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The Major Decrease in Resource Utilization in Recent Decades Seems Guided by Demographic Changes: Fast Tracking—Real Concept or Demographics

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  • Rajesh Bhavsar
  • ,
  • Carl-Johan Jakobsen

Objective: To identify dynamics of associations and potential areas for optimization of patient turnover between various patient profile and comorbidity indicators and selected system performance indicators such as ventilation time, length of stay in the intensive care unit, and in-hospital stay. Design: Retrospective study of prospectively registered data (2000-2017). Setting: Three university hospitals. Participants: The study comprised 38,100 adult cardiac surgical patients registered in the Western Denmark Heart Registry. Interventions: Analysis of dynamics in patient indicators and system performance indicators, including effect on the selected performance parameters. Measurements and Main Results: Comorbidity, calculated from EuroSCORE, decreased from 2.5 ± 2.2 to 1.5 ± 2.0 (p < 0.001), whereas the average age of patients increased from 65.1 ± 9.9 years to 67.6 ± 10.8 years (p < 0.001). Median ventilation time decreased from 380 to 275 minutes (p < 0.0001). The mean length of stay in the intensive care unit demonstrated a statistically significant decrease from 35.1 hours between 2000 to 2002 to 31.8 hours between 2015 to 2017 (p = 0.004), and the median time was unchanged at 22.0 hours throughout the observation period. The median in-hospital stay decreased from 6.5 to 5.1 days (p < 0.001) and the mean in-hospital stay from 8.7 days (2003-2005) to 7.0 days (2015-2017; p < 0.001). Logistic regression analysis of performance factors showed a statistically significant negative independent effect on most comorbidity and surgical factors. Conclusion: The increase in performance parameters appears to be highly associated with decreased comorbidities and fast-tracking protocols and may only offer limited effect in additional patient turnover.

Original languageEnglish
JournalJournal of Cardiothoracic and Vascular Anesthesia
Volume34
Issue6
Pages (from-to)1476-1484
Number of pages9
ISSN1053-0770
DOIs
Publication statusPublished - Jun 2020

    Research areas

  • comorbidity, hospital stay, intensive care unit, length of stay, ventilation time

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