Goal-Directed Intraoperative Therapy Reduces Morbidity and Length of Hospital Stay in High-Risk Surgical Patients

CHEST Journal ◽  
2007 ◽  
Vol 132 (6) ◽  
pp. 1817-1824 ◽  
Author(s):  
Abele Donati ◽  
Silvia Loggi ◽  
Jean-Charles Preiser ◽  
Giovanni Orsetti ◽  
Cristopher Münch ◽  
...  
Keyword(s):  
High Risk ◽  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Surgical Patients

scholarly journals Emergency Cholecystectomy Versus Percutaneous Cholecystostomy for Treatment of Acute Cholecystitis in High-Risk Surgical Patients

2019 ◽  
Vol 103 (11-12) ◽  
pp. 534-541
Author(s):  
Cevher Akarsu ◽  
Ahmet Cem Dural ◽  
Aysun Erbahceci Salik ◽  
Mustafa Gokhan Unsal ◽  
Osman Kones ◽  
...  
Keyword(s):  
High Risk ◽  
Hospital Stay ◽  
Acute Cholecystitis ◽  
Length Of Hospital Stay ◽  
Treatment Method ◽  
Surgical Patients ◽  
Percutaneous Cholecystostomy ◽  
High Risk Patients ◽  
Severity Scores ◽  
Risk Patients

Our aim is to present our experience with laparoscopic cholecystectomy (LC) and percutaneous cholecystostomy (PC) in high-risk patients with acute cholecystitis (AC). The guidelines for AC are still debatable for high-risk patients. We aimed to emphasize the role of LC as a primary treatment method in patients with severe AC instead of a treatment after PC according to the Tokyo Guidelines (TG). AC patients with high surgical risk [American Society of Anesthesiologists (ASA) III-IV] who were admitted to our department between March 2008 and November 2014 were retrospectively evaluated. Disease severity in all patients was assessed according to the 2007 TG for AC. Patients were either treated by emergency LC (group LC) or PC (group PC). Demographic data, ASA scores, treatment methods, rates of conversion to open surgery, duration of drainage, length of hospital stay, and morbidity and mortality rates were compared among groups. Age, ASA score, and TG07 severity scores in the PC group were significantly higher than that in the LC group (P < 0.001, P < 0.001, and P < 0.001, respectively). Sex distribution (P = 0.33), follow-up periods (P = 0.33), and morbidity (P = 0.86) were similar. In the patients with early surgical intervention, mortality was significantly lower (P < 0.001). Length of hospital stay was significantly shorter in the LC group compared with the PC group (P < 0.001). In high-risk surgical patients, PC can serve as an alternative treatment method because of its efficiency in the prevention of sepsis-related complications due to AC. However, LC still should be an option for severe AC with comparable short-term results.

scholarly journals EP.WE.782Retrospective analysis of acute surgical admissions during COVID-19 pandemic

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Shenbaga Rajamanikam ◽  
Suzzana Argyropoulos ◽  
Reza Arsalani Zadeh
Keyword(s):  
Length Of Stay ◽  
Hospital Stay ◽  
Surgical Procedures ◽  
Length Of Hospital Stay ◽  
Period Length ◽  
Surgical Patients ◽  
Surgical Team ◽  
Surgical Operations

Abstract Background COVID-19 pandemic has affected the number of surgical admissions and the number of emergency general surgical operations performed. COVID-19 pandemic has also led to changes in how some of the acute surgical patients were managed. Aim of the study was to compare acute surgical admissions and number of emergency general surgical procedures in this period. Material and Method We retrospectively analyzed acute surgical admissions during the pandemic from 20/3/20 to 19/4/20 and compared it with acute surgical admissions during pre-COVID-19 period from 1/11/2019 to 30/11/2019. Results During the COVID-19 pandemic 97 patients were assessed and admitted by the General surgical team, during the pre COVID-19 period 205 patients were assessed and admitted by the General surgical team. The number of acute surgical admissions during COVID-19 pandemic dropped by 53%. There were 46% less emergency surgeries performed during COVID 19 pandemic period. Length of stay during and before the COVID-19pandemic were 4.1 vs 4.4 days. Conclusion During the COVID-19 pandemic number of acute surgical admissions and the number of emergency surgeries were fewer than during pre COVID-19 pandemic. Length of hospital stay was less during COVID-19 pandemic.

