scholarly journals P.099 Specialty centres for MVD surgery

2018 ◽  
Vol 45 (s2) ◽  
pp. S42-S42
Author(s):  
A Montazeripouragha ◽  
AM Kaufmann
Keyword(s):  
Length Of Stay ◽  
Trigeminal Neuralgia ◽  
Disease Onset ◽  
High Volume ◽  
Referral Process ◽  
Time Intervals ◽  
Patient’S Satisfaction ◽  
Significant Difference ◽  
Postoperative Length ◽  
Delays In Diagnosis

Background: The aim of this study is comparing the waiting time and patient’s satisfaction of microvascular decompression (MVD) surgery between local Manitoba (MB) and out of province (OOP) patients, treated at our Centre for Cranial Nerve Disorder (CCND). Methods: Data from 100 consecutive patients (average age: 56.8±10.6 years), undergoing MVD surgery for Trigeminal Neuralgia (TN) and Hemifacial Spasm (HFS) were reviewed. The outcome measures included the time intervals between disease onset, diagnosis and referral to CCND, postoperative discharge, satisfaction with surgical outcome and referral process. Results: The preoperative time leading to CCND referral were longer for OOP patients, (onset to diagnosis/diagnosis to referral: 2.6±3.8/4.2±4.7 (OOP) versus 1.2±2.1/2.5±4.1 (MB) years; p=0.04/0.04), and referrals were more likely self-directed in OOP patients (62% (OOP), 21% (MB); p=0.007). Postoperative satisfaction with MVD outcome were 8.6/10 for OOP and 8.3/10 for MB patients. There was no significant difference in postoperative length of stay (38±50 (OOP)/43±42 (MB) hours); however, OOP patients were more likely discharged on the first postoperative day (58% (OOP), 31% (MB); p=0.17). Conclusions: Delays in diagnosis and surgical referral of TN/HFS are common, and many patients seek specialist’s opinion in high volume surgical centers. For those OOP patients, travelling for treatment, MVD outcome were at least as good as for local patients.

Surgical Volume Affects Outcomes in Laryngectomy Procedures

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P84-84
Author(s):  
Brenda Mast ◽  
Guy J Petruzzelli ◽  
Tricia J Johnson
Keyword(s):  
Length Of Stay ◽  
Complication Rate ◽  
High Volume ◽  
Surgical Volume ◽  
Total Cost ◽  
Significant Difference ◽  
Dependent Variables ◽  
Kolmogorov Smirnov ◽  
The University ◽  
Smirnov Test

Objective To determine whether statistical differences occur in total cost, length of stay, ICU days, and surgical complications, depending on the volume of laryngectomy procedures performed. Methods Secondary laryngectomy data from 108 hospitals participating in the University Health System Consortium was examined. All laryngectomy surgical cases occurring from July 1, 2001, through June 30, 2005, with an ICD-9 code of 30.3 or 30.4 were analyzed (N=4,551). The cases were divided into 3 categories based on the number of surgical laryngectomy cases performed by hospital. Those volume categories were high, as defined by organizations with 100–233 cases (n=1712); medium, between 60–99 cases (n=1353); and low, between 4–59 cases (n=1458). 4 dependent variables were examined including total cost, length of stay, ICU days, and complications. Results The 4 dependent variables were analyzed for normality by performing a Kolmogorov-Smirnov test. All 4 variables were non-normally distributed. A Kruskal-Wallis test was then performed on each variable to determine if a statistically significant difference appeared between the 3 volume categories. Each variable was found to have statistical significant differences between the groups, with the high volume hospitals having the lowest cost, shortest length of stay, shortest ICU days, and smallest complication rate. Conclusions This study showed that hospitals with higher surgeon volume for total laryngectomies had reduced total cost, length of stay, number of ICU days, and complication rate for their patients.

scholarly journals Day of surgery: the impact on patient length of stay in a tertiary vascular unit

2020 ◽  
Vol 102 (2) ◽  
pp. 98-103 ◽  
Author(s):  
NC Holford ◽  
C Ní Ghuidhir ◽  
L Hands
Keyword(s):  
Length Of Stay ◽  
Hospital Stay ◽  
Support Services ◽  
Length Of Hospital Stay ◽  
Abdominal Aortic Aneurysm Repair ◽  
Significant Difference ◽  
Postoperative Length ◽  
The Difference ◽  
Aneurysm Repair ◽  
The Impact

