Background: Cellulitis is a common skin and soft-tissue infection that often recurs in some patients. Patients with presenting comorbid conditions may require hospitalization which increases the cost of treatment. However, little is known about comorbid conditions as determinants for a patient’s hospital length-of-stay. Objective: 1) To profile the characteristics of patients admitted to Ontario hospitals with a diagnosis of cellulitis according to key demographic, clinical and geographic factors; 2) To examine, among patients hospitalized with cellulitis, comorbidities as possible determinants of hospital length-of-stay. Methods: A retrospective cohort of 7863 patients was identified from the Discharge Abstract Database from April 1, 2006 to March 31, 2008. The Charlson Comorbidity Index was used to measure patients’ comorbidities. Univariate analyses were performed to describe the study population. The chi-square test was used to assess the association between categorical variables. The Kaplan-Meier product-limit method and log-rank test were used to estimate and to test the difference in the distributions of hospital lengths-of-stay between patients with and without comorbidities. Cox regression modeling was used to estimate the comorbidities’ effect on hospital length-of-stay while adjusting for confounding factors. The restricted means of lengths-of-stay were given to estimate and compare the average duration of hospitalization. The effects of specific Charlson comorbidities on hospital length-of-stay were similarly investigated. Results: Forty-six percent (3588/7863) of patients were diagnosed with Charlson comorbidities. Those patients were significantly older (p<.0001), and more likely to be female (p=.006) and to have lower limb cellulitis (p<.001) and C. difficile infections (p<.0001), compared to patients without comorbidities. Patients with comorbidities stayed significantly longer in hospital (8.0 vs. 5.3 days, p<.0001). Comorbidities independently decreased the instantaneous discharge rate by 37% (95% CI, 34% to 40%, p<.001). Hospital lengths-of-stay increased with increasing index of comorbidity. The means of hospital lengths-of-stay for patients with a cumulative index of 1, 2, 3, and 4 (or more than 4) were 7.4, 7.6, 8.8, and 9.7 days, respectively. Conclusion: The Charlson Comorbidity Index is predictive of longer hospital lengths-of-stay in adult patients diagnosed with cellulitis and may be a useful tool in the decision-making process during clinical management of these patients. / Thesis (Master, Community Health & Epidemiology) -- Queen's University, 2009-11-18 11:43:07.897

This research examines hospital length of stay as a feature of contemporary health care reforms. The ideas of Michel Foucault on governmentality enable length of stay to be studied, not as numerical values of hospital use, but rather as one of the social and political processes through which certain concepts are made susceptible to measurement and part of practice. In this study length of stay is examined as a programmatic rationality, evident in the reengineering of the modern hospital. However, the focus of analysis is not the ‘effect’ of this reengineering, as seen in the substantial changes to hospital treatments and the shifting burden of responsibility for health and ill-health care to individuals and communities. Rather, analysis is directed at understanding how such rationalities make possible reengineering or shifts in the local contexts of hospital care practices. (For complete abstract open document)

Reducing ED wait times is a top health care priority for the Ontario government and hospitals in Ontario are incentivised to meet provincial ED wait time targets. In this study, we considered the costs and benefits associated with increasing the number of acute-care beds to reduce the time an admitted patient spends boarding in the ED. A shorter hospital LOS has often been cited as a potential benefit associated with shorter ED wait times. We derived a multivariable Cox regression model to examine this association. We found no significant association between ED boarding times and the time to discharge. Using a Markov model, we estimated an increased annual operating cost of $2.1m to meet the prescribed wait time targets. We concluded that increasing acute-care beds to reduce ED wait times would require significant funding from hospitals and would have no effect on total length of stay of hospitalized patients.

