Search Results (3,980)

Background: Patients undergoing open-heart surgery (OHS) are at risk of postoperative morbidity and mortality. Physical performance has been increasingly recognized as an important factor influencing postoperative outcomes. Therefore, the study aimed to investigate the associations and predictive value of physical performance on postoperative complications and duration of hospital stay. Methods: A prospective cohort study was conducted in 116 patients who were admitted to OHS. Preoperative assessment of physical performance, i.e., Short Physical Performance Battery (SPPB), Five Times Sit to Stand Test (5STS), gait speed (5 m walk test: 5MWT), Timed Up and Go (TUG), and handgrip strength. Duration of hospital stay and incidence of post-operative complications were recorded. Differences between participants with and without postoperative complications were analyzed using independent samples t-tests for continuous variables and chi-square tests for categorical variables. The associations between physical performance and postoperative outcomes were assessed using Spearman’s rank correlation coefficient. Hierarchical regression analysis was conducted to determine the predictive contribution of physical performance. Results: A total of 116 participants were submitted for OHS in two medical school hospitals; however, 108 individuals completed the pre-operative physical performance. The most common procedures were coronary artery bypass grafting and valve surgery. Fifty-one participants (47.22%) experienced postoperative complications, including five deaths, corresponding to 4.63% mortality. For the length of hospital stay analysis, five participants who died postoperatively were excluded, resulting in a final sample of 103 participants. Physical performance was significantly associated with the length of hospital stay (p < 0.05). Hierarchical regression analysis showed that the final prediction model explained 13.4% of the variance in length of hospital stay, with SPPB independently contributing an additional 6.0% to the model, followed by 5STS, 5MWT, handgrip strength, and TUG, which accounted for an additional 5.1%, 4.6%, 4.4%, and 3.7%, respectively. Conclusions: Preoperative physical performance was associated with length of hospital stay. While each measure explained a relatively small proportion of the variance in hospital stay, these assessments offer a simple, non-invasive, and clinically feasible approach to evaluating functional reserve before surgery. These findings highlight the importance of incorporating functional assessment into perioperative care to support risk stratification and guide rehabilitation strategies. Full article

Background/Objectives: Adult patients supported with extracorporeal membrane oxygenation (ECMO) frequently require invasive diagnostic, therapeutic, surgical, or bedside procedures during ongoing extracorporeal support. These procedures are clinically challenging because ECMO-related anticoagulation, platelet dysfunction, acquired coagulopathy, and circuit-related coagulation activation may increase both bleeding and thrombotic risks. This systematic review evaluated the safety of invasive procedures performed during adult ECMO support, excluding tracheostomy/tracheotomy because this procedure has recently been addressed in a dedicated systematic review. Methods: A systematic search of PubMed/MEDLINE and Scopus was performed. The final bibliographic data collection was completed in April 2026. Studies were eligible if they included adult ECMO or extracorporeal life support patients undergoing invasive procedures during ongoing ECMO support, or with ECMO used as procedural support, and reported at least one procedure-specific safety outcome. Primary outcomes were procedure-related complications, bleeding, major bleeding, and transfusion requirements. Secondary outcomes included thrombotic and circuit-related complications, oxygenator exchange, reintervention, reoperation, procedural failure, ECMO duration, intensive care unit and hospital length of stay, and mortality. Results: The final qualitative synthesis included 46 studies, comprising 26 studies from PubMed/MEDLINE and 20 additional unique studies from Scopus. Included procedures were grouped into six domains: airway, bronchoscopic, and tracheobronchial procedures; thoracic surgery and lung resections; abdominal surgery, gastrointestinal endoscopy, and decompressive laparotomy; lung transplantation and perioperative extracorporeal life support; cardiovascular, vascular, pulmonary embolism-related, and mechanical circulatory support-related procedures; and mixed non-cardiac surgery. Airway and bronchoscopic procedures generally showed high procedural success in selected cohorts, although registry-level tracheal procedure data reported hemorrhagic complications in 26.0% and surgical-site bleeding in 13.0%. Emergency thoracic and abdominal procedures carried the highest bleeding, transfusion, reintervention, and mortality burden. Lung transplantation studies showed that ECMO can be integrated into perioperative pathways, but hemothorax, transfusion, thromboembolism, and anticoagulation strategy remained central safety issues. Conclusions: Invasive procedures during adult ECMO are feasible in selected patients and experienced centers, but procedural safety varies markedly by procedure type, urgency, baseline disease severity, and anticoagulation strategy. A procedure-centered, multidisciplinary approach with individualized anticoagulation management and careful planning is essential. Full article

