Search Results (5,991)

Background: This study aimed to compare the emergency department (ED) and intensive care unit (ICU) admission processes of the local population and individuals with migrant, refugee, or asylum status as well as to evaluate differences between the groups. Methods: This retrospective observational study was conducted by analyzing the data of 10,163 patients who presented to the Emergency Medicine Clinic of Sakarya Training and Research Hospital between 1 January 2022 and 1 January 2024, and were determined to require ICU care. Among these, 10,060 were from the local population and 103 were refugees. Key variables, such as patients’ demographic characteristics, comorbidities, ED processes, hospital admission, and referral statuses, were collected and analyzed. The data were analyzed using Statistical Package for the Social Sciences (SPSS) version 26.0. Results: The mean age of refugee patients was 39.1 ± 26.5 years, and they were younger than the local population. No significant difference was observed between the two groups in terms of examination waiting times and time to the first consultation (p = 0.721 and p = 0.060, respectively). Refugees were more frequently admitted to the ICU at the study hospital than the local population (85.4% vs. 61.0%, p < 0.001). Refugee status remained independently associated with ICU admission at the study hospital after adjustment for age, sex, and major comorbidities (adjusted OR: 2.57, 95% CI: 1.47–4.50; p = 0.001). Conclusions: In this study, no significant differences were observed between refugees and the local population in examination waiting time, time to first consultation, or ED length of stay. Refugees were younger and had a higher rate of ICU admission at the study hospital. These findings may contribute to a better understanding of healthcare utilization patterns among refugees requiring intensive care in Türkiye. Full article

Background: Non-alcoholic fatty liver disease (NAFLD), which is recognized under the updated nomenclature as Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD), is increasingly prevalent in the United States and worldwide. Emerging evidence links NAFLD to an elevated risk of atrial fibrillation (AF), yet data regarding the impact of NAFLD on inpatient outcomes among patients admitted for AF remain limited. Methods: The National Inpatient Sample (NIS) from 2016 to 2019 was used to identify adult patients with a primary discharge diagnosis of AF (ICD-10: I48.x). Patients with concurrent NAFLD were compared to those without. Multivariable linear and logistic regression analyses were performed, adjusting for age, sex, race, insurance status, and Charlson Comorbidity Index. The primary outcome was inpatient all-cause mortality. Secondary outcomes included length of stay, inflation-adjusted hospital costs, discharge disposition, and in-hospital complications. Results: Of 1,891,479 weighted AF admissions, 13,840 carried a concurrent NAFLD diagnosis. Concurrent NAFLD was associated with longer length of stay (3.99 vs. 3.35 days, p < 0.001) (which is statistically significant though might be clinically insignificant) and higher hospital costs ($13,841.65 vs. $12,154.55, p = 0.046). No significant difference in inpatient mortality was observed. Conclusions: Concurrent NAFLD among AF hospitalizations is associated with greater resource utilization without a significant mortality difference, highlighting the importance of addressing this comorbidity to reduce the economic burden of AF-related hospitalizations. Full article

Purpose: Delirium is a frequent and serious condition in older patients, associated with severe adverse outcomes and lacking proven pharmacological treatments. Non-pharmacological multicomponent strategies are recommended, and specialized delirium care environments (e.g., delirium room, delirium unit, psychogeriatric unit) have been proposed as a potential strategy to improve the management of delirium in hospitalized older adults. Our objective was to provide the first systematic review and pooled analysis on the subject, synthesizing the characteristics of specialized delirium environments in the care of delirium and their association with clinical outcomes. Methods: A systematic search of MEDLINE, Cochrane, and EMBASE identified studies on patients aged 65 years and older with delirium or related acute confusional states admitted to specialized delirium care environments. Study quality was assessed using Cochrane’s risk of bias tools, and exploratory pooled analyses were conducted when at least three studies reported the same outcome. Results: Nine studies, reported across 15 publications and including 2226 patients, met the inclusion criteria. Interventions were heterogeneous in structure and content, but most combined delirium-oriented staff training, enhanced surveillance, environmental adaptation, and multicomponent non-pharmacological care. Comparator groups were also diverse and included standard wards, earlier versions of specialized care models, indirect admission pathways, and non-delirious controls. The narrative synthesis suggested that specialized delirium care environments were most consistently associated with shorter delirium duration, more favorable discharge outcomes, lower physical restraint use, and better functional recovery, while findings for length of stay, falls, psychotropic drug use, and mortality were less consistent. Exploratory pooled analyses suggested a favorable direction of effect for several outcomes, particularly discharge destination and mortality, but pooled estimates were not statistically significant and should not be interpreted as definitive evidence of efficacy. All included studies were judged to be at a high or critical risk of bias. Conclusions: Specialized delirium care environments appear promising for the management of delirium in hospitalized older adults, particularly for outcomes closely related to day-to-day delirium care. However, the current evidence base is limited by substantial heterogeneity in intervention models, comparator groups, and outcome definitions, as well as by a high risk of bias across studies. These findings support further evaluation of specialized delirium care models, but do not yet allow firm conclusions regarding their effectiveness. Full article

