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Article ; Online: Pouch volvulus after laparoscopic ileal pouch anal anastomosis: the Achilles heel?

Chen, Hui Lionel Raphael / Chok, Aik Yong / Cheng, Tim-Ee Lionel / Tan, Kwong-Wei Emile

2021 Volume 92, Issue 9, Page(s) 2322–2323

MeSH term(s)	Anal Canal/surgery ; Anastomosis, Surgical/adverse effects ; Colitis, Ulcerative/surgery ; Colonic Pouches/adverse effects ; Humans ; Intestinal Volvulus/etiology ; Intestinal Volvulus/surgery ; Laparoscopy/adverse effects ; Proctocolectomy, Restorative/adverse effects ; Treatment Outcome
Language	English
Publishing date	2021-12-27
Publishing country	Australia
Document type	Journal Article
ZDB-ID	2050749-5
ISSN	1445-2197 ; 1445-1433 ; 0004-8682
ISSN (online)	1445-2197
ISSN	1445-1433 ; 0004-8682
DOI	10.1111/ans.17432
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Article: The role of magnetic resonance tumour regression grade in the prediction of regression and survival of rectal adenocarcinoma after long-course chemoradiotherapy: a cohort study.

Chen, Hui Lionel Raphael / Seow-En, Isaac / Chok, Aik Yong / Ngo, Nye Thane / Cheng, Tim-Ee Lionel / Tan, Kwong-Wei Emile

Annals of medicine and surgery (2012)

2023 Volume 85, Issue 4, Page(s) 842–848

Abstract: Rectal cancer response to neoadjuvant long-course chemoradiotherapy (LCCRT) is assessed by magnetic resonance tumour regression grade (mrTRG) and this has an impact on surgical management. However, there is limited data on the correlation between mrTRG ... ...

Abstract	Rectal cancer response to neoadjuvant long-course chemoradiotherapy (LCCRT) is assessed by magnetic resonance tumour regression grade (mrTRG) and this has an impact on surgical management. However, there is limited data on the correlation between mrTRG and pathological tumour regression grade (pTRG). This study aims to evaluate the correlation between mrTRG and pTRG and the prognostic value of mrTRG on survival. Methods: Between 2011 and 2016, patients with rectal cancer who underwent LCCRT and had post-LCCRT MRI were included in the study. Both mrTRG and pTRG were dichotomised into good responders (mrTRG 1-3 and pTRG 0-1) and poor responders (mrTRG 4-5 and pTRG 2-3). Correlation between mrTRG and pTRG was assessed with Cohen κ analysis. Survival analysis was performed with Kaplan-Meier test and Cox proportional hazard models. Results: There were 59 patients included in this study. There were significant reductions in anal sphincter and circumferential resection margin involvement in post-LCCRT MRI. Fair agreement was found between mrTRG and pTRG (κ=0.345). Sensitivity, specificity and accuracy of mrTRG 1-3 to predict good pathological response were 100%, 46.3% and 62.7%, respectively. On survival analysis, mrTRG 1-3 was not associated with improved overall survival and recurrence-free survival. Conclusions: While there is fair agreement in correlation between mrTRG and pTRG, MRI remains an objective, noninvasive assessment of tumour response. Further studies are required to improve the ability of mrTRG to predict good responders to LCCRT and evaluate its role as a prognostic marker for survival.
Language	English
Publishing date	2023-04-03
Publishing country	England
Document type	Journal Article
ZDB-ID	2745440-X
ISSN	2049-0801
ISSN	2049-0801
DOI	10.1097/MS9.0000000000000441
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Article: Elderly patients over 80 years undergoing colorectal cancer resection: Development and validation of a predictive nomogram for survival.

Chok, Aik Yong / Zhao, Yun / Chen, Hui Lionel Raphael / Tan, Ivan En-Howe / Chew, Desmond Han Wen / Zhao, Yue / Au, Marianne Kit Har / Tan, Emile John Kwong Wei

World journal of gastrointestinal surgery

2023 Volume 15, Issue 5, Page(s) 892–905

Abstract: Background: Surgery remains the primary treatment for localized colorectal cancer (CRC). Improving surgical decision-making for elderly CRC patients necessitates an accurate predictive tool.: Aim: To build a nomogram to predict the overall survival ... ...