Objectives: This study aimed to evaluate and compare the cost-effectiveness of the surgery-first and orthodontic-first approaches in Thai patients with dentofacial deformities undergoing orthognathic surgery. Methods: This retrospective cohort study included 30 patients with dentofacial deformities, divided into the surgery-first approach (SFA, n = 15) and orthodontic-first approach (OFA, n = 15). All underwent double-jaw surgery without genioplasty performed by a single surgeon and orthodontist. Data collected included operative and orthodontic costs, operative time, total treatment and hospital costs, treatment duration, and length of hospital stay. Cost-effectiveness was assessed using the incremental cost-effectiveness ratio (ICER) and incremental time-effectiveness ratio (ITER), with effectiveness measured by quality of life via the Thai Orthognathic Quality of Life Questionnaire (OQLQ) before and at the time of debonding the orthodontic appliance. Results: Overall, the SFA demonstrated greater cost-effectiveness than the OFA. However, the SFA group incurred slightly higher hospital costs. There were no statistically significant differences between the two groups in operative cost, hospital cost, total cost, operative time, or length of hospital stay (p > 0.05). By contrast, orthodontic cost, orthodontic treatment duration, and total treatment duration were significantly lower in the SFA group compared with the OFA group (p < 0.05). Conclusions: Within limits, the SFA is a potentially beneficial alternative to OFA. Patients and clinicians may benefit from using SFA by experiencing shorter treatment duration, lower orthodontic treatment costs, and improvements in certain aspects of quality of life. Further studies with larger sample sizes and longitudinal data are necessary to establish the long-term effectiveness. Full article

Background: Healthcare-associated bloodstream infections (HABSIs) are among the main categories of nosocomial infections. This analysis aims to identify the clinical characteristics of patients in the emergency department (ED) who will develop a HABSI during their hospital stay. Methods: Main outcome measures were HABSI and the cumulative survival rate at 30 days. The features tested in a logistic model were age, sex, vitals by the National Early Warning Score (NEWS), priority levels, main complaints, comorbidities by the Charlson Comorbidity Index (CCI), trauma-related disease, main diagnosis and ED length of stay. Results: In 414 (2.3%) out of 18,304 patients, aged 75 (16) years, mean (SD), a diagnosis of HABSI was recorded. HABSIs occurred in subjects with main diagnosis of diseases of the respiratory system (N = 116; 28.0%), digestive system (N = 72; 17.4%), and circulatory system (N = 68; 16.4%). The main key clinical features selected by the logistic model were: NEWS > 6, diagnosis of neoplasms, CCI > 4, and diagnosis of diseases of the digestive system. The ROC curve for the HABSI risk score was 0.703 ± 0.027 in predicting the outcome, (sensitivity 79%, specificity 51%, at optimal cut-off score). The overall hazard mortality risk was twofold higher in patients with HABSIs (hazard ratio: 2.319; 95% confidence interval: 1.871–2.875; p-value: <0.001). The overall 30-day survival rate was lower among patients with HABSIs (33%) vs. non-HABSI patients (62%). Conclusions: A group of main clinical features in subjects without suspect of infectious disease in the ED are associated with HABSIs. These features negatively impact survival rate during hospital stays. Full article

