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Study Management Group, Varghese C, McGuinness M, Wells CI, Elliott BM, Gunawardene A, Edwards M, Expert Advisory Group, Vohra R, Griffiths EA, Connor S, Poole GH, Windsor JA, Wright D, Harmston C, Collaborating Authors, Wang JHS, Windsor J, Chen E, Ghate K, Lal S, Lekamalage B, Ratnayake M, Bansal A, Windsor J, von Keisenberg S, Hemachandran A, Singhal M, Joseph N, Bhat S, Rossaak J, Carson D, Dubey N, Pan M, Ferguson L, Watt I, Choi J, Mclauchlan J, Connor S, Nicholas E, Al-Busaidi I, Wood D, Haran C, Lin A, Fagan P, Bathgate A, Patel S, Mak J, Espiner E, Poole G, Hassan S, Javed Z, Randall M, Clough S, Cook W, Clark S, Finlayson C, Poole G, Bahl P, Singh S, Lin C, Wang C, Kittaka R, Morreau M, Ing A, Logan S, Guest S, Sutherland K, Lewis A, Roberts J, Watson B, Tietjens J, Teague R, Su'a B, Modi A, Modi V, Williams Y, Morreau J, Khoo C, Desmond B, Young M, Christmas R, Holm T, Harmston C, Long K, Garton B, Niki kau, Barber L, Amer M, Haddow J, Amer M, Fearnley-Fitzgerald C, Suresh K, Zeng E, Young-Gough A, Skeet J, El-Haddawi F, Alvarez M, Nguyen S, King J, Crichton J, Welsh F, Edwards M, Tan J, Luo J, Banker K, Field X, Allan P, Rennie S, Ratnayake CB, Srinivasa S, Gloria Kim JH, Bradley S, Singh N, Kang G, Xu W, Srinivasa S, Cook H, Mistry V, Dabla K, de Oca AM, Yoganandarajah V, Lill M, Lu J, Bonnet LA, Uiyapat T. Variation in the practice of cholecystectomy for benign biliary disease in Aotearoa New Zealand: a population-based cohort study. HPB (Oxford) 2023:S1365-182X(23)00128-4. [PMID: 37198069 DOI: 10.1016/j.hpb.2023.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 03/26/2023] [Accepted: 04/18/2023] [Indexed: 05/19/2023]
Abstract
INTRODUCTION Cholecystectomy for benign biliary disease is common and its delivery should be standardised. However, the current practice of cholecystectomy in Aotearoa New Zealand is unknown. METHODS A prospective, national cohort study of consecutive patients having cholecystectomy for benign biliary disease was performed between August and October 2021 with 30-day follow-up, through STRATA, a student- and trainee-led collaborative. RESULTS Data were collected for 1171 patients from 16 centres. 651 (55.6%) had an acute operation at index admission, 304 (26.0%) had delayed cholecystectomy following a previous admission, and 216 (18.4%) had an elective operation with no preceding acute admissions. The median adjusted rate of index cholecystectomy (as a proportion of index and delayed cholecystectomy) was 71.9% (range 27.2%-87.3%). The median adjusted rate of elective cholecystectomy (as proportion of all cholecystectomies) was 20.8% (range 6.7%-35.4%). Variations across centres were significant (p < 0.001) and inadequately explained by patient, operative, or hospital-factors (index cholecystectomy model R2 = 25.8, elective cholecystectomy model R2 = 50.6). CONCLUSIONS Notable variation in the rates of index and elective cholecystectomy exists in Aotearoa New Zealand not attributable to patient, operative or hospital factors alone. National quality improvement efforts to standardise availability of cholecystectomy are needed.
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Predictive Factors for a Long Postoperative Stay after Emergency Laparoscopic Cholecystectomy Using the 2013 Tokyo Guidelines: A Retrospective Study. Minim Invasive Surg 2019; 2019:3942584. [PMID: 31139468 PMCID: PMC6500663 DOI: 10.1155/2019/3942584] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 04/10/2019] [Indexed: 12/27/2022] Open
Abstract
Laparoscopic cholecystectomy (LC) is widely used for treating early acute cholecystitis (AC) and substantially reduces hospital costs. This study aimed to identify and evaluate risk factors associated with long postoperative hospital stays (PHSs) in patients undergoing emergency LC for AC according to the 2013 Tokyo Guidelines (TG13). Clinical data of patients who underwent emergency LC for AC between 2011 and 2017 were retrospectively collected. Patients were divided into early discharge (ED, discharge in three days or less postoperatively) and late discharge (LD, discharge in more than three days postoperatively) groups based on clinical progression and PHS after LC. Preoperative characteristics and perioperative outcomes were analysed as potential risk factors for LD. Among 149 patients, 104 (69.8%) were discharged within 3 days postoperatively, whereas 45 (30.2%) had long PHSs. Main causes of LD were fever and inflammation. Univariate analysis of preoperative risk factors revealed significant differences in age, white blood cell count, C-reactive protein, total bilirubin (T-bil), and alkaline phosphatase (ALP) levels; anticoagulation therapy; and TG13 severity grade. Multivariate analysis revealed that TG13 severity grade II, age >65 years, and elevated T-bil and ALP levels are independent factors for long PHS. Older age, worse biliary function, and increased TG13 severity grade might predict prolonged PHSs in AC patients undergoing emergency LC.