Purpose: Hypernatremia is a common electrolyte disorder in pediatric intensive care units (PICU) and is associated with considerable morbidity and mortality. We aimed to evaluate underlying etiologies, clinical characteristics, and factors associated with outcomes in critically ill children with hypernatremia, while accounting for illness severity. Methods: We retrospectively analyzed pediatric patients with at least one serum sodium measurement > 145 mEq/L during their stay in a tertiary Level 3 PICU. Demographic, clinical, laboratory, Glasgow Coma Scale (GCS), and Pediatric Risk of Mortality (PRISM) data were collected. Factors associated with in-hospital mortality were evaluated using univariate and multivariable analyses. Results: A total of 113 children were included (mean age 4.8 ± 5.3 years; 57.5% male). Neurological disorders were the most common underlying disease category, while free water deficit was the most frequently identified etiology of hypernatremia. Overall in-hospital mortality was 15.9%. Mortality rates were 21.5% among patients with PICU-associated hypernatremia and 8.3% among those with hypernatremia within the first 24 h of admission; the difference was not statistically significant (p = 0.058). PRISM score remained independently associated with mortality (OR 1.124, 95% CI 1.059–1.193; p < 0.001), whereas serum sodium concentration was not significantly different between survivors and non-survivors. Conclusions: Among critically ill children with hypernatremia, mortality was higher than the overall PICU mortality rate but was primarily associated with overall illness severity rather than with the degree of hypernatremia itself. PRISM score, rather than serum sodium concentration, was independently associated with mortality, suggesting that hypernatremia may represent a marker of severe underlying illness rather than an independent determinant of outcome. Full article

Background: Bronchiolitis is a leading cause of hospitalization in infants, with respiratory syncytial virus (RSV) as the main etiological agent. The clinical relevance of respiratory pathogen co-infections and the role of emerging preventive strategies, including nirsevimab immunoprophylaxis, remain under investigation. Methods: We conducted two complementary observational analyses within the pediatric healthcare network of Western Sicily. The first was a retrospective study including 580 children younger than 24 months hospitalized for bronchiolitis between 2019 and 2025 at the “Giovanni Di Cristina” Hospital in Palermo, Italy, to investigate respiratory pathogen detection patterns and their clinical correlates. Patients were classified according to microbiological findings as single-virus infections or viral–viral/viral–bacterial co-detections. The second was a separate observational cohort of 458 newborns from two birth centers in Western Sicily during the 2024–2025 RSV season, established to evaluate the implementation, safety, and respiratory outcomes associated with nirsevimab prophylaxis. Results: Viral–viral and/or viral–bacterial co-detections were identified in 45.5% of hospitalized infants and were associated with longer hospital stay (8.86 vs. 6.35 days, p < 0.001) and a higher frequency of complications (18.6% vs. 8.5%, p < 0.001), without differences in age, sex, or respiratory support requirements. RSV remained the predominant pathogen throughout the study period. In the complementary observational subgroup analysis, the observed safety findings were reassuring, with only mild and self-limiting events reported during follow-up; however, the sample size and observational design limit the ability to assess rare or delayed adverse events. Among infants undergoing clinically indicated respiratory testing, RSV was detected in 7/9 (77.8%) non-prophylaxed infants and 5/24 (20.8%) prophylaxed infants. Among hospitalized infants, complications were less frequently observed among those who had received nirsevimab (3.5% vs. 26.9%, p < 0.001), although substantial baseline differences between groups precluded causal interpretation of this finding. Conclusions: Viral–viral and viral–bacterial co-detections are frequent in hospitalized bronchiolitis and are associated with increased clinical complexity, mainly through prolonged hospitalization and higher occurrence of complications. The observational nirsevimab analysis showed a favorable safety profile and a lower proportion of RSV detection among clinically tested prophylaxed infants. However, because respiratory testing was performed according to clinical indication and differed substantially between groups, these findings cannot be interpreted as estimates of RSV incidence or as definitive evidence of nirsevimab effectiveness. The observed difference in complications should also be interpreted cautiously because of substantial baseline differences between prophylaxed and non-prophylaxed infants. Prospective studies with systematic respiratory testing are warranted. Full article