Abstract	Background: Surgery remains the primary treatment for localized colorectal cancer (CRC). Improving surgical decision-making for elderly CRC patients necessitates an accurate predictive tool. Aim: To build a nomogram to predict the overall survival of elderly patients over 80 years undergoing CRC resection. Methods: Two hundred and ninety-five elderly CRC patients over 80 years undergoing surgery at Singapore General Hospital between 2018 and 2021 were identified from the American College of Surgeons - National Surgical Quality Improvement Program (ACS-NSQIP) database. Prognostic variables were selected using univariate Cox regression, and clinical feature selection was performed by the least absolute shrinkage and selection operator regression. A nomogram for 1- and 3-year overall survival was constructed based on 60% of the study cohort and tested on the remaining 40%. The performance of the nomogram was evaluated using the concordance index (C-index), area under the receiver operating characteristic curve (AUC), and calibration plots. Risk groups were stratified using the total risk points derived from the nomogram and the optimal cut-off point. Survival curves were compared between the high- and low-risk groups. Results: Eight predictors: Age, Charlson comorbidity index, body mass index, serum albumin level, distant metastasis, emergency surgery, postoperative pneumonia, and postoperative myocardial infarction, were included in the nomogram. The AUC values for the 1-year survival were 0.843 and 0.826 for the training and validation cohorts, respectively. The AUC values for the 3-year survival were 0.788 and 0.750 for the training and validation cohorts, respectively. C-index values of the training cohort (0.845) and validation cohort (0.793) suggested the excellent discriminative ability of the nomogram. Calibration curves demonstrated a good consistency between the predictions and actual observations of overall survival in both training and validation cohorts. A significant difference in overall survival was seen between elderly patients stratified into low- and high-risk groups ( Conclusion: We constructed and validated a nomogram predicting 1- and 3-year survival probability in elderly patients over 80 years undergoing CRC resection, thereby facilitating holistic and informed decision-making among these patients.
Language	English
Publishing date	2023-06-15
Publishing country	United States
Document type	Journal Article
ZDB-ID	2573700-4
ISSN	1948-9366
ISSN	1948-9366
DOI	10.4240/wjgs.v15.i5.892
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Article ; Online: Clinical outcomes and cost comparison of laparoscopic versus open surgery in elderly colorectal cancer patients over 80 years.

Chok, Aik Yong / Tan, Ivan En-Howe / Zhao, Yun / Chee, Madeline Yen Min / Chen, Hui Lionel Raphael / Ang, Kwok Ann / Au, Marianne Kit Har / Tan, Emile John Kwong Wei

International journal of colorectal disease

2023 Volume 38, Issue 1, Page(s) 160

Abstract: Purpose: The growth of Singapore's geriatric population, coupled with the rise in colorectal cancer (CRC), has increased the number of colorectal surgeries performed on elderly patients. This study aimed to compare the clinical outcomes and costs of ... ...

