Home-based Preoperative Rehabilitation (PREHAB) to improve physical function and reduce hospital length of stay for frail patients undergoing cardiac surgery

Physiotherapy ◽  
2017 ◽  
Vol 103 ◽  
pp. e12-e13
Author(s):  
I. Waite ◽  
T. Massey ◽  
M. Baghai ◽  
O. Wendler ◽  
R. Deshpande ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Length Of Stay ◽  
Physical Function ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Frail Patients ◽  
Home Based

Service evaluation of an acute Parkinson's therapy pathway between hospital and home

2020 ◽  
Vol 27 (7) ◽  
pp. 1-6
Author(s):  
Christopher J Lovegrove ◽  
Jonathan Marsden
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Length Of Stay ◽  
Intervention Group ◽  
Service Evaluation ◽  
Hospital Length ◽  
Community Services ◽  
Hospital Length Of Stay ◽  
Hospital Environments ◽  
Home Based

Background People with Parkinson's disease report that inpatient hospital environments do not replicate their home setup. A therapy pathway was developed integrating early home-based assessment, therapy sessions with photographs of key home areas, enhanced communication with community services, and staggered discharge. Methods Outcome measures (length of stay and readmissions within 14 days) in people with Parkinson's disease on the therapy pathway (n=5) were compared to those previously receiving standard care (n=5). Results Mean length of stay was 7.2 days shorter in the intervention group and their discharge Lindop Parkinson's mobility scale score was 39.4% higher. No difference was found in the Modified Barthel Index between the groups. Both groups had the same readmission rates. The pathway was accepted by both people with Parkinson's disease and clinicians. Conclusions The pathway reduced hospital length of stay and increased mobility in patients with Parkinson's disease. It was accepted by patients and clinicians and was feasible to integrate into current practice. The pathway warrants further evaluation.

Impact of Frailty on Outcomes Following Spine Surgery: A Prospective Cohort Analysis of 668 Patients

Neurosurgery ◽  
2020 ◽  
Author(s):  
Nitin Agarwal ◽  
Ezequiel Goldschmidt ◽  
Tavis Taylor ◽  
Souvik Roy ◽  
Stefanie C Altieri Dunn ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Spine Surgery ◽  
Cohort Analysis ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Quality Improvement Initiative ◽  
Exact Test ◽  
Frail Patients ◽  
Increased Risk ◽  
Venous Thromboembolic

Abstract BACKGROUND With an aging population, elderly patients with multiple comorbidities are more frequently undergoing spine surgery and may be at increased risk for complications. Objective measurement of frailty may predict the incidence of postoperative adverse events. OBJECTIVE To investigate the associations between preoperative frailty and postoperative spine surgery outcomes including mortality, length of stay, readmission, surgical site infection, and venous thromboembolic disease. METHODS As part of a system-wide quality improvement initiative, frailty assessment was added to the routine assessment of patients considering spine surgery beginning in July 2016. Frailty was assessed with the Risk Analysis Index (RAI), and patients were categorized as nonfrail (RAI 0-29) or prefrail/frail (RAI ≥ 30). Comparisons between nonfrail and prefrail/frail patients were analyzed using Fisher's exact test for categorical data or by Wilcoxon rank sum tests for continuous data. RESULTS From August 2016 through September 2018, 668 patients (age of 59.5 ± 13.3 yr) had a preoperative RAI score recorded and underwent scheduled spine surgery. Prefrail and frail patients suffered comparatively higher rates of mortality at 90 d (1.9% vs 0.2%, P < .05) and 1 yr (5.1% vs 1.2%, P < .01) from the procedure date. They also had longer in-hospital length of stay (LOS) (3.9 d ± 3.6 vs 3.1 d ± 2.8, P < .001) and higher rates of 60 d (14.6% vs 8.2%, P < .05) and 90 d (15.8% vs 9.8%, P < .05) readmissions. CONCLUSION Preoperative frailty, as measured by the RAI, was associated with an increased risk of readmission and 90-d and 1-yr mortality following spine surgery. The RAI can be used to stratify spine patients and inform preoperative surgical decision making.

MORBIDITY ASSOCIATED WITH PROLONGED HOSPITAL LENGTH OF STAY FOLLOWING CARDIAC SURGERY

1998 ◽  
Vol 86 (Supplement) ◽  
pp. 50SCA
Author(s):  
M Panah ◽  
LA Andres ◽  
SA Strope ◽  
F Vela-Cantos ◽  
E Bennett-Guerrero
Keyword(s):  
Cardiac Surgery ◽  
Length Of Stay ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Prolonged Hospital

scholarly journals Lactate levels after major cardiac surgery are associated with hospital length of stay

Critical Care ◽  
2015 ◽  
Vol 19 (Suppl 1) ◽  
pp. P193
Author(s):  
LW Andersen ◽  
M Holmberg ◽  
P Patel ◽  
KM Berg ◽  
M Cocchi ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Length Of Stay ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Lactate Levels

Predictors of extubation failure after open-chest cardiac surgery based on routinely collected data. The importance of a shared interprofessional clinical assessment

