scholarly journals Pancreatic Fistula Following Pancreaticoduodenectomy: Clinical Predictors and Patient Outcomes

HPB Surgery ◽  
2009 ◽  
Vol 2009 ◽  
pp. 1-8 ◽  
Author(s):  
C. Max Schmidt ◽  
Jennifer Choi ◽  
Emilie S. Powell ◽  
Constantin T. Yiannoutsos ◽  
Nicholas J. Zyromski ◽  
...  
Keyword(s):  
Pancreatic Fistula ◽  
Tertiary Care ◽  
High Volume ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Endoscopic Stenting ◽  
Care Hospital ◽  
Clinical Predictors ◽  
Pancreatic Anastomosis ◽  
Septic Complications

Pancreatic fistula continues to be a common complication following PD. This study seeks to identify clinical factors which may predict pancreatic fistula (PF) and evaluate the effect of PF on outcomes following pancreaticoduodenectomy (PD). We performed a retrospective analysis of a clinical database at an academic tertiary care hospital with a high volume of pancreatic surgery. Five hundred ten consecutive patients underwent PD, and PF occurred in 46 patients (9%). Perioperative mortality of patients with PF was 0%. Forty-five of 46 PF (98%) closed without reoperation with a mean time to closure of 34 days. Patients who developed PF showed a higher incidence of wound infection, intra-abdominal abscess, need for reoperation, and hospital length of stay. Multivariate analysis demonstrated an invaginated pancreatic anastomosis and closed suction intraperitoneal drainage were associated with PF whereas a diagnosis of chronic pancreatitis and endoscopic stenting conferred protection. Development of PF following PD in this series was predicted by gender, preoperative stenting, pancreatic anastomotic technique, and pancreas pathology. Outcomes in patients with PF are remarkable for a higher rate of septic complications, longer hospital stays, but in this study, no increased mortality.

Abstract 101: Gender Differences in the Timing of Access to the Prehospital Phase of STEMI Care

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Robert O’Connor ◽  
Ross Megargel ◽  
Angela DiSabatino ◽  
William Weintrub ◽  
Charles Reese
Keyword(s):  
Gender Differences ◽  
Length Of Stay ◽  
Tertiary Care ◽  
Female Gender ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Symptom Duration ◽  
Care Hospital ◽  
Private Vehicle ◽  
Prehospital Management

Introduction : The purpose of this study is to determine the degree of gender differences in lay person recognition, emergency medical services (EMS) activation, and the prehospital management of STEMI. Methods : Data were gathered prospectively from May 1999 to January 2007 on consecutive patients with STEMI who presented to a tertiary care hospital emergency department. Patients arriving by ambulance and private vehicle were included. Data collection included determining symptom duration, whether a prehospital ECG was obtained, whether the cardiac interventional lab was activated prior to patient arrival at the hospital, patient age, and hospital length of stay. Prehospital activation of the cath lab was done by emergency medicine based on paramedic ECG interpretation in consultation with cardiology. Statistical analysis was performed using the Mann-Whitney U test, the Yates-corrected chi-square test, and linear regression. Results : A total of 3260 cases were studied, of which, 3097 had complete data for analysis. Only EMS cases were included in the ECG analysis, and only patients having a prehospital ECG were included in the prehospital activation of cath lab analysis. Regression analysis showed that older age and female gender were significant predictors of access and arrival by EMS. The mean age in years was higher for EMS arrival (69 women; 59 men) than for private vehicle (62 women; 56 men). Conclusion : Women with STEMI tend to use EMS more frequently then men, but are older and wait longer before seeking treatment. Whether these factors contribute to the longer length of stay remains to be determined.

Opioid Requirements in Laparoscopic Colectomies: Do Enhanced Recovery After Surgery Protocols Make a Difference?

2020 ◽  
pp. 000313482095631
Author(s):  
Samer Kawak ◽  
Joanna F. Wasvary ◽  
Matthew A. Ziegler
Keyword(s):  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Tertiary Care ◽  
Patient Characteristics ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Care Hospital ◽  
Pain Scores ◽  
Enhanced Recovery Pathways ◽  
Recovery Pathways