Background Our hypothesis was that patients undergoing surgery earlier in the week would have better access to physiotherapy and other discharge services after surgery and, as a result, would have a shorter length of hospital stay compared with patients undergoing surgery later in the week. This study aimed to assess whether there is a significant difference in postoperative length of hospital stay between the groups with secondary assessment by operation subtype. Methods We identified all patients admitted for vascular surgery in 2015 from a prospectively collected database and divided the week into Monday to Wednesday and Thursday to Friday. Endovascular cases were included but day cases were excluded. Further analysis was performed with a breakdown in both groups by operation type. Statistical analysis was performed using SPSS version 16.0. Results We identified 652 patients who met our criteria. Within the elective patient group, there was a significantly longer length of stay of three days for the late-week group compared with two days for the early-week group (P = 0.016). Femoral artery procedures had a median length of stay of two days for those operated on early in the week compared with four days later in the week (P < 0.005). Open abdominal aortic aneurysm repair showed a trend to longer length of stay in the late-week group (P = 0.06). Conclusion Day of surgery appears to impact on patients’ length of stay following vascular procedures, with the greatest impact on medium-sized procedures. This difference could be explained by the difference in weekend support services, but further evaluation is required following introduction of weekend support services to assess this.

scholarly journals Self-administered succus entericus reinfusion before ileostomy closure improves short-term outcomes

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Zhen Liu ◽  
Liang Fang ◽  
Liang Lv ◽  
Zhaojian Niu ◽  
Litao Hou ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Anterior Resection ◽  
Low Anterior Resection ◽  
Ileostomy Closure ◽  
Control Group ◽  
Short Term ◽  
Function Recovery ◽  
Significant Difference ◽  
Postoperative Length

Abstract Objective The study aims to assess whether reinfusion of succus entericus prior to ileostomy closure can decrease postoperative length of stay and ameliorate low anterior resection score. Methods This study is a retrospective analysis based on prospectively collected data. Patients were screened from May 2016 to November 2019. A total of 30 patients who underwent reinfusion with succus entericus (SER) were enrolled in the SER group and 42 patients without SER were enrolled in the non-SER group. Results There was no significant difference in the incidence of postoperative ileus between succus entericus reinfusion (SER) group and the control group. Time to first passage of flatus or stool after surgery in the SER group (27.9 ± 6.02 h) is significantly shorter than the control group (32.3 ± 6.26, hours p = 0.004). Compared with the control group (5.52 (4.0–7.0) days), postoperative length of stay in the SER group was 4.90 (3.0–7.0)days (p = 0.009). As for low anterior resection score(LARS), the SER group had a lower score 1 week after discharge than the control group (p = 0.034). However, 1 month after discharge, the LARS in the two groups had no significant difference. Conclusions Self-administered succus entericus reinfusion is a feasible prehabilitation management for outpatients and can improve better outcomes. Compared with non-reinfusion group, succus enterius reinfusion group displays significantly shorter time for gastrointestinal function recovery and postoperative hospital stay without increasing complication, and it can bring better quality of life in a short term.

scholarly journals Self-administered Succus Entericus Reinfusion before Ileostomy Closure improves short-term outcomes

2021 ◽  
Author(s):  
Zhen Liu ◽  
Liang Fang ◽  
Liang Lv ◽  
Zhaojian Niu ◽  
Litao Hou ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Anterior Resection ◽  
Low Anterior Resection ◽  
Ileostomy Closure ◽  
Control Group ◽  
Short Term ◽  
Function Recovery ◽  
Significant Difference ◽  
Postoperative Length

Abstract Objective: The study aims to assess whether reinfusion of succus entericus prior to ileostomy closure can decrease postoperative length of stay and ameliorate low anterior resection score. Methods: This study is a retrospective analysis based on prospectively collected data. Patients were screened from May 2016 to November 2019. A total of 30 patients who underwent Reinfusion with Succus Entericus (SER) were enrolled in the SER group and 42 patients without SER were enrolled in the non-SER group. Results: There was no significant difference in the incidence of postoperative ileus between Succus Entericus Reinfusion (SER) group and the control group. Time to first passage of flatus or stool after surgery in the SER group (27.9 ± 1.10 hours) is significantly shorter than the control group (32.3 ± 0.97, hours p= 0.004). Compared with the control group (5.52 (4.0-7.0)days), postoperative length of stay in the SER group was 4.90 (3.0-7.0)days (p= 0.009). As for low anterior resection score(LARS), the SER group had a lower score 1 week after discharge than the control group (p=0.034). However, 1 month after discharge, the LARS in the two groups had no significant difference. Conclusions: Self-administered succus entericus reinfusion is a feasible prehabilitation management for outpatients and can improve better outcomes. Compared with non-reinfusion group, succus enterius reinfusion group displays significantly shorter time for gastrointestinal function recovery and postoperative hospital stay without increasing complication, and it can bring better quality of life in a short term.

