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Yoshida T, Goto A, Shinoda S, Kotani Y, Mihara T. The epidemiology of postoperative dobutamine and phosphodiesterase inhibitors after adult elective cardiac surgery and its impact on the length of hospital stay: a post hoc analysis from the multicenter retrospective observational study. Heart Vessels 2024; 39:438-445. [PMID: 38197915 DOI: 10.1007/s00380-023-02349-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 12/07/2023] [Indexed: 01/11/2024]
Abstract
The optimal administration of inotrope after cardiac surgery is unknown. This study aimed to investigate the impact of postoperative inotrope on clinical outcomes in adult elective cardiac surgery patients. Data from the Blood Pressure and Relative Optimal Target after Heart Surgery in Epidemiologic Registry study were analyzed, employing propensity score considering the hospital of admission. The primary outcome was the length of hospital stay evaluated using quantile regression. Secondary outcomes were kidney injury progression, renal replacement therapy, atrial fibrillation, mortality, mechanical ventilation duration, and length of intensive care unit (ICU) stay. Among 870 patients from 14 ICUs in Japan, 535 received inotropes within 24 h of ICU admission, with usage rates ranging from 40 to 100% among facilities. After propensity score matching, 218 patients were included in each group. The inotrope group had a significantly longer hospital stay compared to the control group (16 days vs. 14 days; median difference 1.78 [95% confidence interval [CI] 0.31-3.24]; p = 0.018). However, no significant differences were observed in the secondary outcomes, except for mechanical ventilation duration. The results of the sensitivity analysis using a mixed-effects quantile regression analysis considering the hospital of admission for length of hospital stay in the original cohort were consistent with the results of the propensity analyses (median difference in days, 2.35 [95% CI, 0.35-4.36]; p = 0.022). The use of inotropes within 24 h of ICU admission in adult elective cardiac surgery patients was associated with an extended hospitalization period of approximately 2 days, without offering any prognostic benefit. Clinical trial registration: UMIN-CTR, https://www.umin.ac.jp/ctr/index-j.htm , UMIN000037074.
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Affiliation(s)
- Takuo Yoshida
- Department of Health Data Science, Graduate School of Data Science, Yokohama City University, 22-2 Seto, Kanazawa, Yokohama, 236-0027, Japan.
- Intensive Care Unit, Department of Emergency Medicine, The Jikei University School of Medicine, 3-19-18, Nishi-Shinbashi Minato-ku, Tokyo, 105-8471, Japan.
| | - Atsushi Goto
- Department of Health Data Science, Graduate School of Data Science, Yokohama City University, 22-2 Seto, Kanazawa, Yokohama, 236-0027, Japan
| | - Satoru Shinoda
- Department of Biostatistics, School of Medicine, Yokohama City University, Yokohama City, Kanagawa, 236-0004, Japan
| | - Yuki Kotani
- Department of Intensive Care Medicine, Kameda Medical Center, Kamogawa, Japan
- Department of Anesthesia and Intensive Care, Vita-Salute San Raffaele University, Milan, Italy
| | - Takahiro Mihara
- Department of Health Data Science, Graduate School of Data Science, Yokohama City University, 22-2 Seto, Kanazawa, Yokohama, 236-0027, Japan
- Department of Anesthesiology, Yokohama City University School of Medicine, Yokohama, Japan
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2
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Idigo AJ, Wells JM, Brown ML, Wiener HW, Griffin RL, Cutter G, Shrestha S, Lee RA. Socio-demographic and comorbid risk factors for poor prognosis in patients hospitalized with community-acquired bacterial pneumonia in southeastern US. Heart Lung 2024; 65:31-39. [PMID: 38382142 DOI: 10.1016/j.hrtlng.2024.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 01/24/2024] [Accepted: 01/28/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND How socio-demographic characteristics and comorbidities affect bacterial community-acquired pneumonia (CAP) prognosis during/after hospitalization is important in disease management. OBJECTIVES To identify predictors of medical intensive care unit (MICU) admission, length of hospital stay (LOS), in-hospital mortality, and bacterial CAP readmission in patients hospitalized with bacterial CAP. METHODS ICD-9/10 codes were used to query electronic medical records to identify a cohort of patients hospitalized for bacterial CAP at a tertiary hospital in Southeastern US between 01/01/2013-12/31/2019. Adjusted accelerated failure time and modified Poisson regression models were used to examine predictors of MICU admission, LOS, in-hospital mortality, and 1-year readmission. RESULTS There were 1956 adults hospitalized with bacterial CAP. Median (interquartile range) LOS was 11 days (6-23), and there were 26 % (513) MICU admission, 14 % (266) in-hospital mortality, and 6 % (117) 1-year readmission with recurrent CAP. MICU admission was associated with heart failure (RR 1.38; 95 % CI 1.17-1.62) and obesity (RR 1.26; 95 % CI 1.04-1.52). Longer LOS was associated with heart failure (adjusted time ratio[TR] 1.27;95 %CI 1.12-1.43), stroke (TR 1.90;95 %CI 1.54,2.35), type 2 diabetes (TR 1.20;95 %CI 1.07-1.36), obesity (TR 1.50;95 %CI 1.31-1.72), Black race (TR 1.17;95 %CI 1.04-1.31), and males (TR 1.24;95 %CI 1.10-1.39). In-hospital mortality was associated with stroke (RR 1.45;95 %CI 1.03-2.04) and age ≥65 years (RR 1.34;95 %CI 1.06-1.68). 1-year readmission was associated with COPD (RR 1.55;95 %CI 1.05-2.27) and underweight BMI (RR 1.74;95 %CI 1.04-2.90). CONCLUSIONS Comorbidities and socio-demographic characteristics have varying impacts on bacterial CAP in-hospital prognosis and readmission. More studies are warranted to confirm these findings to develop comprehensive care plans and inform public health interventions.
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Affiliation(s)
- Adeniyi J Idigo
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham (UAB), Alabama, United States.
| | - J Michael Wells
- Division of Pulmonary, Allergy, and Critical Care Medicine, UAB, United States; UAB Lung Health Center, United States; Birmingham VA Medical Center, United States
| | | | - Howard W Wiener
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham (UAB), Alabama, United States
| | - Russell L Griffin
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham (UAB), Alabama, United States
| | - Gary Cutter
- Department of Biostatistics, School of Public Health, UAB, United States
| | - Sadeep Shrestha
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham (UAB), Alabama, United States
| | - Rachael A Lee
- Birmingham VA Medical Center, United States; Department of Medicine, Division of Infectious Diseases, UAB School of Medicine, Alabama, United States
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Chau EYW, Bakar AA, Zamhot AB, Zaini IZ, Binti Adanan SN, Sabardin DMB. An observational study on the impact of overcrowding towards door-to-antibiotic time among sepsis patients presented to emergency department of a tertiary academic hospital. BMC Emerg Med 2024; 24:58. [PMID: 38609924 PMCID: PMC11015690 DOI: 10.1186/s12873-024-00973-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 03/22/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND The latest Surviving Sepsis Campaign 2021 recommends early antibiotics administration. However, Emergency Department (ED) overcrowding can delay sepsis management. This study aimed to determine the effect of ED overcrowding towards the management and outcome of sepsis patients presented to ED. METHODS This was an observational study conducted among sepsis patients presented to ED of a tertiary university hospital from 18th January 2021 until 28th February 2021. ED overcrowding status was determined using the National Emergency Department Overcrowding Score (NEDOCS) scoring system. Sepsis patients were identified using Sequential Organ Failure Assessment (SOFA) scores and their door-to-antibiotic time (DTA) were recorded. Patient outcomes were hospital length of stay (LOS) and in-hospital mortality. Statistical analysis was done using Statistical Package for Social Sciences (SPSS) version 26. P-value of less than 0.05 for a two-sided test was considered statistically significant. RESULTS Total of 170 patients were recruited. Among them, 33 patients presented with septic shock and only 15% (n = 5) received antibiotics within one hour. Of 137 sepsis patients without shock, 58.4% (n = 80) received antibiotics within three hours. We found no significant association between ED overcrowding with DTA time (p = 0.989) and LOS (p = 0.403). However, in-hospital mortality increased two times during overcrowded ED (95% CI 1-4; p = 0.041). CONCLUSION ED overcrowding has no significant impact on DTA and LOS which are crucial indicators of sepsis care quality but it increases overall mortality outcome. Further research is needed to explore other factors such as lack of resources, delay in initiating fluid resuscitation or vasopressor so as to improve sepsis patient care during ED overcrowding.
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Affiliation(s)
- Evelyn Yi Wen Chau
- Department of Emergency Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.
| | - Afliza Abu Bakar
- Department of Emergency Medicine, Hospital Canselor Tuanku Muhriz UKM, Kuala Lumpur, Malaysia
| | - Aireen Binti Zamhot
- Department of Emergency Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Ida Zarina Zaini
- Department of Emergency Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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Manupeeraphant P, Wanichagool D, Songlin T, Thanathanee P, Chalermsuksant N, Techathuvanan K, Sethasine S. Intravenous metoclopramide for increasing endoscopic mucosal visualization in patients with acute upper gastrointestinal bleeding: a multicenter, randomized, double-blind, controlled trial. Sci Rep 2024; 14:7598. [PMID: 38556533 PMCID: PMC10982284 DOI: 10.1038/s41598-024-57913-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 03/22/2024] [Indexed: 04/02/2024] Open
Abstract
Acute upper gastrointestinal hemorrhage (UGIH) is the most common emergency condition that requires rapid endoscopic treatment. This study aimed to evaluate the effects of pre-endoscopic intravenous metoclopramide on endoscopic mucosal visualization (EMV) in patients with acute UGIH. This was a multicenter, randomized, double-blind controlled trial of participants diagnosed with acute UGIH. All participants underwent esophagogastroduodenoscopy within 24 h. Participants were assigned to either the metoclopramide or placebo group. Modified Avgerinos scores were evaluated during endoscopy. In total, 284 out of 300 patients completed the per-protocol procedure. The mean age was 62.8 ± 14.3 years, and 67.6% were men. Metoclopramide group achieved a higher total EMV and gastric body EMV score than the other group (7.34 ± 1.1 vs 6.94 ± 1.6; P = 0.017 and 1.80 ± 0.4 vs 1.64 ± 0.6; P = 0.006, respectively). Success in identifying lesions was not different between the groups (96.5% in metoclopramide and 93.6% in placebo group; P = 0.26). In the metoclopramide group, those with active variceal bleeding compared with the control group demonstrated substantial improvements in gastric EMV (1.83 ± 0.4 vs 1.28 ± 0.8, P = 0.004), antral EMV (1.96 ± 0.2 vs 1.56 ± 0.6, P = 0.003), and total EMV score (7.48 ± 1.1 vs 6.2 ± 2.3, P = 0.02). Pre-endoscopic intravenous metoclopramide improved the quality of EMV in variceal etiologies of UGIH, which was especially prominent in those who had signs of active bleeding based on nasogastric tube assessment.Trial Registration: Trial was registered in Clinical Trials: TCTR 20210708004 (08/07/2021).
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Affiliation(s)
- Paveeyada Manupeeraphant
- Division of Gastroenterology and Hepatology, Department of Medicine, Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, 681 Samsen Road, Dusit District, Bangkok, 10300, Thailand
| | - Dhanusorn Wanichagool
- Division of Gastroenterology, Phra Nakhon Si Ayutthaya Hospital, Ayutthaya, Thailand
| | - Thaphat Songlin
- Division of Gastroenterology, Panyananthaphikkhu Chonprathan Medical Center, Nonthaburi, Thailand
| | - Piyarat Thanathanee
- Division of Gastroenterology, Banphaeo General Hospital, Samut Sakhon, Thailand
| | - Nalerdon Chalermsuksant
- Division of Gastroenterology and Hepatology, Department of Medicine, Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, 681 Samsen Road, Dusit District, Bangkok, 10300, Thailand
| | - Karjpong Techathuvanan
- Division of Gastroenterology and Hepatology, Department of Medicine, Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, 681 Samsen Road, Dusit District, Bangkok, 10300, Thailand
| | - Supatsri Sethasine
- Division of Gastroenterology and Hepatology, Department of Medicine, Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, 681 Samsen Road, Dusit District, Bangkok, 10300, Thailand.
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Holierook M, Henstra MJ, Dolman DJ, Chekanova EV, Veenis L, Beijk MAM, de Winter RJ, Baan J, Vis MM, Lemkes JS, Snaterse M, Henriques JPS, Delewi R. Higher Edmonton Frail Scale prior to transcatheter Aortic Valve Implantation is related to longer hospital stay and mortality. Int J Cardiol 2024; 399:131637. [PMID: 38065322 DOI: 10.1016/j.ijcard.2023.131637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 11/30/2023] [Accepted: 12/03/2023] [Indexed: 12/31/2023]
Abstract
BACKGROUND International guidelines for the management of valvular heart disease recommend frailty assessment prior to Transcatheter Aortic Valve Implantation (TAVI), however there is no consensus how to assess frailty. We investigated whether frailty status assessed with the Edmonton Frail Scale (EFS, range 0-17 points) relates to length of stay (LOS), short- and long-term mortality and adverse outcomes after TAVI. METHODS In this study we included 357 patients between April 2016 till December 2018. EFS was assessed at baseline. Patients were classified into low (0-3), intermediate (4-7) or high frailty status (8-17). LOS was defined as the number of days between admission and discharge. Mortality data were obtained up to four years after TAVI. Adverse events were defined by Valve Academic Research Consortium (VARC)-2 criteria and collected <30 days after TAVI. RESULTS Patients with higher frailty status had longer median LOS (days (IQR): low 5 (3), intermediate 6 (4) and high 7 (5), p < 0.001) and higher mortality: low vs intermediate vs high at 30 days 0.5%, 2.2%, 7.0% (p = 0.050), 1 year 3.7%, 10.0%, 15.2% (p = 0.052), 2 years 9.2%, 17.8%, 31.7% (p = 0.003), 3 years 17.2%, 24.0, 47.0% (p = 0.001) and 4 years 19.6%, 30.8%, 55.6% (p < 0.001). Frail patients received more often a pacemaker (2.6%, 6.6%, 13.5%, p = 0.048). CONCLUSION In clinical practice, the EFS is a useful tool to screen for frailty in TAVI patients. This tool may possibly be expanded to determine benefit versus harm-risk in these patients and whether specific pre-procedurally interventions are needed in order to reduce mortality.
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Affiliation(s)
- Marja Holierook
- Amsterdam UMC location University of Amsterdam, Cardiology, Meibergdreef 9, Amsterdam, the Netherlands.
| | - Marieke J Henstra
- Amsterdam UMC location University of Amsterdam, Internal Medicine Geriatrics, Meibergdreef 9, Amsterdam, the Netherlands
| | - Doortje J Dolman
- Amsterdam UMC location University of Amsterdam, Cardiology, Meibergdreef 9, Amsterdam, the Netherlands
| | - Elena V Chekanova
- Amsterdam UMC location University of Amsterdam, Cardiology, Meibergdreef 9, Amsterdam, the Netherlands
| | - Linda Veenis
- Amsterdam UMC location University of Amsterdam, Cardiology, Meibergdreef 9, Amsterdam, the Netherlands
| | - Marcel A M Beijk
- Amsterdam UMC location University of Amsterdam, Cardiology, Meibergdreef 9, Amsterdam, the Netherlands
| | - Robbert J de Winter
- Amsterdam UMC location University of Amsterdam, Cardiology, Meibergdreef 9, Amsterdam, the Netherlands
| | - Jan Baan
- Amsterdam UMC location University of Amsterdam, Cardiology, Meibergdreef 9, Amsterdam, the Netherlands
| | - Marije M Vis
- Amsterdam UMC location University of Amsterdam, Cardiology, Meibergdreef 9, Amsterdam, the Netherlands
| | - Jorrit S Lemkes
- Amsterdam UMC location University of Amsterdam, Cardiology, Meibergdreef 9, Amsterdam, the Netherlands
| | - Marjolein Snaterse
- Amsterdam UMC location University of Amsterdam, Cardiology, Meibergdreef 9, Amsterdam, the Netherlands
| | - José P S Henriques
- Amsterdam UMC location University of Amsterdam, Cardiology, Meibergdreef 9, Amsterdam, the Netherlands
| | - Ronak Delewi
- Amsterdam UMC location University of Amsterdam, Cardiology, Meibergdreef 9, Amsterdam, the Netherlands
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Hara K, Kanda M, Kobayashi Y, Miyamoto T, Inoue T. Factors affecting the length of hospital stay for total knee arthroplasty in Japan: a retrospective study using the diagnosis procedure combination database. Eur J Med Res 2024; 29:122. [PMID: 38355542 PMCID: PMC10865593 DOI: 10.1186/s40001-024-01714-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 02/05/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND We aimed to evaluate the length of hospital stay following total knee arthroplasty to determine the impact of relevant factors using data from the Diagnosis Procedure Combination database. METHODS This was a retrospective observational study. The study cohort included 5,831 patients who had osteoarthritis of the knee and had undergone total knee replacement between February 2018 and October 2022 at 38 hospitals. RESULTS Multivariate analysis showed that the factors influencing the length of stay included: age (p < 0.001), height (p < 0.001), weight (p = 0.049), body mass index (p = 0.008), Barthel index (p < 0.001), method of anesthesia (p < 0.001), bone transplant (p = 0.010), timing of postoperative rehabilitation (p < 0.001), atrial fibrillation (p < 0.001), chronic pain (p < 0.001), and number of institutionally treated cases (p < 0.001) (r = 0.451, p < 0.001). CONCLUSIONS Shorter or longer hospital stays were found to be associated with the patients' background characteristics and facility-specific factors; these can lead to more accurate estimates of the length of hospital stay and appropriate allocation of resources.
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Affiliation(s)
- Kentaro Hara
- Department of Operation Center, National Hospital Organization Nagasaki Medical Center, Nagasaki, 856-8562, Japan
- Department of Nursing, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, 852-8523, Japan
| | - Masato Kanda
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, 260-8677, Japan
- Department of Healthcare Management Research Center, Chiba University Hospital, 1-8-1 Inohana, Chuo-Ku, Chiba, Chiba, 260-8677, Japan
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, 260-8677, Japan
| | - Takashi Miyamoto
- Department of Orthopedic Surgery, National Hospital Organization Nagasaki Medical Center, Nagasaki, 856-8562, Japan
| | - Takahiro Inoue
- Department of Healthcare Management Research Center, Chiba University Hospital, 1-8-1 Inohana, Chuo-Ku, Chiba, Chiba, 260-8677, Japan.