Background With the growing opioid epidemic and recent focus on the quantity of opioids prescribed at discharge after surgery, enhanced recovery pathways provide another tool to counteract this epidemic. The aim of this current study is to analyze the differences in opioid requirements and pain scores in the immediate postoperative period for patients who underwent laparoscopic colectomies before and after the implementation of enhanced recovery after surgery (ERAS) protocols. Materials and Methods This study is a retrospective review of patients and was conducted at an academically affiliated tertiary care hospital. In patients undergoing elective laparoscopic colectomies before December 1, 2013-July 31, 2015 and after September 1, 2015-May 31, 2018, the implementation of enhanced recovery pathways was included. The primary end point was opioid consumption from the end of surgery until 48 hours after surgery. Secondary end points included pain scores, surgery length of time, and hospital length of stay after surgery. Results A total of 242 patients (122 pre- and 120 postimplementation) were analyzed. Patient characteristics were similar between groups. Pain scores were higher in the preimplementation patients for postoperative day (POD) 0 scores ( P = .019). There was a decrease in the morphine milligram equivalents (MME) on POD 0-2 for the postimplementation patients. This decrease resulted in a 61% reduction in opioid requirements after implementation of ERAS protocols (32 vs. 12.5 MME, P < .0001). Discussion Enhanced recovery after surgery protocols can reduce opioid requirements after elective laparoscopic colectomies without negatively affecting pain scores.

scholarly journals Bronchiolitis: Can objective criteria predict eligibility for brief hospitalization?

CJEM ◽  
2003 ◽  
Vol 5 (04) ◽  
pp. 239-244 ◽  
Author(s):  
Lance Brown ◽  
David G. Reiley ◽  
Aaron Jeng ◽  
Steven M. Green
Keyword(s):  
Pulse Oximetry ◽  
Tertiary Care ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Predictor Variables ◽  
Care Hospital ◽  
Short Stay ◽  
Entire Study ◽  
Observation Units ◽  
Syncytial Virus

ABSTRACT Objective: To determine if 3 objective criteria – pulse oximetry, respiratory syncytial virus (RSV) testing, and age – could be used to predict which children hospitalized with bronchiolitis will have brief (&lt;36 hour) hospitalizations and therefore be potential candidates for admission to short-stay observation units. Methods: This was a retrospective medical record review of medically uncomplicated children 3 to 24 months of age with emergency department and hospital discharge diagnoses consistent with bronchiolitis who were admitted to a general pediatric ward in our university-based, tertiary care hospital between Jan. 1, 1992, and Nov. 12, 2002. Multiple logistic regression was used to assess the predictor variables. Results: Our study consisted of 225 patients (45% female) with a median age of 7 months (interquartile range [IQR], 4–11 mo; range, 3–22 mo). Median pulse oximetry value was 94% (IQR 91%–96%; range 76%–100%), and 71% of the patients tested positive for RSV. Thirty children (13%) had brief hospitalizations &lt;36 hours, and the median hospital length of stay for the entire study group was 70 hours (IQR 46–108 h; range 6–428 h). None of the 3 predictor variables were independently associated with brief hospitalization. Conclusions: Pulse oximetry, RSV testing and age do not predict which children will have brief hospitalizations and are appropriate candidates for admission to short-stay observation units.

scholarly journals Conjugate Eye Deviation on CT Associated With Worse Outcomes Despite IV Thrombolysis

2016 ◽  
Vol 7 (2) ◽  
pp. 74-77 ◽  
Author(s):  
Nirav H. Shah ◽  
Nirav Bhatt ◽  
Anita Tipirneni ◽  
Diego Condes ◽  
Priyank Khandelwal ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Vascular Occlusion ◽  
Hospital Length ◽  
Large Vessel ◽  
Hospital Length Of Stay ◽  
Care Hospital ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Intravenous Tissue Plasminogen Activator ◽  
Iv Tpa

Introduction: Rapid stroke management has significant implications in patient outcomes. Ipsilateral computed tomography conjugate eye deviation (CT-CED) has been associated with worse outcomes but has never been evaluated as predictive of vascular occlusion. To test the hypothesis that CT-CED is a marker for vascular occlusion, we evaluated patients treated with intravenous tissue plasminogen activator (IV tPA). Methods: We performed a retrospective analysis of patients with acute ischemic stroke treated with IV tPA at a large tertiary care hospital over an 18-month period. A waiver of informed consent was granted. Two examiners evaluated baseline brain CTs blinded to the location of infarct to assess the presence of CT-CED and follow-up imaging for the location of infarct and the presence of intracranial large vessel occlusion. Demographics, initial National Institutes of Health Stroke Scale (NIHSS), modified Rankin Scales (mRSs), and hospital length of stay (LOS) were collected. Results: Among 104 patients treated with IV tPA, 36 had CT-CED. Inter-rater reliability for CT-CED was excellent (κ = 0.97; 95% confidence interval: 0.98-1.0). The CT-CED group was older (69.8 vs 64 years; P = .038), had higher initial NIHSS (14.6 vs 11; P = .01), worse mRS (3.2 vs 2.4; P = .03), and longer LOS (8.4 vs 6.4; P = .05) compared with those without CT-CED. A vascular occlusion in the territory of the infarct was seen in 58% of patients with CT-CED versus 32% without CT-CED ( P < .01). Atrial fibrillation (AF) was diagnosed in 61% patients with CT-CED versus 22% without ( P < .01). Conclusion: The CT-CED is associated with higher initial NIHSS, large vessel occlusion, and AF. Prospective studies are needed to ascertain whether CT-CED may be utilized part of a screen for endovascular therapy.

