DSpace Collection: 3-82 (Februari, 2020)

Hospital characteristics, rather than surgical volume, predict length of stay following colorectal cancer surgery

Sat, 01 Feb 2020 00:00:00 GMT

Title: Hospital characteristics, rather than surgical volume, predict length of stay following colorectal cancer surgery Authors: Vicendese, Don; Marvelde, Luc Te; McNair, Peter D.; Whitfield, Kathryn; English, Dallas R.; Taieb, Souhaib Ben; Hyndman, Rob J.; Thomas, Robert Abstract: Objective: Length of hospital stay (LOS) is considered a vital component for successful colorectal surgery treatment. Evidence of an association between hospital surgery volume and LOS has been mixed. Data modelling techniques may give inconsistent results that adversely impact conclusions. This study applied techniques to overcome possible modelling drawbacks. Method: An additive quantile regression model formulated to isolate hospital contextual effects was applied to every colorectal surgery for cancer conducted in Victoria, Australia, between 2005 and 2015, involving 28,343 admissions in 90 Victorian hospitals. The model compared hospitals’ operational efficiencies regarding LOS. Results: Hospital LOS operational efficiencies for colorectal cancer surgery varied markedly between the 90 hospitals and were independent of volume. This result was adjusted for pertinent patient and hospital characteristics. Conclusion: No evidence was found that higher annual surgery volume was associated with lower LOS for patients undergoing colorectal cancer surgery. Our model showed strong evidence that differences in LOS efficiency between hospitals was driven by hospital contextual effects that were not predicted by provider volume. Further study is required to elucidate these inherent differences between hospitals. Implications for public health: Our model indicated improved efficiency would benefit the patient and medical system by lowering LOS and reducing expenditure by more than $3 million per year.

Factors associated with adverse outcomes during influenza outbreaks in aged care facilities

Sat, 01 Feb 2020 00:00:00 GMT

Title: Factors associated with adverse outcomes during influenza outbreaks in aged care facilities Authors: Tennant, Elaine; Fletcher, Stephanie; Kakar, Sheena; Najjar, Zeina; Lord, Heidi; Clark, Penelope; Gupta, Leena Abstract: Objective: To explore factors associated with adverse outcomes during influenza outbreaks in residential aged care facilities. Methods: A retrospective cohort study of all outbreaks reported to three Sydney metropolitan Public Health Units during 2017. Results: A total of 123 outbreaks affected 1,787 residents and 543 staff. Early notification to a Public Health Unit was associated with shorter outbreak duration (p<0.001; B=0.674). Resident attack rates and resident mortality rates were lower in outbreaks notified early, on univariate analysis (p=0.034 and p=0.048 respectively) but not on an adjusted model. Staff attack rates were significantly associated with resident attack rates (p=0.001; B=0.736). Data on staff vaccination rates was incomplete and reported coverage rates were low (median 39%). Resident vaccination coverage ≥95% was associated with shorter outbreak duration in univariate testing but not on an adjusted model. Conclusions: Early public health notification is associated with improved outbreak parameters; sick staff may pose a risk to residents, yet vaccination rates are low. Resident vaccination may also be valuable. Implications for public health: Measures that facilitate early PHU involvement in influenza outbreaks should be implemented, such as compulsory reporting requirements and processes that permit easier notification through technology. Actions that enhance staff and resident vaccination coverage should also be undertaken.

Epidemiology of chronic hepatitis B and C in Victoria, Australia: insights and impacts from enhanced surveillance

Sat, 01 Feb 2020 00:00:00 GMT

Title: Epidemiology of chronic hepatitis B and C in Victoria, Australia: insights and impacts from enhanced surveillance Authors: MacLachlan, Jennifer H.; Romero, Nicole; Higgins, Nasra; Coutts, Rachel; Chan, Rachel; Stephens, Nicola; Cowie, Benjamin C. Abstract: Objective: To assess the impact of an enhanced viral hepatitis surveillance program on data completeness and on epidemiological assessment of affected populations. Methods: Notified cases of non-acute hepatitis B and C were analysed to determine demographic characteristics and risk factors during the period prior to July 2015–June 2016, and during enhanced surveillance of the period July 2016–June 2017, during which time doctors were contacted for information about new diagnoses. Results: During the enhanced period, completeness for country of birth and Indigenous status doubled for both hepatitis B and hepatitis C, from 18–37% to 48–65%. The incidence ratio of hepatitis C among Aboriginal and Torres Strait Islander people increased from eight-fold to 11.4- fold, and the proportion of hepatitis B cases reported as born in China and Vietnam relative to other countries increased. New data fields identified that 12% of hepatitis C diagnoses occurred in a correctional facility, and 2% of hepatitis B cases were healthcare workers. Conclusions: Improved data completeness highlighted the underlying epidemiology of chronic viral hepatitis, demonstrating the increased burden of infection among specific priority populations. Implications for public health: Enhanced surveillance provides greater insight into the epidemiology of chronic viral hepatitis, identifying groups at risk and opportunities for public health action.

Epidemiology of sepsis in cancer patients in Victoria, Australia: a population-based study using linked data

Sat, 01 Feb 2020 00:00:00 GMT

Title: Epidemiology of sepsis in cancer patients in Victoria, Australia: a population-based study using linked data Authors: Marvelde, Luc te; Whitfield, Ann; Shepheard, Jennie; Read, Carla; Milne, Roger L.; Whitfield, Kathryn Abstract: Objective: To determine the clinical characteristics, outcomes and longitudinal trends of sepsis occurring in cancer patients. Method: Retrospective study using statewide Victorian Cancer Registry data linked to various administrative datasets. Results: Among 215,763 incident cancer patients, incidence of sepsis within one year of cancer diagnosis was estimated at 6.4%. The incidence of sepsis was higher in men, younger patients, patients diagnosed with haematological malignancies and those with de novo metastatic disease. Of the 13,316 patients with a first admission with sepsis, 55% had one or more organ failures, 29% required care within an intensive care unit and 13% required mechanical ventilation. Treatments associated with the highest sepsis incidence were stem cell/bone marrow transplant (33%), major surgery (4.4%), chemotherapy (1.1%) and radical radiotherapy (0.6%). The incidence of sepsis with organ failure increased between 2008 and 2015, while 90- day mortality decreased. Conclusions: Sepsis in patients with cancer has high mortality and occurs most frequently in the first year after cancer diagnosis. Implications for public health: The number of cancer patients diagnosed with sepsis is expected to increase, causing a substantial burden on patients and the healthcare system.