The Evolution Of Early Homo : A Reply To Scott

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/106154/1/evo12344.pd

The Health Status and Unique Health Challenges of Rural Older Adults in California

Examines the demographics, health, and levels of physical activity and food insecurity of rural seniors compared with those of urban and suburban seniors. Outlines environmental and social risk factors that require context-specific policies and programs

Risk factors associated with delayed discharge following robotic assisted surgery for gynecologic malignancy

© 2020 Background: The risk factors for extended length of stay (LOS) have not been examined in a cohort of patients with complex social and medical barriers who undergo robotic assisted (RA) surgery for gynecologic malignancies. We sought to identify those patients with a LOS \u3e 24 h after robotic surgery and the risk factors associated with delayed discharge. Then we aimed to develop a predictive model for clinical care and identify modifiable pre-operative risk factors. Methods: After IRB approval, data was abstracted from medical records of all patients with a gynecologic malignancy who underwent a RA laparoscopic surgery from 2010 to 2015. Univariable and multivariable logistic regression was performed to identify independent risk factors associated with delayed discharge defined as LOS \u3e 24 h. A multi-variable logistic regression model was performed using a stepwise backward selection for the final prediction model. All testing was two-sided and a p-value \u3c 0.05 was considered statistically significant. Results: Of the 406 eligible and evaluable patients, 194 (48%) had a LOS \u3e 24 h. Age ≥ 60 years, a higher usage of narcotic medication, a longer surgical time, and a larger estimated blood loss were all associated with LOS \u3e 24 h (p \u3c 0.05). Many of these women had a social work consultation and went home with home care services despite no surgical or post-operative complications. Our prediction model has the potential to correctly classified 75% of the patients discharged within 24 h. Conclusions: The development of a pre-hospitalization risk stratification and anticipating the possible need for home care services pre-operatively shows promise as a strategy to decrease LOS in patients classified as high-risk. These findings warrant prospective validation through the use of this prediction model in our institution