Nutrition Status and Risk Factors Associated With Length of Hospital Stay for Surgical Patients

2010 ◽  
Vol 35 (2) ◽  
pp. 241-248 ◽  
Author(s):  
Vânia Aparecida Leandro-Merhi ◽  
José Luiz Braga de Aquino ◽  
José Francisco Sales Chagas
Keyword(s):  
Risk Factors ◽  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Surgical Patients ◽  
Nutrition Status ◽  
Factors Associated

Economic and Operational Implications of a Standardized Approach to Hemodynamic Support Therapy Using Percutaneous Cardiac Assist Devices

2014 ◽  
Vol 9 (1) ◽  
pp. 38-42 ◽  
Author(s):  
David Wohns ◽  
Purushothaman Muthusamy ◽  
Alan T. Davis ◽  
Mohsin Khan ◽  
Joseph K. Postma ◽  
...  
Keyword(s):  
High Risk ◽  
Hospital Stay ◽  
Resource Use ◽  
Length Of Hospital Stay ◽  
Coronary Intervention ◽  
Resource Consumption ◽  
Cardiac Assist ◽  
Hemodynamic Support ◽  
Episode Of Care ◽  
Cardiac Assist Devices

Objective Impella 2.5 has been shown to reduce major adverse events for patients undergoing elective high-risk percutaneous coronary intervention. We performed a single-center retrospective study to compare the costs and resource use of Impella 2.5 and intra-aortic balloon pump (IABP) support. Methods All high-risk patients who received Impella 2.5 (n = 35) and IABP (n = 295) support from December 2008 to July 2011 were included. Propensity score matching identified a balanced 1:1 matched cohort (35 Impella vs 35 IABP) based on indications for implantation, preimplantation hemodynamics, and age. Diagnostic, procedural, financial, and resource use data were collected. Results As compared with IABP, Impella offered a more predictable course of treatment/resource consumption and was not associated with any extreme cost outliers (17.1% vs 0.0%, respectively; P = 0.025). The mean admission and 90-day episode of care total costs for Impella were 5.5% ($67,681 vs $71,608, P = 0.79) and 4.2% ($70,680 vs $73,476, P = 0.85) lesser than that for IABP, respectively. Although not statistically significant, Impella patients had a trend toward lower rehospitalization rates (11.4% vs 20%), lesser mean index length of hospital stay (11.2 vs 13.7), and 90-day (11.7 vs 14.2) episode of care length of hospital stay. Conclusions Impella support was associated with consistent course of treatment/resource consumption with significantly fewer 90-day extreme cost outliers than was IABP. The lower index and 90-day follow-up cost trends observed for Impella were driven by shorter length of hospital stay and fewer rehospitalizations. As providers strive to improve quality of care by reducing variability, these findings have implications for the development of hemodynamic support algorithms.

scholarly journals Prognosis Score System to Predict Survival for COVID-19 Cases: a Korean Nationwide Cohort Study (Preprint)

2020 ◽  
Author(s):  
Sung-Yeon Cho ◽  
Sung-Soo Park ◽  
Min-Kyu Song ◽  
Young Yi Bae ◽  
Dong-Gun Lee ◽  
...  
Keyword(s):  
Overall Survival ◽  
Survival Rate ◽  
High Risk ◽  
Hospital Stay ◽  
Risk Score ◽  
Validation Cohort ◽  
Length Of Hospital Stay ◽  
Risk Groups ◽  
Prognosis Score ◽  
Very High

BACKGROUND As the COVID-19 pandemic continues, an initial risk-adapted allocation is crucial for managing medical resources and providing intensive care. OBJECTIVE In this study, we aimed to identify factors that predict the overall survival rate for COVID-19 cases and develop a COVID-19 prognosis score (COPS) system based on these factors. In addition, disease severity and the length of hospital stay for patients with COVID-19 were analyzed. METHODS We retrospectively analyzed a nationwide cohort of laboratory-confirmed COVID-19 cases between January and April 2020 in Korea. The cohort was split randomly into a development cohort and a validation cohort with a 2:1 ratio. In the development cohort (n=3729), we tried to identify factors associated with overall survival and develop a scoring system to predict the overall survival rate by using parameters identified by the Cox proportional hazard regression model with bootstrapping methods. In the validation cohort (n=1865), we evaluated the prediction accuracy using the area under the receiver operating characteristic curve. The score of each variable in the COPS system was rounded off following the log-scaled conversion of the adjusted hazard ratio. RESULTS Among the 5594 patients included in this analysis, 234 (4.2%) died after receiving a COVID-19 diagnosis. In the development cohort, six parameters were significantly related to poor overall survival: older age, dementia, chronic renal failure, dyspnea, mental disturbance, and absolute lymphocyte count &lt;1000/mm<sup>3</sup>. The following risk groups were formed: low-risk (score 0-2), intermediate-risk (score 3), high-risk (score 4), and very high-risk (score 5-7) groups. The COPS system yielded an area under the curve value of 0.918 for predicting the 14-day survival rate and 0.896 for predicting the 28-day survival rate in the validation cohort. Using the COPS system, 28-day survival rates were discriminatively estimated at 99.8%, 95.4%, 82.3%, and 55.1% in the low-risk, intermediate-risk, high-risk, and very high-risk groups, respectively, of the total cohort (<i>P</i>&lt;.001). The length of hospital stay and disease severity were directly associated with overall survival (<i>P</i>&lt;.001), and the hospital stay duration was significantly longer among survivors (mean 26.1, SD 10.7 days) than among nonsurvivors (mean 15.6, SD 13.3 days). CONCLUSIONS The newly developed predictive COPS system may assist in making risk-adapted decisions for the allocation of medical resources, including intensive care, during the COVID-19 pandemic.