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Elrod J, Adathal A, Mohr C, Neuhaus K, Schiestl C, Böttcher-Haberzeth S. As time goes by - Overlooking 40 years of inpatient burn treatment at a national pediatric burn center in Switzerland. Burns 2024; 50:236-243. [PMID: 37690964 DOI: 10.1016/j.burns.2023.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 08/12/2023] [Accepted: 08/18/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND Despite extensive prevention programs, burns remain a frequent cause of injury in Switzerland with a known age peak in children. Pediatric burns may cause substantial morbidity, a psyochological burden and therapy related high economic costs. To improve preventive measures, precise knowledge of etiology and treatment of pediatric burns in Switzerland as well as their temporal evolution is indispensable. METHODS The present retrospective analysis included pediatric burn patients admitted for acute treatment to the Pediatric Burn Center of the University Children`s Hospital Zurich over the last four decades. Sociodemographic, injury related, and treatment related data were extracted from medical records. Linear regression analysis was applied to determine temporal changes during the past four decades and chi-square and t-tests were applied wherever applicable. RESULTS A total of 3425 acute burn patients were included in the study between 1977 and 2020, corresponding to a mean of 89 patients/year. Mean age was 3.60 ± 4.12 years, three quarters of all patients were preschool children (0-5 years) and mean total body surface area (TBSA) burned was 8.01% ± 9.57%, however only around one fifth had severe burns (>10% TBSA). Scald burns (65.31%) and flame burns (32.99%) were most commonly seen. Linear regression analysis showed the total number of thermal injuries treated at our center to have increased significantly as of 2004 (p < 0.001). Separate analysis showed the same for small and medium (<10% TBSA) burns (p < 0.001), whereas the number of severe burns did not increase significantly. Length of stay (LOS) was highly associated with %TBSA burned. The percentage of female patients amongst all patients increased over time (p = 0.012). LOS per TBSA burned decreased significantly (p < 0.001). CONCLUSION The present data show pediatric burns to remain a major health burden in Switzerland, especially small and medium burns in preschool children. Prevention programs should focus on this age population as well as on scald and flame burns as most common etiologies. The observed decrease in length of stay suggests a major improvement in overall quality of care in pediatric burns and supports centralization of care.
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Affiliation(s)
- Julia Elrod
- Pediatric Burn Center, Children's Skin Center, Department of Surgery, University Children's Hospital Zurich; University of Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland; Department of Pediatric Surgery, University Medical Center Mannheim, Heidelberg University, Heidelberg, Germany
| | - Ashal Adathal
- Pediatric Burn Center, Children's Skin Center, Department of Surgery, University Children's Hospital Zurich; University of Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland
| | - Christoph Mohr
- Pediatric Burn Center, Children's Skin Center, Department of Surgery, University Children's Hospital Zurich; University of Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland; Department of Pediatric Surgery, University Medical Center Mannheim, Heidelberg University, Heidelberg, Germany
| | - Kathrin Neuhaus
- Pediatric Burn Center, Children's Skin Center, Department of Surgery, University Children's Hospital Zurich; University of Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland; Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland; University of Zurich, Zurich, Switzerland
| | - Clemens Schiestl
- Pediatric Burn Center, Children's Skin Center, Department of Surgery, University Children's Hospital Zurich; University of Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland; Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland; University of Zurich, Zurich, Switzerland
| | - Sophie Böttcher-Haberzeth
- Pediatric Burn Center, Children's Skin Center, Department of Surgery, University Children's Hospital Zurich; University of Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland; Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland; University of Zurich, Zurich, Switzerland.
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Panth S, Wilson E, Chen B, Clement ND. Accelerated Care of Patients with Hip Fractures is Associated with Lower Risk of Delirium and Infection, and a Shorter Length of Hospital Stay: Systematic Review and Meta-analysis of Level One Evidence. Indian J Orthop 2024; 58:1-10. [PMID: 38161403 PMCID: PMC10754779 DOI: 10.1007/s43465-023-01026-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 10/12/2023] [Indexed: 01/03/2024]
Abstract
Objectives The aim of this systematic review was to assess the impact of time to surgery on patient mortality, peri-operative complication rates and length of stay following a hip fracture using level one data. Data Sources Multiple databases (PubMed, Embase, Medline (Ovid), and Cochrane Library) were searched using terms for "hip fracture" and the intervention "early surgery". Results were filtered to only included randomised controlled trials in the English language published from the year 2000. Study Selection All results were imported into Covidence and screened by two separate reviewers with conflicts resolved by a third reviewer. Studies were included if they reported data on the relationship between time to theatre and at least one of the outcome measures (mortality, peri-operative complications, and length of stay in hospital). Three papers were finalised to include in this review. Data Extraction Once selected, each paper had a bias assessment completed by two separate reviewers using the Cochrane RoB2 tool. Any conflicts were resolved by a third reviewer. Data Synthesis Data from each paper were inputted into RevMan5 for analysis. Approximated sample mean and standard deviation were collected from each paper and included for analysis. RevMan5 was then used to generate forest plots and report data on relative risk and mean difference. Conclusions This review has shown that accelerated care of patients with hip fractures was associated with lower risks of delirium and infection, and a shorter length of hospital stay. However, the effect of time to surgery on patient mortality is not clear, as the standard care group had a lower mortality than expected for the population at risk and had surgery on average within 24-h of presentation.
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Affiliation(s)
- S. Panth
- University of Edinburgh Medical School, 47 Little France Cres, Little France, Edinburgh, EH16 4TJ UK
| | - E. Wilson
- University of Edinburgh Medical School, 47 Little France Cres, Little France, Edinburgh, EH16 4TJ UK
| | - B. Chen
- Department of Orthopaedics, Second Affiliated Hospital of Soochow University, Suzhou, China
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Little France, Edinburgh, UK
| | - N. D. Clement
- University of Edinburgh Medical School, 47 Little France Cres, Little France, Edinburgh, EH16 4TJ UK
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Little France, Edinburgh, UK
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Xu SM, Lu K, Yang XF, Ye YW, Xu MZ, Shi Q, Gong YQ, Li C. Association between perioperative blood transfusion and length of hospital stay in patients with osteoporotic fractures. BMC Musculoskelet Disord 2023; 24:982. [PMID: 38114943 PMCID: PMC10729380 DOI: 10.1186/s12891-023-07101-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 12/07/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Few studies have examined the relationship between perioperative blood transfusion (PBT) and length of hospital stay (LOS) in patients with osteoporotic fractures. This research aims to study the association between PBT and LOS. METHODS This is a retrospective cross-sectional study from the Affiliated Kunshan Hospital of Jiangsu University, Suzhou, China, involving 2357 osteoporotic fractures (OPF) patients who received surgical treatment during hospitalization from January 2017 and March 2022. Multiple linear regression was used to analyze the relationship between PBT and LOS. In the analysis, PBT volume was the dependent variable, whereas LOS was the independent variable. Simultaneously, age, gender, body mass index, hemoglobin, primary diagnosis, American Society of Anesthesiologists, creatinine (Cr), anesthesia, surgical method, and Charlson comorbidity index were included as covariates. The generalized additive model was then used to study nonlinear associations. Two piecewise linear regression exemplary evaluated the inception results for smoothing the curve. RESULTS Our results proved that PBT was positively correlated with LOS in the fully adjusted model (β, 0.21; 95% CI, 0.04 to 0.37; P < 0.0001). Furthermore, a "U-shape" nonlinear relationship existed between PBT and LOS. When the concentration of PBT was between 0 and 1.5 units, it was manifested as a negative correlation between PBT and LOS. However, there was a positive association between PBT and LOS when PBT levels exceeded 1.5 units. CONCLUSIONS This study demonstrated that PBT and LOS in the OPF population were independent with a nonlinear relationship. These results suggest that PBT may be protective for patients with long LOS. If these findings are confirmed, the LOS in OPF patients can be regulated through appropriate perioperative blood transfusion.
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Affiliation(s)
- Si-Ming Xu
- Department of Orthopedics, Gusu School, Nanjing Medical University, The First People's Hospital of Kunshan, Suzhou, Jiangsu, 215300, China
| | - Ke Lu
- Department of Orthopedics, Affiliated Kunshan Hospital of Jiangsu University, No. 566 East of Qianjin Road, Suzhou, Jiangsu, 215300, China
| | - Xu-Feng Yang
- Department of Orthopedics, Affiliated Kunshan Hospital of Jiangsu University, No. 566 East of Qianjin Road, Suzhou, Jiangsu, 215300, China
| | - Yao-Wei Ye
- Department of Orthopedics, Gusu School, Nanjing Medical University, The First People's Hospital of Kunshan, Suzhou, Jiangsu, 215300, China
| | - Min-Zhe Xu
- Department of Orthopedics, Affiliated Kunshan Hospital of Jiangsu University, No. 566 East of Qianjin Road, Suzhou, Jiangsu, 215300, China
| | - Qin Shi
- Department of Orthopedics, the First Affiliated Hospital of Soochow University, Orthopedic Institute of Soochow University, Suzhou, Jiangsu, 215031, China
| | - Ya-Qin Gong
- Information Department, Affiliated Kunshan Hospital of Jiangsu University, Suzhou, Jiangsu, 215300, China
| | - Chong Li
- Department of Orthopedics, Gusu School, Nanjing Medical University, The First People's Hospital of Kunshan, Suzhou, Jiangsu, 215300, China.
- Department of Orthopedics, Affiliated Kunshan Hospital of Jiangsu University, No. 566 East of Qianjin Road, Suzhou, Jiangsu, 215300, China.
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10
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Zhu J, Jin XQ, Li XY, Sun L, Peng Y. The association between oral carbohydrate intake before orthopedic surgery for osteoporotic fractures and outcomes in elderly patients. J Orthop Surg Res 2023; 18:966. [PMID: 38098008 PMCID: PMC10722799 DOI: 10.1186/s13018-023-04458-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 12/10/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Oral carbohydrate (CHO) intake is a safe method with effective clinical results in various surgical patients before surgery. Nevertheless, due to a lack of adequate clinical data, it is not frequently utilized in older patients undergoing orthopedic surgery for osteoporotic fractures (OPFs), especially in China. The purpose of the present study was to examine the relationship between preoperative oral CHO consumption and outcomes in elderly patients undergoing surgical treatment for OPFs. METHODS This retrospective cohort study was conducted at a single Chinese institution and included a total of 879 elderly patients (median age: 71 years; range: 50-99 years) who underwent OPF surgery. Various exclusion criteria were established as follows: (a) the necessity for urgent surgical intervention; (b) the existence of hypoglycemia, hyperglycemia, or diabetes mellitus with blood glucose levels lower than 2.8 mmol/L; (c) a medical history of gastrointestinal motility disorders or delayed gastric emptying; (d) the utilization of local anesthesia; (e) a Charlson comorbidity index (CCI) score over 2; and (f) an American Society of Anesthesiologists (ASA) score exceeding 3. After propensity score (PS) matching, 264 patients from each cohort were included in the analysis. The primary outcome was the all-cause mortality rate within 60 days post-surgery, while secondary outcomes included the length of hospital stay (LOS), hospitalization costs, intraoperative and postoperative blood transfusions, and the incidence of postoperative nausea and vomiting (PONV) and aspiration. The relationship between preoperative oral CHO intake and outcomes was evaluated using multivariate regression analysis. RESULTS After PS matching, preoperative oral CHO intake was negatively associated with 60-day mortality in the fully adjusted model (odds ratio 0.35; 95% confidence interval 0.12-0.97; P-value: 0.04). Patients who received preoperative oral CHO intake also had a shorter LOS and lower hospitalization costs than those who did not receive CHO intake. However, none of the models showed a significant association between CHO intake and PONV or blood transfusion risk. Furthermore, no cases of aspiration were observed in either cohort. CONCLUSIONS Preoperative oral CHO intake may be associated with reduced mortality risk and improved outcomes in elderly patients undergoing surgical treatment for OPFs. However, it is important to acknowledge the limitations of our study, including its retrospective nature, potential unmeasured confounding variables, the small sample size, incomplete data on important variables such as duration of surgery and inflammatory markers, and the limited generalizability due to the participation of only one institution. Future research with larger sample sizes and a broader range of events is warranted to validate and enhance the validity of our findings, particularly in assessing long-term results and understanding the underlying mechanisms.
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Affiliation(s)
- Jing Zhu
- Department of Nursing, Affiliated Kunshan Hospital of Jiangsu University, Suzhou, Jiangsu, China
| | - Xue-Qin Jin
- Department of Nursing, Affiliated Kunshan Hospital of Jiangsu University, Suzhou, Jiangsu, China
| | - Xiao-Yan Li
- Department of Nursing, Affiliated Kunshan Hospital of Jiangsu University, Suzhou, Jiangsu, China
| | - Li Sun
- Department of Nursing, Affiliated Kunshan Hospital of Jiangsu University, Suzhou, Jiangsu, China
| | - Yuan Peng
- Intensive Care Unit, Affiliated Kunshan Hospital of Jiangsu University, No. 566 East of Qianjin Road, Suzhou, Jiangsu, China.
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11
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Albasha A, Salman LA, Elramadi A, Abudalou A, Mustafa A, Hejleh HAA, Ahmed G. Outcomes of drain versus no drain in total knee arthroplasty: a retrospective cohort study. Int Orthop 2023; 47:2985-2989. [PMID: 37610463 PMCID: PMC10673744 DOI: 10.1007/s00264-023-05946-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 08/16/2023] [Indexed: 08/24/2023]
Abstract
PURPOSE The use of suction drains in total knee arthroplasty (TKA) remains controversial. The aim of this study is to compare the outcomes of patients who received suction drains versus those who did not, focusing on blood loss, blood transfusion need, and length of hospital stay. METHODS A retrospective observational cohort study was conducted at a tertiary hospital between January 1, 2015, and December 30, 2019, and included 262 patients who underwent unilateral non-traumatic primary TKA and were over 18 years old. The Institutional Review Board (IRB) approved the study (MRC-02-20-278). RESULTS A total of 262 patients were included, with an age range of 47 to 91 years. Most of the included patients were females, 74.4% (195). Hypertension was the most frequent risk factor, 67.6%, followed by diabetes. Of 262 patients, 156 (59.5%) received a drain. The drain group had significantly longer hospital stay, 30% longer tourniquet time, greater haemoglobin and haematocrit drops, higher count of transfused packed RBC units, and lower use of anticoagulants. Moreover, tranexamic acid (TXA) use (n = 106) in surgery reduced hospital stays, tourniquet time, drain output, and increased pre- and postoperative haemoglobin and hematocrit levels compared to no TXA group (n = 156) (p < 0.05, z-score reported). CONCLUSIONS This study found that patients who received a drain had longer hospital stays and greater blood loss and transfusion rates compared to those who did not. The use of TXA in surgery was associated with improved outcomes and reduced overall complications.
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Affiliation(s)
- Anas Albasha
- Orthopedics Department, Hamad General Hospital, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Loay A Salman
- Orthopedics Department, Hamad General Hospital, Hamad Medical Corporation, PO Box 3050, Doha, Qatar.
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar.
| | - Ahmed Elramadi
- Orthopedics Department, Hamad General Hospital, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Abedallah Abudalou
- Orthopedics Department, Hamad General Hospital, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Ahmed Mustafa
- Medical Intern, Hamad General Hospital, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Hasan Azzam Abu Hejleh
- Orthopedics Department, Hamad General Hospital, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Ghalib Ahmed
- Orthopedics Department, Hamad General Hospital, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
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12
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Dawod MS, Alswerki MN, Haddad BI, Alajlouni J, Alshrouf MA, Alnsour S, Dababseh S, Alsmairat MA. Intraoperative blood loss and haemoglobin drop in patients with developmental dysplasia of the hip in Jordan undergoing total hip arthroplasty. Int Orthop 2023; 47:2933-2940. [PMID: 37341749 DOI: 10.1007/s00264-023-05869-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 06/11/2023] [Indexed: 06/22/2023]
Abstract
PURPOSE Developmental dysplasia of the hip is still a prevailing secondary cause of early hip osteoarthritis in Jordan. Dysplastic coxarthrosis can result in significant and disabling hip pain with impaired patient's functionality. Due to this significant morbidity, patients ultimately need total hip arthroplasty, which offers the best functional outcome. Significant anatomical aberrances do exist in such hips as a result of old dysplasia; such pathoanatomical changes can complicate an already difficult surgery and lead to significant intraoperative blood loss and haemoglobin drop postoperatively. So, the aim of this research was to investigate on the intraoperative blood loos, and postoperative haemoglobin drop in these patients. METHODS A cross-sectional study design was adopted, and 162 patients with advanced hip osteoarthrosis secondary to developmental dysplasia of the hip (DDH) were studied. We studied predictors of hemoglobin drop and blood loss and linked some variables to this outcome variable using different statistical tests. RESULTS Our results showed a positive correlation between blood loss and BMI (r = 0.27, p = 0.73), haemoglobin drop and duration of surgery (r = 0.14, p = 0.07), length of hospital stay and duration of surgery (r = 0.25, p = 0.001). No significant differences between outcome measures (blood loss, haemoglobin drop, and duration of surgery) between males and females (p = 0.38, 0.93, 0.77 respectively). However, there was a statistically significant differences in haemoglobin drop among patients underwent general versus spinal anaesthesia (p = 0.03). additionally, there was a statistically significant association in length of hospital stay among smokers (p = 0.03), and patients who didn't prescribed anxiolytic preoperatively (p = 0.008). CONCLUSION Haemoglobin drop and blood loss in patients with dysplastic coxarthrosis were linked to increased preoperative BMI. Use of preoperative anxiolytics, and being non-smoker decreased the length of hospital stays. General anaesthesia was associated with more haemoglobin drop as well.