Introduction: Intravenous push (IVP) beta-lactam antibiotics have been adopted during parenteral solution shortages to conserve resources. Data evaluating the safety and efficacy of cefepime administered IVP versus intravenous piggyback (IVPB) infusion in Gram-negative bacteremia remain limited. We compared clinical outcomes of cefepime administered IVP versus IVPB in hospitalized patients with Gram-negative bacteremia. Methods: This was a retrospective cohort study across a five-hospital health system from 1 January 2014 through 31 December 2021. Adults receiving cefepime for Gram-negative bacteremia were included. The primary outcome was a tailored desirability of outcome ranking (DOOR) composite assessed through 30 days or hospital discharge, integrating clinical cure and cefepime-associated neurologic adverse effects. Clinical cure was defined as absence of recurrent bacteremia with the index pathogen after 48 h, no antibiotic escalation, and no in-hospital mortality. Results: A total of 254 met the inclusion criteria (127 IVPB; 127 IVP). Baseline severity was similar between groups. The primary outcome assessed by DOOR revealed no difference between IVPB and IVP groups (p = 0.656). Vasopressor support during therapy was more frequent in the IVP group (22.0% vs. 10.2%, p = 0.011), and median hospital length of stay was longer (10 vs. 7 days, p = 0.020). No differences were noted in other endpoints. General ward admission (OIR [aOR] 2.563, 95% CI 1.271–5.168; p = 0.009) and genitourinary source of bacteremia (aOR 3.398, 95% CI 1.509–7.652; p = 0.003) independently predicted clinical cure. Conclusions: In patients with Gram-negative bacteremia, cefepime administered IVP demonstrated similar safety and efficacy to IVPB infusion. Full article

Background: Early-onset ventilator-associated pneumonia (EO-VAP) is a frequent complication in comatose patients requiring endotracheal intubation. This systematic review and Bayesian meta-analysis assesses the effectiveness of antibiotic prophylaxis in preventing EO-VAP in this population. Methods: Randomized controlled trials (RCTs) and observational studies enrolling adult comatose patients (GCS ≤ 8) requiring endotracheal intubation and reporting EO-VAP incidence, late-onset VAP, ICU mortality, 28-day mortality, or ICU length of stay were included. Studies without a control group or not focused on comatose patients were excluded. Following PRISMA 2020 guidelines, a comprehensive search was conducted across three databases from inception to 31 March 2026. Risk of bias was assessed using the RoB2 tool for RCTs and the ROBINS-I tool for observational studies. Results: In accordance with Cochrane Handbook recommendations, only RCTs were included in the quantitative analysis. Five RCTs (735 patients) demonstrated a significant reduction in EO-VAP incidence with antibiotic prophylaxis (RR 0.46 [95% CI: 0.35–0.59], p = 0.001, I² = 0%), with the strongest effect in neurological patients (RR 0.41 [95% CI: 0.32–0.53], NNT = 5.4). No significant effect on mortality was demonstrated. Bayesian analysis confirmed these findings (posterior median RR 0.44 [95% CrI: 0.33–0.59], P(benefit) = 100%). Limitations: The analysis was limited by the small number of RCTs and the absence of data on antimicrobial resistance. Conclusions: Antibiotic prophylaxis reduces EO-VAP incidence in comatose patients, particularly neurological patients. A general recommendation cannot currently be made pending further evidence on mortality and antimicrobial resistance. Registration: This systematic review was prospectively registered on PROSPERO (CRD42024580280). Full article

