Trends in hospital readmissions and emergency room visits 60 days after robotic-assisted and laparoscopic hysterectomy

Objective:Hospital readmission after surgery is one of the major contributors to the increased healthcare cost.Robotic-assisted hysterectomy(RAH)is an innovative surgical procedure most commonly performed within the last decade.The purpose of this study was to analyze the effects on hospital readmission patterns and emergency room(ER)visits within 60 days of discharge for women who had RAH versus laparoscopic hysterectomy(LH)in an academic community hospital in Texas.Method:We performed a retrospective study of women with RAH or LH.We used the univariate and multivariate logistic regression to examine the impact of patients'risk factors,the type of surgery,age,number of comorbidities,and duration of surgery on the 60-day hospital readmissions and ER visits.Results:A total of 291 cases with RAH or LH for benign and malignant indications were examined.The number of comorbidities and duration of surgery were similar between the two treatment groups(p>0.05).Patients in the RAH group were younger than the LH group(RAH:45.4±9.9 y,LH:49.8±11.5 y,p<0.05).No significant difference neither in hospital readmission or ER visits between the two groupswas observed(p?0.544 and p=0.109,respectively).Younger age and longer duration of surgery were significantly associated with a higher risk of ER visits(p<0.05).Conclusion:RAH is comparable with LH in hospital readmissions and ER visits.The younger age and longer operation time could lead to ER visits.

Association of emergency room visits for respiratory diseases with sources of ambient PM2.5

Previous studies have reported associations of short-term exposure to different sources of ambient fine particulate matter(PM2.5)and increased mortality or hospitalizations for respiratory diseases.Few studies,however,have focused on the short-term effects of source-specific PM2.5 on emergency room visits(ERVs)of respiratory diseases.Source apportionment for PM2.5 was performed with Positive Matrix Factorization(PMF)and generalized additive model was applied to estimate associations between source-specific PM2.5 and respiratory disease ERVs.The association of PM2.5 and total respiratory ERVs was found on lag4(RR=1.011,95%CI:1.002,1.020)per interquartile range(76μg/m3)increase.We found PM2.5 to be significantly associated with asthma,bronchitis and chronic obstructive pulmonary disease(COPD)ERVs,with the strongest effects on lag5(RR=1.072,95%CI:1.024,1.119),lag4(RR=1.104,95%CI:1.032,1.176)and lag3(RR=1.091,95%CI:1.047,1.135),respectively.The estimated effects of PM2.5 changed little after adjusting for different air pollutants.Six primary PM2.5 sources were identified using PMF analysis,including dust/soil(6.7%),industry emission(4.5%),secondary aerosols(30.3%),metal processing(3.2%),coal combustion(37.5%)and traffic-related source(17.8%).Some of the sources were identified to have effects on ERVs of total respiratory diseases(dust/soil,secondary aerosols,metal processing,coal combustion and traffic-related source),bronchitis ERVs(dust/soil)and COPD ERVs(traffic-related source,industry emission and secondary aerosols).Different sources of PM2.5 contribute to increased risk of respiratory ERVs to different extents,which may provide potential implications for the decision making of air quality related policies,rational emission control and public health welfare.