Outcomes of Emergent Incisional Hernia Repair

2011 ◽  
Vol 77 (8) ◽  
pp. 971-976 ◽  
Author(s):  
Laura K. Altom ◽  
Christopher W. Snyder ◽  
Stephen H. Gray ◽  
Laura A. Graham ◽  
Catherine C. Vick ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Incisional Hernia ◽  
Hernia Repair ◽  
Incisional Hernia Repair ◽  
Chronic Obstructive ◽  
Suture Repair ◽  
Obstructive Pulmonary Disease ◽  
Significant Difference ◽  
Postoperative Length

This study examines the effect of emergent repair on incisional hernia repair outcomes at 16 Veteran's Affairs Medical Centers between 1998 and 2002. Of the 1452 cases reviewed, 63 (4.3%) were repaired emergently. Patients undergoing emergent repair were older ( P = 0.02), more likely to be black ( P = 0.02), and have congestive heart failure ( P = 0.001) or chronic obstructive pulmonary disease ( P = 0.001). Of emergent repairs, 76.2 per cent involved intestinal incarceration versus 7.2 per cent of elective repairs ( P < 0.0001), and 17.5 per cent had concomitant bowel resection compared with 3.9 per cent of elective cases ( P < 0.0001). Patients undergoing emergent repair were also more likely to receive primary suture repair (49.2 vs 31.1%, P = 0.003), develop a postoperative complication (26.0 vs 11.3%, P = 0.002), and have increased postoperative length of stay (7 vs 4 days, P < 0.0001). There were nine (14.3%) deaths at 30 days for the emergent group compared with 10 (0.7%) in the elective group ( P < 0.001). However, there was no significant difference between emergent and elective repairs in long-term complications. Emergent hernia repair is associated with increased mortality rates, early complications, and longer length of stay; however, long-term outcomes are equivalent to elective cases. These data suggest that technical outcomes for emergent repairs approach those of elective operations.

scholarly journals STARR surgery in treatment of SRUS: an observational study on clinical outcomes

2018 ◽  
Vol 5 (2) ◽  
pp. 507
Author(s):  
Ashwin Porwal ◽  
Paresh Gandhi ◽  
Deepak Kulkarni
Keyword(s):  
Length Of Stay ◽  
Staple Line ◽  
Average Length ◽  
Cost Effective ◽  
Excessive Bleeding ◽  
Patient’S Satisfaction ◽  
Average Length Of Stay ◽  
Post Surgery ◽  
Postoperative Length ◽  
History Of

Background: SRUS is a condition with inadequately learned pathogenesis and usually associated with disorders of pelvic floor. Commonly seen in young adults and impairs quality of life. Because of these facts the management of SRUS is difficult and there is no clear consensus over it.Methods: An observational, prospective study was planned at a single center with purposive sampling. All clinically diagnosed, histologically and endoscopically confirmed SRUS patients treated with STARR surgery and followed for two years. Data collected and analyzed to evaluate the effectiveness and patients satisfaction.Results: Total of 46 patients with median age 47.8 years; of which 27 (58.70%) were females underwent STARR surgery. The average procedure time was 40 minutes, average length of stay was 24 hours and minimum duration of follow up was about 2 years (range 2-4 years). All patients had a pre-surgery history of digitations, which resolved in 91.3% patients post-surgery. There was a significant improvement in the ODS scores at the end of 2 years (82%; P <0.001). Excessive bleeding from staple line (48.57%), staple line dehiscence in 34.28% and staple line stricture (15.71% all males) are complications observed. No recurrence reported at the end of 4 years.Conclusions: Short postoperative length of stay and the short time to return to work after the STARR procedure for management SRUS, minimal manageable complications, no recurrence and patient’s satisfaction makes STARR a cost-effective procedure. 

scholarly journals Prolonged length of stay (PLOS) in a high-volume arthroplasty unit