Background/Objectives: To determine whether ESS provides superior clinical, radiologic, or perioperative outcomes compared with non-ESS surgical strategies in lumbar spondylolisthesis. Methods: We conducted a PRISMA-guided systematic review and meta-analysis comparing ESS with non-ESS strategies specifically for lumbar spondylolisthesis. PubMed, Web of Science, Scopus, and CENTRAL were searched from inception to December 2025, plus reference-list screening. Primary outcomes were mean change in VAS back pain, VAS leg pain, and Oswestry Disability Index (ODI); secondary outcomes included radiologic measures (disc height, lumbar lordosis angle, fusion rate) and perioperative outcomes (blood loss, operative time, length of stay, complications). Results: Eighteen studies (16 retrospective cohorts, 1 RCT, 1 case–control) involving 1200 patients with lumbar spondylolisthesis (2019–2025) were included. ESS showed no significant differences versus non-ESS in mean change in VAS back pain (13 studies; MD −0.07), VAS leg pain (14 studies; MD 0.08), or ODI (12 studies; MD 0.51). No statistically significant differences were detected in radiological outcomes (disc height, lumbar lordosis angle, and fusion rate). ESS was associated with reduced blood loss (MD −132.98) and shorter hospital stay (MD −2.86 days), with no difference in operative time (MD 3.96) or postoperative complications (RR 0.86). Subgroup analyses compared endoscopic fusion with MIS fusion, open fusion, and non-endoscopic decompression. Endoscopic versus MIS fusion showed lower blood loss (MD: −50.9 mL) and shorter hospital stay (MD: −1.4 days) but longer operative time (MD: +17.2 min), with no differences in clinical outcomes. Comparisons involving decompression and open fusion were limited by the small number of studies and should be considered exploratory. Conclusions: For lumbar spondylolisthesis, no statistically significant differences were detected between ESS and non-endoscopic approaches in pain, disability, radiologic outcomes, or complication rates, with potential perioperative advantages in blood loss and length of stay. However, these findings should be interpreted cautiously because the available evidence is predominantly retrospective, procedurally heterogeneous, and affected by substantial variation in follow-up duration. Full article

Background: Hospitalized adults with chronic kidney disease (CKD) experience high morbidity and mortality. Acute inpatient events frequently occur in combination, yet most studies evaluate individual conditions in isolation. Acute hemodynamic and vascular stressors may represent interacting physiological stressors that define heterogeneous patterns of inpatient risk. Methods: Acute hemodynamic stressors (sepsis, shock, acute decompensated heart failure, and mechanical ventilation) and vascular stressors (acute myocardial infarction, major bleeding, stroke, pulmonary embolism, and deep vein thrombosis) were identified using ICD-10-CM and ICD-10-PCS codes. Stressor burden was defined as the number of stressors (0, 1, 2, or ≥3). Hospitalizations were categorized into mutually exclusive domains: none, hemodynamic only, vascular only, or both. Survey-weighted multivariable regression models examined associations with mortality, acute kidney injury (AKI), length of stay (LOS), and hospital charges. Prespecified sensitivity analyses excluded inter-hospital transfers, and interaction analyses assessed modification by age. Results: Among 1,062,813 CKD hospitalizations, 66.1% experienced at least one acute stressor. Increasing stressor burden demonstrated a marked dose–response relationship with mortality, with adjusted odds ratios of 2.15 (95% CI: 2.08–2.23), 7.36 (95% CI: 7.09–7.64), and 31.65 (95% CI: 30.40–32.95) for 1, 2, and ≥3 stressors, respectively. Increasing stressor burden was also associated with higher odds of AKI, longer LOS, and greater hospital charges. Significant dose–response relationships were observed for all outcomes (all P-trend < 0.001). Isolated hemodynamic stressors were associated with greater mortality risk than isolated vascular stressors (aOR: 4.97 vs. 2.15), while hospitalizations experiencing both domains had the greatest risk (aOR: 13.10, 95% CI: 12.52–13.71). These findings were robust in sensitivity analyses excluding inter-hospital transfers. The relative increase in mortality associated with higher stressor burden was greater among patients younger than 65 years than among older adults (P for interaction <0.001). Conclusions: Acute hemodynamic and vascular stressors define heterogeneous patterns of inpatient risk among hospitalized adults with CKD. Both cumulative stressor burden and stressor domain are strongly associated with mortality, AKI, and resource utilization, with robust dose–response relationships that highlight acute physiological stress as an important determinant of inpatient outcomes in CKD. Full article

