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Healy GL, Stuart CM, Dyas AR, Bronsert MR, Meguid RA, Anioke T, Hider AM, Schulick RD, Henderson WG. Association between postoperative complications and hospital length of stay: a large-scale observational study of 4,495,582 patients in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) registry. Patient Saf Surg 2024; 18:29. [PMID: 39354640 PMCID: PMC11443812 DOI: 10.1186/s13037-024-00409-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2024] [Accepted: 08/19/2024] [Indexed: 10/03/2024] Open
Abstract
BACKGROUND Precise estimates of risk-adjusted increases in postoperative length of stay (LOS) associated with postoperative complications across a range of complications and operations are not available in the existing literature. METHODS Associations between preoperative characteristics, postoperative complications and postoperative LOS were tested using medians, interquartile ranges, and nonparametric rank sum tests in a retrospective cohort study using the 2005-2018 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) dataset. A negative binomial model was used with postoperative LOS as the dependent variable and preoperative characteristics and postoperative complications as independent variables. The model was applied to estimate each patient's postoperative LOS with and without each postoperative complication to measure the association between each complication and risk-adjusted change in postoperative LOS. RESULTS A total of 4,495,582 patients were included. After risk-adjustment, occurrence of each postoperative complication was associated with significantly increased postoperative LOS (between + 3.9 and + 20.1 days, p < 0.0001). The longest risk-adjusted postoperative LOS increases were associated with prolonged ventilator use (+ 20.1 days), wound disruption (+ 19.4 days), and acute renal failure (+ 17.1 days). CONCLUSION Occurrence of any postoperative complication was associated with increased risk-adjusted postoperative LOS. Degree of increase varied by complication. These data could be useful for patient counseling, allocation of resources, discharge planning, and quality improvement efforts.
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Affiliation(s)
- Garrett L Healy
- Surgical Outcomes and Applied Research Program, Department of Surgery, University of Colorado School of Medicine, 12631 E 17 Ave #6117, Aurora, CO, 80045, USA.
| | - Christina M Stuart
- Surgical Outcomes and Applied Research Program, Department of Surgery, University of Colorado School of Medicine, 12631 E 17 Ave #6117, Aurora, CO, 80045, USA
| | - Adam R Dyas
- Surgical Outcomes and Applied Research Program, Department of Surgery, University of Colorado School of Medicine, 12631 E 17 Ave #6117, Aurora, CO, 80045, USA
| | - Michael R Bronsert
- Surgical Outcomes and Applied Research Program, Department of Surgery, University of Colorado School of Medicine, 12631 E 17 Ave #6117, Aurora, CO, 80045, USA
- Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, 1890 N Revere Ct Third Floor, Mail StopF443 , Aurora, CO, 80045, USA
| | - Robert A Meguid
- Surgical Outcomes and Applied Research Program, Department of Surgery, University of Colorado School of Medicine, 12631 E 17 Ave #6117, Aurora, CO, 80045, USA
- Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, 1890 N Revere Ct Third Floor, Mail StopF443 , Aurora, CO, 80045, USA
| | - Tochi Anioke
- Surgical Outcomes and Applied Research Program, Department of Surgery, University of Colorado School of Medicine, 12631 E 17 Ave #6117, Aurora, CO, 80045, USA
| | - Ahmad M Hider
- Surgical Outcomes and Applied Research Program, Department of Surgery, University of Colorado School of Medicine, 12631 E 17 Ave #6117, Aurora, CO, 80045, USA
| | - Richard D Schulick
- Surgical Outcomes and Applied Research Program, Department of Surgery, University of Colorado School of Medicine, 12631 E 17 Ave #6117, Aurora, CO, 80045, USA
| | - William G Henderson
- Surgical Outcomes and Applied Research Program, Department of Surgery, University of Colorado School of Medicine, 12631 E 17 Ave #6117, Aurora, CO, 80045, USA
- Department of Biostatistics and Informatics, Colorado School of Public Health, 13001 E 17 Pl B119, Aurora, CO, 80045, USA
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Stuart CM, Bronsert MR, Dyas AR, Mott NM, Healy GL, Anioke T, Henderson WG, Randhawa SK, David EA, Mitchell JD, Meguid RA. Risk-adjusted discrete increases in length of stay by complication following anatomic lung resection: an analysis of 32 133 cases across the USA. Eur J Cardiothorac Surg 2024; 66:ezae293. [PMID: 39107905 DOI: 10.1093/ejcts/ezae293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 07/15/2024] [Accepted: 08/01/2024] [Indexed: 08/10/2024] Open
Abstract