Abstract	Purpose: The growth of Singapore's geriatric population, coupled with the rise in colorectal cancer (CRC), has increased the number of colorectal surgeries performed on elderly patients. This study aimed to compare the clinical outcomes and costs of laparoscopic versus open elective colorectal resections in elderly CRC patients over 80 years. Methods: A retrospective cohort study using data from the American College of Surgeons National Surgery Quality Improvement Program (ACS-NSQIP) identified patients over 80 years undergoing elective colectomy and proctectomy between 2018 and 2021. Patient demographics, length of stay (LOS), 30-day postoperative complications, and mortality rates were analysed. Cost data in Singapore dollars were obtained from the finance database. Univariate and multivariate regression models were used to determine cost drivers. The 5-year overall survival (OS) for the entire octogenarian CRC cohort with and without postoperative complications was estimated using the Kaplan-Meier curves. Results: Of the 192 octogenarian CRC patients undergoing elective colorectal surgery between 2018 and 2021, 114 underwent laparoscopic resection (59.4%), while 78 underwent open surgery (40.6%). The proportion of proctectomy cases was similar between laparoscopic and open groups (24.6% vs. 23.1%, P = 0.949). Baseline characteristics, including Charlson Comorbidity Index, albumin level, and tumour staging, were comparable between both groups. Median operative duration was 52.5 min longer in the laparoscopic group (232.5 vs. 180.0 min, P < 0.001). Both groups had no significant differences in postoperative complications and 30-day and 1-year mortality rates. Median LOS was 6 days in the laparoscopic group compared to 9 days in the open group (P < 0.001). The mean total cost was 11.7% lower in the laparoscopic group (S$25,583.44 vs. S$28,970.85, P = 0.012). Proctectomy (P = 0.024), postoperative pneumonia (P < 0.001) and urinary tract infection (P < 0.001), and prolonged LOS > 6 days (P < 0.001) were factors contributing to increased costs in the entire cohort. The 5-year OS of octogenarians with minor or major postoperative complications was significantly lower than those without complications (P < 0.001). Conclusion: Laparoscopic resection is associated with significantly reduced overall hospitalization costs and decreased LOS compared to open resection among octogenarian CRC patients, with comparable postoperative outcomes and 30-day and 1-year mortality rates. The extended operative time and higher consumables costs from laparoscopic resection were mitigated by the decrease in other inpatient hospitalization costs, including ward accommodation, daily treatment fees, investigation costs, and rehabilitation expenditures. Comprehensive perioperative care and optimised surgical approach to mitigate the impact of postoperative complications can improve survival in elderly patients undergoing CRC resection.
MeSH term(s)	Aged ; Aged, 80 and over ; Humans ; Colectomy/economics ; Colorectal Neoplasms/pathology ; Colorectal Neoplasms/surgery ; Costs and Cost Analysis ; Laparoscopy/economics ; Length of Stay ; Postoperative Complications/epidemiology ; Retrospective Studies ; Treatment Outcome ; Colon/surgery ; Rectum/surgery
Language	English
Publishing date	2023-06-06
Publishing country	Germany
Document type	Comparative Study ; Journal Article
ZDB-ID	84975-3
ISSN	1432-1262 ; 0179-1958
ISSN (online)	1432-1262
ISSN	0179-1958
DOI	10.1007/s00384-023-04459-w
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Article ; Online: A reduction in hospital length of stay reduces costs for colorectal surgery: an economic evaluation of the National Surgical Quality Improvement Program in Singapore.

Tan, Emile John Kwong Wei / Chen, Hui Lionel Raphael / Chok, Aik Yong / Tan, Ivan En-Howe / Zhao, Yun / Lee, Rachel Shiyi / Ang, Kwok Ann / Au, Marianne Kit Har / Ong, Hock Soo / Ho, Henry Sun Sien / Poopalalingam, Ruban / Tan, Hiang Khoon / Kwek, Kenneth Yung Chiang

International journal of colorectal disease

2023 Volume 38, Issue 1, Page(s) 257

Abstract: Purpose: In 2017, the National Surgical Quality Improvement Program (NSQIP) was introduced in the Department of Colorectal Surgery at Singapore General Hospital as a pilot quality improvement initiative. This study aimed to examine the cost- ... ...

Abstract	Purpose: In 2017, the National Surgical Quality Improvement Program (NSQIP) was introduced in the Department of Colorectal Surgery at Singapore General Hospital as a pilot quality improvement initiative. This study aimed to examine the cost-effectiveness of NSQIP by evaluating its effects on surgical outcomes, length of stay (LOS), and costs. Methods: We retrospectively reviewed patients undergoing colorectal surgery (2017-2020). Patients were divided into two cohorts: pre-NSQIP (2017-2018) and post-NSQIP (2019-2020). Outcomes evaluated were 30-day postoperative complications, LOS, and costs. Total cost-savings from NSQIP intervention's impact on LOS were estimated using a decision model with a one-way sensitivity analysis. Multivariate logistic regression was performed to identify factors for prolonged LOS. Results: 1905 patients underwent colorectal surgery, with 996 in the pre-NSQIP cohort and 909 in the post-NSQIP cohort. A significant reduction in overall postoperative complications of 4.7% was observed in the post-NSQIP cohort (36.5% vs. 31.8%, p = 0.029). Patients in the post-NSQIP cohort had a shorter median LOS (8.0 vs. 6.0 days, p < 0.001). The implementation of NSQIP resulted in an 8.5% decrease in prolonged LOS > 6 days (p < 0.001), saving S$0.31 million on LOS. Total costs per case were reduced by 20.8% following NSQIP (S$39,539.05 vs. S$31,311.93, p < 0.001). Conclusion: Implementing NSQIP has significantly reduced overall postoperative complications, LOS, and costs and achieved cost savings following colorectal surgery.
MeSH term(s)	Humans ; Cost-Benefit Analysis ; Colorectal Surgery ; Length of Stay ; Quality Improvement ; Retrospective Studies ; Singapore ; Postoperative Complications/etiology ; Hospitals
Language	English
Publishing date	2023-10-26
Publishing country	Germany
Document type	Journal Article
ZDB-ID	84975-3
ISSN	1432-1262 ; 0179-1958
ISSN (online)	1432-1262
ISSN	0179-1958
DOI	10.1007/s00384-023-04551-1
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Article ; Online: Impact of an electronic alert on prescription patterns of meropenem, voriconazole and caspofungin.