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Lee SY, Lee SH, Tan JHH, Foo HSL, Phan PH, Kow AWC, Lwin S, Seah PMY, Mordiffi SZ. Factors associated with prolonged length of stay for elective hepatobiliary and neurosurgery patients: a retrospective medical record review. BMC Health Serv Res 2018; 18:5. [PMID: 29304787 PMCID: PMC5755148 DOI: 10.1186/s12913-017-2817-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 12/20/2017] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Patients with prolonged length of hospital stay (LOS) not only increase their risks of nosocomial infections but also deny other patients access to inpatient care. Hepatobiliary (HPB) malignancies have some of highest incidences in East and Southeast Asia and the management of patients undergoing HPB surgeries have yet to be standardized. With improved neurosurgery techniques for intracranial aneurysms and tumors, neurosurgeries (NS) can be expected to increase. Elective surgeries account for far more operations than emergencies surgeries. Thus, with potentially increased numbers of elective HPB and NS, this study seeks to explore perioperative factors associated with prolonged LOS for these patients to improve safety and quality of practice. METHODS A retrospective cross-sectional medical record review study from January 2014 to January 2015 was conducted at a 1250-bed tertiary academic hospital in Singapore. All elective HPB and NS patients over 18 years old were included in the study except day and emergency surgeries, resulting in 150 and 166 patients respectively. Prolonged LOS was defined as above median LOS based on the complexity of the surgical procedure. The predictor variables were preoperative, intraoperative, and postoperative factors. Student's t-test and stepwise logistic regression analyses were conducted to determine which factors were associated with prolonged LOS. RESULTS Factors associated with prolonged LOS for the HPB sample were age and admission after 5 pm but for the NS sample, they were functional status, referral to occupational therapy, and the number of hospital-acquired infections. CONCLUSION Our findings indicate that preoperative factors had the greatest association with prolonged LOS for HPB and NS elective surgeries even after adjusting for surgical complexity, suggesting that patient safety and quality of care may be improved with better pre-surgery patient preparation and admission practices.
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Affiliation(s)
- Siu Yin Lee
- National University Hospital, 5 Lower Kent Ridge Road, Singapore, 119074 Singapore
| | - Soo-Hoon Lee
- Old Dominion University, 1 Old Dominion University, Norfolk, VA 23529 USA
| | - Jenny H. H. Tan
- Ngee Ann Polytechnic, 535 Clementi Road, Singapore, 599489 Singapore
| | | | - Phillip H. Phan
- Johns Hopkins University, 100 International Drive, Baltimore, MD 21202 USA
| | - Alfred W. C. Kow
- National University Hospital, 5 Lower Kent Ridge Road, Singapore, 119074 Singapore
| | - Sein Lwin
- National University Hospital, 5 Lower Kent Ridge Road, Singapore, 119074 Singapore
| | - Penelope M. Y. Seah
- National University Hospital, 5 Lower Kent Ridge Road, Singapore, 119074 Singapore
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Zhu M, Zhou C, Huang B, Ruan L, Liang R. Granisetron plus dexamethasone for prevention of postoperative nausea and vomiting in patients undergoing laparoscopic surgery: A meta-analysis. J Int Med Res 2017; 45:904-911. [PMID: 28436248 PMCID: PMC5536409 DOI: 10.1177/0300060517703276] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective This study was designed to compare the effectiveness of granisetron plus dexamethasone for preventing postoperative nausea and vomiting (PONV) in patients undergoing laparoscopic surgery. Methods We searched the literature in the Cochrane Library, PubMed, EMBASE, and CNKI. Results In total, 11 randomized controlled trials were enrolled in this analysis. The meta-analysis showed that granisetron in combination with dexamethasone was significantly more effective than granisetron alone in preventing PONV in patients undergoing laparoscopy surgery. No significant differences in adverse reactions (dizziness and headache) were found in association with dexamethasone. Conclusion Granisetron in combination with dexamethasone was significantly more effective than granisetron alone in preventing PONV in patients undergoing laparoscopic surgery, with no difference in adverse reactions between the two groups. Granisetron alone or granisetron plus dexamethasone can be used to prevent PONV in patients undergoing laparoscopic surgery.