2020 ◽  
Vol 1 (8) ◽  
pp. 488-493
Author(s):  
Hean Wu Kang ◽  
Leeann Bryce ◽  
Roslyn Cassidy ◽  
Janet Catherine Hill ◽  
Owen Diamond ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Social Services ◽  
Enhanced Recovery ◽  
High Volume ◽  
Prolonged Length ◽  
Discharge Plan ◽  
Postoperative Length ◽  
Bed Days ◽  
The Mean ◽  
Day Of Surgery Admission

Introduction The enhanced recovery after surgery (ERAS) concept in arthroplasty surgery has led to a reduction in postoperative length of stay in recent years. Patients with prolonged length of stay (PLOS) add to the burden of a strained NHS. Our aim was to identify the main reasons. Methods A PLOS was arbitrarily defined as an inpatient hospital stay of four days or longer from admission date. A total of 2,000 consecutive arthroplasty patients between September 2017 and July 2018 were reviewed. Of these, 1,878 patients were included after exclusion criteria were applied. Notes for 524 PLOS patients were audited to determine predominant reasons for PLOS. Results The mean total length of stay was 4 days (1 to 42). The top three reasons for PLOS were social services, day-before-surgery admission, and slow to mobilize. Social services accounted for 1,224 excess bed days, almost half (49.2%, 1,224/2,489) of the sum of excess bed days. Conclusion A preadmission discharge plan, plus day of surgery admission and mobilization on the day of surgery, would have the potential to significantly reduce length of stay without compromising patient care. Cite this article: Bone Joint Open 2020;1-8:488–493.

scholarly journals Analisa Biaya Pengobatan Demam Tifoid Berdasarkan Clinical Pathway Di Rumah Sakit Harapan Bunda

2019 ◽  
Vol 13 (2) ◽  
Author(s):  
Pieter Hazmen ◽  
Shirly Kumala ◽  
Prih Sarnianto
Keyword(s):  
Length Of Stay ◽  
Typhoid Fever ◽  
Clinical Pathway ◽  
Clinical Pathways ◽  
High Volume ◽  
Antibiotic Use ◽  
Observational Research ◽  
Cost Of Treatment ◽  
Significant Difference ◽  
The Cost

Clinical pathways are used in quality and cost control with indicators of length of stay. Cases of typhoid fever at Harapan Bunda Hospital include the criteria for the first rank of High Volume in 2018 and Problem Prone in the cost of treatment. The purpose of the study is to analyze the cost of treatment based on the implementation of clinical pathways in antibiotic therapy. Observational research with comparative studies of the use of injection antibiotics based on clinical pathway implementation. Retrospective data collection with dependent outcome therapy variables (cost and length of stay) while the independent variable regimen of antibiotic use. The population of typhoid fever patients according to the criteria for the implementation of clinical pathway ICD code (A0.10) 571 patients. Samples using total sampling that fulfills the criteria of direct inclusion are made into samples divided by the antibiotic regimen of the payment system, the group with the least amount excluded. There were 4 observation groups: generic ceftriaxone (n = 52) branded ceftriaxone (n = 51), generic cefotaxime (n = 53) and branded cefotaxime (n = 57) totaling 213 patients. Satatistic test results of length of stay (p> 0.05) explained that they did not have a significant difference, the average value (5.1596). Medical expenses for generic cefotaxime (Rp 4,072,002,6792), generic cherryax (Rp 4,479,480,4808), branded cefotaxime (Rp 6,945,258,3333) and branded ceftriaxone (Rp 7,296,933,5686). Conclusions based on JKN (AMiB) antibiotic payment systems are cheaper than general and the cheapest cefotaxime cheapest generic antibiotics.

scholarly journals The Safety of Bilateral Simultaneous Hip and Knee Arthroplasty versus Staged Arthroplasty in a High-Volume Center Comparing Blood Loss, Peri- and Postoperative Complications, and Early Functional Outcome

2021 ◽  
Vol 10 (19) ◽  
pp. 4507
Author(s):  
Michael Najfeld ◽  
Thomas Kalteis ◽  
Christian Spiegler ◽  
Christophe Ley ◽  
Robert Hube
Keyword(s):  
Length Of Stay ◽  
Functional Outcome ◽  
Knee Arthroplasty ◽  
High Volume ◽  
Transfusion Rate ◽  
Early Functional Outcome ◽  
Significant Difference ◽  
Hip And Knee Arthroplasty ◽  
High Volume Center ◽  
Hemoglobin Drop