scholarly journals Predictors of Disseminated Intravascular Coagulation in Patients with Septic Shock

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Diana J. Kelm ◽  
Juan Carlos Valerio-Rojas ◽  
Javier Cabello-Garza ◽  
Ognjen Gajic ◽  
Rodrigo Cartin-Ceba
Keyword(s):  
Septic Shock ◽  
Antiplatelet Therapy ◽  
Disseminated Intravascular Coagulation ◽  
Tertiary Care ◽  
Multivariate Logistic Regression Model ◽  
Care Hospital ◽  
Clinical Predictors ◽  
Intravascular Coagulation ◽  
Early Goal Directed Therapy ◽  
Increased Risk

Purpose. The goal of this study was to identify potential clinical predictors for the development of disseminated intravascular coagulation (DIC) in patients with septic shock. Material and Methods. We performed a retrospective analysis of a cohort of adult (>18 years of age) patients with septic shock admitted to a medical ICU in a tertiary care hospital from July 2005 until September 2007. A multivariate logistic regression model was used to determine the association of risk factors with overt DIC. Results. In this study, a total of 390 patients with septic shock were analyzed, of whom 66 (17%) developed overt DIC. Hospital mortality was significantly greater in patients who developed overt DIC (68% versus 38%, P<0.001). A delay in the timing of antibiotics was associated with an increased risk of the development of overt DIC (P<0.001). Patients on antiplatelet therapy prior to hospital admission and who that received adequate early goal-directed therapy (EGDT) were associated with a decreased risk of overt DIC (P<0.001). Conclusions. In our cohort of patients with septic shock, there was a risk reduction for overt DIC in patients on antiplatelet therapy and adequate EGDT, while there was an increased risk of DIC with antibiotic delay.

Five-Year Retrospective Review of Blunt Renal Injuries at a Level I Trauma Center

2017 ◽  
Vol 83 (2) ◽  
pp. 148-156 ◽  
Author(s):  
Jessica Burns ◽  
Megan Brown ◽  
Zakaria I. Assi ◽  
Eric J. Ferguson
Keyword(s):  
Renal Injury ◽  
Trauma Center ◽  
Injury Severity ◽  
Exploratory Laparotomy ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Free Fluid ◽  
Specific Information ◽  
Septic Complications ◽  
Level I

We report the experience of a Level I trauma center in the management of blunt renal injury during a 5-year period, with special attention to those treated using angiography with embolization. The institutional trauma registry was queried for all patients with blunt renal injury between September 1, 2009 and August 30, 2014. Each injury was graded using the American Association for the Surgery of Trauma guidelines. Patients that underwent angiography with embolization were reviewed for case-specific information including imaging findings, treatment, materials used, clinical course, and mortality. The registry identified 48 blunt renal injury patients. Median Injury Severity Score was higher and hospital length of stay was significantly longer in those with blunt renal injury when compared with those without blunt renal injury (P < 0.001). The majority of patients with blunt renal injury were managed nonoperatively. Mortality was three out of 48 patients (5%). Nine patients underwent exploratory laparotomy. These operations were always performed for reasons other than the renal trauma (e.g., splenic injury, free fluid, free air). No patient underwent invasive renal operation. Six patients were treated using angiography with embolization. Of the six, one patient died of pulmonary septic complications. We conclude that selective nonoperative management is the mainstay of treatment for blunt renal injury. Angiography with embolization is a useful modality for cases of ongoing bleeding, and is typically preferable to nephrectomy in our experience.

Adverse Events in Older Patients Admitted to Acute Care: A Preliminary Cost Description

2009 ◽  
Vol 22 (3) ◽  
pp. 32-36 ◽  
Author(s):  
Stacy Ackroyd-Stolarz ◽  
Judith Read Guernsey ◽  
Neil J. MacKinnon ◽  
George Kovacs
Keyword(s):  
Adverse Events ◽  
Older Patients ◽  
Tertiary Care ◽  
Care Facility ◽  
Hospital Length ◽  
Acute Hospital ◽  
Hospital Length Of Stay ◽  
Financial Costs ◽  
Tertiary Care Facility ◽  
Acute Hospital Admission

The financial costs associated with Adverse Events (AEs) for older patients (≥65 years) in Canadian hospitals are unknown. The objective of this paper is to describe and compare costs between patients who experienced an AE and those who did not during an acute hospital admission to a tertiary care facility Patients with an AE had twice the hospital length of stay (20.2 versus 9.8 days, p < 0.00001), resulting in 1,400 extra days at a cost of approximately $7,500/patient.