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Affiliation(s)
- Min Zhu
- 1 Department of Anesthesiology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, China
| | - Chengmao Zhou
- 2 Department of Surgery, Zhaoqing Medical College, Zhaoqing, Guangdong, China
| | - Bing Huang
- 1 Department of Anesthesiology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, China
| | - Lin Ruan
- 1 Department of Anesthesiology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, China
| | - Rui Liang
- 1 Department of Anesthesiology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, China
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Ko-iam W, Sandhu T, Paiboonworachat S, Pongchairerks P, Chotirosniramit A, Chotirosniramit N, Chandacham K, Jirapongcharoenlap T, Junrungsee S. Predictive Factors for a Long Hospital Stay in Patients Undergoing Laparoscopic Cholecystectomy. Int J Hepatol 2017; 2017:5497936. [PMID: 28239497 PMCID: PMC5292377 DOI: 10.1155/2017/5497936] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 12/28/2016] [Indexed: 12/19/2022] Open
Abstract
Background. Although the advantages of laparoscopic cholecystectomy (LC) over open cholecystectomy are immediately obvious and appreciated, several patients need a postoperative hospital stay of more than 24 hours. Thus, the predictive factors for this longer stay need to be investigated. The aim of this study was to identify the causes of a long hospital stay after LC. Methods. This is a retrospective cohort study with 500 successful elective LC patients being included in the analysis. Short hospital stay was defined as being discharged within 24 hours after the operation, whereas long hospital stay was defined as the need for a stay of more than 24 hours after the operation. Results. Using multivariable analysis, ten independent predictive factors were identified for a long hospital stay. These included patients with cirrhosis, patients with a history of previous acute cholecystitis, cholangitis, or pancreatitis, patients on anticoagulation with warfarin, patients with standard-pressure pneumoperitoneum, patients who had been given metoclopramide as an intraoperative antiemetic drug, patients who had been using abdominal drain, patients who had numeric rating scale for pain > 3, patients with an oral analgesia requirement > 2 doses, complications, and private ward admission. Conclusions. LC difficulties were important predictive factors for a long hospital stay, as well as medication and operative factors.
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Affiliation(s)
- Wasana Ko-iam
- Clinical Epidemiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Trichak Sandhu
- Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | | | | | - Anon Chotirosniramit
- Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | | | - Kamtone Chandacham
- Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | | | - Sunhawit Junrungsee
- Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Chong JU, Lee JH, Yoon YC, Kwon KH, Cho JY, Kim SJ, Kim JK, Kim SH, Choi SB, Kim KS. Influencing factors on postoperative hospital stay after laparoscopic cholecystectomy. KOREAN JOURNAL OF HEPATO-BILIARY-PANCREATIC SURGERY 2016; 20:12-6. [PMID: 26925145 PMCID: PMC4767266 DOI: 10.14701/kjhbps.2016.20.1.12] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 11/09/2015] [Accepted: 11/20/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUNDS/AIMS Laparoscopic cholecystectomy can reduce postoperative pain and recovery time. However, some patients experience prolonged postoperative hospital stay. We aimed to identify factors influencing the postoperative hospital stay after laparoscopic cholecystectomy. METHODS Patients (n=336) undergoing laparoscopic cholecystectomy for gallbladder pathology at 8 hospitals were enrolled and divided into 2 groups: 2 or less and more than 2 days postoperative stay. Perioperative factors and patient factors were retrospectively analyzed. RESULTS The patient population median age was 52 years, and consisted of 32 emergency and 304 elective operations. A univariate analysis of perioperative factors revealed significant differences in operation time (p<0.001), perioperative transfusion (p=0.006), emergency operation (p<0.001), acute inflammation (p<0.001), and surgical site infection (p=0.041). A univariate analysis of patient factors revealed significant differences in age (p<0.001), gender (p=0.036), diabetes mellitus (p=0.011), preoperative albumin level (p=0.024), smoking (p=0.010), and American Society of Anesthesiologists score (p=0.003). In a multivariate analysis, operation time (p<0.001), emergency operation (p<0.001), age (p=0.014), and smoking (p=0.022) were identified as independent factors influencing length of postoperative hospital stay. CONCLUSIONS Operation time, emergency operation, patient age, and smoking influenced the postoperative hospital stay and should be the focus of efforts to reduce hospital stay after laparoscopic cholecystectomy.
