Intrinsic predictors of prolonged length of stay in a colorectal enhanced recovery pathway: a prospective cohort study and multivariate analysis

2019 ◽  
Vol 21 (9) ◽  
pp. 1079-1089
Author(s):  
J. van Dellen ◽  
E.A. Carapeti ◽  
A.A. Darakhshan ◽  
V. Datta ◽  
M.L. George ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Cohort Study ◽  
Length Of Stay ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Enhanced Recovery ◽  
Enhanced Recovery Pathway ◽  
Prolonged Length

Decline in nutritional status is associated with prolonged length of stay in hospitalized patients admitted for 7 days or more: A prospective cohort study

2016 ◽  
Vol 35 (1) ◽  
pp. 144-152 ◽  
Author(s):  
Johane P. Allard ◽  
Heather Keller ◽  
Khursheed N. Jeejeebhoy ◽  
Manon Laporte ◽  
Don R. Duerksen ◽  
...  
Keyword(s):  
Cohort Study ◽  
Length Of Stay ◽  
Nutritional Status ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Hospitalized Patients ◽  
Prolonged Length

scholarly journals Safety and feasibility of an enhanced recovery pathway after a liver resection: prospective cohort study

HPB ◽  
2015 ◽  
Vol 17 (8) ◽  
pp. 700-706 ◽  
Author(s):  
Bobby V.M. Dasari ◽  
Rasha Rahman ◽  
Shakeeb Khan ◽  
Davinia Bennett ◽  
James Hodson ◽  
...  
Keyword(s):  
Cohort Study ◽  
Liver Resection ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Enhanced Recovery ◽  
Enhanced Recovery Pathway

scholarly journals Fast-Track Liver Transplantation: Six-year Prospective Cohort Study with an Enhanced Recovery After Surgery (ERAS) Protocol

2021 ◽  
Author(s):  
Gonzalo P. Rodríguez-Laiz ◽  
Paola Melgar-Requena ◽  
Cándido F. Alcázar-López ◽  
Mariano Franco-Campello ◽  
Celia Villodre-Tudela ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Cohort Study ◽  
Length Of Stay ◽  
Liver Transplant ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Fast Track ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Fluid Restriction

Abstract Introduction Enhanced recovery after surgery (ERAS) has been shown to facilitate discharge, decrease length of stay, improve outcomes and reduce costs. We used this concept to design a comprehensive fast-track pathway (OR-to-discharge) before starting our liver transplant activity and then applied this protocol prospectively to every patient undergoing liver transplantation at our institution, monitoring the results periodically. We now report our first six years results. Patients and methods Prospective cohort study of all the liver transplants performed at our institution for the first six years. Balanced general anesthesia, fluid restriction, thromboelastometry, inferior vena cava preservation and temporary portocaval shunt were strategies common to all cases. Standard immunosuppression administered included steroids, tacrolimus (delayed in the setting of renal impairment, with basiliximab induction added) and mycophenolate mofetil. Tacrolimus dosing was adjusted using a Bayesian estimation methodology. Oral intake and ambulation were started early. Results A total of 240 transplants were performed in 236 patients (191♂/45♀) over 74 months, mean age 56.3±9.6 years, raw MELD score 15.5±7.7. Predominant etiologies were alcohol (n = 136) and HCV (n = 82), with hepatocellular carcinoma present in 129 (54.7%). Nine patients received combined liver and kidney transplants. The mean operating time was 315±64 min with cold ischemia times of 279±88 min. Thirty-one patients (13.1%) were transfused in the OR (2.4±1.2 units of PRBC). Extubation was immediate (< 30 min) in all but four patients. Median ICU length of stay was 12.7 hours, and median post-transplant hospital stay was 4 days (2-76) with 30 patients (13.8%) going home by day 2, 87 (39.9%) by day 3, and 133 (61%) by day 4, defining our fast-track group. Thirty-day-readmission rate (34.9%) was significantly lower (28.6% vs. 44.7% p=0.015) in the fast-track group. Patient survival was 86.8% at 1 year and 78.6% at five years. Conclusion Fast-Tracking of Liver Transplant patients is feasible and can be applied as the standard of care

scholarly journals Decreased calorie and protein intake is a risk factor for infection and prolonged length of stay in surgical patients: A prospective cohort study