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Affiliation(s)
- Moh'd S Dawod
- Faculty of Medicine, Mutah University, Al-Karak, Jordan
| | - Mohammad N Alswerki
- Department of Orthopedics, Jordan University Hospital, P.O. Box: 13046, Amman, 11942, Jordan.
| | - Bassem I Haddad
- Department of Orthopedics, Jordan University Hospital, P.O. Box: 13046, Amman, 11942, Jordan
| | - Jihad Alajlouni
- Department of Orthopedics, Jordan University Hospital, P.O. Box: 13046, Amman, 11942, Jordan
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13
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Dimech N, Cassar M, Carabott J. The health literacy and patient discharge experience dyad after cardiac surgery: an exploratory study. Br J Nurs 2023; 32:1046-1052. [PMID: 38006591 DOI: 10.12968/bjon.2023.32.21.1046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2023]
Abstract
Health literacy concerns the ability to access, appraise and use information to maintain good health. The purpose of this study was to explore the health literacy of older adults and their experiences after cardiac surgery. A purposive sample of eight patients (aged ≥65 years) who had undergone cardiac surgery participated in this qualitative study. A validated health literacy assessment instrument was used to gather data on their health literacy levels. Two semi-structured interviews were conducted with each participant to explore the experiences of recovery in the immediate and medium-term post-discharge period. The data from the assessment instrument and the interviews were analysed and collated. Data analysis gave rise to seven themes: aftermath of cardiac surgery; settling in; whirlwind of emotions; shifting perspective; faith and hope; sense of community; and COVID-19 experience. The findings suggest health literacy plays a part in a patient's cardiac surgical discharge experience, along with other factors. As patients' responses and experiences vary, health professionals need to adopt a context-sensitive approach when discharging patients after surgery.
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Affiliation(s)
- Nadine Dimech
- MSc Nursing Student, Faculty of Health Sciences, University of Malta
| | - Maria Cassar
- Senior Lecturer, Department of Nursing, Faculty of Health Sciences, University of Malta, Malta
| | - James Carabott
- Hospital Planning Manager, St Vincent de Paul Long Term Care Facility, Malta
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14
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Nasr SS, Sherif GM, Wahab MA, Aboelkasem H. Targeting average length of hospital stay as a control measure to decrease COVID-19 hospital-acquired infection in surgical cancer patients. J Egypt Natl Canc Inst 2023; 35:36. [PMID: 37981621 DOI: 10.1186/s43046-023-00199-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 11/02/2023] [Indexed: 11/21/2023] Open
Abstract
BACKGROUND The global spread of coronaviruses had a great impact on the economic and social situation of most countries. As the backbone of any society, the health sector made a significant contribution through applying emergency risk management plans in order to control the pandemic. Monitoring the average length of hospital stay (ALOS) was an effective way to release the capacity of the health system during this time. The aim was to evaluate the effect of applying risk assessment/management strategies on ALOS and the impact of this ALOS on COVID-19 infection rates among cancer patients. METHODS This is a prospective cohort study. All admitted cancer patients in 6 surgical departments from January to June 2021 were included. RESULTS A total of 1287 patients were admitted to 6 surgical departments during the selected period. About 46% of them had surgery (n = 578), while 54% did not have surgery (n = 700). Among surgical patients, admission rates were highest in February and head and neck department (24% and 22.1%, respectively), and lowest in April and chest department (12.4% and 8%, respectively). ALOS was significantly different across the 6 months (p value < 0.001) with lower ALOS in (April, May, and June) than in (January-February, and March). No significant difference was found across the 6 surgical departments (p value = 0.423). Twenty-eight patients became COVID-19 positive after admission, 25 of them (89%) were infected from March to June-during the time of the third wave-and a significant decreasing linear trend (p value = 0.009) was found. CONCLUSION ALOS had significantly reduced with commitment to infection control (IC) interventions and recommendations. The significant decreasing trend of COVID-19 infection from March to June (unlike the rising curve of the 3rd COVID-19 wave by that time) could be explained by improvement in ALOS.
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Affiliation(s)
- Sarah S Nasr
- Cancer Epidemiology and Biostatistics Department, National Cancer Institute, Cairo University, Cairo, Egypt.
| | - Ghada M Sherif
- Cancer Epidemiology and Biostatistics Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Maha Abdel Wahab
- Anesthesia Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Hatem Aboelkasem
- Surgical Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
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15
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Kojima I, Koyama S, Otobe Y, Suzuki M, Tanaka S, Terao Y, Aoki T, Kimura Y, Masuda H, Abe R, Nishizawa K, Yamada M. Combination of low muscle strength and malnutrition is associated with longer length of hospital stay among older patients with heart failure. Heart Lung 2023; 62:9-15. [PMID: 37290139 DOI: 10.1016/j.hrtlng.2023.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/24/2023] [Accepted: 05/24/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND Muscle strength and nutritional status are associated with length of hospital stay (LOHS) in older patients with heart failure (HF). OBJECTIVES The purpose of the study was to examine the association of the combination of muscle strength and nutritional status on LOHS in older patients with HF. METHODS This retrospective cohort study included 414 older inpatients with HF (men, 57.2%; median age, 81 years; interquartile range, 75-86 years). Patients were categorized into four groups according to their muscle strength and nutritional status: group 1, high muscle strength and normal nutritional status; group 2, low muscle strength and normal nutritional status; group 3, high muscle strength and malnutrition; and group 4, low muscle strength and malnutrition. The outcome variable was the LOHS, and an LOHS of >16 days was defined as long LOHS. RESULTS Multivariate logistic regression analysis adjusted for baseline characteristics (reference, group 1) showed that group 4 was associated with a more significant risk of long LOHS (odds ratio [OR], 3.54 [95% confidence interval, 1.85-6.78]). In the subgroup analysis, this relationship was maintained for the first admission HF group (OR, 4.65 [2.07-10.45]) but not for the HF readmission group (OR, 2.80 [0.72-10.90]). CONCLUSIONS Our results suggest that the long LOHS for older patients with HF at first admission was associated with a combination of low muscle strength and malnutrition but not by either factor individually.
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Affiliation(s)
- Iwao Kojima
- Department of Rehabilitation Medicine, Kawasaki Municipal Kawasaki Hospital, 12-1, Shinkawa-dori, Kawasaki-ku, Kawasaki-City, Kanagawa 210-0013, Japan; Graduate School of Comprehensive Human Sciences, University of Tsukuba, 3-29-1 Otsuka, Bunkyo-ku, Tokyo 112-0012, Japan.
| | - Shingo Koyama
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, 3-29-1 Otsuka, Bunkyo-ku, Tokyo 112-0012, Japan
| | - Yuhei Otobe
- Graduate School of Rehabilitation Science, Osaka Metropolitan University, 3-7-30 Habikino, Habikino-city, Osaka 583-8555, Japan
| | - Mizue Suzuki
- Department of Rehabilitation, Faculty of Allied health sciences, Yamato University, 2-5-1, Katayama-cho, Suita-city, Osaka, 564-0082, Japan
| | - Shu Tanaka
- Major of Physical Therapy, Department of Rehabilitation, School of Health Sciences, Tokyo University of Technology, 5-23-22 Nishikamata, Ota-ku, Tokyo 144-8535, Japan
| | - Yusuke Terao
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, 3-29-1 Otsuka, Bunkyo-ku, Tokyo 112-0012, Japan
| | - Takuya Aoki
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, 3-29-1 Otsuka, Bunkyo-ku, Tokyo 112-0012, Japan
| | - Yosuke Kimura
- College of Science and Engineering, Health and Sports Technology Course, Kanto Gakuin University, 1-50-1 Mutsuura-higashi, Kanazawa-ku, Yokohama 236-8501, Japan
| | - Hiroaki Masuda
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, 3-29-1 Otsuka, Bunkyo-ku, Tokyo 112-0012, Japan
| | - Reon Abe
- Department of Rehabilitation Medicine, Kawasaki Municipal Kawasaki Hospital, 12-1, Shinkawa-dori, Kawasaki-ku, Kawasaki-City, Kanagawa 210-0013, Japan
| | - Kenya Nishizawa
- Division of Cardiology, Department of Internal Medicine, Kawasaki Municipal Kawasaki Hospital, 12-1, Shinkawa-dori, Kawasaki-ku, Kawasaki-City, Kanagawa 210-0013, Japan
| | - Minoru Yamada
- Faculty of Human Sciences, University of Tsukuba, 3-29-1 Otsuka, Bunkyo-ku, Tokyo 112-0012, Japan
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16
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Kaur J, Martin JA, Vege SS, Garimella V, Majumder S, Levy MJ, Abu Dayyeh BK, Storm AC, Vargas EJ, Law RJ, Bofill AM, Decker GA, Petersen BT, Chandrasekhara V. Utility of Urgent Endoscopic Retrograde Cholangiopancreatography in Patients with Predicted Mild Acute Pancreatitis and Cholestasis. Dig Dis Sci 2023; 68:4259-4265. [PMID: 37665426 DOI: 10.1007/s10620-023-08004-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 06/13/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND Endoscopic retrograde cholangiopancreatography (ERCP) within 72 h is suggested for patients presenting with acute biliary pancreatitis (ABP) and biliary obstruction without cholangitis. This study aimed to identify if urgent ERCP (within 24 h) improved outcomes compared to early ERCP (24-72 h) in patients admitted with predicted mild ABP. METHODS Patients admitted for predicted mild ABP defined as a bedside index of severity in acute pancreatitis score < 3 and underwent ERCP for biliary obstruction within 72 h of presentation during the study period were included. Patients with prior biliary sphincterotomy or surgically altered anatomy preventing conventional ERCP were excluded. The primary outcome was the development of moderately severe or severe pancreatitis based on the revised Atlanta classification. Secondary outcomes were the length of hospital stay, the need for ICU admission, and ERCP-related adverse events (AEs). RESULTS Of the identified 166 patients, baseline characteristics were similar between both the groups except for the WBC count (9.4 vs. 8.3/µL; p < 0.044) and serum bilirubin level (3.0 vs. 1.6 mg/dL; p < 0.0039). Biliary cannulation rate and technical success were both high in the overall cohort (98.8%). Urgent ERCP was not associated with increased development of moderately severe pancreatitis (10.4% vs. 15.7%; p = 0.3115). The urgent ERCP group had a significantly shorter length of hospital stay [median 3 (IQR 2-3) vs. 3 days (IQR 3-4), p < 0.01]. CONCLUSION Urgent ERCP did not impact the rate of developing more severe pancreatitis in patients with predicted mild ABP but was associated with a shorter length of hospital stay and a lower rate of hospital readmission.
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Affiliation(s)
- Jyotroop Kaur
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - John A Martin
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - Santhi S Vege
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - Vishal Garimella
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - Shounak Majumder
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - Michael J Levy
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - Barham K Abu Dayyeh
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - Andrew C Storm
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - Eric J Vargas
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - Ryan J Law
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - Aliana M Bofill
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - G Anton Decker
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - Bret T Petersen
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - Vinay Chandrasekhara
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA.
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Mahdavi Sharif P, Merati M, Baigi V, Zafarghandi M, Rahimi-Movaghar V, Khormali M, Laal M, Salamati P. Comparison of epidemiologic features between upper and lower limb injuries and risk factors for intensive care unit admission in a university hospital affiliated with the National Trauma Registry of Iran. Chin J Traumatol 2023:S1008-1275(23)00100-1. [PMID: 37925271 DOI: 10.1016/j.cjtee.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 05/18/2023] [Accepted: 05/23/2023] [Indexed: 11/06/2023] Open
Abstract
PURPOSE Upper extremity injuries (UEIs) and lower extremity injuries (LEIs) constitute a considerable component of traumas. However, their epidemiologic differences and short-term in-hospital outcomes are not fully elucidated. This study aims to compare such discrepancies in a large-scale study. METHODS In this retrospective study, all patients with UEIs and/or LEIs hospitalized from 24th July 2016 to 16th May 2020 in Sina Hospital, Tehran, Iran, and registered at the National Trauma Registry of Iran were enrolled in the study. Relevant demographic and clinical characteristics were extracted from the National Trauma Registry of Iran database. Patients were grouped into either UEI or LEI. For those with concomitant UEIs and LEIs, the more severe one based on the abbreviated injury scale was defined as the principal diagnosis. In addition, cases with the abbreviated injury scale > 3 for both UEI and LEI or concomitant injuries to body areas other than the limbs were excluded. Independent samples t-test, Mann-Whitney U test, Chi-square test, quintile regression models, and logistic regression models with "margins" command were used for statistical analyses, as indicated. RESULTS In this research, 3170 eligible cases were identified. For the LEI group, there was a much higher proportion of male patients (86.7% vs. 82.0%) and higher mean age (years, 42.9 vs. 35.3) compared to the UEI group (both p < 0.001). Patients with an injury severity score (ISS) of 9 - 15 were outnumbered in the LEI group (22.9% vs. 1.6%, p < 0.001), while the proportion of those with an ISS < 9 was higher in the UEI group (98.1% vs. 76.8%, p < 0.001). The multiple logistic regression model showed a statistically significant association between intensive care unit (ICU) admission and ISS (odds ratio (OR) = 4.01 for ISS 9 - 15 vs. ISS <9, 95% confidence interval (CI)|: 3.01 - 5.35; OR = 17.65 for ISS ≥16 vs. ISS < 9, 95% CI: 4.03 - 77.27), age (OR = 1.02, 95% CI: 1.01 - 1.03), cause of injury (OR = 0.27 for blunt trauma vs. road traffic crash, 95% CI: 0.08 - 0.90; OR = 0.49 for cut/stab injuries vs. road traffic crash, 95% CI: 0.28 - 0.84) and body region (OR = 1.65 for lower extremity, 95% CI: 1.19 - 2.29). Having adjusted for other covariates, the odds of ICU admission in patients with LEIs was 1.65 times the odds in patients with UEIs. CONCLUSIONS Patients with LEIs were older and suffered from more severe injuries. In addition, the age- and ISS-adjusted ICU admission and length of hospital stay were significantly higher in LEI patients. The chance of ICU admission was associated with age, cause of injury, ISS, and body region. The findings of this study can aid in the meticulous selection of ICU-candidate patients. In addition, the role of factors other than ISS and age in ICU admission and prolongation of hospitalization should be addressed by prospective studies.
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Affiliation(s)
- Pouya Mahdavi Sharif
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Mohsen Merati
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Vali Baigi
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran; Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Vafa Rahimi-Movaghar
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Moein Khormali
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Marjan Laal
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Payman Salamati
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran.
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Koch K, Szoverfi Z, Jakab G, Varga PP, Hoffer Z, Lazary A. Complication Pattern After Percutaneous Cement Discoplasty: Identification of Factors Influencing Reoperation and Length of Hospital Stay. World Neurosurg 2023; 178:e700-e711. [PMID: 37544606 DOI: 10.1016/j.wneu.2023.07.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 07/30/2023] [Accepted: 07/31/2023] [Indexed: 08/08/2023]
Abstract
OBJECTIVE Percutaneous cement discoplasty (PCD) was introduced to treat symptomatic vertical instability of the lumbar spine in a minimally invasive way. The aim of the present study was to analyze the complication pattern after PCD and to identify factors that predict the chance of cement leakage, reoperation, and length of hospital stay (LOS). METHODS patients were treated with PCD within the study period. Clinical features and complications were analyzed by applying descriptive statistics, whereas perioperative factors predictive of cement leakage, reoperation, and LOS were identified by regression models. RESULTS Cement leakage rate was 30.4% in the total cohort; however, only fifth of them were symptomatic. Cement leakage itself did not have a significant influence on clinical outcome. Other complications and nonsurgical adverse events were registered only in 2.0% of cases. Age, subcutaneous fat tissue thickness, low viscosity cement, lower level of surgeon's experience and the number of operated levels were identified as risk factors of cement leakage (P < 0.01; c-index = 0.836). Type of procedure, Charlson comorbidity score, reoperation, and nonsurgical adverse events significantly increased the LOS (P < 0.01). Cement leakage, early surgical practice, and increased subcutaneous fat tissue thickness were risk factors for reoperation (P < 0.01; c-index = 0.72). CONCLUSIONS PCD is a relatively safe and effective procedure for treating spinal instability caused by advanced-stage disc degeneration characterized by vacuum phenomenon. Cement leakage is not uncommon but is only a radiologic complication without clinical consequences in most cases. On the other hand, it can increase the LOS and is a significant risk factor for reoperation.
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Affiliation(s)
- Kristof Koch
- National Center for Spinal Disorders, Buda Health Center, Budapest, Hungary; School of PhD Studies, Semmelweis University, Budapest, Hungary
| | - Zsolt Szoverfi
- National Center for Spinal Disorders, Buda Health Center, Budapest, Hungary; Department of Spine Surgery, Department of Orthopaedics, Semmelweis University, Budapest, Hungary
| | - Gabor Jakab
- National Center for Spinal Disorders, Buda Health Center, Budapest, Hungary
| | - Peter Pal Varga
- National Center for Spinal Disorders, Buda Health Center, Budapest, Hungary
| | - Zoltan Hoffer
- National Center for Spinal Disorders, Buda Health Center, Budapest, Hungary
| | - Aron Lazary
- National Center for Spinal Disorders, Buda Health Center, Budapest, Hungary; Department of Spine Surgery, Department of Orthopaedics, Semmelweis University, Budapest, Hungary.
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Allahbakhshian A, Khalili AF, Gholizadeh L, Esmealy L. Comparison of early mobilization protocols on postoperative cognitive dysfunction, pain, and length of hospital stay in patients undergoing coronary artery bypass graft surgery: A randomized controlled trial. Appl Nurs Res 2023; 73:151731. [PMID: 37722799 DOI: 10.1016/j.apnr.2023.151731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 08/05/2023] [Accepted: 08/14/2023] [Indexed: 09/20/2023]
Abstract
Although coronary artery bypass graft (CABG) surgery improves the life expectancy of patients with coronary artery disease, it is associated with various short and long-term complications. Early mobilization has been shown to reduce the risk of these complications. This study aimed to compare the effectiveness of different early mobilization protocols on postoperative cognitive dysfunction (POCD), pain intensity, and length of hospital stay (LOS) in patients undergoing CABG. This three-arm parallel randomized controlled trial included 120 patients undergoing CABG surgery who were randomly assigned to Intervention A, which received a four-phase early mobilization protocol; Intervention B, which received a three-phase early mobilization protocol; and the Control group, which received routine care. Postoperative cognitive dysfunction and pain were assessed using Mini Mental State Examination (MMSE) and visual analog scale (VAS), respectively. Groups were comparable in demographic and clinical characteristics and postoperative cognitive dysfunction at baseline. After the intervention, Group B had statistically significantly (p < 0.001) less cognitive dysfunction (25.8 ± 1.7) compared to Group A (24.1 ± 2.2) and the Control Group (23.4 ± 2.7). Likewise, hospital stay was statistically (p < 0.01) shorter for Group B (7.7 ± 1.5) than the Control group (8.9 ± 1.9). However, the experience of pain was statistically significantly lower over time in Group A than in the other groups (p < 0.001). This study concludes that an early mobilization protocol based on deep breathing exercises and chest physiotherapy may better improve postoperative cognitive dysfunction and length of hospital stay than an early mobilization protocol based on passive and active range of motion activities or routine care.
