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Levy M, Connors C, Ravivarapu KT, Chin CP, Tomer N, Larenas F, Stock J, Palese M. Evaluating the safety of same-day discharge following pediatric pyeloplasty and ureteral reimplantation; A NSQIP analysis 2012-2020. J Pediatr Urol 2023:S1477-5131(23)00141-9. [PMID: 37147143 DOI: 10.1016/j.jpurol.2023.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 04/04/2023] [Accepted: 04/11/2023] [Indexed: 05/07/2023]
Abstract
INTRODUCTION Same-day discharge (SDD) is a safe option for several adult urologic surgeries, benefiting patients and hospitals. By decreasing length of stay while maintaining patient safety, SDD is in-line with recent goals to provide high value care while minimizing costs. Literature on SDD in the pediatric population, however, is scarce, and no study has identified the efficacy of SDD for pediatric pyeloplasty (PP) and ureteral reimplantation (UR). OBJECTIVE The aim of this study was to identify trends in the usage of SDD as well as its efficacy and safety based on surgical outcomes for pediatric PP and UR. STUDY DESIGN The 2012-2020 files of the American College of Surgeon's National Surgical Quality Improvement Project pediatric database were queried for PP and UR. Patients were stratified as SDD or standard-length discharge (SLD). Trends in SDD usage, differences in baseline characteristics, surgical approach, and surgical outcomes including 30-day readmission, complication, and reoperation rates were analyzed between SDD and SLD groups. RESULTS 8213 PP (SDD: 202 [2.46%]) and 10,866 UR (469 [4.32%]) were included in analysis. There were no significant changes in SDD rates between 2012 and 2020, averaging 2.39% (PP), and 4.39% (UR). For both procedures, SDD was associated with higher rates of open versus minimally invasive (MIS) surgical approach and with shorter operative and anesthesia durations. For PP, there were no differences in readmission, complication, or reoperation rates in the SDD group. For UR, there was a 1.69% increase in CD I/II complications in those receiving SDD, correlating to 1.96-fold higher odds of CD I/II in all SDD patients compared to SLD patients. DISCUSSION These results suggest that while the rate of SDD has not increased in recent years, the current screening methods for SDD have been generally effective in maintaining the safety of SDD for pediatric procedures. Though SDD for UR did show a very small increase in minor complications, this may be due to less strict screening protocols, and may be alleviated via MIS surgical approach. While this is the first paper to investigate SDD for pediatric urology procedures, these results are similar to those found for adult procedures. This study is limited by the lack of clinical data reported in the database. CONCLUSION SDD is a generally safe option for pediatric PP and UR, and further research should identify proper screening protocols to continue to allow for safe SDD.
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Affiliation(s)
- Micah Levy
- Department of Urology, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY, 10029, USA.
| | - Christopher Connors
- Department of Urology, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY, 10029, USA.
| | - Krishna T Ravivarapu
- Department of Urology, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY, 10029, USA.
| | - Chih Peng Chin
- Department of Urology, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY, 10029, USA.
| | - Nir Tomer
- Department of Urology, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY, 10029, USA.
| | - Francisca Larenas
- Department of Urology, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY, 10029, USA.
| | - Jeffrey Stock
- Department of Urology, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY, 10029, USA.
| | - Michael Palese
- Department of Urology, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY, 10029, USA.
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MingJun H, Yan D, JiPing L, HongSheng M. Thirty-Day Unplanned Readmission After Ambulatory Laparoscopic Cholecystectomy in Western China: A Retrospective Study. Cureus 2021; 13:e13932. [PMID: 33868863 PMCID: PMC8049883 DOI: 10.7759/cureus.13932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2021] [Indexed: 02/05/2023] Open
Abstract
Background Day surgery has been gradually accepted by health professions globally, which can shorten the hospital stay and reduce medical costs. The ambulatory laparoscopic cholecystectomy (LC) has been performed in China since over 10 years. However, few studies focus on its 30-day unplanned readmission rate of ambulatory LC and no standard of unplanned readmission rate for that now. Purpose This study aimed to evaluate the unplanned readmission rate and the reasons readmission after ambulatory LC in a tertiary hospital, which is the earliest ambulatory surgery implementation place in western China. Methods A retrospective analysis was conducted. The patients who underwent ambulatory LC from September 2015 to September 2019 in West China Hospital were screened. The 30-day unplanned readmission rate was calculated as the first outcome. The reasons for unplanned readmission were analyzed and classified as the second outcome. Results The study included 3,014 patients, and the unplanned readmission rate was 1.53%. The rate of patients diagnosed with cholecystolithiasis with cholecystitis was significantly higher in the unplanned readmission group (73.9% vs. 48.9%, p=0.003), and medical cost of unplanned readmission patients was significantly more than that of non-readmission patients (8,102.4±1,375.7 Yuan vs. 7,574.61±10,14.0 Yuan; p=0.008). It was observed that 71.7% readmission happened in the first seven days. Wound problems (60.9%) and abdominal pain (26.1%) went the two main reasons for unplanned readmission. Conclusions The analysis revealed that the unplanned readmission rate of 1.53% was low for ambulatory LC. Some causes of unplanned readmission, such as abdominal pain and wound site pain, wound exudate could be reduced by some simple interventions of the clinical professions.