Background/Objectives: Post-hepatectomy biliary leakage (BL) remains a major source of postoperative morbidity. While traditional risk models treat BL as a single clinical entity, its chronological presentation follows distinct patterns that raise the hypothesis of distinct underlying pathophysiological mechanisms. This study aimed to stratify post-hepatectomy biliary fistulas into early and late onset to identify unique independent risk factors and clarify their separate risk profiles. Methods: This retrospective cohort study evaluated 370 patients who underwent hepatic resection between 2020 and 2024. BL was defined according to the International Study Group of Liver Surgery criteria. Based on the bimodal distribution of diagnostic timing within the cohort, patients were stratified by the postoperative day (POD) of diagnosis into Early Biliary Leakage (EBL, diagnosed on POD ≤ 7) and Late Biliary Leakage (LBL, diagnosed on POD > 7). Independent predictors were identified using binary and multinomial logistic regression models. Results: The overall incidence of BL was 9.7% (36/370), with diagnostic peaks occurring at PODs 3 and 11. EBL accounted for 55.6% of leaks, while LBL accounted for 44.4%. In multivariable analysis, an operative time exceeding 5 h was the sole independent global predictor for overall leakage (OR = 6.9; 95% CI 2.4–19.4; p < 0.001). For EBL, independent predictors were tumor proximity to major intrahepatic vessels (OR = 4.1; 95% CI 1.5–11.6; p = 0.007) and an operative time exceeding 5 h (OR = 5.2; 95% CI 1.4–19.2; p = 0.012). For LBL, an operative time exceeding 5 h was the single independent predictor, carrying a substantial risk (OR = 12.2; 95% CI 2.6–56.7; p = 0.001). Histologically, cholangiocarcinoma was significantly overrepresented in the leakage cohort compared to non-leak patients (41.7% vs. 11.7%; p = 0.05). Conclusions: Stratifying post-hepatectomy biliary leakage by diagnostic timing highlights critical differences in patient pathways and hospital readmission rates. While EBL are identified during the initial stay, LBL present insidiously after an uneventful first week, causing a higher 30-day readmission rate (62.5% vs. 30.0%, p = 0.091). Clinical surveillance and patient education at discharge are essential to identify late biliary complications early. Full article

Background/Objectives: Surgical pulmonary resection in lung cancer remains the cornerstone of curative treatment; however, it is associated with considerable postoperative pulmonary complications. Patients previously treated for head and neck cancer (HNC) have a significantly increased risk of developing second primary lung cancer (LC) and a higher incidence of adverse pulmonary outcomes after LC resective surgery due to increased baseline frailty. Methods: A retrospective observational longitudinal study was conducted on 1679 patients who underwent surgical resection with curative intent for LC at the Thoracic Surgery Department of Hospital Clínico San Carlos, Madrid, Spain, between December 1989 and December 2024. Patients were divided into two groups based on the presence or absence of prior HNC: 87 with HNC vs. 1592 without. Special attention was paid to respiratory complications, particularly bronchopleural fistula (BPF), empyema, atelectasis, and pneumonia. Variables significantly associated with BPF and HNC in univariate analyses (excluding those related to other complications to avoid collinearity), as well as clinically relevant baseline differences between groups, were included in a stepwise multivariable logistic regression modeling procedure to identify independent risk factors associated with BPF. Results: In comparison with the control group, significantly higher rates of postoperative BPF (12.6% vs. 3.6%), empyema (10.3% vs. 2.8%), atelectasis (14.9% vs. 8.3%) and need of reintervention (10.3% vs. 4.2%) were found in the HNC group under unadjusted approach and stratified by surgery period. Sex, history of HNC, chronic obstructive pulmonary disease (COPD) and length of preoperative hospital stay were independently associated with BPF according to several multivariable logistic regression fits, which showed a moderate discriminatory capacity (AUC values ranging from 0.723 to 0.732). In particular, the presence of HNC was significantly associated with BPF, with adjusted odds ratio (aOR) estimates ranging from 3.562 (95% CI: 1.773 to 7.156) to 3.789 (95% CI: 1.863 to 7.709). Conclusions: In our study, COPD, male sex, preoperative hospital stay as well as HNC history were found independently associated with an increased odds of BPF after surgical treatment for LC. In particular, patients previously treated for HNC had more than threefold higher odds of developing BPF than those without a history of HNC, with this association remaining consistent over the 35-year study period. Full article