2018 ◽  
Vol 17 (8) ◽  
pp. 751-759 ◽  
Author(s):  
Gianfranco Sanson ◽  
Massimiliano Sartori ◽  
Lorella Dreas ◽  
Roberta Ciraolo ◽  
Adam Fabiani
Keyword(s):  
Cardiac Surgery ◽  
Length Of Stay ◽  
Invasive Mechanical Ventilation ◽  
Extubation Failure ◽  
Hospital Length ◽  
Neurological Function ◽  
Hospital Length Of Stay ◽  
Rapid Shallow Breathing Index ◽  
Shallow Breathing ◽  
Rapid Shallow Breathing

Background: Extubation failure (ExtF) is associated with prolonged hospital length of stay and mortality in adult cardiac surgery patients postoperatively. In this population, ExtF-related variables such as the arterial partial pressure of oxygen to fraction of inspired oxygen ratio (PaO2/FiO2), rapid shallow breathing index, cough strength, endotracheal secretions and neurological function have been sparsely researched. Aim: To identify variables that are predictive of ExtF and related outcomes. Method: Prospective observational longitudinal study. Consecutively presenting patients ( n=205) undergoing open-heart cardiac surgery and admitted to the Cardiosurgical Intensive Care Unit (CICU) were recruited. The clinical data were collected at CICU admission and immediately prior to extubation. ExtF was defined as the need to restart invasive or non-invasive mechanical ventilation while the patient was in the CICU. Results: The ExtF incidence was 13%. ExtF related significantly to hospital mortality, CICU length of stay and total hospital length of stay. The risk of ExtF decreased significantly, by 93% in patients with good neurological function and by 83% in those with a Rapid Shallow Breathing Index of ≥57 breaths/min per litre. Conversely, ExtF risk increased 27 times when the PaO2/FiO2 was <150 and 11 times when it was ≥450. Also, a reassuring PaO2/FiO2 value may hide critical pulmonary or extra-pulmonary conditions independent from alveolar function. Conclusion: The decision to extubate patients should be taken after thoroughly discussing and combining the data derived from nursing and medical clinical assessments. Extubation should be delayed until the patient achieves safe respiratory, oxygenation and haemodynamic conditions, and good neurocognitive function.

Postoperative Lactate Levels and Hospital Length of Stay After Cardiac Surgery

2015 ◽  
Vol 29 (6) ◽  
pp. 1454-1460 ◽  
Author(s):  
Lars W. Andersen ◽  
Mathias J. Holmberg ◽  
Michelle Doherty ◽  
Kamal Khabbaz ◽  
Adam Lerner ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Length Of Stay ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Lactate Levels

scholarly journals Preoperative hospital length of stay as a modifiable risk factor for mediastinitis after cardiac surgery

2013 ◽  
Vol 8 (1) ◽  
Author(s):  
Stephane Leung Wai Sang ◽  
Rakesh Chaturvedi ◽  
Ahsan Alam ◽  
Gordan Samoukovic ◽  
Benoit de Varennes ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Risk Factor ◽  
Length Of Stay ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Modifiable Risk Factor

scholarly journals Preoperative walking recommendation for non-cardiac surgery patients to reduce the length of hospital stay: a randomized control trial

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Olga L. Cortés ◽  
Mauricio Herrera-Galindo ◽  
Claudia Becerra ◽  
Mónica Rincón-Roncancio ◽  
Camilo Povea-Combariza ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Length Of Stay ◽  
Waiting Time ◽  
Length Of Hospital Stay ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Rank Test ◽  
Early Ambulation ◽  
Log Rank Test ◽  
The Impact

Abstract Background Even though the importance of preparing patients for a surgical event is recognized, there are still gaps about the benefit of improving functional capacity by walking during the waiting time among patients scheduled for non-cardiac surgery. The aim of this study was to evaluate the impact of pre-surgical walking in-hospital length of stay, early ambulation, and the appearance of complications after surgery among patients scheduled for non-cardiac surgery. Methods A two-arm, single- blinded randomized controlled trial was developed from May 2016 to August 2017. Eligible outpatients scheduled for non-cardiac surgery, capable of walking, were randomized (2:1 ratio) to receive a prescription of walking 150 min/week during the whole pre-surgical waiting time (n = 249) or conventional care (n = 119). The primary outcome was the difference in hospital length of stay, and secondary results were time to first ambulation during hospitalization, description of ischemic events during hospitalization and after six months of hospital discharge, and the walking continuation. We performed an intention to treat analysis and compared length of stay between both groups by Kaplan–Meier estimator (log-rank test). Results There were no significant differences in the length of hospital stay between both groups (log-rank test p = 0.367) and no differences in the first ambulation time during hospitalization (log-rank test p = 0.299). Similar rates of postoperative complications were observed in both groups, but patients in the intervention group continued to practice walking six months after discharge (p < 0.001). Conclusion Our study is the first clinical trial evaluating the impact of walking before non-cardiac surgery in the length of stay, early ambulation, and complications after surgery. Prescription of walking for patients before non-cardiac surgery had no significant effect in reducing the length of stay, and early ambulation. The results become a crucial element for further investigation. Trial registration: PAMP-Phase2 was registered in ClinicalTrials.gov NCT03213496 on July 11, 2017.

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