depression (2 points), malignancy (2 points), and dependent functional status (1 point). A score of 3 or higher suggested 82 % probability of readmission within 30 days following discharge. Area under the curve (AUC) was 0.694 (p = 0.001). CONCLUSIONS Malnutrition, depression, malignancy and functional problem are predictors for 30-day readmission. A practical CGA-based 7 scoring system had moderate accuracy and strong calibration in predicting 30-day unplanned readmission for older patients.
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Ni CH, Guo SL, Chao CY, Wang CH, Susanty S, Chuang YH. Nurses' Late-Life Depression Knowledge and Attitudes Toward Depression: A Cross-Sectional Study. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2020; 57:46958020945179. [PMID: 32723125 PMCID: PMC7391434 DOI: 10.1177/0046958020945179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Depression in older population is more common now. Due to increasing numbers of older patients in hospitals, nurses have more opportunities to care for these patients. Therefore, nurses should have correct knowledge of late-life depression and more favorable attitudes about depression. The study aimed to understand hospital nurses' knowledge level of late-life depression and attitudes about depression. A cross-sectional research design was used. A convenience sample of 307 nurses from 3 hospitals in Taiwan was recruited. Nurses scored 55.15% in the Late-Life Depression Quiz. The average score of the Revised Depression Attitude Questionnaire was 71.76 (SD = 6.13). The study also found that hospital nurses had more favorable attitudes about depression when their late-life depression knowledge was higher; their interest level in providing care for older patients with depression was greater; they had ever taken care of older patients with depressive symptoms or depression; they had never received in-service training on depression in the past year; and they had ever attended lectures about depression in school. Hospital nurses' knowledge about late-life depression was limited, and they had neutral to slightly favorable attitudes about depression in Taiwan. It is suggested to carefully examine and evaluate in-service training related to depression for nurses in hospitals. In addition, developing appropriate interventions to increase hospital nurses' knowledge level of late-life depression and attitudes toward depression is recommended.
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Affiliation(s)
- Cheng-Hua Ni
- School of Nursing, College of Nursing, Taipei Medical University, Taiwan.,Department of Nursing, Wan Fang Hospital, Taipei Medical University, Taiwan.,Center for Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Taipei Medical University, Taiwan
| | - Shu-Liu Guo
- School of Nursing, College of Nursing, Taipei Medical University, Taiwan.,Department of Nursing, Center of Faculty Development, Department of Education, Taipei Medical University Hospital, Taiwan
| | - Chia-Yu Chao
- Nursing Department, Taipei Veterans General Hospital, Taiwan
| | - Chia-Hui Wang
- School of Nursing, College of Nursing, Taipei Medical University, Taiwan
| | - Sri Susanty
- School of Nursing, College of Nursing, Taipei Medical University, Taiwan.,Faculty of Medicine, Halu Oleo University, Indonesia
| | - Yeu-Hui Chuang
- School of Nursing, College of Nursing, Taipei Medical University, Taiwan.,Center for Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Taipei Medical University, Taiwan
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Lawrence TJ, Harsh JS, Lyden L. Physician and behavioral health provider diagnostic agreement in a general hospital setting. Int J Psychiatry Med 2020; 55:249-254. [PMID: 32046539 DOI: 10.1177/0091217420905462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Behavioral health providers are often employed in inpatient settings. However, it is unclear if there is mental health diagnosis agreement between referring physicians and behavioral health providers. The purpose of this study is to assess for referring physician and behavioral health provider mental health diagnostic agreement in a general hospital setting. METHOD An analysis of 60 consecutive inpatient referrals to a behavioral health provider in a general hospital setting was conducted. The initial referral diagnosis from referring internal medicine physicians was compared with the diagnosis made by the behavioral health provider. RESULTS Kappa statistics indicated good diagnostic agreement for substance abuse (.79), anxiety disorders (.82), adjustment disorders (.88), relational conflict (.88), and "other" (.74). There was less agreement for depressive disorders (.55). CONCLUSIONS Diagnostic agreement was good overall, suggesting that referrals to inpatient behavioral health providers are often appropriate. Results indicated that depression was underdiagnosed by physicians in the study sample. This is problematic given that depression can be successfully treated through the use of medication and psychotherapy.
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Affiliation(s)
- Tyler J Lawrence
- Sea Mar Marysville Family Medicine Residency, Sea Mar Community Health Centers, Marysville, WA, USA
| | - Jennifer S Harsh
- Division of General Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Liz Lyden
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, NE, USA
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The prediction of readmission and mortality by the domains and components of the Tilburg Frailty Indicator (TFI): A prospective cohort study among acutely admitted older patients. Arch Gerontol Geriatr 2020; 89:104077. [PMID: 32334333 DOI: 10.1016/j.archger.2020.104077] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 03/20/2020] [Accepted: 04/08/2020] [Indexed: 11/23/2022]
Abstract
PURPOSE To assess the predictive value of three different frailty domains (physical, psychological, social) for both readmission and mortality in a population of acutely admitted older patients, and to determine which components of the individual three frailty domains had an effect on readmission and mortality. METHODS This prospective cohort study was conducted in a sample of 1,328 Danish acutely admitted patients aged 65 years or older. The follow-up period on readmission and death was six months. The Tilburg Frailty Indicator (TFI), a validated questionnaire, was used to assess the three frailty domains and their 15 components. RESULTS After using sequential logistic regression analyses, including controlling for socio-demographic characteristics and comorbidity, physical and social frailty predicted readmission and death, while psychological frailty predicted only readmission. The analyses also demonstrated that the component weight loss had predictive value for both outcomes, and feeling down and missing people around you were only associated with readmission, after controlling for all the predictors. CONCLUSION Our study emphasizes the importance of a multidimensional measurement of frailty, including a physical, psychological and social domain. Health care professionals aiming to prevent readmission and death among acutely admitted patients should at least conduct interventions focused on unintentional weight loss, feeling down, and missing people around you, because their effect on the outcomes was the largest.
