Aft Colorado Federation of Teachers School Health & Public Em

Cardiac rehabilitation (CR) continues to be under-utilized despite known benefits across the cardiovascular disease spectrum. Unfortunately, despite efforts to augment access, barriers persist in patient access to rehabilitation and ability to participate due to logistical challenges. A choice of home-based CR may present an appealing alternative that circumvents these known obstacles. Similarly, nudge reminders, or messages designed to elicit behavioral change, may improve adherence to CR.

Providing a choice of home or hospital-based CR, and nudge reminders will improve adherence to CR in an urban safety net population.

The Enhancing Cardiac Rehabilitation Adherence through Home-Based Rehabilitation and Behavioral Nudges (ERA-Nudge) study utilizes a 2 × 2 factorial design to randomize eligible CR patients to usual care versus choice of home or hospital-based CR, and tailored nudge messages versus generic reminders to encourage healthy behavior. The study assesses the effectiveness of choice of CR location (ie, home versus hospital) and nudge messages in improving CR adherence. The study also uses an implementation framework to understand reach, adoption, implementation, and maintenance of this approach within the context of real-world care delivery in a pragmatic trial design. The enrollment was completed in May 2023, with a total of 447 patients.

The ERA-Nudge trial assesses the implementation, effectiveness, and safety of choice in CR location and nudge messaging to improve CR adherence. If successful, this approach can be easily disseminated and may inform future implementations for rehabilitation and other behavioral therapies.

URL: https://clinicaltrials.gov; Unique identifier: NCT03834155.

Reduction in postoperative length of stay improves financial and operational outcomes and is a target for quality improvement. However, the relationship between postoperative length of stay and unplanned readmission, which may offset these improvements, is poorly understood. The aim of this study was to examine the association between postoperative length of stay and readmission in a broad surgical population.

Associations between patient preoperative characteristics, in-hospital postoperative complications, postoperative length of stay and unplanned readmissions were examined in surgical inpatients in the American College of Surgeons National Surgical Quality Improvement Program database, 2012-2018. The risk-adjusted association between postoperative length of stay intervals and readmission was assessed using multiple logistic regression analysis. Subgroup analyses by surgical specialty and the 20 most common operations were performed.

Of 3,140,280 patients, the majority were female (56.9%), White (66.0%), American Society of Anesthesiologists physical status II or III (88.5%), and underwent general or orthopedic procedures (68.8%). A total of 168,672 patients (5.4%) experienced an unplanned readmission in the 30-day postoperative period. When compared to patients with postoperative length of stay of 0-2 days, risk-adjusted readmission was significantly increased for postoperative length of stay of 3-5 days (odds ratio 1.72, 95% confidence interval 1.70-1.74), 6-8 days (2.29, 2.25-2.33), and 9-10 days (2.32, 2.27-2.38). This association was also observed for each surgical specialty and 17 of 20 different individual operations. Surgical site infection was the reason for 22.9% of all readmissions.

After adjusting for preoperative risk, surgical complexity, and in-hospital postoperative complications, increased postoperative length of stay up to 10 days was associated with increased 30-day unplanned readmissions. This finding held true across a subanalysis of surgical specialties and operations, with variations in magnitude of effect. The largest effects were seen in otolaryngology procedures and in laparoscopic bariatric surgery procedures.