Background: Infective endocarditis (IE) requires 4–6 weeks of intravenous antimicrobial therapy, and timely transition to outpatient parenteral antimicrobial therapy (OPAT) allows clinically stable patients to complete treatment outside the hospital. Because OPAT requires home infusion services or post-acute facility placement that typically depend on coverage, insurance status may strongly influence length of stay (LOS); national data on this association in IE remain limited. Methods: We performed a retrospective cross-sectional analysis of the 2016–2019 National Inpatient Sample (NIS) using ICD-10-CM codes I33 and I38 to identify adult IE hospitalizations. Patients were classified as insured (Medicare, Medicaid, or private insurance) or uninsured (self-pay or no charge). Outcomes included mean and prolonged LOS (>14 and >28 days), in-hospital mortality, discharge against medical advice (AMA), and hospitalization costs. Comparisons used chi-square and Student’s t-tests with appropriate NIS survey weighting. Multivariable Gamma regression (LOS, cost) and logistic regression (binary outcomes) were performed, adjusting for age, sex, race/ethnicity, income quartile, injection drug use (IDU), Elixhauser Comorbidity Index, and hospital characteristics, with an insurance × IDU interaction term. Results: Of 87,211 weighted IE hospitalizations, 81,667 (93.6%) were insured and 5544 (6.4%) were uninsured. Uninsured patients were younger (mean age 40.1 vs. 59.4 years) with lower comorbidity burden but higher injection drug use (IDU) prevalence (38.7% vs. 15.5%). Mean LOS was longer among the uninsured (15.5 vs. 12.4 days, p < 0.001); LOS > 14 days occurred in 35.8% vs. 26.6%, and LOS > 28 days in 18.5% vs. 9.2% (both p < 0.001). AMA discharge was four-fold higher among the uninsured (22.2% vs. 5.5%, p < 0.001), while unadjusted in-hospital mortality was similar (9.0% vs. 9.4%, p = 0.32). LOS and AMA disparities persisted in both IDU and non-IDU subgroups, with a six-fold AMA disparity among non-IDU patients (15.2% vs. 2.5%). Based on multivariable analysis, uninsured status remained independently associated with prolonged LOS > 28 days (adjusted odds ratio [aOR] 1.46, 95% CI 1.30–1.65), AMA discharge (aOR 3.51, 95% CI 3.10–3.97), and—after accounting for age and comorbidity differences—higher in-hospital mortality (aOR 1.25, 95% CI 1.10–1.43). Conclusions: Uninsured adults hospitalized with IE experienced longer stays, markedly higher AMA rates, and—after adjustment for age and comorbidity—higher in-hospital mortality than insured patients. These findings are consistent with nonclinical barriers to discharge—particularly limited OPAT and post-acute care access—and suggest that the younger, less comorbid profile of uninsured patients masks an underlying outcome disparity. The results identify uninsured IE patients as a population that may benefit from alternative care models and policy reforms expanding safe post-acute antimicrobial therapy. Full article