Background: Female sex is widely regarded as an independent risk factor for adverse outcomes after conventional coronary artery bypass grafting (CABG) and is incorporated as a risk variable in EuroSCORE II. Whether this disadvantage persists in the setting of minimally invasive direct coronary artery bypass (MIDCAB), in which sternotomy and cardiopulmonary bypass are avoided, remains insufficiently characterised. We assessed sex-specific short- and long-term outcomes after MIDCAB in a single-centre cohort with extended follow-up. Methods: We retrospectively analysed 350 consecutive patients who underwent MIDCAB at Hannover Medical School between July 1999 and April 2025 (follow-up to April 2025). Eligibility criteria and heart team-applied exclusion criteria (prior left thoracotomy, unfavourable LAD anatomy, prohibitive respiratory reserve, hostile chest wall, active endocarditis, or haemodynamic instability requiring on-pump revascularization) are detailed in the Methods. Females (n = 102) and males (n = 248) were compared before and after 1:1 propensity score matching using greedy nearest-neighbour matching with a caliper of 0.2 × SD of the logit propensity score. The primary endpoint was all-cause long-term mortality; secondary endpoints included perioperative complications and in-hospital outcomes. Long-term survival was assessed by Kaplan–Meier analysis and multivariable Cox proportional hazards regression performed in the full unmatched cohort. A pre-specified subgroup analysis of long-term survival by coronary disease pattern (single-vessel vs. multivessel disease) was also performed. Results: Matching produced 100 female–male pairs with excellent covariate balance (all standardized mean differences < 0.20). MIDCAB was completed without intraoperative conversion in all patients. Thirty-day mortality was 0% in both sexes; no postoperative stroke or new requirement for dialysis occurred. New-onset atrial fibrillation (3.0% vs. 1.0%, p = 0.621), length of intensive care unit stay (median 1 day in both groups), and hospital length of stay (median 8 days in both groups) were comparable between females and males. Re-exploration for bleeding was numerically more frequent in women (5.0% vs. 0.0%; Newcombe 95% CI for the risk difference +0.3 to +11.2%; Fisher’s exact p = 0.059). At a median follow-up of 19.0 years (IQR 11.8–23.9), all-cause mortality was identical (12.0% vs. 12.0%, p = 1.000; log-rank p = 0.703). In multivariable Cox regression in the full unmatched cohort, female sex was not associated with long-term mortality (adjusted HR 0.80, 95% CI 0.38–1.70, p = 0.560); only advancing age emerged as a strong independent predictor (HR 1.10 per year, 95% CI 1.05–1.15, p < 0.001), with EuroSCORE II approaching significance (HR 1.67 per unit, 95% CI 1.00–2.82, p = 0.052). Long-term survival in patients with multivessel disease (20-year Kaplan–Meier 90.9%) was equivalent to that in single-vessel disease (92.3%; log-rank p = 0.94). Conclusions: In this propensity-matched analysis with two decades of follow-up, MIDCAB conferred equivalent perioperative safety and long-term survival in women and men. Female sex was not an independent predictor of adverse outcome. These findings support MIDCAB as a sex-neutral revascularization strategy for single-vessel and LAD-predominant coronary artery disease in the very low-risk, appropriately selected population studied, and are consistent with the most recent published MIDCAB literature. Full article