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Effect of Mental Health Conditions on Complications, Revision Rates, and Readmission Rates Following Femoral Shaft, Tibial Shaft, and Pilon Fracture. J Orthop Trauma 2019; 33:e210-e214. [PMID: 31125328 DOI: 10.1097/bot.0000000000001438] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To evaluate the effect of pre-existing mental health (MH) conditions on 90-day complication, 90-day readmission, and all-time revision surgical intervention rates following femoral, tibial, and pilon fractures. DESIGN Data were collected using a commercially available database software for which Current Procedural Terminology codes were used to identify patients who underwent surgical treatment of tibial, femoral, or pilon fractures. These patients were then subdivided into those with and without pre-existing MH condition using International Classification of Disease, Ninth Edition codes. Ninety-day postoperative complications, revision surgery, and 90-day readmission rates were then compared between those with and without MH conditions. SETTING National databases of 70 million combined patients from 2007 to 2015. PATIENTS/PARTICIPANTS Humana and Medicare insured patients. INTERVENTION Surgical treatment of tibial, femoral, and pilon fractures. MAIN OUTCOME MEASUREMENTS Ninety-day readmission, 90-day complications, and all-time revision surgical intervention. RESULTS The total number of patients for femoral, tibial, and pilon treatment, respectively, included 6207, 6253, and 5940 without MH conditions and 4879, 5247, and 2911 with MH conditions. Femoral, tibial, and pilon readmission rates, revision rates, and complication rates were significantly higher among patients with MH disorders in matched cohorts after controlling for medical comorbidities (P ≤ 0.05 for all). CONCLUSIONS Comorbid MH conditions are associated with higher postoperative complication, readmission, and revision surgery rates for treated femoral, tibial, and pilon fractures. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Association of depression with malnutrition, grip strength and impaired cognitive function among senior trauma patients. J Affect Disord 2019; 247:175-182. [PMID: 30684891 DOI: 10.1016/j.jad.2019.01.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 12/17/2018] [Accepted: 01/13/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND Depression is common among senior adults, yet understudied among trauma patients. The purpose of this study was to assess the prevalence of depressive symptoms among seniors hospitalized in acute trauma care, to compare patients with depressive symptoms vs. those without, and to evaluate whether depression symptoms affects discharge destination. METHODS This cross-sectional and prospective analysis was conducted among community-dwelling patients ≥70 years old, hospitalized at the Senior Trauma Center of the University Hospital Zurich, Switzerland. We used the Geriatric Depression Scale (GDS-15) to assess presence of depressive symptoms. Using a cutoff value of 5 points, we compared age- and gender-adjusted characteristics of patients with and without depressive symptoms. Multinomial logistic regression models were used to estimate the odds of returning home vs. not adjusting for age, gender, nutritional status, cognitive function and others. RESULTS Of the 273 seniors enrolled, 104 (38.1%) were men and the mean age was 79.4 (SD = 6.5) years. We identified 52 (19.0%) patients with depressive symptoms. These patients were more likely to be older (p = 0.04), at risk for malnutrition (p<0.0001), at least pre-frail (p = 0.005), and have decreased cognitive function (p = 0.001). They were also more than twice as likely to be discharged to acute geriatric care compared to home (OR = 2.28 (CI = 1.12-4.68)). LIMITATIONS Depressive symptoms were assessed during acute care without data before hospitalization. CONCLUSIONS Senior trauma patients with depressive symptoms during acute care were more likely to be at higher risk of malnutrition, have cognitive decline and are more likely to receive additional geriatric care.
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Ketterer MW, Chawa M, Paone G. Prospective correlates of early (30 day) readmissions on a Cardiothoracic Surgery Service. PSYCHOL HEALTH MED 2017; 22:947-954. [PMID: 28161983 DOI: 10.1080/13548506.2017.1287408] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Known to vary widely among hospitals for unclear reasons, early readmissions are associated with higher mortality and are suspected to frequently be due to inadequate discharge preparation/planning. It has been previously documented that the strongest and most consistent predictor of early readmissions in CHF patients is chronic cognitive impairment, and compensatory assistance with adherence on discharge improves early readmission rates. Prospective observational study. The present investigation examined multiple putative perioperative predictors of early readmission in a hospitalized Cardiothoracic Surgery Service. A subtest of the Mini-Cog, Short Term Memory, was the strongestunivariate predictor of early readmissions (p < .001), but the overall Mini-Cog (p = .024), Age (p = .045), Number of Admissions over the Preceding Year (p = .036), an Anxiety Scale (p = .035), Years of Education (p = .055) and a Depression Scale (p = .056) also demonstrated covariation. In a Logistic Regression, only Short Term Memory survived as a predictor variable (p = .007), correctly classifying 76% of patients. Chronic cognitive impairment is a predictor of early readmissions in Cardiothoracic patients. A brief bedside exam interpreted in medical context may permit identification of patients requiring familial assistance for adherence on discharge.
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Affiliation(s)
- Mark W Ketterer
- a Department of Behavioral Health , Henry Ford Hospital/WSU , Detroit , MI , USA
| | - Mansi Chawa
- b Behavioral Health , Henry Ford Health System , Detroit , MI , USA
| | - Gaetano Paone
- c Division of Cardiothoracic Surgery , Henry Ford Hospital , Detroit , MI , USA
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