OBJECTIVES Prior studies have associated morbidity following anatomic lung resection with prolonged postoperative length of stay; however, each complication's individual impact on length of stay as a continuous variable has not been studied. The purpose of this study was to determine the risk-adjusted increase in length of stay associated with each individual postoperative complications following anatomic lung resection. METHODS Patients who underwent anatomic lung resection cataloged in the prospectively collected American College of Surgeons National Surgical Quality Improvement Program participant use file, 2005-2018, were targeted. The association between preoperative characteristics, postoperative complications and length of stay in days was tested. A negative binomial model adjusting for the effect of preoperative characteristics and 18 concurrent postoperative complications was used to generate incidence rate ratios. This model was fit to generate risk-adjusted increases in length of stay by complication. RESULTS Of 32 133 patients, 5065 patients (15.8%) experienced at least one post-operative complication. The most frequent complications were pneumonia (n = 1829, 5.7%), the need for transfusion (n = 1794, 5.6%) and unplanned reintubation (n = 1064, 3.3%). The occurrence of each of the 18 individual complications was associated with significantly increased length of stay. This finding persisted after risk-adjustment, with the greatest risk-adjusted increases being associated with prolonged ventilation (+17.4 days), followed by septic shock (+17.2 days), acute renal failure (+16.5 days) and deep surgical site infection (+13.2 days). CONCLUSIONS All 18 postoperative complications studied following anatomic lung resection were associated with significant risk-adjusted increases in length of stay, ranging from an increase of 17.4 days with prolonged ventilation to 2.6 days following the need for transfusion.
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Affiliation(s)
- Christina M Stuart
- Division of Cardiothoracic Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Surgical Outcomes and Applied Research Program, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Michael R Bronsert
- Surgical Outcomes and Applied Research Program, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Adam R Dyas
- Division of Cardiothoracic Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Surgical Outcomes and Applied Research Program, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Nicole M Mott
- Division of Cardiothoracic Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Surgical Outcomes and Applied Research Program, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Garrett L Healy
- Surgical Outcomes and Applied Research Program, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Tochi Anioke
- Surgical Outcomes and Applied Research Program, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - William G Henderson
- Surgical Outcomes and Applied Research Program, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Simran K Randhawa
- Division of Cardiothoracic Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Elizabeth A David
- Division of Cardiothoracic Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - John D Mitchell
- Division of Cardiothoracic Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Robert A Meguid
- Division of Cardiothoracic Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Surgical Outcomes and Applied Research Program, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Rondelet B, Dehanne F, Van Den Bulcke J, Martins D, Belhaj A, Libert B, Leclercq P, Pirson M. Daly/Cost comparison in the management of peripheral arterial disease at 17 Belgian hospitals. BMC Health Serv Res 2024; 24:109. [PMID: 38243251 PMCID: PMC10797854 DOI: 10.1186/s12913-023-10535-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 12/28/2023] [Indexed: 01/21/2024] Open
Abstract
OBJECTIVE Peripheral arterial disease (PAD) is a manifestation of atherosclerosis that affects the lower extremities and afflicts more than 200 million people worldwide. Because of limited resources, the need to provide quality care associated with cost control is essential for health policies. Our study concerns an interhospital comparison among seventeen Belgian hospitals that integrates the weighting of quality indicators and the costs of care, from the hospital perspective, for a patient with this pathology in 2018. METHODS The disability-adjusted life years (DALYs) were calculated by adding the number of years of life lost due to premature death and the number of years of life lost due to disability for each in-hospital stay. The DALY impact was interpreted according to patient safety indicators. We compared the hospitals using the adjusted values of costs and DALYs for their case mix index, obtained by relating the observed value to the predicted value obtained by linear regression. RESULTS We studied 2,437 patients and recorded a total of 560.1 DALYs in hospitals. The in-hospital cost average [standard deviation (SD)] was €8,673 (€10,893). Our model identified the hospitals whose observed values were higher than predicted; six needed to reduce the costs and impacts of DALYs, six needed to improve one of the two factors, and four seemed to have good results. The average cost (SD) for the worst performing hospitals amounted to €27,803 (€28,358). CONCLUSIONS Studying the costs of treatment according to patient safety indicators permits us to evaluate the entire chain of care using a comparable unit of measurement.