Chok, Lionel / Kusejko, Katharina / Eberhard, Nadia / Chaudron, Sandra E / Saleschus, Dirk / Kocher, Claudine / Kouyos, Roger D / Weber, Rainer / Kuster, Stefan P

BMC infectious diseases

2021 Volume 21, Issue 1, Page(s) 1263

Abstract: Background: Antimicrobial stewardship programs promote the appropriate use of antimicrobial substances through the implementation of evidence-based, active and passive interventions. We analyzed the effect of a computer-assisted intervention on ... ...

Abstract	Background: Antimicrobial stewardship programs promote the appropriate use of antimicrobial substances through the implementation of evidence-based, active and passive interventions. We analyzed the effect of a computer-assisted intervention on antimicrobial use in a tertiary care hospital. Methods: Between 2011 and 2016 we introduced an electronic alert for patients being prescribed meropenem, voriconazole and caspofungin. At prescription and at day 3 of treatment, physicians were informed about the risk related to these antimicrobial substances by an electronic alert in the medical records. Physicians were invited to revoke or confirm the prescription and to contact the infectious disease (ID) team. Using interrupted time series regression, the days of therapy (DOTs) and the number of prescriptions before and after the intervention were compared. Results: We counted 64,281 DOTs for 5549 prescriptions during 4100 hospital stays. Overall, the DOTs decreased continuously over time. An additional benefit of the alert could not be observed. Similarly, the number of prescriptions decreased over time, without significant effect of the intervention. When considering the three drugs separately, the alert impacted the duration (change in slope of DOTs/1000 bed days; P = 0.0017) as well as the number of prescriptions (change in slope of prescriptions/1000 bed days; P < 0.001) of voriconazole only. Conclusions: The introduction of the alert lowered prescriptions of voriconazole only. Thus, self-stewardship alone seems to have a limited impact on electronic prescriptions of anti-infective substances. Additional measures such as face-to-face prompting with ID physicians or audit and feedback are indispensable to optimize antimicrobial use.
MeSH term(s)	Caspofungin/administration & dosage ; Electronic Prescribing ; Humans ; Medical Order Entry Systems ; Meropenem/administration & dosage ; Voriconazole/administration & dosage
Chemical Substances	Caspofungin (F0XDI6ZL63) ; Meropenem (FV9J3JU8B1) ; Voriconazole (JFU09I87TR)
Language	English
Publishing date	2021-12-20
Publishing country	England
Document type	Journal Article
ZDB-ID	2041550-3
ISSN	1471-2334 ; 1471-2334
ISSN (online)	1471-2334
ISSN	1471-2334
DOI	10.1186/s12879-021-06980-1
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Article: An echo to Choosing Wisely

Chok, Lionel / Debrunner, Johann / Jaeggli, Sandra / Kusic, Karmen / Bachli, Esther B

International journal of general medicine

2018 Volume 11, Page(s) 167–174

Abstract: Background: Inspired by the US Choosing Wisely: Methods: This retrospective analysis was conducted in the Department of Internal Medicine, Uster Hospital, Canton of Zurich, Switzerland. Patients hospitalized in the 3 months before and after ... ...

Abstract	Background: Inspired by the US Choosing Wisely Methods: This retrospective analysis was conducted in the Department of Internal Medicine, Uster Hospital, Canton of Zurich, Switzerland. Patients hospitalized in the 3 months before and after implementation were analyzed. Results: A total of 2023 hospitalizations were analyzed. There was a significant decrease in the number of blood draws after introduction of the recommendation: before implementation, the median number of blood draws per patient was 4 (interquartile range [IQR], 2-7); after implementation, the median was 4 (IQR, 2-6; Discussion: Inappropriate blood draws may lead to anemia, patient discomfort and false-positive results. The simple and low-cost interventions used to implement "Smarter Medicine" have changed physician behavior by reducing the number of blood orders. These results are promising. Whether such recommendations will impact patient and clinical outcomes remains unknown; hence, further studies are needed to clarify this issue.
Language	English
Publishing date	2018-05-04
Publishing country	New Zealand
Document type	Journal Article
ZDB-ID	2452220-X
ISSN	1178-7074
ISSN	1178-7074
DOI	10.2147/IJGM.S155544
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Article ; Online: Effect of diagnosis related groups implementation on the intensive care unit of a Swiss tertiary hospital: a cohort study.