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Introduction: La réinstitution de l’alimentation entérale en deçà de 24h après une chirurgie digestive semble a priori conférer une diminution du risque d’infections de plaie, de pneumonies et de la durée de séjour. Le but de cette étude est de vérifier l’effet de la reprise précoce de l’alimentation entérale sur la durée de séjour hospitalier suite à une chirurgie colique. Méthodes: Il s’agit d’une étude prospective randomisée dans laquelle 95 patients ont été divisés aléatoirement en deux groupes. Dans le groupe contrôle, la diète est réintroduite lorsque le patient passe des gaz ou des selles per rectum, et qu’en plus il n’est ni nauséeux ni ballonné. Les patients du groupe expérimental reçoivent pour leur part une diète liquide dans les 12 heures suivant la chirurgie, puis une diète normale aux repas subséquents. L’objectif primaire de cette étude est de déterminer si la réinstitution précoce de l'alimentation entérale post chirurgie colique diminue la durée de séjour hospitalier lorsque comparée au régime traditionnel de réintroduction de l’alimentation. Les objectifs secondaires sont de quantifier l’effet de la réintroduction précoce de la diète sur les morbidités periopératoires et sur la reprise du transit digestif. Résultats: La durée de séjour hospitalier a semblé être légèrement diminuée dans le groupe expérimental (8,78±3,85 versus 9,41±5,22), mais cette difference n’était pas statistiquement significative. Des nausées ou des vomissements furent rapportés chez 24 (51%) patients du bras experimental et chez 30 (62.5%) patients du groupe contrôle. Un tube nasogastrique a du être installé chez un seul patient du groupe experimental. La morbidité périopératoire fut faible dans les deux groupes. Conclusion: Il semble sécuritaire de nourrir précocément les patients suite à une chirurgie colique. Cependant cette étude n’a pu démontrer un impact significatif de la reintroduction précoce de l alimentation per os sur la durée de séjour hospitalier. / Introduction: of early feeding within 24 hours of intestinal surgery seems advantageous in terms of reduction of wound infection, pneumonia and length of hospital stay. The aim of the study is to evaluate the impact of early enteral nutrition in length of hospital stay in comparison to traditional postoperative feeding regimen. Method: This prospective study enrolled 95 patients randomized in two groups: control group patients receive enteral feeding in absence of nausea or vomiting, abdominal distension and after passage of flatus or stools, while patients in experimental group were fed a liquid diet within 12 hours of surgery, followed by a regular diet at the next meal. The primary endpoint was the impact of early oral feeding on hospital length of stay. The secondary endpoint was to measure the impact of the diet reintroduction modality on the incidence of early postoperative morbidity and return of bowel function. Result: Length of hospital stay was slightly diminished in the experimental group compared to control (8,78±3,85 versus 9,41±5,22), but the difference was not statistically significant. Postoperative nausea and vomiting were reported in 24 (51,0%) patients in experimental group and 30 (62,5%) in control group. Only one patient required nasogastric tube insertion. The majority of patients did not demonstrate any postoperative morbidity in both groups. Conclusion: Early enteral nutrition is safe after intestinal surgery. However we did not demonstrate that early enteral feeding diminished length of hospital stay or hastened the return of bowel function.

Introduction: La réinstitution de l’alimentation entérale en deçà de 24h après une chirurgie digestive semble a priori conférer une diminution du risque d’infections de plaie, de pneumonies et de la durée de séjour. Le but de cette étude est de vérifier l’effet de la reprise précoce de l’alimentation entérale sur la durée de séjour hospitalier suite à une chirurgie colique. Méthodes: Il s’agit d’une étude prospective randomisée dans laquelle 95 patients ont été divisés aléatoirement en deux groupes. Dans le groupe contrôle, la diète est réintroduite lorsque le patient passe des gaz ou des selles per rectum, et qu’en plus il n’est ni nauséeux ni ballonné. Les patients du groupe expérimental reçoivent pour leur part une diète liquide dans les 12 heures suivant la chirurgie, puis une diète normale aux repas subséquents. L’objectif primaire de cette étude est de déterminer si la réinstitution précoce de l'alimentation entérale post chirurgie colique diminue la durée de séjour hospitalier lorsque comparée au régime traditionnel de réintroduction de l’alimentation. Les objectifs secondaires sont de quantifier l’effet de la réintroduction précoce de la diète sur les morbidités periopératoires et sur la reprise du transit digestif. Résultats: La durée de séjour hospitalier a semblé être légèrement diminuée dans le groupe expérimental (8,78±3,85 versus 9,41±5,22), mais cette difference n’était pas statistiquement significative. Des nausées ou des vomissements furent rapportés chez 24 (51%) patients du bras experimental et chez 30 (62.5%) patients du groupe contrôle. Un tube nasogastrique a du être installé chez un seul patient du groupe experimental. La morbidité périopératoire fut faible dans les deux groupes. Conclusion: Il semble sécuritaire de nourrir précocément les patients suite à une chirurgie colique. Cependant cette étude n’a pu démontrer un impact significatif de la reintroduction précoce de l alimentation per os sur la durée de séjour hospitalier. / Introduction: of early feeding within 24 hours of intestinal surgery seems advantageous in terms of reduction of wound infection, pneumonia and length of hospital stay. The aim of the study is to evaluate the impact of early enteral nutrition in length of hospital stay in comparison to traditional postoperative feeding regimen. Method: This prospective study enrolled 95 patients randomized in two groups: control group patients receive enteral feeding in absence of nausea or vomiting, abdominal distension and after passage of flatus or stools, while patients in experimental group were fed a liquid diet within 12 hours of surgery, followed by a regular diet at the next meal. The primary endpoint was the impact of early oral feeding on hospital length of stay. The secondary endpoint was to measure the impact of the diet reintroduction modality on the incidence of early postoperative morbidity and return of bowel function. Result: Length of hospital stay was slightly diminished in the experimental group compared to control (8,78±3,85 versus 9,41±5,22), but the difference was not statistically significant. Postoperative nausea and vomiting were reported in 24 (51,0%) patients in experimental group and 30 (62,5%) in control group. Only one patient required nasogastric tube insertion. The majority of patients did not demonstrate any postoperative morbidity in both groups. Conclusion: Early enteral nutrition is safe after intestinal surgery. However we did not demonstrate that early enteral feeding diminished length of hospital stay or hastened the return of bowel function.