Background/Objectives: Community hospitals can be a valuable and cost-effective resource for elderly people, especially in rural areas. Their aim is to promote self-reliance, prevent unnecessary hospital admissions, and facilitate rapid recovery after acute illness. The widespread adoption of intermediate care facilities helps alleviate hospital overcrowding by preventing clinical deterioration through advanced and continuous nursing care. An intermediate care unit was established in a rural area of central Italy. This study aims to describe the impact of a community hospital on patients’ functional status from admission to discharge, describing a real-life model. Methods: This single-center descriptive study examines trends in the quality of care provided. Data were retrieved from anonymized electronic clinical records. Statistical analyses were performed using descriptive statistics, paired t-tests, and Pearson correlation coefficients. Results: A total of 532 residents (mean age 80.7 ± 13.2 years; 61% female) were admitted to the community hospital between January 2022 and September 2025. The mean length of stay was 15.2 ± 7.6 days, with a mean improvement in Modified Barthel Index score of 5.24 ± 7.95 (p < 0.05). Most patients (81.8%) were discharged home, while 6.0% required hospitalization. No readmissions were recorded in 2025. Clinical risk events occurred only in 1.2% of the total. Nursing specialization increased during the study period, correlating with improved patient outcomes (R = 0.88). Conclusions: This descriptive cross-sectional study in a rural nurse-led intermediate care unit found relatively short lengths of stay, high rates of home discharges and modest, but statistically significant, improvements in functional autonomy. Full article

Chimeric antigen receptor (CAR) T-cell therapy is a new standard of care for patients with diffuse large B-cell lymphoma (DLBCL); however, studies including healthcare resource utilization (HRU) during routine care are lacking. Accordingly, a population-based study was conducted using linked administrative databases from Ontario, Canada. Patients with DLBCL that failed ≥2 lines of systemic therapy were included. Cox proportional hazard models estimated associations between covariates and overall survival (OS). Logistic, binomial and Poisson regression explored associations between covariates with toxicity and HRU. We identified 308 patients enrolled to receive CAR T-cell therapy of which 255 patients received CAR T-cells (mean age 59 years; 39% female). From the date of CAR T-cell infusion, the median OS was 25.0 months (95% CI, 21.6–28.1 months). Cytokine release syndrome and immune effector cell-associated neurotoxicity syndrome data were available for 155 patients and were reported in 135 (87.1%) and 42 (27.1%) patients, respectively. Of those that received CAR-T cells, 172 patients (67%) were hospitalized with a median length of stay of 5 days (IQR, 0–20) and 243 (95%) had an emergency department visit without hospitalization. Our prospective population-based study demonstrates comparable efficacy and safety of CAR T-cell therapy in the real-world to the pivotal trials and highlights this as an efficacious and relatively safe treatment option for patients with DLBCL in routine clinical care. Full article

Background: Coronary artery disease (CAD) is an important comorbidity that may increase perioperative cardiovascular risk in major noncardiac surgery. However, data evaluating its impact on outcomes following pancreatic cancer surgery remain limited. This study evaluated inpatient outcomes among patients undergoing pancreatic cancer resection with versus without CAD in the United States. Methods: We performed a retrospective analysis using the National Inpatient Sample (2016–2022). Adult hospitalizations with ICD-10 diagnosis codes for pancreatic cancer and procedure codes for pancreatic resection were identified and stratified by the presence of CAD. The primary outcome was in-hospital mortality. Secondary outcomes included length of stay, hospitalization cost, and complications such as shock, respiratory failure, acute kidney injury, and transfusion. Results: A total of 49,395 hospitalizations were identified, including 6910 (14.0%) with CAD. Patients with CAD were older and had a greater comorbidity burden. In-hospital mortality was similar between groups (2.32% vs. 2.34%). Most complications were comparable, although shock was more frequent in CAD patients (6.66% vs. 5.44%). Length of stay was similar, while hospitalization costs were modestly higher in the CAD cohort. Conclusions: Pre-existing CAD was not associated with increased in-hospital mortality or longer hospitalization following pancreatic cancer surgery despite a greater comorbidity burden. Full article