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Affiliation(s)
- Huang MingJun
- Day Surgery Center, West China Hospital, Sichuan University, Chengdu, CHN
- West China School of Nursing, West China Hospital, Sichuan University, Chengdu, CHN
| | - Dai Yan
- Day Surgery Center, West China Hospital, Sichuan University, Chengdu, CHN
| | - Li JiPing
- Nursing Department, West China Hospital, Sichuan University, Chengdu, CHN
| | - Ma HongSheng
- Day Surgery Center, West China Hospital, Sichuan University, Chengdu, CHN
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Pham H, Chiong C, Sinclair JL, Pang TCY, Yuen L, Lam VWT, Pleass HC, Johnston E, Richardson AJ, Hollands MJ. Day-only elective cholecystectomy: early experience and barriers to implementation in Australia. ANZ J Surg 2020; 91:590-596. [PMID: 33369857 DOI: 10.1111/ans.16526] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 11/26/2020] [Accepted: 11/26/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Day-only laparoscopic cholecystectomy (DOLC) has been shown to be safe and feasible yet has not been widely implemented in Australia. This study explores the introduction of routine DOLC to Westmead Hospital, and highlights the barriers to its implementation. METHODS Routine day-only cholecystectomy protocol was introduced at Westmead Hospital in 2014. A retrospective review of patients who underwent elective laparoscopic cholecystectomy during a 12-month period in 2014 was compared to a 12-month period in 2018, to examine the changes in practice after implementation of a unit protocol. Data were collected on patient demographics, admission category, outcomes and re-presentations. RESULTS A total of 282 patients were included in the study, of these 169 were booked as day procedures, with 124 (73%) successfully discharged on the same day. There was a significant increase in the proportion of patients booked as day-only from 2014 to 2018 (48% versus 73%, P < 0.001). Day-only failure rates (unplanned overnight admissions), readmissions and complication rates were comparable between the two periods. The most common reason for unplanned overnight admissions were due to intraoperative findings (n = 28/45). CONCLUSION Routine DOLC can be adopted in Australian hospitals without compromise to patient safety. Unplanned overnight admission is predominantly due to unexpected surgical pathology and can be reduced by protocols for the use of drains and planned outpatient endoscopic retrograde cholangiopancreatography. Unplanned outpatient review can be minimized by optimizing both intra- and post-operative pain management. Individual surgeon and anaesthetist preferences remain an obstacle to a standardized protocol in the Australian setting.