Chok, Lionel / Bachli, Esther B / Steiger, Peter / Bettex, Dominique / Cottini, Silvia R / Keller, Emanuela / Maggiorini, Marco / Schuepbach, Reto A

BMC health services research

2018 Volume 18, Issue 1, Page(s) 84

Abstract: Background: In 2013 the Swiss Diagnosis Related Groups ((Swiss)-DRG) was implemented in Intensive Care Units (ICU). Its impact on hospitalizations has not yet been examined. We compared the number of ICU admissions, according to clinical severity and ... ...

Abstract	Background: In 2013 the Swiss Diagnosis Related Groups ((Swiss)-DRG) was implemented in Intensive Care Units (ICU). Its impact on hospitalizations has not yet been examined. We compared the number of ICU admissions, according to clinical severity and referring institution, and screened whether implementation of Swiss-DRG affected admission policy, ICU length-of-stay (ICU-LOS) or ICU mortality. Methods: Retrospective, single centre, cohort study conducted at the University Hospital Zurich, Switzerland between January 2009 and end of September 2013. Demographic and clinical data was retrieved from a quality assurance database. Results: Admissions (n = 17,231) before the introduction of Swiss-DRG were used to model expected admissions after DRG, and then compared to the observed admissions. Forecasting matched observations in patients with a high clinical severity admitted from internal units and external hospitals (admitted / predicted: 709 / 703, [95% Confidence Interval (CI), 658-748] and 302 / 332, [95% CI, 269-365] respectively). In patients with low severity of disease, in-house admissions became more frequent than expected and external admission were less frequent (admitted / predicted: 1972 / 1910, [95% CI, 1898-1940] and 436 / 518, [95% CI, 482-554] respectively). Various mechanisms related to Swiss-DRG may have led to these changes. DRG could not be linked to significant changes in regard to ICU-LOS and ICU mortality. Conclusions: DRG introduction had not affected ICU admissions policy, except for an increase of in-house patients with a low clinical severity of disease. DRG had neither affected ICU mortality nor ICU-LOS.
MeSH term(s)	Adult ; Aged ; Diagnosis-Related Groups ; Female ; Hospital Mortality/trends ; Humans ; Intensive Care Units ; Length of Stay/statistics & numerical data ; Male ; Middle Aged ; Patient Admission/statistics & numerical data ; Retrospective Studies ; Switzerland ; Tertiary Care Centers
Language	English
Publishing date	2018--05
Publishing country	England
Document type	Journal Article ; Observational Study ; Research Support, Non-U.S. Gov't
ISSN	1472-6963
ISSN (online)	1472-6963
DOI	10.1186/s12913-018-2869-4
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Article ; Online: Characterisation of clinical manifestations and treatment strategies for invasive beta-haemolytic streptococcal infections in a Swiss tertiary hospital.

Neff, Andrina / Chok, Lionel / von Both, Ulrich / Matt, Ulrich / Tarnutzer, Andrea / Andreoni, Federica / van der Linden, Mark / Plock, Jan A / Bühler, Philipp Karl / Brugger, Silvio Daniel / Schüpbach, Reto Andreas / Zbinden, Reinhard / Zinkernagel, Annelies Sofie

Swiss medical weekly

2020 Volume 150, Page(s) w20378

Abstract: Aims of the study: Invasive streptococcal infections affect more than half a million patients worldwide every year and have a high lethality. Little is known about the epidemiology and microbiological characteristics of streptococcal infections in ... ...