Background: Endometrial cancer is the most common gynecologic malignancy in North America, with over 8000 new diagnoses in 2022 alone. Surgical management is the mainstay of treatment, with a shift towards the use of minimally invasive surgery, including laparoscopic and robotic techniques. Therefore, our study aims to compare the surgical and oncologic outcomes of hysterectomy approaches for patients with endometrial cancer. Methods: We have used a retrospective design to review all the endometrial cancer cases from Kingston Health Sciences Centre between January 2017 and November 2022. Variables were collected and categorized. Surgical outcomes were compared based on the route of surgery. Kaplan–Meier and Cox proportional hazard models were used to compare recurrence-free and overall survival. Results: A total of 341 cases were included in this review. One-hundred-fifty-two (44.6%) of these cases were minimally invasive surgeries (total laparoscopic, laparoscopic-assisted vaginal and robotic-assisted hysterectomies) and 189 (55.4%) were open hysterectomies. The early complication rates (p < 0.001) and length of stay (p < 0.001) were lower in the laparoscopic group. Despite the abdominal group including more advanced cases, there were no differences in recurrence-free and overall survival between the groups (p = 0.39; p = 0.85). Conclusions: Minimally invasive hysterectomy approaches result in improved surgical outcomes, while oncologic outcomes remain similar across techniques. Full article

Background/Objectives: textbook outcome (TO) is an established surgical quality measure, but failure is recognized only after postoperative events. We evaluated whether intraoperative stress burden (blood loss, fluid administration, and transfusion) is associated with adapted TO attainment and overall survival (OS) after curative-intent gastrectomy. Methods: in 2352 patients with gastric adenocarcinoma (2010–2020), an intraoperative stress burden score summed three binary components (blood loss > 200 mL, fluid > 68 mL/kg, and any transfusion) and was categorized as low, intermediate, or high. Adapted TO required R0 resection, ≥15 retrieved nodes, no Clavien–Dindo ≥ III complication, no unplanned reoperation, no 30-day mortality, and length of stay ≤ 12 days. Multivariable logistic and Cox models, overlap weighting, and sensitivity analyses were applied. Results: the median age was 60 years; 66.9% were male, 67.7% had pT3–4 and 42.0% pN2–3 disease, and 30.1% underwent minimally invasive surgery. TO attainment declined with increasing burden (78.0%, 70.5%, and 65.2%; p < 0.001). Intermediate and high burden were associated with TO failure (adjusted odds ratios 1.50 and 1.68), though the high-burden association was attenuated after adjusting for operative time. High burden was associated with worse OS (adjusted hazard ratio 1.36; 95% CI 1.15–1.62; 1.44 after overlap weighting). Risk was time-varying—strongest in the first postoperative year (HR 2.03), persisting at 12–60 months (HR 1.54), and absent beyond 60 months. Conclusions: higher intraoperative stress burden identified patients with lower adapted TO attainment and increased early mortality after gastrectomy. External validation is needed. Full article

Meeting the physiological and psychological needs of shelter cats through appropriate care is critical to reducing stress and disease risk, as well as enabling positive homing outcomes. Shelter organisations across the British Isles provide care for many cats; however, little is known about the types of housing and husbandry approaches applied. This study, therefore, aimed to quantify current approaches to cat housing, husbandry, and general care practices, in addition to providing information relevant to local site capacity, considering reported practices against sector minimum standards where applicable. Nine hundred and sixty-one shelter organisations and/or sites caring for cats were identified and invited to complete an online survey including predominantly multiple-choice questions. A total of 393 unique responses were collected from employees and volunteers, and quantitative data were summarised descriptively. In most cases, the results provided evidence of majority alignment with sector standards, although substantial variations in reported practices were also consistently captured. While most responses described approaches supportive of meeting cats’ basic physiological needs (e.g., access to veterinary care and basic resources), psychological needs were addressed less consistently (e.g., general housing and husbandry approaches), potentially leading to poor welfare outcomes. Identified opportunities to better meet cats’ needs include more cat-friendly, low-stress approaches to pen cleaning and cat handling; greater and more consistent provisioning of within-pen resources; and improved approaches to multi-cat housing and associated decision-making. Additional opportunities to enhance both cat and human wellbeing include more structured intake and assessment processes and capacity management to support optimal cat-to-staff ratios, staff working hours, cat lengths of stay and more consistent access to isolation and emergency intake facilities. Full article