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Affiliation(s)
- Atefeh Allahbakhshian
- Department of Medical-Surgical, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Azizeh Farshbaf Khalili
- Department of Physical Medicine Research Center, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Leila Gholizadeh
- Faculty of Health, University of Technology Sydney, Sydney, Australia.
| | - Leyla Esmealy
- Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran.
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Lee CC, Hung YP, Hsieh CC, Ho CY, Hsu CY, Li CT, Ko WC. Predictive models for short-term mortality and length of hospital stay among adults with community-onset bacteraemia before and during the COVID-19 pandemic: application of early data dynamics. BMC Infect Dis 2023; 23:605. [PMID: 37715116 PMCID: PMC10504793 DOI: 10.1186/s12879-023-08547-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 08/18/2023] [Indexed: 09/17/2023] Open
Abstract
BACKGROUND The development of scoring systems to predict the short-term mortality and the length of hospital stay (LOS) in patients with bacteraemia is essential to improve the quality of care and reduce the occupancy variance in the hospital bed. METHODS Adults hospitalised with community-onset bacteraemia in the coronavirus disease 2019 (COVID-19) and pre-COVID-19 eras were captured as the validation and derivation cohorts in the multicentre study, respectively. Model I incorporated all variables available on day 0, Model II incorporated all variables available on day 3, and Models III, IV, and V incorporated the variables that changed from day 0 to day 3. This study adopted the statistical and machine learning (ML) methods to jointly determine the prediction performance of these models in two study cohorts. RESULTS A total of 3,639 (81.4%) and 834 (18.6%) patients were included in the derivation and validation cohorts, respectively. Model IV achieved the best performance in predicting 30-day mortality in both cohorts. The most frequently identified variables incorporated into Model IV were deteriorated consciousness from day 0 to day 3 and deteriorated respiration from day 0 to day 3. Model V achieved the best performance in predicting LOS in both cohorts. The most frequently identified variables in Model V were deteriorated consciousness from day 0 to day 3, a body temperature ≤ 36.0 °C or ≥ 39.0 °C on day 3, and a diagnosis of complicated bacteraemia. CONCLUSIONS For hospitalised adults with community-onset bacteraemia, clinical variables that dynamically changed from day 0 to day 3 were crucial in predicting the short-term mortality and LOS.
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Affiliation(s)
- Ching-Chi Lee
- Clinical Medical Research Center, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan
- Department of Internal Medicine, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, No. 138, Sheng Li Road, Tainan, 70403, Taiwan
| | - Yuan-Pin Hung
- Department of Internal Medicine, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, No. 138, Sheng Li Road, Tainan, 70403, Taiwan
- Department of Internal Medicine, Tainan Hospital, Ministry of Health and Welfare, Tainan, Taiwan
- Department of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chih-Chia Hsieh
- Department of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Emergency Medicine, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan
| | - Ching-Yu Ho
- Department of Adult Critical Care Medicine, Tainan Sin-Lau Hospital, Tainan, Taiwan
- Department of Nursing, National Tainan Junior College of Nursing, Tainan, Taiwan
| | - Chiao-Ya Hsu
- Institute of Data Science, National Cheng Kung University, No. 1, University Road, Tainan, 701, Taiwan
| | - Cheng-Te Li
- Institute of Data Science, National Cheng Kung University, No. 1, University Road, Tainan, 701, Taiwan.
| | - Wen-Chien Ko
- Department of Internal Medicine, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, No. 138, Sheng Li Road, Tainan, 70403, Taiwan.
- Department of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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Laird A, Bramley L, Barnes R, Englin A, Winderlich J, Mount E, Nataraja RM, Pacilli M. Effects of a Preoperative Carbohydrate Load on Postoperative Recovery in Children: A Randomised, Double-Blind, Placebo-Controlled Trial. J Pediatr Surg 2023; 58:1824-1831. [PMID: 37280132 DOI: 10.1016/j.jpedsurg.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 04/27/2023] [Accepted: 05/07/2023] [Indexed: 06/08/2023]
Abstract
BACKGROUND Nausea and vomiting are common causes for prolonged postoperative length of hospital stay (LOS) in children. A preoperative carbohydrate load may reduce postoperative nausea and vomiting by improving the perioperative metabolic state. The aim of this study was to determine if a preoperative carbohydrate-containing drink would lead to an improvement in the perioperative metabolic state and consequently reduce the incidence of postoperative nausea, vomiting and LOS in children undergoing day-case surgical procedures. METHOD Randomised, double-blind, placebo-controlled trial involving children aged 4 to 16-years undergoing day-case surgical procedures. Patients were randomised to receive a carbohydrate-containing drink or a placebo. During the induction of anaesthesia, a venous blood gas, and blood glucose and ketone levels were measured. Postoperatively, the incidence of nausea, vomiting, and LOS were documented. RESULTS 120 patients were randomised with 119/120 (99.2%) undergoing analysis. Blood glucose level was higher in the carbohydrate group; 5.4 mmol/L [3.3-9.4] versus 4.9 mmol/L [3.6-6.5] (p = 0.01). Blood ketone level was lower in the carbohydrate group; 0.2 mmol/L versus 0.3 mmol/L (p = 0.003). The incidence of nausea and vomiting was not different (p > 0.9 and p = 0.8, respectively). LOS in the carbohydrate group was 26 min shorter than the placebo group (p = 0.02). CONCLUSION Although a preoperative carbohydrate load may provide a more stable metabolic state at the induction of anaesthesia, we did not find a reduction in postoperative nausea and vomiting. A preoperative carbohydrate load has also minimal effects on the postoperative LOS. TYPE OF STUDY Randomised clinical trial. LEVEL OF EVIDENCE I.
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Affiliation(s)
- Ashleigh Laird
- Department of Paediatrics and Surgery, School of Clinical Sciences, Monash University, 246 Clayton Road, Melbourne, Australia
| | - Lynsey Bramley
- Department of Nutrition and Dietetics, Monash Children's Hospital, 246 Clayton Road, Melbourne, Australia
| | - Richard Barnes
- Department of Anaesthetics, Monash Children's Hospital, 246 Clayton Road, Melbourne, Australia
| | - Anna Englin
- Department of Anaesthetics, Monash Children's Hospital, 246 Clayton Road, Melbourne, Australia
| | - Jacinta Winderlich
- Department of Nutrition and Dietetics, Monash Children's Hospital, 246 Clayton Road, Melbourne, Australia
| | - Elizabeth Mount
- Department of Nutrition and Dietetics, Monash Children's Hospital, 246 Clayton Road, Melbourne, Australia
| | - Ramesh M Nataraja
- Department of Paediatrics and Surgery, School of Clinical Sciences, Monash University, 246 Clayton Road, Melbourne, Australia; Department of Paediatric Surgery, Monash Children's Hospital, 246 Clayton Road, Melbourne, Australia
| | - Maurizio Pacilli
- Department of Paediatrics and Surgery, School of Clinical Sciences, Monash University, 246 Clayton Road, Melbourne, Australia; Department of Paediatric Surgery, Monash Children's Hospital, 246 Clayton Road, Melbourne, Australia.
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22
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Nakashima H, Nagae M, Komiya H, Fujisawa C, Watanabe K, Yamada Y, Tajima T, Miyahara S, Sakai T, Umegaki H. Combined use of the Clinical Frailty Scale and laboratory tests in acutely hospitalized older patients. Aging Clin Exp Res 2023; 35:1927-1935. [PMID: 37378813 DOI: 10.1007/s40520-023-02477-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 06/10/2023] [Indexed: 06/29/2023]
Abstract
AIMS To evaluate the Clinical Frailty Scale (CFS) and a Frailty Index based on laboratory tests (FI-lab) in terms of what each assesses about frailty and to determine the appropriateness of combined use of these two frailty scales. METHODS This was a prospective observational cohort study in an acute geriatric ward of a university hospital. The FI-lab is the proportion of laboratory parameters that yield abnormal results from a total of 23. The FI-lab and CFS were assessed at admission. Data on activities of daily living (ADL), cognition, geriatric syndromes, and comorbidities were also collected. Main outcomes were in-hospital mortality and 90-day mortality after admission. RESULTS In total, 378 inpatients (mean age 85.2 ± 5.8 years, 59.3% female) were enrolled. ADL and cognition correlated strongly with the CFS (Spearman's |r|> 0.60) but weakly with the FI-lab (|r|< 0.30). Both the CFS and FI-lab correlated weakly with geriatric syndromes and comorbidities (|r|< 0.40). The correlation between the CFS and FI-lab was also weak (r = 0.28). The CFS and FI-lab were independently associated with in-hospital mortality and 90-day mortality after admission. The Akaike information criterion was lower for models using both the CFS and FI-lab than for models using either tool alone. CONCLUSIONS The CFS and FI-lab each reflected only some of the aspects of frailty in acutely hospitalized older patients. The model fit was better when the two frailty scales were used together to assess the mortality risk than when either was used alone.
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Affiliation(s)
- Hirotaka Nakashima
- Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, Aichi, 466-8560, Japan.
| | - Masaaki Nagae
- Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, Aichi, 466-8560, Japan
| | - Hitoshi Komiya
- Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, Aichi, 466-8560, Japan
| | - Chisato Fujisawa
- Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, Aichi, 466-8560, Japan
| | - Kazuhisa Watanabe
- Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, Aichi, 466-8560, Japan
| | - Yosuke Yamada
- Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, Aichi, 466-8560, Japan
| | - Tomihiko Tajima
- Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, Aichi, 466-8560, Japan
| | - Shuzo Miyahara
- Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, Aichi, 466-8560, Japan
| | - Tomomichi Sakai
- Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, Aichi, 466-8560, Japan
| | - Hiroyuki Umegaki
- Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, Aichi, 466-8560, Japan
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Khammarnia M, Bagherbarahouei F, Ansari-Moghaddam A. Length of Hospital Stay and Its Related Factors in Iran: A Systematic Review and Meta-Analysis. Iran J Public Health 2023; 52:1877-1888. [PMID: 38033834 PMCID: PMC10682571 DOI: 10.18502/ijph.v52i9.13570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 04/09/2022] [Indexed: 12/02/2023]
Abstract
Background One of the effective indicators used to determine the efficiency and optimal use of hospital resources is the length of stay (LOS). Then, we aimed to determine LOS and its related factors in Iran. Methods A systematic literature review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using the online databases; Medline, EMBASE, Scopus, PubMed, SID, MagIran, and Medlib from 1995 to 2022 using a combination of medical subject. STATA version 11 used for data analysis. Results Overall, 75 (cross-sectional, cohort, and case-control) reports were identified. The average length of stay in Iranian hospitals was 6.7 (95% CI: 5.32 -7.74) d. There was a significant relationship between the length of stay in the hospital and different wards of hospital (P=0.001). The average of men' LOS was longer than women were [6.9 (95% CI: 5.32 -7.74) vs. 3.9 (95% CI: 1.67-9.41)]. Moreover, the average LOS before and after the Health Transformation Plan (HTP) in Iran has changed, so that it has increased from 5.8 (95% CI: 4.39 -7.86) to 7.1 (95% CI: 5.59 -9.25) d after HTP (P=0.30). Conclusion The average length of stay of patients in Iranian hospitals is more than the expected index of the Ministry of Health and Medical Education and is in the unfavorable range (> four days). Moreover, considering the direct effect of the type of departments on LOS; therefore, hospital managers should pay more attention to hospital processes using new process-oriented and customer-oriented management approaches.
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Affiliation(s)
- Mohammad Khammarnia
- Department of Health Care Management, Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Fatemeh Bagherbarahouei
- Student Research Committee, School of Health, Zahedan University of Medical Sciences, Zahedan, Iran
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Selenius S, Ilvesvuo J, Ruotsalainen H, Mattila I, Pätilä T, Helle E, Ojala T. Risk factors for mortality in patients with hypoplastic left heart syndrome after the Norwood procedure. Interdiscip Cardiovasc Thorac Surg 2023; 37:ivad127. [PMID: 37549099 PMCID: PMC10448988 DOI: 10.1093/icvts/ivad127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 06/12/2023] [Accepted: 08/04/2023] [Indexed: 08/09/2023]
Abstract
OBJECTIVES Several studies have reported mortality risk factors associated with hypoplastic left heart syndrome (HLHS). However, these data are ambiguous and mainly focused on the independent effects of these factors. We examined both the independent and the cumulative effects of preoperative risk factors for poor outcome in patients undergoing the Norwood procedure. Moreover, we studied the risk factors associated with prolonged initial hospital stays in these patients. METHODS We performed a retrospective national 18-year observational study of preoperative risk factors for 1 year, as well as total follow-up mortality or need for transplant in patients with HLHS (N = 99) born in Finland between 1 January 2004 and 31 December 2021. RESULTS Overall, one-year survival was 85.6%. In a multivariable analysis, having a major extracardiac anomaly and being small for gestational age were significant predictors of one-year mortality or the need for a transplant. Aortic atresia was a predictor of total follow-up mortality. An analysis of the cumulative effect indicated that the presence of 2 risk factors was associated with higher mortality. CONCLUSIONS HLHS remains the defect with the highest procedural risks for mortality in paediatric cardiac surgery. From a prognostic point of view, recognition of independent preoperative risk factors as well as the cumulative effect of risk factors for mortality is essential.The results of this study were presented orally at the 55th Annual Meeting of the Association for European Paediatric and Congenital Cardiology, Geneva, Switzerland, 28 May 2022.
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Affiliation(s)
- Sabina Selenius
- New Children’s Hospital Pediatric Research Center, Helsinki University Hospital, Helsinki, Finland
- Stem Cells and Metabolism Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Johanna Ilvesvuo
- Department of Obstetrics and Gynecology, Women’s Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | | | - Ilkka Mattila
- Department of Cardiac and Transplantation Surgery, Children’s Hospital, University Hospital of Helsinki and University of Helsinki, Helsinki, Finland
| | - Tommi Pätilä
- Department of Cardiac and Transplantation Surgery, Children’s Hospital, University Hospital of Helsinki and University of Helsinki, Helsinki, Finland
| | - Emmi Helle
- New Children’s Hospital Pediatric Research Center, Helsinki University Hospital, Helsinki, Finland
- Stem Cells and Metabolism Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Tiina Ojala
- New Children’s Hospital Pediatric Research Center, Helsinki University Hospital, Helsinki, Finland
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Bahrami S, Hajian-Tilaki K, Bayani M, Chehrazi M, Mohamadi-Pirouz Z, Amoozadeh A. Bayesian model averaging for predicting factors associated with length of COVID-19 hospitalization. BMC Med Res Methodol 2023; 23:163. [PMID: 37415112 PMCID: PMC10326965 DOI: 10.1186/s12874-023-01981-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 06/18/2023] [Indexed: 07/08/2023] Open
Abstract
INTRODUCTION The length of hospital stay (LOHS) caused by COVID-19 has imposed a financial burden, and cost on the healthcare service system and a high psychological burden on patients and health workers. The purpose of this study is to adopt the Bayesian model averaging (BMA) based on linear regression models and to determine the predictors of the LOHS of COVID-19. METHODS In this historical cohort study, from 5100 COVID-19 patients who had registered in the hospital database, 4996 patients were eligible to enter the study. The data included demographic, clinical, biomarkers, and LOHS. Factors affecting the LOHS were fitted in six models, including the stepwise method, AIC, BIC in classical linear regression models, two BMA using Occam's Window and Markov Chain Monte Carlo (MCMC) methods, and GBDT algorithm, a new method of machine learning. RESULTS The average length of hospitalization was 6.7 ± 5.7 days. In fitting classical linear models, both stepwise and AIC methods (R 2 = 0.168 and adjusted R 2 = 0.165) performed better than BIC (R 2 = 0.160 and adjusted = 0.158). In fitting the BMA, Occam's Window model has performed better than MCMC with R 2 = 0.174. The GBDT method with the value of R 2 = 0.64, has performed worse than the BMA in the testing dataset but not in the training dataset. Based on the six fitted models, hospitalized in ICU, respiratory distress, age, diabetes, CRP, PO2, WBC, AST, BUN, and NLR were associated significantly with predicting LOHS of COVID-19. CONCLUSION The BMA with Occam's Window method has a better fit and better performance in predicting affecting factors on the LOHS in the testing dataset than other models.
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Affiliation(s)
- Shabnam Bahrami
- Student Research Center, Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Karimollah Hajian-Tilaki
- Department of Biostatistics and Epidemiology, School of Public Health, Babol University of Medical Sciences, Babol, Iran.
- Social Determinants of Health Research Center, Research Institute, Babol University of Medical Sciences, Babol, Iran.
| | - Masomeh Bayani
- Department of Infectious Diseases, Ayatollah Rohani Hospital, Babol University of Medical Sciences, Babol, Iran
| | - Mohammad Chehrazi
- Department of Biostatistics and Epidemiology, School of Public Health, Babol University of Medical Sciences, Babol, Iran
- Neonatal Research Unit, Imperial College London, Exhibition Rd, South Kensington, London, SW7 2BX, UK
| | - Zahra Mohamadi-Pirouz
- Student Research Center, Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Abazar Amoozadeh
- Social Determinants of Health Research Center, Research Institute, Babol University of Medical Sciences, Babol, Iran
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Van Den Heede K, Vatansever S, Girgin T, Van Slycke S, Makay Ö. Posterior retroperitoneal versus transperitoneal laparoscopic adrenalectomy in adults: results from the EUROCRINE® surgical registry. Langenbecks Arch Surg 2023; 408:241. [PMID: 37349535 DOI: 10.1007/s00423-023-02975-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 06/10/2023] [Indexed: 06/24/2023]
Abstract
PURPOSE This study aims to compare posterior retroperitoneal laparoscopic adrenalectomy (PRLA) and laparoscopic transperitoneal adrenalectomy (LTA) in adults using pan-European data as conflicting results have been published regarding length of hospital stay, institutional volume, and morbidity. METHODS This retrospective cohort study analyzed data from the surgical registry EUROCRINE®. All patients undergoing PRLA and TLA for adrenal tumours and registered between 2015 and 2020 were included and compared for morbidity, length of hospital stay, and conversion to open surgery. RESULTS A total of 2660 patients from 11 different countries and 69 different hospitals were analyzed and 1696 LTA were compared to 964 PRLA. Length of hospital stay was shorter after RPLA, with less patients (N = 434, 45.5%, vs N = 1094, 65.0%, p < 0.001) staying more than 2 days. In total, 96 patients (3.6%) developed a complication Clavien-Dindo grade 2 or higher. No statistical difference was found between both study groups. After propensity score matching, length of hospital stay was shorter after PRLA (> 2 days 45.2% vs 63.0%, p < 0.001). After multivariable logistic regression, factors associated with morbidity were age (OR 1.03), male sex (OR 1.52), and conversion to open surgery (OR 5.73). CONCLUSION This study presents the largest retrospective observational analysis comparing LTA and PRLA. Our findings confirm the shorter length of hospital stay after PRLA. Both techniques are safe leading to comparable morbidity and conversion rates.