Purpose: In recent years, there has been increasing interest in the use of simultaneous hip and knee arthroplasty compared to staged procedures in patients with bilateral pathology. The aim of this study was to compare simultaneous and staged hip and knee arthroplasty in patients with bilateral pathology by assessing the transfusion rate, postoperative hemoglobin drop, length of stay (LOS), in-hospital complications, 30-day readmissions and early functional outcome. Methods: We conducted a retrospective cohort study that included all patients who were undergoing primary TKA, THA and UKA by a single surgeon in a high-volume arthroplasty center between 2015 and 2020 as simultaneous or staged procedures. Staged bilateral arthroplasties were performed within 12 months and were stratified by the time between procedures. Data were acquired through the electronic files at the Orthopädische Chirurgie München (OCM). For functional outcome, the ability of the patients to walk independently on the ward was compared with the ability to walk a set of stairs alone, which was recorded daily by the attending physiotherapist. Results: In total n = 305 patients were assessed for eligibility and included in this study. One hundred and forty-five patients were allocated to the staged arthroplasty group. This group was subdivided into a hip and a knee group, whereas the knee group was split into TKA and UKA. The second staged procedure was performed within 12 months of the first procedure. One hundred and sixty patients were allocated to the simultaneous arthroplasty group. This group was also subdivided into a hip and knee group, whereas the knee group was split again into a TKA and UKA group. No statistical difference was found between the two groups regarding demographic data. Primary outcome measurements: There was no significant difference in the transfusion rate or complication rate. Secondarily, no statistically significant difference was found between the postoperative hemoglobin drop and the functional outcome, or in the length of stay (LOS) between both groups. Walking the stairs showed a significant difference in the knee group. Conclusions: There were no significant differences observed in the transfusion rate in-hospital complications, or readmission rate between both groups. The early functional outcome showed no significant difference in mobility for all groups. Simultaneous arthroplasty for knee or hip is as safe as a staged procedure, with no higher risk for the patient, in a specialized high-volume center. Level of evidence: Level IV.

scholarly journals LO54: A descriptive analysis of ED length of stay of admitted patients ‘boarded’ in the emergency department

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S46
Author(s):  
L. Salehi ◽  
P. Phalpher ◽  
R. Valani
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Descriptive Analysis ◽  
High Volume ◽  
Increased Risk ◽  
Significant Difference ◽  
Ed Overcrowding ◽  
Day Of The Week ◽  
The Mean ◽  
The Impact

Introduction: Previous studies have shown a link between Emergency Department (ED) overcrowding and worse clinical outcomes, increased risk of in-hospital mortality, higher costs, and longer times to treatment. Prolonged ED Length of Stay (LoS) of admitted patients awaiting a bed on in-patient units has been identified as a major driver of ED overcrowding. The purpose of this study is to provide a descriptive analysis of ED LoS among admitted patients, and determine the impact of prolonged ED LoS on total hospital in-patient length of stay (IP LoS). Methods: We conducted a single-site retrospective study for the period between January 1-December 31, 2015 at a very high volume community hospital. All patients aged ≥18 years admitted from the ED to acute in-patient Medicine units were identified. We carried out overall descriptive analysis (including analysis of day-of-the-week variability) on ED LoS. The mean total IP LoS for those patients with ED LoS&lt;12 hours, 12-24 hours, and ≥24 hours were calculated and analyzed using ANOVA and Tukey HSD tests. Results: A total of 6,961 individuals were admitted to the medical units over the 12-month period. The median and mean ED LoS for admitted patients were 22.9 hrs (IQR: 13.9 hrs- 33.1 hrs) and 25.6 hrs respectively. Using ANOVA, there was a statistically significant difference in means of ED LoS as a function of the day of the week (p&lt;0.0001), with Mondays having the highest mean ED LoS (27.6 hrs), and Fridays having the lowest (23.1 hrs). The mean IP LoS for those with ED LoS&lt;12 hours, 12-24 hours, and ≥24 hours, were 6.8 days, 6.9 days, and 8.5 days respectively, with a statistically significant difference between group means (p&lt;0.0001). Multiple pairwise comparisons of group means showed a statistically significant (p&lt;0.05) difference between mean IP LOS of those with an EDLOS≥24 hours and those with an EDLOS&lt;24 hours. Conclusion: Preliminary results indicate that ED LoS≥24 hours among admitted patients was associated with an increase in total IP LoS.*In the next 1-2 months, we intend to explore the role of other independent variables (age, sex, comorbidity, isolation status, and telemetry) on total ED LoS, and its association with IP LoS.

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