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Affiliation(s)
- Helen Pham
- Department of Upper Gastrointestinal Tract Surgery, Westmead Hospital, Sydney, New South Wales, Australia.,Western Clinical School, The University of Sydney Faculty of Medical and Health Sciences, Sydney, New South Wales, Australia.,Surgical Innovations Unit, Westmead Hospital, Sydney, New South Wales, Australia
| | - Corinna Chiong
- Department of Upper Gastrointestinal Tract Surgery, Westmead Hospital, Sydney, New South Wales, Australia
| | - Jane-Louise Sinclair
- Department of Upper Gastrointestinal Tract Surgery, Westmead Hospital, Sydney, New South Wales, Australia
| | - Tony C Y Pang
- Department of Upper Gastrointestinal Tract Surgery, Westmead Hospital, Sydney, New South Wales, Australia.,Western Clinical School, The University of Sydney Faculty of Medical and Health Sciences, Sydney, New South Wales, Australia.,Surgical Innovations Unit, Westmead Hospital, Sydney, New South Wales, Australia
| | - Lawrence Yuen
- Department of Upper Gastrointestinal Tract Surgery, Westmead Hospital, Sydney, New South Wales, Australia.,Western Clinical School, The University of Sydney Faculty of Medical and Health Sciences, Sydney, New South Wales, Australia
| | - Vincent W T Lam
- Department of Upper Gastrointestinal Tract Surgery, Westmead Hospital, Sydney, New South Wales, Australia.,Western Clinical School, The University of Sydney Faculty of Medical and Health Sciences, Sydney, New South Wales, Australia
| | - Henry C Pleass
- Department of Upper Gastrointestinal Tract Surgery, Westmead Hospital, Sydney, New South Wales, Australia.,Western Clinical School, The University of Sydney Faculty of Medical and Health Sciences, Sydney, New South Wales, Australia
| | - Emma Johnston
- Department of Upper Gastrointestinal Tract Surgery, Westmead Hospital, Sydney, New South Wales, Australia.,Western Clinical School, The University of Sydney Faculty of Medical and Health Sciences, Sydney, New South Wales, Australia
| | - Arthur J Richardson
- Department of Upper Gastrointestinal Tract Surgery, Westmead Hospital, Sydney, New South Wales, Australia.,Sydney Adventist Hospital Clinical School, The University of Sydney Faculty of Medical and Health Sciences, Sydney, New South Wales, Australia
| | - Michael J Hollands
- Department of Upper Gastrointestinal Tract Surgery, Westmead Hospital, Sydney, New South Wales, Australia.,Western Clinical School, The University of Sydney Faculty of Medical and Health Sciences, Sydney, New South Wales, Australia
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Coelho JCU, Dalledone GO, Martins Filho EL, Ramos EJB, Roeder da Costa MA, de Loyola E Silva OOHM. Feasibility of Routine Ambulatory Laparoscopic Cholecystectomy in Brazil. JSLS 2019; 23:JSLS.2019.00016. [PMID: 31097907 PMCID: PMC6502133 DOI: 10.4293/jsls.2019.00016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background and Objectives In several developed countries, most laparoscopic cholecystectomies (LCs) are performed as an ambulatory operation (ALC) with a high rate of success. In Latin America, the experience with this procedure is still limited. Our objective is to evaluate the feasibility to implement ALC in a Brazilian teaching hospital. Methods Data obtained from electronic medical records and study protocols of all patients who underwent an LC between January 2011 and March 2018 were evaluated. All patients with chronic or acute cholecystitis were initially considered for an ALC. Results Of a total of 1645 patients who underwent LC, 1577 (95.9%) were discharged on the same day of the operation. The main reasons for hospital admission after ALC were patient refusal to be discharged (n = 23; 1.4%), nausea and vomiting (n = 15; 0.9%), and complicated acute cholecystitis. No patient was excluded from consideration for ALC based only on age, history of previous upper abdominal operation, and presence of comorbidity. Patient age ranged from 12 to 100 years, with a mean of 50.23 ± 15.35 years. Intraoperative and postoperative complication rates were 0.4% and 5.5%, respectively. Most perioperative complications were because of technical surgical difficulties and complications common to most abdominal operations (surgical site, pulmonary, urinary, and venous complications). Thirteen (0.8%) patients were readmitted to the hospital because of abdominal pain and fever (n = 4), pneumonia (n = 3), deep venous thrombosis (n = 3), or urinary retention (n = 3). Conclusions ALC may be performed in Brazil with low rates of morbidity, mortality, and hospital readmission. Its implementation should be stimulated in Latin America.
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Affiliation(s)
- Júlio Cezar Uili Coelho
- Department of Surgery. Hospital Nossa Senhora das Graças and Hospital de Clinicas. Federal University of Parana, Curitiba, Brazil
| | - Giuliano Ohde Dalledone
- Department of Surgery. Hospital Nossa Senhora das Graças and Hospital de Clinicas. Federal University of Parana, Curitiba, Brazil
| | - Eduardo Lopes Martins Filho
- Department of Surgery. Hospital Nossa Senhora das Graças and Hospital de Clinicas. Federal University of Parana, Curitiba, Brazil
| | - Eduardo José Brommelstroet Ramos
- Department of Surgery. Hospital Nossa Senhora das Graças and Hospital de Clinicas. Federal University of Parana, Curitiba, Brazil
| | - Marco Aurélio Roeder da Costa
- Department of Surgery. Hospital Nossa Senhora das Graças and Hospital de Clinicas. Federal University of Parana, Curitiba, Brazil
| | - Omar O H M de Loyola E Silva
- Department of Surgery. Hospital Nossa Senhora das Graças and Hospital de Clinicas. Federal University of Parana, Curitiba, Brazil
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