Abstract	Aims of the study: Invasive streptococcal infections affect more than half a million patients worldwide every year and have a high lethality. Little is known about the epidemiology and microbiological characteristics of streptococcal infections in Switzerland. This case series study aims to describe the demographics, known risk factors for streptococcal skin and soft tissue infections, clinical presentations, treatment and outcomes of patients admitted to the University Hospital Zurich between 2000 and 2014 with invasive streptococcal infections caused by Streptococcus pyogenes (group A Streptococcus), Streptococcus dysgalactiae ssp. equisimilis or the Streptococcus anginosus group, as well as the microbiological characteristics of the clinical isolates. Methods: Data collected retrospectively from patients hospitalised between 2000 and 2014 with invasive streptococcal infections were analysed. M protein gene (emm) typing of the bacterial clinical isolates was carried out according to the Centers for Disease Control and Prevention guidelines. Results: A total of 86 patients with invasive beta-haemolytic streptococcal infections were included in this study, of which 49% presented with necrotising fasciitis (NF). The median age was 44 years and half were female. The most common risk factor was acute skin lesions. C-reactive protein levels were significantly higher in patients with NF, as were acute renal failure and distributive shock. Beta-lactam antibiotics were given to most patients, and intravenous immunoglobulins were given to 18% of patients within the first 24 hours. All patients suffering from NF underwent surgery. The overall case fatality rate was 8.1% at 30 days post admission. All Group A Streptococcus strains were susceptible to penicillin and clindamycin, and we found resistance to tetracycline in 11.9% of strains. The most common emm-type isolated was emm1 (44.4%). Conclusions: Invasive beta-haemolytic streptococcal infections, the most severe presentation of which is NF, remain a serious clinical issue and require rapid diagnosis and treatment. This is the first representative analysis monitoring clinical and microbiological characteristics of patients with a severe invasive beta-haemolytic streptococcal infection and treated in Zurich, Switzerland. In addition to the detailed reporting of various clinical and microbiological characteristics, we show that C-reactive protein levels, acute renal failure and distributive shock were higher in the patients with NF. We also found a low case fatality rate compared to other reports. The detailed clinical data and microbiological characteristics depicted in this study will lead to a better understanding of regional differences in severe invasive streptococcal infections.
MeSH term(s)	Adult ; Female ; Humans ; Retrospective Studies ; Streptococcal Infections/drug therapy ; Streptococcal Infections/epidemiology ; Streptococcus ; Streptococcus pyogenes ; Switzerland/epidemiology ; Tertiary Care Centers
Language	English
Publishing date	2020-12-05
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2036179-8
ISSN	1424-3997 ; 1424-7860
ISSN (online)	1424-3997
ISSN	1424-7860
DOI	10.4414/smw.2020.20378
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Article ; Online: Effect of diagnosis related groups implementation on the intensive care unit of a Swiss tertiary hospital

Lionel Chok / Esther B. Bachli / Peter Steiger / Dominique Bettex / Silvia R. Cottini / Emanuela Keller / Marco Maggiorini / Reto A. Schuepbach

BMC Health Services Research, Vol 18, Iss 1, Pp 1-

a cohort study

2018 Volume 10

Abstract: Abstract Background In 2013 the Swiss Diagnosis Related Groups ((Swiss)-DRG) was implemented in Intensive Care Units (ICU). Its impact on hospitalizations has not yet been examined. We compared the number of ICU admissions, according to clinical severity ...

Abstract	Abstract Background In 2013 the Swiss Diagnosis Related Groups ((Swiss)-DRG) was implemented in Intensive Care Units (ICU). Its impact on hospitalizations has not yet been examined. We compared the number of ICU admissions, according to clinical severity and referring institution, and screened whether implementation of Swiss-DRG affected admission policy, ICU length-of-stay (ICU-LOS) or ICU mortality. Methods Retrospective, single centre, cohort study conducted at the University Hospital Zurich, Switzerland between January 2009 and end of September 2013. Demographic and clinical data was retrieved from a quality assurance database. Results Admissions (n = 17,231) before the introduction of Swiss-DRG were used to model expected admissions after DRG, and then compared to the observed admissions. Forecasting matched observations in patients with a high clinical severity admitted from internal units and external hospitals (admitted / predicted: 709 / 703, [95% Confidence Interval (CI), 658–748] and 302 / 332, [95% CI, 269–365] respectively). In patients with low severity of disease, in-house admissions became more frequent than expected and external admission were less frequent (admitted / predicted: 1972 / 1910, [95% CI, 1898–1940] and 436 / 518, [95% CI, 482–554] respectively). Various mechanisms related to Swiss-DRG may have led to these changes. DRG could not be linked to significant changes in regard to ICU-LOS and ICU mortality. Conclusions DRG introduction had not affected ICU admissions policy, except for an increase of in-house patients with a low clinical severity of disease. DRG had neither affected ICU mortality nor ICU-LOS.
Keywords	Diagnosis related groups ; DRG ; ICU admissions ; Epidemiology ; Switzerland ; Public aspects of medicine ; RA1-1270
Subject code	610
Language	English
Publishing date	2018-02-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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