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Affiliation(s)
- Benoît Rondelet
- Department of Cardio-Vascular, Thoracic Surgery and Lung Transplantation, CHU UCL Namur, UCLouvain, Avenue G. Therasse, 1, 5530, Yvoir, Belgium.
- Chief Medical Officer Department, CHU UCL Namur, UCLouvain, Yvoir, Belgium.
| | - Fabian Dehanne
- Chief Executive Officer Department, CHU UCL Namur, UCLouvain, Yvoir, Belgium
- Health and Society Research Institute (IRSS) - UCLouvain, Louvain-La-Neuve, Belgium
- Health Economics, Hospital Management and Nursing Research Department, School of Public Health, Université Libre de Bruxelles, Brussels, Belgium
| | - Julie Van Den Bulcke
- Health Economics, Hospital Management and Nursing Research Department, School of Public Health, Université Libre de Bruxelles, Brussels, Belgium
| | - Dimitri Martins
- Health Economics, Hospital Management and Nursing Research Department, School of Public Health, Université Libre de Bruxelles, Brussels, Belgium
| | - Asmae Belhaj
- Department of Cardio-Vascular, Thoracic Surgery and Lung Transplantation, CHU UCL Namur, UCLouvain, Avenue G. Therasse, 1, 5530, Yvoir, Belgium
| | - Benoît Libert
- Chief Executive Officer Department, CHU UCL Namur, UCLouvain, Yvoir, Belgium
| | - Pol Leclercq
- Health Economics, Hospital Management and Nursing Research Department, School of Public Health, Université Libre de Bruxelles, Brussels, Belgium
| | - Magali Pirson
- Health Economics, Hospital Management and Nursing Research Department, School of Public Health, Université Libre de Bruxelles, Brussels, Belgium
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Elahi F, Spuck N, Berger M, Kramer FJ, Heim N. Mathematical approach improves predictability of length of hospitalisation due to oral squamous cell carcinoma: a retrospective investigation of 153 patients. Br J Oral Maxillofac Surg 2023; 61:605-611. [PMID: 37852819 DOI: 10.1016/j.bjoms.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 07/06/2023] [Accepted: 09/18/2023] [Indexed: 10/20/2023]
Abstract
Oral squamous cell carcinoma (OSCC), a common cancer of the head and neck, is a major public health problem. The length of stay in hospital (LOS) of patients with OSCC, which can range from a few days to several months, has implications for the patient's recovery. The aim of the study was to identify and evaluate risk factors that have an impact on the prolongation of inpatient hospital stay. A four-year retrospective study reviewed hospital records of 153 inpatients with OSCC. A statistical model for discrete time-to-event data, with the LOS in hospital measured in days for which the event of interest was discharge from hospital, was applied. The model utilises a tree-building algorithm to identify relevant risk factors for a prolonged LOS. Age, type of flap, and occurrence of complications turned out to be relevant variables. Before, and on day 12, the LOS was mainly dependent on flap type and age, whereas after day 12 it was influenced by the presence of early complications. Predicting the likelihood of discharge can improve the management and resource utilisation of the healthcare system among inpatients.
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Affiliation(s)
- Franziska Elahi
- Department of Oral and Cranio-Maxillo and Facial Plastic Surgery, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany.
| | - Nikolai Spuck
- Institute of Medical Biometry, Informatics and Epidemiology, Medical Faculty, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany.
| | - Moritz Berger
- Institute of Medical Biometry, Informatics and Epidemiology, Medical Faculty, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany.
| | - Franz-Josef Kramer
- Department of Oral and Cranio-Maxillo and Facial Plastic Surgery, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany.
| | - Nils Heim
- Department of Oral and Cranio-Maxillo and Facial Plastic Surgery, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany.