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Affiliation(s)
- Klaas Van Den Heede
- Department of General and Endocrine Surgery, Pitié Salpêtrière University Hospital, APHP, Sorbonne University, 47-83 Boulevard de L'Hôpital, Paris, France.
- Department of General and Endocrine Surgery, OLV Hospital Aalst, Aalst, Belgium.
| | - Safa Vatansever
- Division of Endocrine Surgery, Department of General Surgery, Ege University Hospital, Izmir, Turkey
| | - Tolga Girgin
- Division of Endocrine Surgery, Department of General Surgery, Ege University Hospital, Izmir, Turkey
| | - Sam Van Slycke
- Department of General and Endocrine Surgery, OLV Hospital Aalst, Aalst, Belgium
- Department of Head and Skin, Ghent University Hospital, Ghent, Belgium
- Department of General Surgery, AZ Damiaan, Ostend, Belgium
| | - Özer Makay
- Division of Endocrine Surgery, Department of General Surgery, Ege University Hospital, Izmir, Turkey
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Di Y, Li H, He C, Peng H. En-bloc transurethral resection vs. conventional transurethral resection for primary non-muscle invasive bladder cancer: A meta-analysis. Actas Urol Esp 2023; 47:309-316. [PMID: 36319557 DOI: 10.1016/j.acuroe.2022.08.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 04/28/2022] [Indexed: 06/05/2023]
Abstract
INTRODUCTION We performed a meta-analysis to evaluate the effect of en-bloc transurethral resection vs. conventional transurethral resection for primary non-muscle invasive bladder cancer. METHODS A systematic literature search up to January 2022 was done and 28 studies included 3714 primary non-muscle invasive bladder cancer subjects at the start of the study; 1870 of them were en-bloc transurethral resection, and 1844 were conventional transurethral resection for primary non-muscle invasive bladder cancer. We calculated the odds-ratio (OR) and mean-difference (MD) with 95% confidence-intervals (CIs) to evaluate the effect of en-bloc transurethral resection compared with conventional transurethral resection for primary non-muscle invasive bladder cancer by the dichotomous or continuous methods with random or fixed-effects models. RESULTS En-bloc transurethral resection had significantly lower twenty-four-month recurrence (OR: 0.63; 95%CI: 0.50-0.78; p < 0.001), catheterization-time (MD: -0.66; 95%CI: -1.02-[-0.29]; p < 0.001), length of hospital stay (MD: -0.95; 95%CI: -1.55-[-0.34]; p = 0.002), postoperative bladder irrigation duration (MD: -6.06; 95%CI: -9.45-[-2.67]; p < 0.001), obturator nerve reflex (OR: 0.08; 95%CI: 0.02-0.34; p = 0.03), and bladder perforation (OR: 0.14; 95%CI: 0.06-0.36: p < 0.001) and no significant difference in the 12-month-recurrence (OR: 0.79; 95%CI: 0.61-1.04; p = 0.09), the operation time (MD: 0.67; 95%CI: -1.92 to 3.25; p = 0.61), and urethral stricture (OR: 0.46; 95%CI: 0.14-1.47; p = 0.0.19) compared with conventional transurethral resection for primary non-muscle invasive bladder cancer subjects. CONCLUSIONS En-bloc transurethral resection had a significantly lower twenty-four-month recurrence, catheterization time, length of hospital stay, postoperative bladder irrigation duration, obturator nerve reflex, bladder perforation, and no significant difference in the twelve-month recurrence, operation time, and urethral stricture compared with conventional transurethral resection for primary non-muscle invasive bladder cancer subjects. Further studies are required.
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Affiliation(s)
- Y Di
- Department of Urology, Hongqi Hospital Affiliated to Mudanjiang Medical University, Heilongjiang, China
| | - H Li
- Department of Urology, Hongqi Hospital Affiliated to Mudanjiang Medical University, Heilongjiang, China
| | - C He
- Department of Urology, Hongqi Hospital Affiliated to Mudanjiang Medical University, Heilongjiang, China
| | - H Peng
- Department of Urology, The Fourth Hospital of Changsha, Hunan, China.
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Fatemeh G, Fotsing G, Marques-Vidal P, Kopp P, Barigou M. Predictive value of multiple variable models including nutritional risk score (NRS 2002) on mortality and length of stay of patients with covid-19 infections. The INCOVO study. Clin Nutr ESPEN 2023; 55:357-363. [PMID: 37202068 DOI: 10.1016/j.clnesp.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 04/01/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND AND AIMS This study aimed at evaluating associations between nutritional status and outcomes in patients with Covid-19 and to identify statistical models including nutritional parameters associated with in-hospital mortality and length of stay. METHODS Data of 5707 adult patients hospitalized in the University Hospital of Lausanne between March 2020 and March 2021 were screened retrospectively 920 patients (35% female) with confirmed Covid-19 and complete data including nutritional risk score (NRS 2002), were included. This cohort was divided into three subgroups: NRS <3: no risk of malnutrition; NRS ≥3 to <5: moderate risk malnutrition; and NRS ≥5: severe risk of malnutrition. The primary outcome was the percentage of in-hospital deaths in the different NRS subgroups. The secondary outcomes were the length of hospital stay (LOS), the percentage of admissions to intensive care units (ICU), and the length of stay in the ICU (ILOS). Logistic regression was performed to identify risk factors associated with in-hospital mortality and hospital stay. Multivariate clinical-biological models were developed to study predictions of mortality and very long length of stay. RESULTS The mean age of the cohort was 69.7 years. The death rate was 4 times higher in the subgroup with a NRS ≥ 5 (44%), and 3 times higher with a NRS ≥ 3 to <5 (33%) compared to the patients with a NRS<3 (10%) (p < 0.001). LOS was significantly higher in the NRS ≥ 5 and NRS ≥ 3 to <5 subgroups (26.0 days; CI [21; 30.9]; and 24.9; CI [22.5; 27.1] respectively) versus 13.4; CI [12; 14.8] for NRS<3 (p < 0.001). The mean ILOS was significantly higher in the NRS ≥ 5 (5.9 days; versus 2.8 for NRS ≥ 3 to <5, and 1.58 for NRS<3 (p < 0.001)). In logistic regression, NRS ≥ 3 was significantly associated with the risk of mortality (OR: 4.8; CI [3.3; 7.1]; p < 0.001) and very long in-hospital stay (>12 days) (OR: 2.5; CI [1.9; 3.3]; p < 0.001). Statistical models that included a NRS ≥ 3 and albumin revealed to be strong predictors for mortality and LOS (area under the curve 0.800 and 0.715). CONCLUSION NRS was found to be an independent risk factor for in-hospital death and LOS in hospitalized Covid-19 patients. Patients with a NRS ≥ 5 had a significant increase in ILOS and mortality. Statistical models including NRS are strong predictors for an increased risk of death and LOS.
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Affiliation(s)
- Ghadamieh Fatemeh
- Division of Endocrinology, Diabetology and Metabolism, University Hospital of Lausanne and University of Lausanne, Avenue de la Sallaz 8, 1011 Lausanne, Switzerland; School of Life Sciences, Ecole Polytechnique fédérale de Lausanne, SV, Station 19, 1015 Lausanne, Switzerland.
| | - Ginette Fotsing
- Division of Endocrinology, Diabetology and Metabolism, University Hospital of Lausanne and University of Lausanne, Avenue de la Sallaz 8, 1011 Lausanne, Switzerland.
| | - Pedro Marques-Vidal
- Department of Medicine, Internal Medicine, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland.
| | - Peter Kopp
- Division of Endocrinology, Diabetology and Metabolism, University Hospital of Lausanne and University of Lausanne, Avenue de la Sallaz 8, 1011 Lausanne, Switzerland.
| | - Mohammed Barigou
- Division of Endocrinology, Diabetology and Metabolism, University Hospital of Lausanne and University of Lausanne, Avenue de la Sallaz 8, 1011 Lausanne, Switzerland.
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Banjer T, Attiya D, Baeesa S, Al Said Y, Babtain F. The impact of the time to last seizure before admission to the epilepsy monitoring unit (EMU) on epilepsy classifications. Epilepsy Behav 2023; 144:109252. [PMID: 37207403 DOI: 10.1016/j.yebeh.2023.109252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 04/27/2023] [Accepted: 04/28/2023] [Indexed: 05/21/2023]
Abstract
INTRODUCTION AND BACKGROUND The impact of the timing of the last seizure (TTLS) prior to admission to the epilepsy monitoring unit (EMU) on epilepsy classification is unclear for which we conducted this study. METHODS We reviewed patients with epilepsy admitted to EMU between January 2021 and April 2022 and identified TTLS before EMU admission. We considered EMU yield as whether; it confirmed epilepsy classification, added new knowledge to the classification, or failed to classify epilepsy. RESULTS We studied 156 patients. There were 72 (46%) men, with a mean age of 30. TTLS was divided according to a one- or three-month cutoff. We confirmed the pre-EMU epilepsy classification in 52 (33%) patients, learned new findings on epilepsy classification in 80 (51%) patients, and failed to classify epilepsy in 24 (15%) patients. Patients with "confirmed epilepsy classifications" reported seizures sooner to EMU admission than other groups (0.7 vs. 2.3 months, p-value = 0.02, 95% CI; -1.8, -1.3). Also, the odds of confirming epilepsy classification were more than two times in patients with TTLS within a month compared to those with TTLS of more than a month (OR = 2.4, p-value = 0.04, 95% CI; 1.1, 5.9). The odds were also higher when the 3-month TTLS cutoff was considered (OR = 6.2, p-value = 0.002, 95% CI; 1.6, 40.2). Confirming epilepsy classification was also associated with earlier seizures recorded at one- or three-month cutoff (OR = 2.1 and OR = 2.3, respectively, p-value = 0.05). We did not observe similar findings when we modified the classification or failed to reach a classification. CONCLUSIONS The timing of the last seizure before EMU admission appeared to influence the yield of EMU and enhanced the confirmation of epilepsy classifications. Such findings can improve the utilization of EMU in the presurgical evaluation of patients with epilepsy.
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Affiliation(s)
- Tasneem Banjer
- Department of Neurosciences, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Dania Attiya
- Department of Neurosciences, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Saleh Baeesa
- Department of Neurosciences, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Youssef Al Said
- Department of Neurosciences, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Fawzi Babtain
- Department of Neurosciences, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia.
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Algera MD, Slangen BFM, van Driel WJ, Wouters MWJM, Kruitwagen RFPM. Textbook outcome as a composite outcome measure to compare hospital performances regarding cytoreductive surgery for ovarian cancer: A nationwide population-based study. Gynecol Oncol 2023; 174:89-97. [PMID: 37167897 DOI: 10.1016/j.ygyno.2023.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 04/17/2023] [Accepted: 04/20/2023] [Indexed: 05/13/2023]
Abstract
OBJECTIVE Textbook outcome (TO) is a composite outcome measure used in surgical oncology to compare hospital outcomes using multiple quality indicators. This study aimed to develop TO as an outcome measure to assess healthcare quality for patients undergoing cytoreductive surgery (CRS) for advanced-stage ovarian cancer. METHODS This population-based study included all CRS for FIGO IIIC-IVB primary ovarian cancer registered in the Netherlands between 2017 and 2020. The primary outcome was TO, defined as a complete CRS, combined with the absence of 30-day mortality, severe complications, and prolonged length of admission (≥ten days). Delayed start of adjuvant chemotherapy (≥six weeks) was not included in TO because of missing data. Logistic regressions were used to assess the association of case-mix factors with TO. Hospital variation was displayed using funnel plots. RESULTS A total of 1909 CRS were included, of which 1434 were interval CRS and 475 were primary CRS. TO was achieved in 54% of the interval CRS cohort and 47% of the primary CRS cohort. Macroscopic residual disease after CRS was the most important factor for not achieving TO. Age ≥ 70 was associated with lower TO rates in multivariable logistic regressions. TO rates ranged from 40% to 69% between hospitals in the interval CRS cohort and 22% to 100% in the primary CRS cohort. In both analyses, one hospital had significantly lower TO rates (different hospitals). Case-mix adjustment significantly affected TO rates in the primary CRS analysis. CONCLUSIONS TO is a suitable composite outcome measure to detect hospital variation in healthcare quality for patients with advanced-stage ovarian cancer undergoing CRS. Case-mix adjustment improves the accuracy of the hospital comparison.
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Affiliation(s)
- M D Algera
- Dutch Institute for Clinical Auditing (DICA), Scientific Bureau, Leiden, the Netherlands; Maastricht University Medical Center (MUMC+), Department of Obstetrics and Gynecology, Maastricht, the Netherlands; GROW- School for Oncology and Reproduction, Maastricht, the Netherlands.
| | - B F M Slangen
- Maastricht University Medical Center (MUMC+), Department of Obstetrics and Gynecology, Maastricht, the Netherlands; GROW- School for Oncology and Reproduction, Maastricht, the Netherlands
| | - W J van Driel
- Center for Gynecological Oncology Amsterdam, Netherlands Cancer Institute, Department of Gynecology, Amsterdam, the Netherlands
| | - M W J M Wouters
- Dutch Institute for Clinical Auditing (DICA), Scientific Bureau, Leiden, the Netherlands; Netherlands Cancer Institute, Department of Surgical Oncology, Amsterdam, the Netherlands; Leiden University Medical Center, Department of Biomedical Data Sciences, Leiden, the Netherlands
| | - R F P M Kruitwagen
- Maastricht University Medical Center (MUMC+), Department of Obstetrics and Gynecology, Maastricht, the Netherlands; GROW- School for Oncology and Reproduction, Maastricht, the Netherlands
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Chau WW, Lo KCH, Lau LCM, Ong MTY, Ho KKW. Single use Negative Pressure Wound Therapy (NPWT) system in the management of knee arthroplasty. BMC Musculoskelet Disord 2023; 24:351. [PMID: 37147702 PMCID: PMC10161500 DOI: 10.1186/s12891-023-06470-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 04/27/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND Wound complication, skin blister formation in particular, causes devastating consequences after total knee arthroplasty (TKA). Negative Pressure Wound Therapy (NPWT) tries to improve wound management leading to decrease length of hospital stay and better clinical outcomes. Low body mass index (BMI) could play a part in wound recovery management although lacking evidence. This study compared length of hospital stay and clinical outcomes between NPWT and Conventional groups, and factors affected and how BMI affected. METHODS This was a retrospective clinical record review of 255 (160 NPWT and 95 Conventional) patients between 2018 and 2022. Patient demographics including body mass index (BMI), surgical details (unilateral or bilateral), length of hospital stay, clinical outcomes including skin blisters occurrence, and major wound complications were investigated. RESULTS Mean age of patients at surgery was 69.95 (66.3% were female). Patients treated with NPWT stayed significantly longer in the hospital after joint replacement (5.18 days vs. 4.55 days; p = 0.01). Significantly fewer patients treated with NPWT found to have blisters (No blisters: 95.0% vs. 87.4%; p = 0.05). In patients with BMI < 30, percentage of patients requiring dressing change was significantly lower when treated with NPWT than conventional (0.8% vs. 33.3%). CONCLUSION Percentage of blisters occurrence in patients who underwent joint replacement surgery is significantly lower using NPWT. Patients using NPWT stayed significantly longer in the hospital after surgery because significant proportion received bilateral surgery. NPWT patients with BMI < 30 were significantly less likely to change wound dressing.
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Affiliation(s)
- Wai-Wang Chau
- Department of Orthopaedics and Traumatology, Chinese University of Hong Kong, Shatin, Hong Kong SAR
| | - Kelvin Chin-Hei Lo
- Department of Orthopaedics and Traumatology, Alice Ho Miu Ling Nethersole Hospital, Tai Po, Hong Kong SAR
| | - Lawrence Chun-Man Lau
- Department of Orthopaedics and Traumatology, Chinese University of Hong Kong, Shatin, Hong Kong SAR
| | - Michael Tim-Yun Ong
- Department of Orthopaedics and Traumatology, Chinese University of Hong Kong, Shatin, Hong Kong SAR
| | - Kevin Ki-Wai Ho
- Department of Orthopaedics and Traumatology, Chinese University of Hong Kong Medical Centre, Shatin, Hong Kong SAR.
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Kaarto P, Westfall KM, Brockhaus K, Paulus AL, Albright J, Ramm C, Cleary RK. Alvimopan is associated with favorable outcomes in open and minimally invasive colorectal surgery: a regional database analysis. Surg Endosc 2023:10.1007/s00464-023-10098-7. [PMID: 37130983 DOI: 10.1007/s00464-023-10098-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 04/20/2023] [Indexed: 05/04/2023]
Abstract
BACKGROUND Alvimopan is a µ-opioid receptor antagonist associated with shorter time to gastrointestinal recovery in patients having open colorectal surgery. Data demonstrating the benefit of perioperative alvimopan for the minimally invasive surgical approach are inconsistent. The aim of this study is to determine colorectal surgery groups that benefit from perioperative alvimopan. METHODS This is a retrospective cohort analysis of colorectal surgery patients who had, and patients who did not have, perioperative alvimopan in the Michigan Surgical Quality Collaborative regional risk-adjusted database from 2018 through 2021. Main outcome measures were postoperative length of hospital stay, time to return of bowel function, and postoperative ileus. RESULTS There were 10,010 patients (30.3% open, 40.5% laparoscopic, 12.7% hand-assist laparoscopic, 43.5% robotic) who met inclusion criteria-4919 received alvimopan in the perioperative period and 5091 did not. When compared to those not receiving alvimopan, unadjusted outcomes showed that the alvimopan group had significantly shorter postoperative length of stay (4.75 days vs 5.5 days, p < 0.001), shorter time to return of bowel function (1.61 days vs 2.01 days, p < 0.001) and less postoperative ileus (5.45% vs 7.94%, p < 0.001). After adjustment, regression models confirmed that alvimopan was associated with an 9.6% reduction in hospital length of stay (p < 0.001), a 14.9% shorter time to return of bowel function (p < 0.001), and a 42.1% reduction in postoperative ileus (p < 0.001). Subgroup analysis showed significant benefit of alvimopan for all three outcomes in patients having the minimally invasive approach. CONCLUSIONS Alvimopan is associated with shorter hospital length of stay, shorter time to return of bowel function, and decreased postoperative ileus when administered to patients undergoing colorectal surgery. Benefit is not limited to the open approach and includes minimally invasive laparoscopic and robotic colorectal procedures.