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Affiliation(s)
- Jae Uk Chong
- Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Ho Lee
- Department of Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Young Chul Yoon
- Department of Surgery, Incheon St. Mary Hospital, Catholic University College of Medicine, Incheon, Korea
| | - Kuk Hwan Kwon
- Department of Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Jai Young Cho
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Say-Jun Kim
- Department of Surgery, Daejeon St. Mary Hospital, Catholic University College of Medicine, Daejeon, Korea
| | - Jae Keun Kim
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Hoon Kim
- Department of Surgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Sae Byeol Choi
- Department of Surgery, Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Kyung Sik Kim
- Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Morimoto Y, Mizuno H, Akamaru Y, Yasumasa K, Noro H, Kono E, Yamasaki Y. Predicting prolonged hospital stay after laparoscopic cholecystectomy. Asian J Endosc Surg 2015; 8:289-95. [PMID: 25786914 DOI: 10.1111/ases.12183] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Revised: 12/26/2014] [Accepted: 02/07/2015] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Widespread application of laparoscopic cholecystectomy (LC) has resulted in a high complication rate and leads to prolonged hospital stays. This study aimed to investigate the preoperative and intraoperative clinical factors that relate to prolongation of hospital stay. METHODS We studied 370 patients who underwent LC for gallbladder disease between 2008 and 2012. Clinical risk factors were retrospectively collected. The clinical pathway for LC was indicated for all patients, and they were divided into two groups according to postoperative length of stay (LOS): the normal duration group (LOS ≤5 days) and the long duration (LD) group (LOS ≥6 days). Multiple regression analysis was used to predict risk factors that identified hospital prolongation to create a LOS prediction score. RESULTS The normal duration group was 236 patients and the LD group was 134. Seventeen patients (4.6%) required conversion from laparoscopic to open surgery. LOS was 4.82 days in the normal duration group and 12.08 days in the LD group. In the LD group, 18.7% of the patients stayed more than 14 days, but no patients were readmitted. Thirteen clinical factors were statistically different between the two groups. ASA score and LC difficulty were the most predictive risk factors for LOS prolongation. LOS prediction score consisted of eight variables selected from 13 factors; it helped determine the likelihood of whether a patients' hospital stay was prolonged (sensitivity, 82.1%; specificity, 75.0%). CONCLUSION Thirteen factors closely related to hospital stay duration and LOS prediction score could predict the prolongation of a patient's hospital stay.
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Affiliation(s)
- Yoshikazu Morimoto
- Department of Surgery, Japan Community Healthcare Organization (JCHO), Osaka Hospital, Osaka, Japan
| | - Hitoshi Mizuno
- Department of Surgery, Japan Community Healthcare Organization (JCHO), Osaka Hospital, Osaka, Japan
| | - Yusuke Akamaru
- Department of Surgery, Japan Community Healthcare Organization (JCHO), Osaka Hospital, Osaka, Japan
| | - Keigo Yasumasa
- Department of Surgery, Japan Community Healthcare Organization (JCHO), Osaka Hospital, Osaka, Japan
| | - Hiroshi Noro
- Department of Surgery, Japan Community Healthcare Organization (JCHO), Osaka Hospital, Osaka, Japan
| | - Emiko Kono
- Department of Surgery, Japan Community Healthcare Organization (JCHO), Osaka Hospital, Osaka, Japan
| | - Yoshio Yamasaki
- Department of Surgery, Japan Community Healthcare Organization (JCHO), Osaka Hospital, Osaka, Japan
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Minig L, Velazco A, Lamm M, Velez JI, Venturini NC, Testa R. Evaluation of laparoscopic management of gynecologic emergencies by residents. Int J Gynaecol Obstet 2010; 111:62-7. [PMID: 20579997 DOI: 10.1016/j.ijgo.2010.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2010] [Revised: 05/05/2010] [Accepted: 05/26/2010] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To evaluate the feasibility of laparoscopic management of women with gynecologic emergencies by the residents and the chief resident in an organized resident training program. METHODS A retrospective study of patients with gynecologic emergencies who underwent laparoscopic surgery between January 1, 1999, and May 31, 2006 was done. RESULTS For the 369 patients included, the mean operative time of 74±31.35 minutes was significantly increased by advanced patient age (P<0.001), pelvic inflammatory disease with or without tubo-ovarian abscess (PID±TOA) (P<0.050), the first semester of chief residency (P<0.050), and conversion to laparotomy (P<0.001). Mean length of hospital stay was 40±24 hours. Factors such as advanced patient age (P<0.001), prolonged length of surgery (P<0.001), PID±TOA (P<0.001), first semester of chief residency (P<0.050), conversion to laparotomy (P<0.001), and blood transfusion (P<0.050) significantly increased the length of hospital stay. The conversion rate to laparotomy was 4.6% (n=17), and it was significantly associated with advanced women age (OR 1.11; 95% CI, 1.05-1.17, P<0.001) and PID±TOA (OR 6.04; 95%CI, 2.17-16.62, P<0.001). Postoperative complications were recorded in 3 (0.81%) patients. CONCLUSION Laparoscopic management of gynecologic emergencies by senior residents and a chief resident within an organized resident training program is feasible. These results reinforce the relevance of a well-structured residency endoscopic training program.
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Affiliation(s)
- Lucas Minig
- Gynecologic Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
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