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Horne-Thompson A, Khalil H, Harding K, Kane R, Taylor NF. The impact of outsourcing bed-based aged care services on quality of care: A multisite observational study. Int J Qual Health Care 2022; 34:6827223. [PMID: 36373866 PMCID: PMC9729762 DOI: 10.1093/intqhc/mzac092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 10/09/2022] [Accepted: 11/16/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Outsourcing health-care services has become popular globally, provided by both profit and non-for-profit organizations with varying degrees of quality. To date, few published studies have evaluated the quality of care in health services using outsourcing. OBJECTIVE The purpose of this study was to determine if there were differences in quality of care (effectiveness, safety and patient experience) for a Transition Care Program designed to improve older people's independence and confidence after a hospital stay, when provided within a public health network compared to being outsourced to private facilities. METHODS For clients discharged to a residential Transition Care Program operating across three sites from a large health service network (n = 1546), an audit of medical records was completed. Site 1 remained within the public health service (internally managed), whereas Sites 2 and 3 involved outsourcing to residential aged care facilities. The main outcome measures were discharge destination, length of stay and number of falls. Client demographics were analysed descriptively, and inferential statistics for continuous data and negative binomial regression for event data were used to examine differences between the sites. RESULTS There were differences in quality of care between the internally and outsourced managed sites. One outsourced site discharged a smaller proportion to rehabilitation (P = 0.003) compared to the other two sites. There were differences in length of stay between the three sites. The length of stay was a mean of 4.8 days less at Site 1 (internally managed) (95% Confidence Interval (CI) 0.5 to 9.1) than Site 2 and 4.6 days less (95% CI 1.2 to 8.1) than Site 3. For those discharged to permanent residential care, the length of stay was 9.4 days less at the internal site than Site 2 (95% CI 3.5 to 15.2) and 7.0 days less than Site 3 (95% CI 1.9 to 12). Additionally, a lower rate of falls was recorded at Site 1 (internally managed) compared to Site 2 (outsourced) (incidence rate ratio = 0.44 (95% CI 0.32 to 0.60), P < 0.001). CONCLUSION An internally managed Transition Care Program in a public health network was associated with better quality of care outcomes compared to outsourced services.
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Affiliation(s)
- Anne Horne-Thompson
- Eastern Health, Allied Health Clinical Research Office, 5 Arnold Street, Box Hill, VIC 3128, Australia
| | - Hanan Khalil
- Address reprint requests to: Hanan Khalil, Department of Public Health, School of Psychology and Public Health, La Trobe University, Kingsbury Dr, Bundoora, Melbourne, VIC 3085, Australia. Tel: +(03) 9479 8802; E-mail:
| | - Katherine Harding
- Eastern Health, Allied Health Clinical Research Office, 5 Arnold Street, Box Hill, VIC 3128, Australia,Human Services and Sport, School of Allied Health, La Trobe University, Kingsbury, Dr, Bundoora, VIC 3086, Australia
| | - Richard Kane
- Eastern Health, Allied Health Clinical Research Office, 5 Arnold Street, Box Hill, VIC 3128, Australia,Department of Medicine, Monash University, Wellington Rd, Clayton, VIC 3800, Australia,Geriatric Medicine, Home and Community Services, St Vincent’s Health Melbourne, 41 Victoria Pde, Fitzroy, VIC 3065, Australia
| | - Nicholas F Taylor
- Eastern Health, Allied Health Clinical Research Office, 5 Arnold Street, Box Hill, VIC 3128, Australia,Human Services and Sport, School of Allied Health, La Trobe University, Kingsbury, Dr, Bundoora, VIC 3086, Australia
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Predicting Length of Stay and Discharge Destination for Surgical Patients: A Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17249490. [PMID: 33352913 PMCID: PMC7766289 DOI: 10.3390/ijerph17249490] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 12/07/2020] [Accepted: 12/16/2020] [Indexed: 01/02/2023]
Abstract
Discharge planning is important to prevent surgical site infections, reduce costs, and improve the hospitalization experience. The identification of early variables that can predict a longer-than-expected length of stay or the need for a discharge with additional needs can improve this process. A cohort study was conducted in the largest hospital of Northern Italy, collecting discharge records from January 2017 to January 2020 and pre-admission visits in the last three months. Socio-demographic and clinical data were collected. Linear and logistic regression models were fitted. The main outcomes were the length of stay (LOS) and discharge destination. The main predictors of a longer LOS were the need for additional care at discharge (+10.76 days), hospitalization from the emergency department (ED) (+5.21 days), and age (+0.04 days per year), accounting for clinical variables (p < 0.001 for all variables). Each year of age and hospitalization from the ED were associated with a higher probability of needing additional care at discharge (OR 1.02 and 1.77, respectively, p < 0.001). No additional findings came from pre-admission forms. Discharge difficulties seem to be related mainly to age and hospitalization procedures: those factors are probably masking underlying social risk factors that do not show up in patients with planned admissions.