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Affiliation(s)
- Patricia Kaarto
- Department of Pharmacy, St Joseph Mercy Hospital, Ann Arbor, MI, USA
| | | | - Kara Brockhaus
- Department of Pharmacy, St Joseph Mercy Hospital, Ann Arbor, MI, USA
| | - Amanda L Paulus
- Michigan State University School of Medicine, East Lansing, USA
| | - Jeremy Albright
- Biostatistics and Epidemiology Methods Consulting, BEMC, LLC, Ypsilanti, MI, USA
| | - Carole Ramm
- St Joseph Mercy Hospital, Ann Arbor, MI, USA
| | - Robert K Cleary
- Department of Surgery, St Joseph Mercy Hospital, Ann Arbor, MI, USA.
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Mahmood N, Riaz Z, Sattar A, Kiran M. Hematological findings in COVID-19 and their correlation with severity of Disease. Pak J Med Sci 2023; 39:795-798. [PMID: 37250575 PMCID: PMC10214815 DOI: 10.12669/pjms.39.3.6836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 08/31/2022] [Accepted: 01/18/2023] [Indexed: 11/02/2023] Open
Abstract
Objective To evaluate the efficacy of hematological parameters to predict severity of COVID-19 patients. Method This was a cross-sectional comparative study conducted at Central Park Teaching Hospital, Lahore in COVID ward and COVID ICU between April 23, 2021 to June 23, 2021. Patients of all ages and both genders with positive PCR admitted in the COVID ward and ICU during this time span of two months were included in the study. Data was collected retrospectively. Results This study included 50 patients with male to female ratio of 1.38:1. Though males are more affected by COVID-19 but the difference is not statistically significant. The mean age of the study population was 56.21 and the patients in the severe disease group have higher age. It was observed that in severe/critical group the mean values of total leukocyte count 21.76×103 μI (p-value= 0.002), absolute neutrophil count 71.37% (p-value=0.045), neutrophil lymphocyte ratio (NLR) 12.80 (p-value=0.00) and PT 11.9 seconds (p-value=0.034) and the difference was statistically significant. While in severe/critical group, the mean values of hemoglobin 12.03g/dl (p-value=0.075), lymphocyte count 28.41% (p-value=0.8), platelet count 226×103 μI (p-value=0.67) and APTT 30.7 (p-value=0.081) and the difference was not significantly different between groups. Conclusion It can be concluded from the study that total leucocyte count, absolute neutrophil count and neutrophil lymphocyte ratio can predict in-hospital mortality and morbidity in COVID-19 patients.
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Affiliation(s)
- Namra Mahmood
- Namra Mahmood, MBBS, M.Phil. Assistant Professor, Pathology. Central Park Medical College, Lahore - Pakistan
| | - Zahra Riaz
- Zahra Riaz, MBBS, M.Phil. Senior Demonstrator, Department of Pathology. Central Park Medical College, Lahore - Pakistan
| | - Arooj Sattar
- Arooj Sattar, MBBS, M.Phil. Assistant Professor, Pathology. Central Park Medical College, Lahore - Pakistan
| | - Mehwish Kiran
- Mehwish Kiran, Senior Registrar, Pulmonology. Central Park Medical College, Lahore - Pakistan
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Li H, Liu J, Li C, Shi H. Influencing factors of dexmedetomidine on postoperative myocardial protection in patients with Video-Assisted Thoracoscopic Surgery lobectomy: A retrospective cohort study. Pak J Med Sci 2023; 39:650-655. [PMID: 37250551 PMCID: PMC10214822 DOI: 10.12669/pjms.39.3.7594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 01/24/2023] [Accepted: 03/28/2023] [Indexed: 05/31/2023] Open
Abstract
Objective To investigate factors affecting the cardioprotective proprieties of dexmedetomidine in patients after pulmonary lobectomy. Methods The data of 504 patients who received dexmedetomidine combined with general anesthesia and video-assisted thoracoscopic surgery (VATS) lobectomy in Shanghai Lung Hospital from April 2018 to April 2019 were analyzed retrospectively. Patients were divided into normal troponin group (LTG) and high troponin group (HTG) according to whether the postoperative troponin level was greater than 13. Ratio of systolic blood pressure greater than 180, heart rate greater than 110, the dose of dopamine and other drugs, the ratio of neutrophils to lymphocytes, postoperative visual analog scale (VAS) pain score and hospital stay were compared between the two groups. Results Preoperative systolic blood pressure, intraoperative maximum systolic blood pressure, intraoperative maximum heart rate, intraoperative minimum heart rate and N-terminal pro hormone brain natriuretic peptide (NT-proBNP) correlated with troponin values. The proportion of patients with systolic blood pressure greater than 180 in the HTG was higher than that in the LTG (p=0.0068), and the proportion of patients with heart rate greater than 110 was significantly higher in the HTG compared to the LTG (p=0.044). The ratio of neutrophils/lymphocytes in the LTG was lower than that in the HTG (P<0.001). At 24 and 48 hours after operation, the VAS score in the LTG was lower than that in the HTG. Patients with high troponin had longer hospital stay. Conclusions Intraoperative systolic blood pressure, maximum heart rate, and postoperative neutrophil/lymphocyte ratio are important factors that affect the myocardial protection properties of dexmedetomidine and may affect the postoperative analgesia effect and the length of hospital stay.
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Affiliation(s)
- Hua Li
- Hua Li, Department of Anesthesiology, Shanghai Pulmonary Hospital, Tongji University, School of Medicine, Shanghai 200433, P.R. China
| | - Ji Liu
- Ji Liu, Department of Anesthesiology, Shanghai Pulmonary Hospital, Tongji University, School of Medicine, Shanghai 200433, P.R. China
| | - Chun Li
- Chun Li, Department of Anesthesiology, Shanghai Pulmonary Hospital, Tongji University, School of Medicine, Shanghai 200433, P.R. China
| | - Hong Shi
- Hong Shi, Department of Anesthesiology, Shanghai Pulmonary Hospital, Tongji University, School of Medicine, Shanghai 200433, P.R. China
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Fan Y, Li N, Zhang J, Fu Q, Qiu Y, Chen Y. The Effect of immunonutrition in patients undergoing pancreaticoduodenectomy: a systematic review and meta-analysis. BMC Cancer 2023; 23:351. [PMID: 37069556 PMCID: PMC10108524 DOI: 10.1186/s12885-023-10820-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 04/06/2023] [Indexed: 04/19/2023] Open
Abstract
BACKGROUND Pancreaticoduodenectomy (PD) is a complex and traumatic abdominal surgery with a high risk of postoperative complications. Nutritional support, including immunonutrition (IMN) with added glutamine, arginine, and ω-3 polyunsaturated fatty acids, can improve patients' prognosis by regulating postoperative inflammatory response. However, the effects of IMN on PD patients' outcomes require further investigation. METHODS PMC, EMbase, web of science databases were used to search literatures related to IMN and PD. Data such as length of hospital stay, infectious complications, non-infectious complications, postoperative pancreatic fistula (POPF), delayed gastric emptying (DGE), mortality, systemic inflammatory response syndrome (SIRS) duration, IL-6, and C-reactive protein (CRP) were extracted, and meta-analyses were performed on these data to study their pooled results, heterogeneity, and publication bias. RESULTS This meta-analysis involved 10 studies and a total of 572 patients. The results showed that the use of IMN significantly reduced the length of hospital stay for PD patients (MD = -2.31; 95% CI = -4.43, -0.18; P = 0.03) with low heterogeneity. Additionally, the incidence of infectious complications was significantly reduced (MD = 0.42; 95% CI = 0.18, 1.00, P = 0.05), with low heterogeneity after excluding one study. However, there was no significant impact on non-infectious complications, the incidence of POPF and DGE, mortality rates, duration of SIRS, levels of IL-6 and CRP. CONCLUSION The use of IMN has been shown to significantly shorten hospital stays and decrease the frequency of infectious complications in PD patients. Early implementation of IMN is recommended for those undergoing PD. However, further research is needed to fully assess the impact of IMN on PD patients through larger and higher-quality studies.
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Affiliation(s)
- Yinyin Fan
- Department of Biliary-Pancreatic Surgery, Nanjing Drum Tower Hospital Clinical College of Jiangsu University, Nanjing, 210008, China
- Department of Biliary-Pancreatic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210002, China
| | - Nianxing Li
- Department of Biliary-Pancreatic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210002, China
| | - Jing Zhang
- Department of Biliary-Pancreatic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210002, China
| | - Qiaomei Fu
- Department of Biliary-Pancreatic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210002, China
| | - Yudong Qiu
- Department of Biliary-Pancreatic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210002, China
| | - Yan Chen
- Department of Biliary-Pancreatic Surgery, Nanjing Drum Tower Hospital Clinical College of Jiangsu University, Nanjing, 210008, China.
- Department of Biliary-Pancreatic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210002, China.
- Department of Nursing, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China.
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Feng J, Cao D, Zheng D, Qian ZM, Huang C, Shen H, Liu Y, Liu Q, Sun J, Jiao G, Yang X, McMillin SE, Wang C, Lin H, Zhang X, Zhang S. Cold spells linked with respiratory disease hospitalization, length of hospital stay, and hospital expenses: Exploring cumulative and harvesting effects. Sci Total Environ 2023; 863:160726. [PMID: 36502973 DOI: 10.1016/j.scitotenv.2022.160726] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 12/02/2022] [Accepted: 12/02/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Previous studies have revealed the relationship between cold spells and morbidity and mortality due to respiratory diseases, while the detrimental effects of cold spells on the length of hospital stay and hospitalization expenses remain largely unknown. METHODS We collected hospitalization data for respiratory diseases in 11 cities of Shanxi, China during 2017-2019. In each case, exposure to meteorological variables and air pollution was estimated by the bilinear interpolation approach and inverse distance weighting method, respectively, and then averaged at the city level. Cold spells were defined as the daily mean temperature below the 10th, 7.5th, or 5th percentiles for at least 2 to 5 consecutive days. We applied distributed lag non-linear models combined with generalized additive models to assess cumulative effects and harvesting effects. RESULTS There were significant associations between cold spells and hospital admissions, length of hospital stay, and hospital expenses for respiratory diseases. Compared with the non-cold spell period, the overall (lag 0-21) cumulative risk of hospitalization for total respiratory diseases was 1.232 (95 % CI: 1.090, 1.394) on cold spell days, and the increased length of hospital stay and hospitalization expenses were 112.793 (95 % CI: 10.755, 214.830) days and 127.568 (95 % CI: 40.513, 214.624) thousand Chinese yuan. The overall cumulative risks of cold spells on total respiratory diseases and pneumonia were statistically significant. We further observed harvesting effects in the associations between cold spells and hospital admission, length of hospital stay, and hospitalization expenses for respiratory diseases. CONCLUSIONS Cumulative cold-spell exposure for up to three weeks is associated with hospitalization, length of hospital stay, and hospital expenses for respiratory diseases. The observed harmful effects of cold spells on respiratory diseases can be partly attributable to harvesting effects.
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Affiliation(s)
- Jin Feng
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, Guangdong, China
| | - Dawei Cao
- NHC Key Laboratory of Pneumoconiosis, Shanxi Key Laboratory of Respiratory Diseases, Department of Pulmonary and Critical Care Medicine, The First Hospital of Shanxi Medical University, Taiyuan 030000, Shanxi, China
| | - Dashan Zheng
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, Guangdong, China
| | - Zhengmin Min Qian
- Department of Epidemiology and Biostatistics, College for Public Health & Social Justice, Saint Louis University, 3545 Lafayette Avenue, Saint Louis, MO 63104, USA
| | - Cunrui Huang
- Vanke School of Public Health, Tsinghua University, Beijing 102200, China; Institute of Healthy China, Tsinghua University, Beijing 102200, China
| | - Huiqing Shen
- NHC Key Laboratory of Pneumoconiosis, Shanxi Key Laboratory of Respiratory Diseases, Department of Pulmonary and Critical Care Medicine, The First Hospital of Shanxi Medical University, Taiyuan 030000, Shanxi, China
| | - Yi Liu
- NHC Key Laboratory of Pneumoconiosis, Shanxi Key Laboratory of Respiratory Diseases, Department of Pulmonary and Critical Care Medicine, The First Hospital of Shanxi Medical University, Taiyuan 030000, Shanxi, China
| | - Qiyong Liu
- Key Laboratory of Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102200, China
| | - Jimin Sun
- Key Laboratory of Vaccine, Prevention and Control of Infectious Disease of Zhejiang Province, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310000, Zhejiang, China
| | - Guangyuan Jiao
- Department of Ideological and Political Education, School of Marxism, Capital Medical University, Beijing 102200, China
| | - Xiaoran Yang
- Department of Standards and Evaluation, Beijing Municipal Health Commission Policy Research Center, Beijing Municipal health Commission Information Center, Beijing 102200, China
| | - Stephen Edward McMillin
- School of Social Work, Saint Louis University, Tegeler Hall, 3550 Lindell Boulevard, St. Louis, MO 63103, USA
| | - Chongjian Wang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou 450000, Henan, China
| | - Hualiang Lin
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, Guangdong, China
| | - Xinri Zhang
- NHC Key Laboratory of Pneumoconiosis, Shanxi Key Laboratory of Respiratory Diseases, Department of Pulmonary and Critical Care Medicine, The First Hospital of Shanxi Medical University, Taiyuan 030000, Shanxi, China.
| | - Shiyu Zhang
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, Guangdong, China.
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Lei SH, Guo GF, Yan T, Zhao BC, Qiu SD, Liu KX. Acute Kidney Injury After General Thoracic Surgery: A Systematic Review and Meta-Analysis. J Surg Res 2023; 287:72-81. [PMID: 36870304 DOI: 10.1016/j.jss.2023.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 12/28/2022] [Accepted: 01/27/2023] [Indexed: 03/06/2023]
Abstract
INTRODUCTION The clinical importance of postoperative acute kidney injury (AKI) in patients undergoing general thoracic surgery is unclear. We aimed to systematically review the incidence, risk factors, and prognostic implications of AKI as a complication after general thoracic surgery. METHODS We searched PubMed, EMBASE, and the Cochrane Library from January 2004 to September 2021. Observational or interventional studies that enrolled ≥50 patients undergoing general thoracic surgery and reported postoperative AKI defined using contemporary consensus criteria were included for meta-analysis. RESULTS Thirty-seven articles reporting 35 unique cohorts were eligible. In 29 studies that enrolled 58,140 consecutive patients, the pooled incidence of postoperative AKI was 8.0% (95% confidence interval [CI]: 6.2-10.0). The incidence was 3.8 (2.0-6.2) % after sublobar resection, 6.7 (4.1-9.9) % after lobectomy, 12.1 (8.1-16.6) % after bilobectomy/pneumonectomy, and 10.5 (5.6-16.7) % after esophagectomy. Considerable heterogeneity in reported incidences of AKI was observed across studies. Short-term mortality was higher (unadjusted risk ratio: 5.07, 95% CI: 2.99-8.60) and length of hospital stay was longer (weighted mean difference: 3.53, 95% CI: 2.56-4.49, d) in patients with postoperative AKI (11 studies, 28,480 patients). Several risk factors for AKI after thoracic surgery were identified. CONCLUSIONS AKI occurs frequently after general thoracic surgery and is associated with increased short-term mortality and length of hospital stay. For patients undergoing general thoracic surgery, AKI may be an important postoperative complication that needs early risk evaluation and mitigation.
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Affiliation(s)
- Shao-Hui Lei
- Department of Anesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Gao-Feng Guo
- Department of Anesthesiology and Perioperative Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Ting Yan
- Department of Anesthesiology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Bing-Cheng Zhao
- Department of Anesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Shi-Da Qiu
- Department of Anesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Ke-Xuan Liu
- Department of Anesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
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Brown D, Loeliger J, Stewart J, Graham KL, Goradia S, Gerges C, Lyons S, Connor M, Stewart S, Di Giovanni A, D'Angelo S, Kiss N. Relationship between global leadership initiative on malnutrition (GLIM) defined malnutrition and survival, length of stay and post-operative complications in people with cancer: A systematic review. Clin Nutr 2023; 42:255-268. [PMID: 36716618 DOI: 10.1016/j.clnu.2023.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 12/11/2022] [Accepted: 01/09/2023] [Indexed: 01/15/2023]
Abstract
BACKGROUND & AIMS The predictive validity of the GLIM criteria for survival, length of hospital stay (LOHS) and post-operative complications among people with cancer have not been systematically reviewed. This systematic review aims to determine whether GLIM malnutrition is predictive of these outcomes, and whether the predictive validity is affected by how phenotypic and etiologic criteria are assessed. METHODS Cohort studies published after 2018 were systematically reviewed according to PRISMA guidelines from Embase, Medline Complete and CINAHL Complete. Risk of bias and methodologic quality were assessed using the Journal of the Academy of Nutrition and Dietetics' Quality Criteria Checklist tool for Primary research. RESULTS In total, 21 studies were included, including 28,726 participants. All studies investigated survival, where 18 reported GLIM malnutrition is associated with decreased survival. LOHS was investigated in six studies, with all finding an association between GLIM malnutrition and longer LOHS. Post-operative complications were assessed in seven studies, of which five reported GLIM malnutrition was predictive of increased post-operative complications. Methods to assess the GLIM phenotypic and etiologic criteria varied, with consistent predictive ability for survival regardless of method of assessing reduced muscle mass. However, predictive ability was more variable across different measures of inflammation and reduced intake. CONCLUSION GLIM malnutrition was consistently predictive of worse clinical outcomes. Different measures of reduced muscle mass did not affect the predictive ability of GLIM for survival. However, variation in assessment of the etiologic criteria resulted in varying predictive ability of the GLIM diagnosis for survival.
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Affiliation(s)
- Dylan Brown
- School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Jenelle Loeliger
- School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia; Nutrition and Speech Pathology Department, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Jane Stewart
- Nutrition and Speech Pathology Department, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Kate L Graham
- Nutrition and Speech Pathology Department, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Sunita Goradia
- School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Chantal Gerges
- School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Shania Lyons
- School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Molly Connor
- School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Sam Stewart
- School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Adrian Di Giovanni
- School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Sarah D'Angelo
- School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Nicole Kiss
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia; Allied Health Department, Peter MacCallum Cancer Centre, Melbourne, Australia.