Background: Emergency thoracic conditions remain an important cause of hospitalization, emergency surgery, and mortality, requiring well-organized multidisciplinary thoracic surgical services. Objectives: To comprehensively evaluate the organization of emergency thoracic surgical care in multidisciplinary hospitals in Almaty using retrospective hospital data together with patient and healthcare professional-reported assessments. Methods: A multicomponent study was conducted comprising three complementary components: (1) a retrospective analysis of official hospital data from five multidisciplinary hospitals providing emergency thoracic surgical care in Almaty during 2019–2023; (2) a questionnaire survey of patients evaluating their experiences with emergency thoracic care; and (3) a questionnaire survey of healthcare professionals assessing the organization of emergency thoracic surgical services. Descriptive statistics, Pearson’s χ² test, Fisher’s exact test where appropriate, Spearman’s rank correlation coefficient, and multivariable ordinal logistic regression were used. Statistical significance was defined as p < 0.05. Results: During 2019–2023, the annual number of hospitalized patients averaged 519.0 ± 31.7. Chest injuries without internal organ involvement accounted for 50.9% of the 2152 cases included in the pathology-specific analysis, and the distribution of the main thoracic pathology groups changed significantly over time (χ² = 158.8, df = 12, p< 0.001). Hospital mortality decreased from 3.13% to 2.59%, while the average length of hospital stay declined from 8.74 to 7.72 days. Patient-reported assessments were generally favorable. In the adjusted analysis, treatment type and treatment-related complications were independently associated with overall satisfaction, whereas age, gender and time to diagnosis were not. Healthcare professionals identified equipment availability, staff training, and interdepartmental coordination as areas requiring further improvement. Conclusions: Integrating hospital performance indicators with patient-reported experiences and healthcare professional perspectives provided a comprehensive assessment of emergency thoracic surgical care in Almaty. The observed reductions in mortality and length of hospital stay, together with findings from patient and healthcare professional surveys, identify several organizational priorities to strengthen emergency thoracic surgical services further. Full article

Objective: To compare the clinical characteristics, healthcare exposures, and antimicrobial susceptibility profiles of pediatric Enterococcus faecium and Enterococcus faecalis infections. Methods: This retrospective study included hospitalized children with E. faecium or E. faecalis isolated from sterile specimens between August 2018 and June 2025. Clinical characteristics and antimicrobial susceptibility were compared. Logistic regression identified factors associated with pathogen species, while negative binomial regression evaluated the association between species and length of hospital stay. Results: Among 167 patients, 98 had E. faecium infection and 69 had E. faecalis infection. No significant annual trend in species distribution was observed. Multi-site infection was more common with E. faecium than with E. faecalis (36.73% vs. 15.94%, p = 0.003). Hematologic malignancy, previous hospitalization, central venous catheterization, immunosuppressive therapy, higher procalcitonin levels, and longer hospitalization were more common in the E. faecium group. In three separate primary logistic regression models adjusted for septic shock, central venous catheterization and hospitalization for ≥14 days before culture positivity were associated with higher odds of E. faecium infection, whereas endotracheal intubation was associated with higher odds of E. faecalis infection. In post hoc sensitivity analyses jointly incorporating these healthcare exposures and either hematologic malignancy or immunosuppressive therapy, only central venous catheterization remained significantly associated with E. faecium infection. E. faecium infection was associated with a 33.8% longer hospital stay (aIRR = 1.338, 95% CI: 1.160–1.543, p < 0.001). E. faecium showed substantially greater resistance to ampicillin and penicillin. Conclusions: Pediatric E. faecium and E. faecalis infections differed in patient profiles, healthcare exposures, antimicrobial susceptibility, and disease burden. Species identification may support clinical assessment and antimicrobial stewardship. Full article

The application of artificial intelligence (AI) and the Internet of Things (IoT) is transforming smart hotel services by simultaneously creating technological benefits and privacy-related concerns. Although previous studies have extensively examined the effects of AI and IoT on tourist experiences, they have predominantly adopted an individual perspective, with limited attention to potential interdependence among co-present guests. This study examines how technological benefits (AI usefulness, IoT convenience, and personalization) and technological risk (perceived privacy risk) are associated with tourists’ satisfaction and electronic word-of-mouth (eWOM) intention, while also investigating whether these outcomes exhibit dependence across social, spatial, and temporal structures of guest co-presence. The study draws on survey data collected from tourists staying in AI-and IoT-enabled hotels in Hungary, Croatia, and Serbia. The findings show that AI usefulness, IoT convenience, and personalization are positively associated with satisfaction and eWOM intention, whereas perceived privacy risk is negatively associated with both outcomes. Furthermore, technological benefit constructs exhibit significant positive indirect associations across guest co-presence structures, whereas privacy risk exhibits less consistently statistically significant indirect associations, particularly for eWOM intention. These findings indicate the coexistence of positive technology evaluations and privacy concerns and reveal different patterns of co-presence-associated interdependence rather than demonstrating that technological benefits statistically dominate privacy risks. These findings contribute to smart hospitality research by extending the benefit–risk perspective beyond exclusively individual-level evaluations and highlighting the importance of considering conditional interdependence among co-present guests when evaluating AI- and IoT-enabled hotel services. Full article