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Park EP, Le JM, Gigliotti J, Feinstein J, Ying YP, Morlandt AB. Does Supplemental Regional Anesthesia Decrease Length of Stay and Opioid Use for Patients Undergoing Head and Neck Microvascular Reconstruction? J Oral Maxillofac Surg 2020; 79:712-721. [PMID: 32976833 DOI: 10.1016/j.joms.2020.08.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 08/25/2020] [Accepted: 08/25/2020] [Indexed: 12/01/2022]
Abstract
PURPOSE The purpose of this study was to compare length of hospital stay and opioid usage among head and neck surgery (HNS) patients treated with and without regional anesthesia for microvascular free-flap donor sites. METHODS The authors performed a retrospective cohort study for HNS patients undergoing microvascular free-flap reconstruction. The control group received no regional anesthesia. The experimental group had a regional anesthesia nerve block performed immediately before surgery. The primary outcome variable was length of stay, and the secondary outcome variable was total morphine milliequivalents. The data were analyzed using Student t tests, analysis of variance, Mann-Whitney U test, Kruskal-Wallis test, χ2 test, and multiple linear regression. RESULTS The study sample was composed of 148 patients with a mean age of 58.1 years. The mean length of stay for the control group was 6.74 ± 1.57 days, compared with the experimental group at 5.84 ± 1.01 days (P < .0001). The mean morphine milliequivalent was 256.5 ± 164.6 mg for the control group and 208.9 ± 164.8 mg for the experimental group (P = .56). Importantly, the demographics, pathology spectrum, flap selection, duration of procedure, and complication rate were similar in both groups. CONCLUSIONS This study demonstrates that for HNS patients undergoing microvascular reconstruction, regional nerve block at the donor site is associated with significantly shorter hospital stays. Although there was a trend toward decreased opioid usage in the regional anesthesia group, these results did not reach statistical significance. Consideration should be given to incorporate regional anesthesia techniques into early recovery after surgery protocols for centers performing high-volume head and neck microvascular reconstruction.
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Affiliation(s)
- Earl Peter Park
- Assistant Professor, Department of Oral & Maxillofacial Surgery, Louisiana State University Health Science Center, New Orleans, LA.
| | - John Minh Le
- Surgical Resident, Department of Oral & Maxillofacial Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Jordan Gigliotti
- Assistant Professor, Department of Oral & Maxillofacial Surgery, McGill University, Montreal, Canada
| | - Joel Feinstein
- Associate Professor and Director of Regional Anesthesia for University Hospitals, Department of Anesthesia and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Yedeh P Ying
- Assistant Professor, Department of Oral & Maxillofacial Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Anthony B Morlandt
- Associate Professor and Section Chief of Oral Oncology and Microvascular Surgery, Department of Oral & Maxillofacial Surgery, University of Alabama at Birmingham, Birmingham, AL
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Lindeborg MM, Sethi RKV, Puram SV, Parikh A, Yarlagadda B, Varvares M, Emerick K, Lin D, Durand ML, Deschler DG. Predicting length of stay in head and neck patients who undergo free flap reconstruction. Laryngoscope Investig Otolaryngol 2020; 5:461-467. [PMID: 32596488 PMCID: PMC7314462 DOI: 10.1002/lio2.410] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/09/2020] [Accepted: 05/15/2020] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Understanding factors that affect postoperative length of stay (LOS) may improve patient recovery, hasten postoperative discharge, and minimize institutional costs. This study sought to (a) describe LOS among head and neck patients undergoing free flap reconstruction and (b) identify factors that predict increased LOS. METHODS A retrospective cohort was performed of 282 head and neck patients with free flap reconstruction for oncologic resection between 2011 and 2013 at a tertiary academic medical center. Patient demographics, tumor characteristics, and surgical and infectious complications were characterized. Multivariable regression identified predictors of increased LOS. RESULTS A total of 282 patients were included. Mean age was 64.7 years (SD = 12.2) and 40% were female. Most tumors were located in the oral cavity (53.9% of patients), and most patients underwent radial forearm free flap (RFFF) reconstruction (RFFF-73.8%, anterolateral thigh flap-11.3%, and fibula free flap-14.9%). Intraoperative complications were rare. The most common postoperative complications included nonwound infection (pneumonia [PNA] or urinary tract infection [UTI]) (15.6%) and wound breakdown/fistula (15.2%). Mean and median LOS were 13 days (SD = 7.7) and 10 days (interquartile range = 7), respectively. Statistically significant predictors of increased LOS included flap take back (Beta coefficient [C] = +4.26, P < .0001), in-hospital PNA or UTI (C = +2.52, P = .037), wound breakdown or fistula (C = +5.0, P < .0001), surgical site infection (C = +3.54, P = .017), and prior radiation therapy (C = +2.59, P = .004). CONCLUSION Several perioperative factors are associated with increased LOS. These findings may help with perioperative planning, including the need for vigilant wound care, optimization of antibiotics prophylaxis, and institution-level protocols for postoperative care and disposition of free flap patients. LEVEL OF EVIDENCE 2b; retrospective cohort.