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Sharma Y, Horwood C, Shahi R, Hakendorf P, Thompson C. Impact of Malnutrition on Clinical Outcomes of Acutely Hospitalised Heart Failure Patients at Two Tertiary Hospitals in Australia: An Observational Study. Heart Lung Circ 2023; 32:330-337. [PMID: 36428179 DOI: 10.1016/j.hlc.2022.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 09/19/2022] [Accepted: 10/02/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Malnutrition is common in patients with heart failure (HF) but is often neglected, despite guidelines suggesting that all hospitalised patients should undergo nutritional screening within 24-hours of admission. AIMS This study investigated the nutritional screening rates and determined the immediate and long-term clinical outcomes in patients with HF admitted at two tertiary hospitals in Australia. METHODS Nutritional screening was assessed by the Malnutrition Universal Screening Tool (MUST) completion rates. Patients were classified into two categories based on their MUST scores (0=low malnutrition risk and ≥1=at risk of malnutrition). Propensity-score-matching (PSM) was used to match 20 variables depending upon the risk of malnutrition. Clinical outcomes included the days-alive-and-out-of-hospital at 90 days of discharge (DAOH90), length of hospital stay, in-hospital, 30-day and 180-day mortality and 30-day readmissions. RESULTS There were 5,734 HF admissions between 2013-2020, of whom, only 789 (13.8%) patients underwent MUST screening. The mean (SD) age was 76.2 (14.0) years and 51.9% were males. Five-hundred and fifty-four (554) (70.2%) patients were at low malnutrition risk and 235 (29.8%) at risk of malnutrition. In HF patients, who were at risk of malnutrition, the DAOH90 were lower by 5.9 days (95% CI -11.49 to -0.42, p=0.035) and 180-day mortality was significantly worse (coefficient 0.10, 95% CI 0.02-0.18, p=0.007) compared to those who were at low risk of malnutrition. However, other clinical outcomes were similar between the two groups. CONCLUSION Nutrition screening is poor in hospitalised HF patients and long-term but not short-term clinical outcomes were worse in malnourished HF patients.
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Affiliation(s)
- Yogesh Sharma
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia; Department of General Medicine, Division of Medicine, Cardiac & Critical Care, Flinders Medical Centre, Adelaide, SA, Australia.
| | - Chris Horwood
- Department of Clinical Epidemiology, Flinders Medical Centre, Adelaide, SA, Australia
| | - Rashmi Shahi
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Paul Hakendorf
- Department of Clinical Epidemiology, Flinders Medical Centre, Adelaide, SA, Australia
| | - Campbell Thompson
- Discipline of Medicine, The University of Adelaide, Adelaide, SA, Australia
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Voorn MJJ, Franssen RFW, Hoogeboom TJ, van Kampen-van den Boogaart VEM, Bootsma GP, Bongers BC, Janssen-Heijnen MLG. Evidence base for exercise prehabilitation suggests favourable outcomes for patients undergoing surgery for non-small cell lung cancer despite being of low therapeutic quality: a systematic review and meta-analysis. Eur J Surg Oncol 2023; 49:879-894. [PMID: 36788040 DOI: 10.1016/j.ejso.2023.01.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 01/12/2023] [Accepted: 01/23/2023] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The aim of this systematic review was to evaluate whether exercise prehabilitation programs reduce postoperative complications, postoperative mortality, and length of hospital stay (LoS) in patients undergoing surgery for non-small cell lung cancer (NSCLC), thereby accounting for the quality of the physical exercise program. METHODS Two reviewers independently selected randomized controlled trials (RCTs) and observational studies and assessed them for methodological quality and therapeutic quality of the exercise prehabilitation program (i-CONTENT tool). Eligible studies included patients with NSCLC performing exercise prehabilitation and reported the occurrence of 90-day postoperative complications, postoperative mortality, and LoS. Meta-analyses were performed and the certainty of the evidence was graded (Grading of Recommendations Assessment, Development and Evaluation (GRADE)) for each outcome. RESULTS Sixteen studies, comprising 2,096 patients, were included. Pooled analyses of RCTs and observational studies showed that prehabilitation reduces postoperative pulmonary complications (OR 0.45), postoperative severe complications (OR 0.51), and LoS (mean difference -2.46 days), but not postoperative mortality (OR 1.11). The certainty of evidence was very low to moderate for all outcomes. Risk of ineffectiveness of the prehabilitation program was high in half of the studies due to an inadequate reporting of the dosage of the exercise program, inadequate type and timing of the outcome assessment, and low adherence. CONCLUSION Although risk of ineffectiveness was high for half of the prehabilitation programs and certainty of evidence was very low to moderate, prehabilitation seems to result in a reduction of postoperative pulmonary and severe complications, as well as LoS in patients undergoing surgery for NSCLC.
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Affiliation(s)
- M J J Voorn
- Department of Clinical Epidemiology, VieCuri Medical Centre, Venlo, the Netherlands; Adelante Rehabilitation Centre, Venlo, the Netherlands; Department of Epidemiology, GROW School for Oncology and Reproduction, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands.
| | - R F W Franssen
- Department of Clinical Epidemiology, VieCuri Medical Centre, Venlo, the Netherlands; Department of Epidemiology, GROW School for Oncology and Reproduction, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands; Department of Clinical Physical Therapy, VieCuri Medical Centre, Venlo, the Netherlands
| | - T J Hoogeboom
- Radboud Institute for Health Sciences, IQ Healthcare, Radboudumc, Nijmegen, the Netherlands
| | | | - G P Bootsma
- Department of Pulmonology, Zuyderland Medical Centre, Heerlen, the Netherlands
| | - B C Bongers
- Department of Nutrition and Movement Sciences, School for Nutrition and Translational Research in Metabolism (NUTRIM), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands; Department of Surgery, School for Nutrition and Translational Research in Metabolism (NUTRIM), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - M L G Janssen-Heijnen
- Department of Clinical Epidemiology, VieCuri Medical Centre, Venlo, the Netherlands; Department of Epidemiology, GROW School for Oncology and Reproduction, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
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Sato H, Ota H, Munakata K, Matsuura Y, Fujii M, Wada N, Takiuchi D, Hama N, Takachi K, Yukawa M. Perioperative fluid management influences complication rates and length of hospital stay in the enhanced recovery after surgery (ERAS) protocol for patients with colorectal cancer. Surg Today 2023; 53:242-251. [PMID: 35933631 DOI: 10.1007/s00595-022-02568-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 06/18/2022] [Indexed: 01/28/2023]
Abstract
PURPOSE To evaluate the efficacy and safety of the enhanced recovery after surgery (ERAS) protocol and quantify the impact of each ERAS item on postoperative outcomes. METHODS We used a generalized linear model to compare 289 colorectal cancer patients treated with the ERAS protocol between June, 2015 and April, 2021, with 99 colorectal cancer patients treated with the conventional colorectal surgery pathway between April, 2014 and June, 2015. RESULTS The median length of hospital stay (LOHS) was significantly shorter in the ERAS group, at 9 days (range 3-104 days) vs. 14 days (range 4-44 days) (p < 0.001), but the complication rates (Clavien-Dindo grade 2 or more) were similar (16.6% vs. 22.2%; p = 0.227). However, in the ERAS group, the higher the compliance with ERAS items, the lower the complication rate and LOHS (both p < 0.001). Multiple regression analysis demonstrated that "Discontinuation of continuous intravenous infusion on POD1" and "Avoidance of fluid overload" were significantly associated with the LOHS (p < 0.001 and p = 0.008). CONCLUSION The ERAS protocol is safe and effective for elective colorectal cancer surgery, and compliance with the ERAS protocol contributes to shorter LOHS and fewer complications. Items related to perioperative fluid management had a crucial impact on these outcomes.
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Affiliation(s)
- Hiromichi Sato
- Department of Gastroenterological Surgery, Ikeda City Hospital, Ikeda, Japan
| | - Hirofumi Ota
- Department of Gastroenterological Surgery, Ikeda City Hospital, Ikeda, Japan.
| | - Koji Munakata
- Department of Gastroenterological Surgery, Ikeda City Hospital, Ikeda, Japan
| | - Yusuke Matsuura
- Department of Gastroenterological Surgery, Ikeda City Hospital, Ikeda, Japan
| | - Makoto Fujii
- Division of Health Sciences, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Noriko Wada
- Department of Gastroenterological Surgery, Ikeda City Hospital, Ikeda, Japan
| | - Daisuke Takiuchi
- Department of Gastroenterological Surgery, Ikeda City Hospital, Ikeda, Japan
| | - Naoki Hama
- Department of Gastroenterological Surgery, Ikeda City Hospital, Ikeda, Japan
| | - Kou Takachi
- Department of Gastroenterological Surgery, Ikeda City Hospital, Ikeda, Japan
| | - Masao Yukawa
- Department of General and Breast Surgery, Ikeda City Hospital, Ikeda, Japan
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Zhang N, Lin Q, Jiang H, Zhu H. Age-adjusted Charlson Comorbidity Index as effective predictor for in-hospital mortality of patients with cardiac arrest: a retrospective study. BMC Emerg Med 2023; 23:7. [PMID: 36703122 PMCID: PMC9878885 DOI: 10.1186/s12873-022-00769-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 12/27/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Cardiac arrest is currently one of the leading causes of mortality in clinical practice, and the Charlson Comorbidity Index (CCI) is widely utilized to assess the severity of comorbidities. We aimed to evaluate the relationship between the age-adjusted CCI score and in-hospital mortality in intensive care unit (ICU) patients with the diagnosis of cardiac arrest, which is important but less explored previously. METHODS This was a retrospective study including patients aged over 18 years from the MIMIC-IV database. We calculated the age-adjusted CCI using age information and ICD codes. The univariate analysis for varied predictors' differences between the survival and the non-survival groups was performed. In addition, a multiple factor analysis was conducted based on logistic regression analysis with the primary result set as hospitalization death. An additional multivariate regression analysis was conducted to estimate the influence of hospital and ICU stay. RESULTS A total of 1772 patients were included in our study, with median age of 66, among which 705 (39.8%) were female. Amongst these patients, 963 (54.3%) died during the hospitalization period. Patients with higher age-adjusted CCI scores had a higher likelihood of dying during hospitalization (P < 0.001; OR: 1.109; 95% CI: 1.068-1.151). With the age-adjusted CCI incorporated into the predictive model, the area under the receiver operating characteristic curve was 0.794 (CI: 0.773-0.814), showing that the prediction model is effective. Additionally, patients with higher age-adjusted CCI scores stayed longer in the hospital (P = 0.026, 95% CI: 0.056-0.896), but there was no significant difference between patients with varied age-adjusted CCI scores on the days of ICU stay. CONCLUSION The age-adjusted CCI is a valid indicator to predict death in ICU patients with cardiac arrest, which can offer enlightenment for both theory literatures and clinical practice.
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Affiliation(s)
- Nan Zhang
- grid.413106.10000 0000 9889 6335Emergency Department, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730 China
| | - Qingting Lin
- grid.413106.10000 0000 9889 6335Emergency Department, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730 China
| | - Hui Jiang
- grid.413106.10000 0000 9889 6335Emergency Department, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730 China
| | - Huadong Zhu
- grid.413106.10000 0000 9889 6335Emergency Department, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730 China
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Chen P, Huang J, Li S, Tang Y, Xiao Y, Zou B, Chen X, Li J, Zhao Z, Shen M. Nitrogen dioxide and hospital length of stay and cost for systemic lupus erythematosus in Hunan, China. Sci Total Environ 2023; 856:159013. [PMID: 36162573 DOI: 10.1016/j.scitotenv.2022.159013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 09/13/2022] [Accepted: 09/20/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Evidence of both epidemiological and clinical studies exploring the impact of nitrogen dioxide (NO2) on the systemic lupus erythematosus (SLE) disease activity have been contradictory. OBJECTIVES To evaluate the association between short-term NO2 exposure and length of hospital stay (LOS) and hospital cost of SLE and estimate the burden of disease attributable to NO2 exposure. METHODS We collected health data of SLE inpatients who were hospitalized at secondary and tertiary hospitals in Hunan province of China during 2017-2019. Daily ambient concentrations of air pollutants (O3, CO, NO2, SO2, PM2.5 and PM10) and other environmental factors were obtained from public repositories by linking to individual addresses and date of hospitalization. Mixed effect models were employed to assess the associations between LOS and hospital cost for SLE inpatients and NO2 exposures during the previous 1 to 21 days (lag1-lag21) before hospitalization. We further estimated excess LOS and hospital cost attributable to NO2 exposure according to China's and World Health Organization's air quality guideline (AQG) respectively. RESULTS A total of 11,447 records from 221 hospitals were finally included in our study. After full adjustments, 1 μg/m3 increment of NO2 was significantly associated with 0.038 day increase in LOS (95%CI: 0.0159-0.0601, P = 0.0008) and 0.0384 thousand yuan increase in hospital cost (95%CI: 0.0017-0.0679, P = 0.0395) with a lagged effect of 7 days prior to admission. Based on the adjusted effects of lag7, controlling for short-term NO2 exposure according to AQG could avoid up to 1.47 thousand days of hospitalization and 1.35 million yuan of cost for SLE in Hunan province during 2017 to 2019. CONCLUSIONS Excess LOS and substantial economic burden among SLE inpatients attributable to NO2 could be avoid if policies were implemented to reduce the exposure.
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Affiliation(s)
- Peng Chen
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
| | - Jundong Huang
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
| | - Shenxin Li
- Department of Surveying and Remote Sensing Science, School of Geosciences and Info-physics, Central South University, Changsha, China
| | - Yan Tang
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
| | - Yi Xiao
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
| | - Bin Zou
- Department of Surveying and Remote Sensing Science, School of Geosciences and Info-physics, Central South University, Changsha, China
| | - Xiang Chen
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China; Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha, China
| | - Ji Li
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China; Hunan Key Laboratory of Aging Biology, Xiangya Hospital, Central South University, Changsha, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Zhixiang Zhao
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China; Hunan Key Laboratory of Aging Biology, Xiangya Hospital, Central South University, Changsha, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Minxue Shen
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China; Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China.
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Elsamadicy AA, Koo AB, Sarkozy M, David WB, Reeves BC, Patel S, Hansen J, Sandhu MRS, Hengartner AC, Hersh A, Kolb L, Lo SFL, Shin JH, Mendel E, Sciubba DM. Leveraging HFRS to assess how frailty affects healthcare resource utilization after elective ACDF for CSM. Spine J 2023; 23:124-135. [PMID: 35988878 DOI: 10.1016/j.spinee.2022.08.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 07/15/2022] [Accepted: 08/04/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND CONTEXT Frailty is a common comorbidity associated with worsening outcomes in various medical and surgical fields. The Hospital Frailty Risk Score (HFRS) is a recently developed tool which assesses frailty using 109 International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) comorbidity codes to assess severity of frailty. However, there is a paucity of studies utilizing the HFRS with patients undergoing anterior cervical discectomy and fusion (ACDF) for cervical spondylotic myelopathy (CSM). PURPOSE The aim of this study was to investigate the impact of HFRS on health care resource utilization following ACDF for CSM. STUDY DESIGN A retrospective cohort study was performed using the Nationwide Inpatient Sample (NIS) database from 2016-2019. PATIENT SAMPLE All adult (≥18 years old) patients undergoing primary, ACDF for CSM were identified using the ICD-10 CM codes. OUTCOME MEASURES Weighted patient demographics, comorbidities, perioperative complications, LOS, discharge disposition, and total admission costs were assessed. METHODS The 109 ICD-10 codes with pre-assigned values from 0.1 to 7.1 pertaining to frailty were queried in each patient, with a cumulative HFRS ≥5 indicating a frail patient. Patients were then categorized as either Low HFRS (HFRS<5) or Moderate to High HFRS (HFRS≥5). A multivariate stepwise logistic regression was used to determine the odds ratio for risk-adjusted extended LOS, non-routine discharge disposition, and increased hospital cost. RESULTS A total of 29,305 patients were identified, of which 3,135 (10.7%) had a Moderate to High HFRS. Patients with a Moderate to High HFRS had higher rates of 1 or more postoperative complications (Low HFRS: 9.5% vs. Moderate-High HFRS: 38.6%, p≤.001), significantly longer hospital stays (Low HFRS: 1.8±1.7 days vs. Moderate-High HFRS: 4.4 ± 6.0, p≤.001), higher rates of non-routine discharge (Low HFRS: 5.8% vs. Moderate-High HFRS: 28.2%, p≤.001), and increased total cost of admission (Low HFRS: $19,691±9,740 vs. Moderate-High HFRS: $26,935±22,824, p≤.001) than patients in the Low HFRS cohort. On multivariate analysis, Moderate to High HFRS was found to be a significant independent predictor for extended LOS [OR: 3.19, 95% CI: (2.60, 3.91), p≤.001] and non-routine discharge disposition [OR: 3.88, 95% CI: (3.05, 4.95), p≤.001] but not increased cost [OR: 1.10, 95% CI: (0.87, 1.40), p=.418]. CONCLUSIONS Our study suggests that patients with a higher HFRS have increased total hospital costs, a longer LOS, higher complication rates, and more frequent nonroutine discharge compared with patients with a low HFRS following elective ACDF for CSM. Although frail patients should not be precluded from surgical management of cervical spine pathology, these findings highlight the need for peri-operative protocols to medically optimize patients to improve health care quality and decrease costs.
