Mid Cheshire Hospitals NHS Foundation Trust (MCHFT) is an acute hospital trust in Cheshire. It runs Leighton Hospital in Crewe, Victoria Infirmary in Northwich and Elmhurst Intermediate Care Centre in Winsford.MCHFT became registered as a Foundation Trust on 1 April 2008, following authorisation by the independent regulator, Monitor. The trust is currently under the leadership of chair Dennis Dunn MBE JP DL and chief executive James Sumner.Services are provided to a population of approximately 300,000 living in and around Alsager, Crewe, Congleton, Knutsford, Middlewich, Nantwich, Northwich, Sandbach and Winsford. The Trust is registered with the Care Quality Commission (CQC), without conditions, and provides acute, maternity, child health and intermediate care services.
Background The appropriate timing of gastrostomy tube placement in patients with acute ischemic stroke who have dysphagia remains unclear. Objective To identify factors and outcomes associated with the early and deferred gastrostomy tube placement in patients with ischemic stroke after hospitalization in the United States. Methods We analyzed all acute ischemic stroke patients who underwent gastrostomy tube placement using data from the Nationwide Inpatient Sample (2016-2022). Early gastrostomy was identified if gastrostomy tube placement was performed within 7 days of admission. We performed logistic regression analysis to identify the effect of timing of gastrostomy (early versus deferred) on none to minimal disability, length of stay, and hospitalization cost after adjusting for variables that were significantly different in univariate analysis. Results Of 174,000 acute ischemic stroke patients who underwent gastrostomy tube placement during hospitalization, 57,475 (33.0%) underwent early gastrostomy tube placement. Patients who underwent early gastrostomy were significantly more likely to be older, white, women, and admitted to non-teaching hospitals. Patients who received mechanical thrombectomy were significantly less likely to undergo early gastrostomy tube placement. The proportions of patients who developed acute myocardial infarction (5.6% vs 11.9%), pulmonary embolism (1.9% vs 4.5%), urinary tract infection (21.3% vs 26.3%), sepsis (12.1% vs 29.8%), pneumonia (11.4% vs 30.3%), or deep venous thrombosis (5.2% vs 13.3%) were lower in patients who underwent early gastrostomy tube placement. Early gastrostomy was associated with both shorter length of stay (-9.46 days, 95% CI: -9.95 to -8.97, p<0.001) and hospitalization cost (-$26,944, 95% CI: -28,604 to -252,284, p<0.001) in the multivariate analyses. Conclusion Early gastrostomy tube placement is associated with both a reduction in hospital costs and length of stay and lower rates of in-hospital adverse events.
Abstract. Objective:. This study aims to evaluate the incidence of pulmonary artery aneurysm (PAA) diagnoses among hospitalized patients and the outcome for these patients in the United States. Methods:. This was a retrospective, observational cohort study performed in accordance with the STROBE and RECORD guidelines. The United States National Inpatient Sample 2016 to 2020 was analyzed for hospital admissions with a discharge diagnosis of PAA identified by the International Classification of Diseases, Tenth Revision, Clinical Modification code I28.1. Data on demographics, admission type, hospital characteristics, and comorbidities associated with PAA were collected. Backward stepwise logistic regression was used for the primary outcome of in-hospital mortality, and backward stepwise linear regression was used for secondary outcomes including length of stay and hospitalization cost. Results:. There were 5,305 hospital admissions with patients who had a diagnosis of PAA between 2016 and 2020 (median age: 62 years; 53.1% (2,815/5,305) female). The in-hospital mortality rate for the cohort with PAA was 6.7% (355/5,305), and the median length of stay was 5 d. The median cost of inpatient care for patients with PAA was $17,526. The most common conditions associated with PAA were pulmonary arterial hypertension (1,440/5,305, 27.1%), secondary pulmonary hypertension due to left heart disease (1,395/5,305, 26.3%), pneumonia (1,125/5,305, 21.2%), pulmonary embolus (725/5,305, 13.7%), and unspecified secondary pulmonary hypertension (575/5,305, 10.8%). The factors most associated with in-hospital mortality were tuberculosis (odds ratio (OR): 22.67, 95% confidence interval (CI): 3.35–153.32, P = 0.001), liver failure (OR: 15.91, 95% CI: 6.31–40.09, P < 0.001), and Eisenmenger syndrome (OR: 12.05, 95% CI: 1.06–136.42, P = 0.044). Liver failure (coefficient 17.84, 95% CI: 12.99–22.67, P < 0.001) was most associated with longer lengths of stay, and iatrogenic complication (coefficient 64,590, 95% CI: 35,308–93,872, P < 0.001) was most associated with cost. Conclusions:. PAA is an uncommon diagnosis among hospitalized patients and is associated with substantial in-hospital mortality, prolonged length of stay, and increased healthcare costs.
Uterine rupture can occur in labour or spontaneously, but it is more common in a scarred uterus after a previous lower segment or classical caesarean section, open myomectomy or operative hysteroscopy for a congenital abnormality. The authors present the case of a multiparous woman (Gravida 10, para 5+4) in her early 30s presenting with abdominal pain and vaginal bleeding at 22+6 weeks of gestation. She was booked for high-risk antenatal care due to her history of preterm deliveries and a previous classical caesarean section at 25+6 weeks of gestation. She was diagnosed with a fetal intrauterine death and a uterine rupture. She became haemodynamically unstable and developed disseminated intravascular coagulopathy. A laparotomy was performed. Intraoperatively, there was evidence of complete uterine rupture through the classical incision. The blood loss was 5.5 L. This case illustrates how the physical reserve of a young healthy woman may mask serious intra-abdominal pathology until she begins to decompensate, which is inevitably a late sign.