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Affiliation(s)
- Michael M. Lindeborg
- Department of OtolaryngologyMassachusetts Eye and Ear InfirmaryBostonMassachusettsUSA
- Department of OtolaryngologyHarvard Medical SchoolBostonMassachusettsUSA
| | - Rosh K. V. Sethi
- Department of OtolaryngologyUniversity of MichiganAnn ArborMichiganUSA
| | - Sidharth V. Puram
- Department of OtolaryngologyWashington University School of Medicine in Saint LouisSaint LouisMissouriUSA
| | - Anuraag Parikh
- Department of OtolaryngologyMassachusetts Eye and Ear InfirmaryBostonMassachusettsUSA
- Department of OtolaryngologyHarvard Medical SchoolBostonMassachusettsUSA
| | - Bharat Yarlagadda
- Department of OtolaryngologyMassachusetts Eye and Ear InfirmaryBostonMassachusettsUSA
- Department of OtolaryngologyHarvard Medical SchoolBostonMassachusettsUSA
| | - Mark Varvares
- Department of OtolaryngologyMassachusetts Eye and Ear InfirmaryBostonMassachusettsUSA
- Department of OtolaryngologyHarvard Medical SchoolBostonMassachusettsUSA
| | - Kevin Emerick
- Department of OtolaryngologyMassachusetts Eye and Ear InfirmaryBostonMassachusettsUSA
- Department of OtolaryngologyHarvard Medical SchoolBostonMassachusettsUSA
| | - Derrick Lin
- Department of OtolaryngologyMassachusetts Eye and Ear InfirmaryBostonMassachusettsUSA
- Department of OtolaryngologyHarvard Medical SchoolBostonMassachusettsUSA
| | - Marlene L. Durand
- Department of OtolaryngologyMassachusetts Eye and Ear InfirmaryBostonMassachusettsUSA
- Department of OtolaryngologyHarvard Medical SchoolBostonMassachusettsUSA
- Department of MedicineMassachusetts General HospitalBostonMassachusettsUSA
| | - Daniel G. Deschler
- Department of OtolaryngologyMassachusetts Eye and Ear InfirmaryBostonMassachusettsUSA
- Department of OtolaryngologyHarvard Medical SchoolBostonMassachusettsUSA
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Disparity in access to bariatric surgery among African-American men. Surg Endosc 2019; 34:2630-2637. [DOI: 10.1007/s00464-019-07034-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 07/20/2019] [Indexed: 01/25/2023]
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Sánchez López JD, Cambil Martín J, Villegas Calvo M, Toledo Páez MA, Cariati P, Moreno Martín ML. [Management of adverse events in an Oral and Maxillofacial Surgery Unit]. J Healthc Qual Res 2018; 33:256-263. [PMID: 30361103 DOI: 10.1016/j.jhqr.2018.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 07/17/2018] [Accepted: 07/23/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Patient safety in oral and maxillofacial surgery is oriented towards providing patient care by means of adequate risk management that minimises adverse events and fosters a culture of safe clinical practices as the fundamental basis of quality health care. To implement preventive actions are implemented in order to improve patient safety and to reduce the incidence of adverse events, as well as to improve the quality of care. The aim of this report is to implement preventive measures in order to improve the health care of the patient in an Oral and Maxillofacial Surgery Unit by reducing the Adverse Events and proving good quality healthcare. MATERIALS AND METHODS A longitudinal, prospective, single centre study was conducted using a methodology of analysis of modes of failure and effects of the management of potentially serious adverse events in the Oral and Maxillofacial surgical unit of the University Hospital of Granada (June-November 2017), as well as the preparation and implementation of a series of corrective measures. RESULTS A total of 33 adverse events were recorded, with 10 of them considered as critical, distributed in different areas of care, and referred from Primary Health Care and from other hospitals. Seven preventive actions were implemented: information to the patient, training actions, improvements in the protocols and procedures, in the care process and clinical practice, as well as the need to set up an adequate checklist, and other miscellaneous. DISCUSSION The implementation of preventive measures represent a notable advance in the prevention of harm to the patient and the organisation, involving healthcare staff in a safety culture oriented towards quality care.