scholarly journals Characteristics and Outcomes of Critically Ill Patients with Raised Cardiac Troponins Admitted in the Intensive Care Unit

2021 ◽  
Author(s):  
Sunil K. Nadar ◽  
Muhammad M. Shaikh ◽  
Muhammad A. Khatri ◽  
Wael A. Abdelmottaleb ◽  
Sheeraz Ahmed ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Myocardial Injury ◽  
Tertiary Care ◽  
Hospital Length Of Stay ◽  
Care Hospital ◽  
Coronary Syndrome

Objectives: Critically ill patients have been shown to have raised troponins.  The aim of our study was to assess the incidence of myocardial injury in the intensive care unit (ICU) a tertiary care hospital in Oman and assess their management and prognosis. Methods: This was a retrospective study involving adult patients admitted to the ICU of our institution between 1st January and 31st December 2019 who had a high sensitive cardiac troponin (Hs-CTn) assay performed. We excluded patients who were admitted with a primary diagnosis of myocardial infarction. Results: A total of 264 patients had a Hs-cTn measured during this period. Of these 128 patients (64.3+17.1 years; 58.5% male) had elevated levels giving an incidence of around 48.4%. Those with raised troponin were older and had more co-morbidities. These patients were also more critical with lower blood pressure, higher heart rates, hypotensive episodes. Of the 128 patients, 47 were treated as acute coronary syndrome and 32 underwent coronary angiography. Of these only 3 patients required stenting. Patients with raised troponin had a poor outcome with only 45 (35.1%) surviving to discharge as compared to 73.5% where troponin was normal. They had a shorter hospital length of stay as compared to those with normal troponin (16(8-25) vs 19(13-28) p=0.017). Conclusion: A high proportion of critically ill patients have evidence of myocardial injury without significant coronary artery disease. It is associated with poor prognosis. Further prospective studies are required to ascertain the best mode of treatment in these patients. Keywords: Troponin; Biomarkers; Intensive Care; Myocardial Infarction.

Prevalence and predictors of hypocalcaemia in severe acute malnutrition

2020 ◽  
Vol 23 (17) ◽  
pp. 3181-3186
Author(s):  
Chabungbam Smilie ◽  
Dheeraj Shah ◽  
Prerna Batra ◽  
Rafat S Ahmed ◽  
Piyush Gupta
Keyword(s):  
Vitamin D ◽  
Severe Acute Malnutrition ◽  
Tertiary Care ◽  
Abdominal Distension ◽  
Cross Sectional Study ◽  
Acute Malnutrition ◽  
Care Hospital ◽  
Clinical Predictors ◽  
Cross Sectional ◽  
Malnourished Children

AbstractObjective:To determine the prevalence and predictors of hypocalcaemia in under-five children (1–59 months) hospitalised with severe acute malnutrition (SAM).Design:A cross-sectional study was designed to determine the prevalence of hypocalcaemia among children hospitalised with SAM. Serum Ca and 25-hydroxycholecalciferol (25-(OH)D) were estimated. Hypocalcaemia was defined as serum Ca (albumin-adjusted) <2·12 mmol/l. To identify the clinical predictors of hypocalcaemia, a logistic regression model was constructed taking hypocalcaemia as a dependent variable, and sociodemographic and clinical variables as independent variables.Setting:A tertiary care hospital in Delhi, between November 2017 and April 2019.Participants:One-hundred and fifty children (1–59 months) hospitalised with SAM were enrolled.Results:Hypocalcaemia was documented in thirty-nine (26 %) children hospitalised with SAM, the prevalence being comparable between children aged <6 months (11/41, 26·8 %) and those between 6 and 59 months (28/109, 25·7 %) (P = 0·887). Vitamin D deficiency (serum 25-(OH)D <30 nmol/l) and clinical rickets were observed in ninety-eight (65·3 %) and sixty-three (42 %) children, respectively. Hypocalcaemia occurred more frequently in severely malnourished children with clinical rickets (OR 6·6, 95 % CI 2·54, 17·15, P < 0·001), abdominal distension (OR 4·5, 95 % CI 1·39, 14·54, P = 0·012) and sepsis (OR 2·6, 95 % CI 1·00, 6·57, P = 0·050).Conclusion:Rickets and hypocalcaemia are common in children with SAM. Routine supplementation of vitamin D should be considered for severely malnourished children. Ca may be empirically prescribed to severely malnourished children with clinical rickets, abdominal distension and/or sepsis.

Sign in / Sign up

Export Citation Format

Share Document