scholarly journals Fluid type and volume reduce risk of post-ERCP pancreatitis and length of hospital stay in high-risk patients: a secondary analysis of the INDIEH trial

2020 ◽  
Vol 08 (07) ◽  
pp. E834-E839
Author(s):  
Rupjyoti Talukdar ◽  
Ayesha Kamal ◽  
Vikesh K. Singh ◽  
D. Nageshwar Reddy ◽  
Venkata S. Akshintala ◽  
...  
Keyword(s):  
High Risk ◽  
Hospital Stay ◽  
Controlled Trial ◽  
Secondary Analysis ◽  
Length Of Hospital Stay ◽  
Endoscopic Retrograde ◽  
High Risk Patients ◽  
Intravenous Fluid Administration ◽  
Risk Patients ◽  
Rectal Indomethacin

Abstract Background and study aims Impact of intravenous fluid administration on prophylaxis against post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) has not been rigorously evaluated among patients at high-risk for PEP. Patients and methods Effect of volume and type of fluid administered on PEP incidence was studied through a secondary analysis of high-risk patients who underwent endoscopic retrograde cholangopancreatography (ERCP) as a part of a randomized controlled trial in which all patients received rectal indomethacin. Periprocedural fluid was defined as fluid infused during and after ERCP. Results A total 960 patients were randomized during the trial, of whom 476 (49.6 %) received periprocedural fluids (mean volume = 1245 mL [± 629]). There was a trend towards a lower incidence of PEP in patients who received periprocedural fluid vs. those who did not (5.2 % vs. 8.0 %, P = 0.079). Among those receiving fluids, those who did not develop PEP received a higher mean volume of fluid vs. who developed PEP (1012 ± 725 mL vs. 752 ± 783 mL, P = 0.036). Among 174 patients (37 %) who received LR, patients who did not develop PEP received a higher mean volume of LR vs. those who developed PEP (570 ± 559 mL vs. 329 ± 356 mL, P = 0.006). Length of hospital stay decreased as the volume of periprocedural volume administration increased (r = 0.16, P < 0.001). Conclusion Higher fluid volume and lactated Ringerʼs use during the periprocedural period was associated with a decreased risk of PEP and length of hospital stay beyond rectal indomethacin in high risk patients.

scholarly journals Systematic review and meta-analysis of the association between frailty and outcome in surgical patients

2016 ◽  
Vol 98 (2) ◽  
pp. 80-85 ◽  
Author(s):  
K Oakland ◽  
R Nadler ◽  
L Cresswell ◽  
D Jackson ◽  
PA Coughlin
Keyword(s):  
Mortality Rate ◽  
Hospital Stay ◽  
Surgical Intervention ◽  
Discharge Rate ◽  
Meta Analysis ◽  
Length Of Hospital Stay ◽  
The Elderly ◽  
Surgical Patients ◽  
Step Down ◽  
One Year

Introduction Frailty is becoming increasingly prevalent in the elderly population although a lack of consensus regarding a clinical definition hampers comparison of clinical studies. More elderly patients are being assessed for surgical intervention but the effect of frailty on surgical related outcomes is still not clear. Methods A systematic literature search for studies prospectively reporting frailty and postoperative outcomes in patients undergoing surgical intervention was performed with data collated from a total of 12 studies. Random effects meta-analysis modelling was undertaken to estimate the association between frailty and mortality rates (in-hospital and one-year), length of hospital stay and the need for step-down care for further rehabilitation/nursing home placement. Results Frailty was associated with a higher in-hospital mortality rate (pooled odds ratio [OR]: 2.77, 95% confidence interval [CI]: 1.62–4.73), a higher one-year mortality rate (pooled OR: 1.99, 95% CI: 1.49–2.66), a longer hospital stay (pooled mean difference: 1.05 days, 95% CI: 0.02–2.07 days) and a higher discharge rate to further rehabilitation/step-down care (pooled OR: 5.71, 95% CI: 3.41–9.55). Conclusions The presence of frailty in patients undergoing surgical intervention is associated with poorer outcomes with regard to mortality and return to independence. Further in-depth studies are required to identify factors that can be optimised to reduce the burden of frailty in surgical patients.

PP108 NUTRITIONAL STATUS AND LENGTH OF HOSPITAL STAY FOR SURGICAL PATIENTS

2010 ◽  
Vol 5 (2) ◽  
pp. 65
Author(s):  
V.A. Leandro-Merhi ◽  
L.H. Villagelin ◽  
J.L.B. Aquino
Keyword(s):  
Nutritional Status ◽  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Surgical Patients
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