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Affiliation(s)
- J D Sánchez López
- Facultativo especialista de Área de Cirugía Oral y Maxilofacial, Hospital Universitario Virgen de las Nieves, Granada, España.
| | - J Cambil Martín
- Enfermero, profesor del Departamento de Enfermería, Facultad de Ciencias de la Salud, Universidad de Granada, Granada, España
| | - M Villegas Calvo
- Enfermera, supervisora de Enfermería, Hospital Universitario Virgen de las Nieves, Granada, España
| | - M A Toledo Páez
- Enfermera, jefa de Bloque de Área Quirúrgica, Hospital Universitario Virgen de las Nieves, Granada, España
| | - P Cariati
- Médico residente de Cirugía Oral y Maxilofacial, Hospital Universitario Virgen de las Nieves, Granada, España
| | - M L Moreno Martín
- Enfermera, Práctica Asistencial en el área de Reanimación. Parque Tecnológico de la Salud, Granada, España
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Vora D, Kinnard M, Falk D, Hoy M, Gupta S, Piper C, Yu W, Siddiqui F, O'Brien J. A comparison of narcotic usage and length of post-operative hospital stay in open versus minimally invasive lumbar interbody fusion with percutaneous pedicle screws. JOURNAL OF SPINE SURGERY 2018; 4:516-521. [PMID: 30547113 DOI: 10.21037/jss.2018.08.04] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Instrumented lumbar fusion can be accomplished through open or minimally invasive techniques. The focus of this study was to compare perioperative narcotic usage and length of hospital stay between patients undergoing open versus minimally invasive spinal surgery (MISS). Methods A retrospective chart review was performed on 110 patients who underwent instrumented lumbar fusion over 2 years at our institution. These patients were divided into two groups: those that received open transforaminal interbody fusion (n=69), and those whose surgeries were performed minimally invasively with lateral lumbar transpsoas interbody fusion (LLIF) and percutaneous pedicle screws (n=41). Narcotic usage was recorded for both groups intra-operatively and post-operatively throughout their hospital stay. These values were standardized using an equianalgesia chart. Results Average narcotic usage post-operatively was significantly lower for the LLIF group relative to those who underwent open lumbar fusion (278.48 vs. 442.06 mg, P=0.03). The average length of post-operative hospital stay was significantly shorter for patients who underwent LLIF compared to those who had an open procedure (4.10 vs. 6.19 days, P=0.02). Conclusions Patients who underwent minimally invasive surgery (MIS) LLIF had decreased overall use of opioids in the perioperative period and shorter hospital stays when compared to patients who underwent the open transforaminal interbody fusion approach. These findings support pre-existing literature in favor of LLIF MISS with regards to the above stated outcome measures. The long-term benefits of MISS with regards to narcotic usage in spine patients are not yet known.
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Affiliation(s)
- Darshan Vora
- School of Medicine & Health Sciences, The George Washington University, Washington, DC, USA
| | - Matthew Kinnard
- School of Medicine & Health Sciences, The George Washington University, Washington, DC, USA
| | - David Falk
- School of Medicine & Health Sciences, The George Washington University, Washington, DC, USA
| | - Michael Hoy
- School of Medicine & Health Sciences, The George Washington University, Washington, DC, USA
| | - Sachin Gupta
- School of Medicine & Health Sciences, The George Washington University, Washington, DC, USA
| | - Christine Piper
- School of Medicine & Health Sciences, The George Washington University, Washington, DC, USA
| | - Warren Yu
- School of Medicine & Health Sciences, The George Washington University, Washington, DC, USA
| | | | - Joseph O'Brien
- Washington Spine & Scoliosis Institute, Bethesda, MD, USA
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