Infective endocarditis (IE) is associated with an in-hospital mortality rate of 15–30%. Standard treatment requires 2 to 6 weeks of intravenous (IV) antibiotic therapy, resulting in prolonged hospitalization with its attendant risks, including catheter-related complications, increased length of stay, and cost. This review summarizes the current evidence, eligibility criteria, antibiotic regimen selection, and practical aspects of partial oral antibiotic therapy (POAT) for IE. Oral treatment is already recommended for right-sided Staphylococcus aureus IE and IE caused by selected atypical pathogens (e.g., Brucella spp., Coxiella burnetii, Bartonella spp., and Tropheryma whipplei). The landmark Partial Oral Treatment of Endocarditis trial (2019) demonstrated the non-inferiority of POAT—initiated after at least 10 days of IV therapy—versus continued IV treatment for left-sided IE caused by streptococci, Enterococcus faecalis, S. aureus, or coagulase-negative staphylococci. Long-term follow-up at 5.4 years demonstrated lower all-cause mortality in the POAT group. The 2023 European Society of Cardiology Guidelines now formally endorse POAT for selected patients fulfilling strict criteria. Despite robust evidence, POAT is currently implemented in fewer than half of eligible patients. These findings have since been corroborated by the WikiGuidelines Group consensus statement and the French Société de Pathologie Infectieuse de Langue Française–Association pour l’Étude et la Prévention de l’Endocardite Infectieuse position statement, and extended by real-world evidence (the ENDO-ORAL study) suggesting that carefully selected patients falling outside strict trial-based eligibility criteria may also benefit from oral step-down therapy. In appropriately selected and clinically stable patients, POAT is supported by randomized and real-world evidence as an alternative to prolonged IV therapy. Strict adherence to eligibility criteria, appropriate antibiotic selection based on pathogen susceptibility, and close clinical follow-up are essential to optimize outcomes. Full article

Background/Objectives: Days alive and out of the hospital at 30 days (DAOH30) integrates survival, index hospitalization, and readmission. We characterized DAOH30 after gastrectomy, assessed its complication-severity gradient and readmission burden, and explored its association with an index-cancer-excluded Charlson Comorbidity Index (CCI). Methods: This single-center retrospective analysis included adults undergoing R0 total gastrectomy or subtotal distal gastrectomy for non-metastatic gastric adenocarcinoma between January 2020 and April 2026. DAOH30 was derived from the index postoperative length of stay, readmission days, and 30-day mortality. Rank-based tests and median quantile regression were used. Results: Among 123 patients, median DAOH30 was 21 days (interquartile range, 18–22; range, 4–26). No 30-day deaths occurred; eight patients (6.5%) were readmitted. Median DAOH30 decreased from 22 days without complications to 21 days after Clavien–Dindo grade I–II complications and 17 days after grade ≥ III complications (Kruskal–Wallis p < 0.001; one-sided Jonckheere–Terpstra p < 0.001; two-sided permutation sensitivity p < 0.001). After adjustment, grade ≥ III complications were associated with 4.00 fewer median DAOH30 days (bootstrap 95% confidence interval, −7.31 to −2.25; model-based p < 0.001). Readmissions contributed 73 additional inpatient days, with a median decrement of 9.5 days per readmitted patient. No statistically significant independent association was detected between the index-cancer-excluded CCI and DAOH30 (adjusted median difference, −0.17 days per point; bootstrap 95% confidence interval, −1.34 to 0.40; model-based p = 0.640). Conclusions: DAOH30 summarized early hospital burden, but in this no-mortality, low-readmission cohort it was largely determined by index length of stay. Multicenter validation with patient-reported anchoring is warranted. Full article