2016 ◽  
Vol 29 (3) ◽  
pp. 307-316 ◽  
Author(s):  
Michelli Cristina Silva de ASSIS ◽  
Carla Rosane de Moraes SILVEIRA ◽  
Mariur Gomes BEGHETTO ◽  
Elza Daniel de MELLO
Keyword(s):  
Cohort Study ◽  
Length Of Stay ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Tertiary Care ◽  
Nutritional Therapy ◽  
University Hospital ◽  
Risk Of Infection ◽  
Prolonged Length ◽  
Increased Risk

ABSTRACT Objective The aim was to assess whether postoperative calorie and protein intakes increase the risk of infection and prolonged length of stay in a tertiary care university hospital in Southern Brazil. Methods This is a prospective cohort study approved by the hospital's Research Ethics Committee. The sample consisted of adult patients undergoing elective surgery. The exclusion criteria included patients who could not undergo nutritional assessment and those with a planned hospital stay of fewer than 72 hours. Nutritional status was assessed on admission and every seven days thereafter until hospital discharge or death. Demographic and clinical data, as well as information regarding independent and outcome variables, were collected from the patient's records. Food intake assessment was conducted by researchers six times a week. Calorie and protein intakes were considered adequate if equal to or greater than 75% of the prescribed amount, and length of stay was considered prolonged when above the average for specialty and type of surgery. Data was analyzed using Poisson regression. Results Of the 519 study patients, 16.2% had adequate nutritional therapy. Most of these patients were men with ischemic heart disease and acquired immunodeficiency syndrome. After adjusting for confounders, inadequate nutritional therapy increased risk of infection by 121.0% (RR=2.21; 95%CI=1.01-4.86) and risk of prolonged length of stay by 89.0% (RR=1.89; 95%CI=1.01-3.53). Conclusion Most patients did not have adequate nutritional therapy. Those with inadequate nutritional therapy had a higher risk of infection and longer length of stay.

scholarly journals Clinical outcomes of colistin in combination with either 6-g sulbactam or carbapenems for the treatment of extensively drug-resistant Acinetobacter baumannii pneumonia with high MIC to sulbactam, a prospective cohort study

2019 ◽  
Author(s):  
Chutchawan Ungthammakhun ◽  
Vasin Vasikasin ◽  
Dhitiwat Changpradub
Keyword(s):  
Cohort Study ◽  
Length Of Stay ◽  
Acinetobacter Baumannii ◽  
Clinical Outcomes ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Mortality Rates ◽  
P Value ◽  
Drug Resistant ◽  
Extensively Drug Resistant

Abstract Background: Extensively drug-resistant Acinetobacter baumannii (XDRAB) is an important cause of nosocomial pneumonia with limited therapeutic options. Colistin based regimen is recommended treatment. Which drugs should be combined with colistin remains uncertain. The aim of this study was to investigate the clinical outcomes of patients with XDRAB pneumonia who were treated with colistin, combined with either 6-g sulbactam or carbapenems, in the setting of high MIC to sulbactam. Methods: In this prospective cohort study, hospitalized patients diagnosed with XDRAB pneumonia in Phramongkutklao Hospital were enrolled. The primary outcome was the 28-day mortality. Secondary outcomes were 7 and 14-day mortality, length of stay, ventilator days and factors associated with mortality. Results: From 1 July 2016 to 30 September 2017, 192 patients were included; 92 received colistin plus sulbactam and 90 received colistin plus carbapenems. Most of the patients were male diagnosed with ventilator associated pneumonia in medical intensive care unit. Overall mortality rates at 7, 14, 28 days were 24.2%, 37.4%, 53.3%, respectively. Mortality rates did not differ between sulbactam group and carbapenems groups at 7 days (19.6% vs. 28.9%, p-value 0.424, adjusted HR 1.277; 95% CI = 0.702-2.322), 14 days (34.8% vs. 40%, p = 0.658, adjusted HR 1.109; 95% CI = 0.703-1.749) and 28 days (51.1% vs. 55.6%, p = 0.857, adjusted HR 1.038; 95% CI = 0.690-1.562). Length of stay, ICU days and ventilator days did not differ. Complications of treatment including acute kidney injury were not statistically different. Conclusions: In XDRAB pneumonia with high MIC to sulbactam, mortality rates were not statistically significant between colistin plus 6-g sulbactam and colistin plus carbapenems. Keywords: XDR A. baumannii pneumonia, mortality rate, colistin based, sulbactam, carbapenems

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