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Affiliation(s)
- Aladine A Elsamadicy
- Department of Neurosurgery, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06520, USA.
| | - Andrew B Koo
- Department of Neurosurgery, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06520, USA
| | - Margot Sarkozy
- Department of Neurosurgery, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06520, USA
| | - Wyatt B David
- Department of Orthopedics, Yale University School of Medicine, New Haven, CT, USA
| | - Benjamin C Reeves
- Department of Neurosurgery, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06520, USA
| | - Saarang Patel
- Department of Neurosurgery, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06520, USA
| | - Justice Hansen
- Department of Neurosurgery, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06520, USA
| | - Mani Ratnesh S Sandhu
- Department of Neurosurgery, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06520, USA
| | - Astrid C Hengartner
- Department of Neurosurgery, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06520, USA
| | - Andrew Hersh
- Department of Neurosurgery, John Hopkins School of Medicine, Baltimore, MD, USA
| | - Luis Kolb
- Department of Neurosurgery, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06520, USA
| | - Sheng-Fu Larry Lo
- Department of Neurosurgery, Zucker School of Medicine at Hofstra, Long Island Jewish Medical Center and North Shore University Hospital, Northwell Health, Manhasset, NY, USA
| | - John H Shin
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ehud Mendel
- Department of Neurosurgery, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06520, USA
| | - Daniel M Sciubba
- Department of Neurosurgery, John Hopkins School of Medicine, Baltimore, MD, USA; Department of Neurosurgery, Zucker School of Medicine at Hofstra, Long Island Jewish Medical Center and North Shore University Hospital, Northwell Health, Manhasset, NY, USA
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Hamid M, Khalid A, Parmar J. Does percutaneous cholecystostomy timing in high anaesthetic-risk patients impact on outcome? Updates Surg 2023; 75:133-140. [PMID: 36333564 DOI: 10.1007/s13304-022-01405-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 10/05/2022] [Indexed: 11/06/2022]
Abstract
The optimal timing for percutaneous cholecystostomy (PCT) in patients with acute biliary sepsis, who are high-risk for cholecystectomy, requires further investigation. We aimed to study local factors influencing the timing to PCT placement, and investigate patient outcomes in early (≤ 48 h) vs. delayed PCT over a six-year period. A retrospective observational study investigating patients who required a PCT at a single hospital in the UK between January 2014 and December 2019. Placement of a PCT was at the discretion of the on-call surgical consultant according to their own personal experience and not based on a standard local protocol. Clinical outcomes, hospital statistics and details of any subsequent bridging surgery were analysed using multivariate logistic regression models adjusting for age, sex, Charlson Comorbidity Index (CCI) and American Society of Anaesthesiologists (ASA) grade. There were 72 patients with 35/72 (48.6%) classed as TG18 AC grade 3; 26/72 (36.1%) had an early PCT placed and 46/72 (63.9%) delayed. Median age was 76 (65-83) years, 52.8% were female, and 51.4% were classed ASA ≥ 3 with 94.0% scoring CCI > 2. Trial on antibiotic therapy was the primary reason for delayed PCT. In adjusted models, early PCT was associated with a shorter length in hospital stay (OR 3.02, p = 0.044), successful definitive treatment (OR 6.26, p = 0.009); and reduced likelihood for catheter dislodgment (OR 0.12, p = 0.004) with fewer patients bridging to later emergency open surgery (OR 0.19, p = 0.024). Clinical outcomes may be superior in urgent or early PCT for high anaesthetic-risk patients following acute biliary sepsis.
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Affiliation(s)
- Mohammed Hamid
- University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham, B15 2TH, UK. .,Department of Upper Gastrointestinal Surgery, Birmingham Heartlands Hospital, Bordesley Green East, Birmingham, B9 5SS, UK.
| | - Ayesha Khalid
- University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham, B15 2TH, UK.,Department of Upper Gastrointestinal Surgery, Birmingham Heartlands Hospital, Bordesley Green East, Birmingham, B9 5SS, UK
| | - Jitesh Parmar
- University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham, B15 2TH, UK.,Department of Upper Gastrointestinal Surgery, Birmingham Heartlands Hospital, Bordesley Green East, Birmingham, B9 5SS, UK
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Zhu T, Yang W, Lu W. Risk factors associated with length of hospital stay and medical expenses in pulmonary abscess patients: retrospective study. PeerJ 2023; 11:e15106. [PMID: 37070093 PMCID: PMC10105557 DOI: 10.7717/peerj.15106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 02/28/2023] [Indexed: 04/19/2023] Open
Abstract
Background Pulmonary abscess carries a high mortality and requires long-term managements. A better understanding of the risk factors associated with the prolonged hospital stay and high medical expenses in these patients can improve the management strategy in individual patient and optimize the overall healthcare resources. Methods We performed a retrospective study and reviewed the medical records on consecutive patients hospitalized at the Department of Respiratory Medicine of the General Hospital of Northern Theater Command, Shenyang, Liaoning, China, between January 1, 2015, and December 31, 2020. Demographics, comorbidity, clinical symptoms, laboratory tests, length of hospital stay, and medical expenses were recorded. Their relationships with the length of hospital stay and medical expenses in pulmonary abscess patients were analyzed. Results There were 190 patients with the pulmonary abscess and 12,189 patients without the pulmonary abscess. Compared with patients without the pulmonary abscess, patients with the pulmonary abscess had longer hospital stays (21.8 ± SD vs 12.8 ± SD, P < 0.01), In patients with the pulmonary abscess, the mean length of hospital stay was 5.3 days longer in male vs female patients (P = 0.025). Multivariate linear regression analyses showed that extrapulmonary disease and clinical symptoms were associated with the length of hospital stay and medical expenses, respectively. In addition, anemia was associated with both the length of hospital stay and medical expenses. Sex and hypoproteinemia were associated with the medical expenses. Conclusions The mean length of hospital stay was longer in patients with the pulmonary abscess than those without the pulmonary abscess. The length of hospital stay and medical expense were associated with sex, clinical symptoms, extrapulmonary disease, and abnormal laboratory tests in patients with the pulmonary abscess.
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Ingabire PM, Nantale R, Sserwanja Q, Nakireka S, Musaba MW, Muyinda A, Tumuhaise C, Namulema E, Bongomin F, Napyo A, Ainembabazi R, Olum R, Munabi I, Kiguli S, Mukunya D. Factors associated with prolonged hospitalization of patients with corona virus disease (COVID-19) in Uganda: a retrospective cohort study. Trop Med Health 2022; 50:100. [PMID: 36578071 PMCID: PMC9795158 DOI: 10.1186/s41182-022-00491-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 12/08/2022] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Identification of factors predicting prolonged hospitalization of patients with coronavirus disease (COVID-19) guides the planning, care and flow of patients in the COVID-19 Treatment Units (CTUs). We determined the length of hospital stay and factors associated with prolonged hospitalization among patients with COVID-19 at six CTUs in Uganda. METHODS We conducted a retrospective cohort study of patients admitted with COVID-19 between January and December 2021 in six CTUs in Uganda. We conducted generalized linear regression models of the binomial family with a log link and robust variance estimation to estimate risk ratios of selected exposure variables and prolonged hospitalization (defined as a hospital stay for 14 days or more). We also conducted negative binomial regression models with robust variance to estimate the rate ratios between selected exposures and hospitalization duration. RESULTS Data from 968 participants were analyzed. The median length of hospitalization was 5 (range: 1-89) days. A total of 136/968 (14.1%: 95% confidence interval (CI): 11.9-16.4%) patients had prolonged hospitalization. Hospitalization in a public facility (adjusted risk ratio (ARR) = 2.49, 95% CI: 1.65-3.76), critical COVID-19 severity scores (ARR = 3.24: 95% CI: 1.01-10.42), and malaria co-infection (adjusted incident rate ratio (AIRR) = 0.67: 95% CI: 0.55-0.83) were associated with prolonged hospitalization. CONCLUSION One out of seven COVID-19 patients had prolonged hospitalization. Healthcare providers in public health facilities should watch out for unnecessary hospitalization. We encourage screening for possible co-morbidities such as malaria among patients admitted for COVID-19.
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Affiliation(s)
- Prossie M. Ingabire
- grid.461255.10000 0004 1780 2544Department of Medicine, Nsambya Hospital, Kampala, Uganda
| | - Ritah Nantale
- grid.448602.c0000 0004 0367 1045Department of Nursing, Busitema University, Tororo, Uganda
| | - Quraish Sserwanja
- Department of Programmes, GOAL, Arkaweet Block 65 House No. 227, Khartoum, Sudan
| | - Susan Nakireka
- grid.461227.40000 0004 0512 5435Department of Medicine, Mengo Hospital, Kampala, Uganda ,grid.442658.90000 0004 4687 3018Department of Medicine and Dentistry, Uganda Christian University, Kampala, Uganda
| | - Milton W. Musaba
- Department of Obstetrics and Gynaecology, Mbale Regional Referral and Teaching Hospital, Mbale, Uganda ,grid.448602.c0000 0004 0367 1045Department of Obstetrics and Gynaecology, Busitema University, Tororo, Uganda
| | - Asad Muyinda
- grid.461350.50000 0004 0504 1186Department of Medicine, Jinja Regional Referral Hospital, Jinja, Uganda
| | - Criscent Tumuhaise
- grid.461252.60000 0004 0514 4556Department of Medicine, Our Lady Health of the Sick, Nkozi Hospital, Nkozi, Uganda
| | - Edith Namulema
- grid.461227.40000 0004 0512 5435Covid Task Force Institution, Mengo Hospital, Kampala, Uganda
| | - Felix Bongomin
- grid.442626.00000 0001 0750 0866Department of Medical Microbiology, Gulu University, Gulu, Uganda
| | - Agnes Napyo
- grid.448602.c0000 0004 0367 1045Department of Community and Public Health, Busitema Universiy, Tororo, Uganda
| | | | - Ronald Olum
- grid.461255.10000 0004 1780 2544Department of Medicine, Nsambya Hospital, Kampala, Uganda
| | - Ian Munabi
- grid.11194.3c0000 0004 0620 0548Department of Anatomy, Makerere University, Kampala, Uganda
| | - Sarah Kiguli
- grid.11194.3c0000 0004 0620 0548Department of Pediatrics and Child Health, Makerere University, Kampala, Uganda
| | - David Mukunya
- grid.448602.c0000 0004 0367 1045Department of Community and Public Health, Busitema Universiy, Tororo, Uganda
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Cano ME, Uad P, Ardiles V, Sanchez Claria R, Mazza O, Palavecino M, de Santibañes E, Pekolj J, de Santibañes M. Impact of resident involvement on patient outcomes in laparoscopic cholecystectomy of different degrees of complexity: analysis of 2331 cases. Surg Endosc 2022; 36:8975-8980. [PMID: 35687252 DOI: 10.1007/s00464-022-09349-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 05/20/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Resident involvement in the operating room is a vital component of their medical education. Laparoscopic cholecystectomy (LC) represents the paradigmatic minimally invasive training procedure, both due to its prevalence and its different forms of complexity. We aim to evaluate whether the supervised participation of residents as operative surgeons in LC of different degrees of complexity affects postoperative outcomes in a university hospital. METHODS This is a retrospective, single-center study that included all consecutive adult (> 18 years old) patients operated for a LC between January 1, 2012 and December 31, 2017. Each surgical procedure was recorded according to the level of complexity that we established in three types of categorization (level 1: elective surgery; level 2: cholecystitis; level 3: biliary instrumentation). Patients were clinically monitored at an outpatient clinic 7 and 30-day postoperative. Postoperative outcomes of patients operated by supervised residents (SR) and trained surgeons (TS) were compared. Postoperative complications were graded according to the Clavien-Dindo classification of surgical complications. RESULTS A total of 2331 patients underwent LC during the study period, of whom 1573 patients (67.5%) were operated by SR and 758 patients (32.5%) by TS. There were no significant differences among age, sex, and BMI between patients operated in both groups, with the exception of ASA (P = 0.0001). Intraoperative cholangiography was performed in 100% of the patients, without bile duct injuries. There were no deaths in the 30 postoperative days. The overall complication rate was 5.70% (133 patients), with no significant differences when comparing LC performed by SR and TS (5.09 vs. 6.99%; P = 0.063). The severity rates of complications were similar in both groups (P = 0.379). Patient readmission showed a statistical difference comparing SR vs TS (0.76% vs. 2.2%; P = 0.010). The postoperative complications rate according to the complexity level of LC was not significant in level 1 and 2 for both groups. However in complexity level 3 the TS group experienced a greater rate of complications compared to the SR group (18.12% vs. 9.38%; P = 0.058). In the multivariate analysis, the participation of the residents as operating surgeons was not independently associated with an increased risk of complications (OR 1.22, 95% CI 0.84-1.77; P = 0.275), neither other risk factors like age ≥ 65 years, BMI, complexity level 2-3, or ASA ≥ 3-4. The association of another surgical procedure with the LC was an independent factor of morbidity (OR 3.85, 95% CI 2.54-5.85; P = 0.000). CONCLUSION Resident involvement in LC with different degrees of complexity did not affect postoperative outcomes. The participation of a resident as operating surgeon is not an independent risk factor and may be considered ethical, safe, and reliable whenever implemented in the background of a residency-training program with continuous supervision and national accreditation. The sum of other procedures not related to a LC should be taken as a risk factor of morbidity.
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Affiliation(s)
- Maria Emilia Cano
- Department of General Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Pedro Uad
- Department of General Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Victoria Ardiles
- Division of HPB Surgery and Liver Transplant Unit, Department of General Surgery, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, C1181ACH, Buenos Aires, Argentina
| | - Rodrigo Sanchez Claria
- Division of HPB Surgery, Department of General Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Oscar Mazza
- Division of HPB Surgery, Department of General Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Martin Palavecino
- Division of HPB Surgery, Department of General Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Eduardo de Santibañes
- Division of HPB Surgery and Liver Transplant Unit, Department of General Surgery, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, C1181ACH, Buenos Aires, Argentina
| | - Juan Pekolj
- Division of HPB Surgery and Liver Transplant Unit, Department of General Surgery, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, C1181ACH, Buenos Aires, Argentina
| | - Martín de Santibañes
- Division of HPB Surgery and Liver Transplant Unit, Department of General Surgery, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, C1181ACH, Buenos Aires, Argentina.
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Huang YC, Wu CH, Lee MH, Wang SF, Tsou YK, Lin CH, Sung KF, Liu NJ. Timing of endoscopic retrograde cholangiopancreatography in the treatment of acute cholangitis of different severity. World J Gastroenterol 2022; 28:5602-5613. [PMID: 36304084 PMCID: PMC9594008 DOI: 10.3748/wjg.v28.i38.5602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 08/12/2022] [Accepted: 09/23/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The optimal timing of endoscopic retrograde cholangiopancreatography (ERCP) in acute cholangitis (AC) is uncertain, especially in patients with AC of varying severity.
AIM To report whether the timing of ERCP is associated with outcomes in AC patients with different severities.
METHODS According to the 2018 Tokyo guidelines, 683 patients who met the definite diagnostic criteria for AC were retrospectively identified. The results were first compared between patients receiving ERCP ≤ 24 h and > 24 h and then between patients receiving ERCP ≤ 48 h and > 48 h. Subgroup analyses were performed in patients with grade I, II or III AC. The primary outcome was 30-d mortality. Secondary outcomes were intensive care unit (ICU) admission rate, length of hospital stay (LOHS) and 30-d readmission rate.
RESULTS Taking 24 h as the critical value, compared with ERCP > 24 h, malignant biliary obstruction as a cause of AC was significantly less common in the ERCP ≤ 24 h group (5.2% vs 11.5%). The proportion of cardiovascular dysfunction (11.2% vs 2.6%), respiratory dysfunction (14.2% vs 5.3%), and ICU admission (11.2% vs 4%) in the ERCP ≤ 24 h group was significantly higher, while the LOHS was significantly shorter (median, 6 d vs 7 d). Stratified by the severity of AC, higher ICU admission was only observed in grade III AC and shorter LOHS was only observed in grade I and II AC. There were no significant differences in 30-d mortality between groups, either in the overall population or in patients with grade I, II or III AC. With 48 h as the critical value, compared with ERCP > 48 h, the proportion of choledocholithiasis as the cause of AC was significantly higher in the ERCP ≤ 48 h group (81.5% vs 68.3%). The ERCP ≤ 48 h group had significantly lower 30-d mortality (0 vs 1.9%) and shorter LOHS (6 d vs 8 d). Stratified by AC severity, lower 30-d mortality (0 vs 6.1%) and higher ICU admission rates (22.2% vs 10.2%) were only observed in grade III AC, and shorter LOHS was only observed in grade I and II AC. In the multivariate analysis, cardiovascular dysfunction and time to ERCP were two independent factors associated with 30-d mortality.
CONCLUSION ERCP ≤ 48 h conferred a survival benefit in patients with grade III AC. Early ERCP shortened the LOHS in patients with grade I and II AC.
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Affiliation(s)
- Yao-Chi Huang
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Chi-Huan Wu
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
| | - Mu Hsien Lee
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
| | - Sheng Fu Wang
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
| | - Yung-Kuan Tsou
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
| | - Cheng-Hui Lin
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
| | - Kai-Feng Sung
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
| | - Nai-Jen Liu
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
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Hamed Al-Farsi FA, Said Al-Alyani OB, Jose S, Al-Saadi T. Predicting Patients at Risk for Prolonged Hospital Stays Following Pediatrics Traumatic Head Injuries in High-Income Developing Country: A Retrospective Cohort Study. World Neurosurg 2022; 166:e382-e387. [PMID: 35817350 DOI: 10.1016/j.wneu.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 07/02/2022] [Accepted: 07/04/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Traumatic brain injuries (TBIs) in pediatrics are the most common cause of long-term morbidity and mortality, generating a considerable burden on the health care system. In the current retrospective study, we aimed to identify the predictors that contribute to prolonged hospital stays in pediatric TBI. METHODS A retrospective cohort study including all pediatric cases (age younger than 14) who presented to Khoula Hospital with TBI and were seen from January 2015 to December 2019. The multivariate binary logistic regression analysis has been used to determine the independent predictors of prolonged hospital stay. Prolonged hospitalization was defined as mean ± 2 standard deviation days. RESULTS A total of 866 cases of pediatric TBI were documented. The mean age was 4.33 years. The length of hospital stay ranged from <1 day to 90 days (mean = 3.65, standard deviation = 6.84). Prolonged hospitalization was calculated to be >17 days. Thirty-one patients had prolonged hospital stay out of the studied cohort, with an incidence proportion of prolonged stay = 3.6% (95% CI = 2.4%-5.0%). Prolonged hospitalizations were associated with motor vehicle collision injuries (odds ratio [OR]: 27.028, 95% confidence interval [CI] = 2.744-266.194, P = 0.005); pedestrian injuries (OR = 11.667, 95% CI = 1.017-133.805, P = 0.048), and Glasgow Coma Scale score on arrival of <9 (OR = 8.149, 95% CI = 1.167-56.921, P = 0.034). CONCLUSIONS The current study identified motor vehicle collision and pedestrian injuries, as well as initial Glasgow Coma Scale score of <9 as independent predictors of prolonged hospitalization in pediatrics TBI.
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Affiliation(s)
| | | | - Sachin Jose
- Oman Medical Speciality Board, Muscat, Sultanate of Oman
| | - Tariq Al-Saadi
- Department of Neurosurgery, Khoula Hospital, Muscat, Sultanate of Oman; Department of Neurology & Neurosurgery, Faculty of Medicine, McGill University, Montreal, Quebec, Canada.
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