Background/Objectives: We examined discharge-level associations between an administrative NQI03 numerator-code-positive bloodstream infection construct and hospital outcomes in very low birth weight (VLBW) discharges and whether the NQI03 short-stay criterion altered mortality estimates. Methods: Using the 2022 HCUP Kids’ Inpatient Database, we constructed an independent 500–1499 g cohort from ICD-10-CM birth-weight codes. Mortality, procedure-defined mechanical ventilation, and prolonged hospitalization (≥108 days, cohort P90) were modeled with adjustment for birth weight, completed gestational age, patient/discharge characteristics, and hospital characteristics. Missing baseline covariates were addressed with 50 multiple imputations; survey-design, transfer/inborn, short-stay, and model-specification sensitivities were examined. Results: Among 39,630 discharges from 1750 hospitals, 1655 (4.18%) were NQI03 numerator-code-positive. Multiple-imputation aORs were 1.20 (95% CI 1.005–1.432) for mortality, 2.50 (2.14–2.93) for mechanical ventilation, and 2.02 (1.75–2.33) for prolonged hospitalization; corresponding adjusted risk ratios were 1.17, 1.29, and 1.60. Secondary complete-case record-level standardized probabilities were 7.5% versus 6.5%, 58.6% versus 42.6%, and 15.4% versus 9.5%, respectively; uncertainty for these estimates is reported using hospital-cluster bootstrap confidence intervals. Of 3041 deaths, 1528 (50.25%) occurred during stays <3 days; imposing LOS ≥ 3 days increased the mortality aOR to 1.96. Conclusions: NQI03 numerator-code-positive bloodstream infection showed a modest, imprecise association with mortality and more pronounced associations with mechanical ventilation and prolonged hospitalization. Mortality estimates were sensitive to short-stay eligibility. Because infection timing is unavailable, findings are non-causal discharge-level associations. Full article

Background: Oral cavity cancer is a clinically relevant subgroup of head and neck malignancies and is associated with substantial treatment burden and healthcare utilization. Hospital length of stay (LOS) is an important indicator of inpatient resource use and complexity of care, yet large multicenter data from Germany are limited. Methods: This retrospective multicenter analysis used anonymized inpatient administrative data from 49 German hospitals; eligible oral cavity cancer hospitalizations were contributed by 34 of these hospitals. Adult inpatient hospitalizations (≥18 years) with malignant neoplasms of the oral cavity, defined using ICD-10-GM codes C00–C06, recorded between January 1 2019 and 31 December 2024 were included. The primary outcome was hospital LOS in days. Multimorbidity was quantified using the van Walraven-weighted Elixhauser Comorbidity Score. Prolonged hospitalization was defined as LOS ≥ 7 days and LOS ≥ 14 days. Associations between demographic, clinical, and treatment-related variables and LOS were examined using multivariable Poisson regression models. Because overdispersion was present, a negative binomial mixed model was additionally fitted as a sensitivity analysis. To account for inter-hospital variability, hospital was included as a random intercept in all multivariable models. Associations with prolonged LOS were analyzed using multivariable logistic regression models. All analyses were performed at the hospitalization level. Results: A total of 3957 inpatient hospitalizations for oral cavity cancer were included. Mean age was 65.6 years, and 66.2% of hospitalizations involved male patients. The median LOS was 6 days (interquartile range [IQR] 3–13; mean 10.2 days, standard deviation 11.8). Overall, 49.4% of hospitalizations had an LOS ≥ 7 days and 23.5% had an LOS ≥ 14 days. Older age, particularly >80 years, and higher comorbidity burden were associated with longer LOS (adjusted Poisson rate ratio [RR] for age > 80 years 1.17, 95% CI 1.13–1.21; high comorbidity burden RR 1.58, 95% CI 1.54–1.63). Several treatment-related variables, including surgical procedures in the oral and facial region, lymphatic system operations, blood transfusions, and complex intensive care treatment, were associated with prolonged hospitalization (e.g., blood transfusion RR 1.80, 95% CI 1.76–1.85; complex intensive care RR 1.70, 95% CI 1.65–1.75). Chemotherapy-related hospitalizations were associated with shorter LOS. Conclusions: LOS varied substantially across inpatient hospitalizations for oral cavity cancer in Germany. Older age, higher comorbidity burden, and markers of more complex inpatient treatment were associated with extended hospital stay. These findings may help identify hospitalizations at increased risk of prolonged LOS and inform inpatient planning and resource allocation. Full article