Length of hospital stay and dementia: A systematic review of observational studies

Abstract Esophagectomy has high morbidity and mortality, mainly due to pulmonary complications. Consequently, ventilatory support is a cornerstone in postoperative management. However, there is still no consensus on the timing for extubation. There is a fear that untimely extubation would lead to a high risk for an urgent reintubation. On the other hand, there is a risk for pulmonary damage in prolonged intubation. Thus, the present study aimed to compare early and late extubation after esophagectomy. Methods A systematic review was carried out on PubMed, Lilacs, Cochrane Library Central, and Embase, comparing early and late extubation after esophagectomy. The primary outcome was reintubation. Secondary outcomes included mortality; complications; pulmonary complications; pneumonia; anastomotic fistula; length of hospital stay; and ICU length of stay. The inclusion criteria were: a) clinical trials and cohort studies; b) adult patients (> 18 years); and c) patients with esophageal cancer undergoing esophagectomy. The results were summarized by risk difference and mean difference. 95% confidence interval and random model were applied. Results Four articles were selected, comprising 490 patients. Early extubation did not increase the risk for reintubation, with a risk difference of 0.01 (95%CI -0.03; 0.04). Also, there was no difference for mortality −0.01 (95%CI -0.04; 0.03); complications −0.09 (95%CI -0.22; 0.05); pulmonary complications −0.05 (95%CI -0.13; 0.03); pneumonia −0.06 (95% CI-0.18; 0.05); anastomotic fistula −0.01 (95% CI -0.09; 0.08). In addition, there was no significant mean difference for: length of hospital stay −0.10 (95%CI -0.38; 0.1); and ICU length of stay 0.00 (95%CI -0.22; 0.22). Conclusion Early extubation after esophagectomy does not increase the risk for reintubation, mortality, complications, and lenght of stay.

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Haemostatic devices in parotid surgery: a systematic review

The Journal of Laryngology & Otology ◽

10.1017/s0022215121001973 ◽

2021 ◽

pp. 1-7

Author(s):

L Allen ◽

C MacKay ◽

M H Rigby ◽

J Trites ◽

S M Taylor

Keyword(s):

Systematic Review ◽

Blood Loss ◽

Facial Nerve ◽

Hospital Stay ◽

Outcome Measures ◽

Meta Analysis ◽

Operating Time ◽

Length Of Hospital Stay ◽

Operative Blood Loss ◽

Parotid Surgery

Abstract Objective The Harmonic Scalpel and Ligasure (Covidien) devices are commonly used in head and neck surgery. Parotidectomy is a complex and intricate surgery that requires careful dissection of the facial nerve. This study aimed to compare surgical outcomes in parotidectomy using these haemostatic devices with traditional scalpel and cautery. Method A systematic review of the literature was performed with subsequent meta-analysis of seven studies that compared the use of haemostatic devices to traditional scalpel and cautery in parotidectomy. Outcome measures included: temporary facial paresis, operating time, intra-operative blood loss, post-operative drain output and length of hospital stay. Results A total of 7 studies representing 675 patients were identified: 372 patients were treated with haemostatic devices, and 303 patients were treated with scalpel and cautery. Statistically significant outcomes favouring the use of haemostatic devices included operating time, intra-operative blood loss and post-operative drain output. Outcome measures that did not favour either treatment included facial nerve paresis and length of hospital stay. Conclusion Overall, haemostatic devices were found to reduce operating time, intra-operative blood loss and post-operative drain output.

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Nonoperative treatment for nonperforated appendicitis in children: a systematic review and meta-analysis

Pediatric Surgery International ◽

10.1007/s00383-019-04610-1 ◽

2019 ◽

Vol 36 (3) ◽

pp. 261-269 ◽

Cited By ~ 3

Author(s):

Sonia Maita ◽

Björn Andersson ◽

Jan F. Svensson ◽

Tomas Wester

Keyword(s):

Systematic Review ◽

Acute Appendicitis ◽

Hospital Stay ◽

Meta Analysis ◽

Length Of Hospital Stay ◽

Nonoperative Treatment ◽

Controlled Study ◽

Randomized Controlled ◽

Search Terms ◽

Initial Hospital

AbstractAcute appendicitis is the most common surgical emergency in children. Nonoperative treatment of nonperforated acute appendicitis in children is an alternative to appendectomy. The purpose of this systematic review and meta-analysis was to determine the outcomes of nonoperative treatment of nonperforated acute appendicitis in children in the literature. Databases were searched to identify abstracts, using predefined search terms. The abstracts were reviewed by two independent reviewers and articles were selected according to inclusion and exclusion criteria. Data were extracted by the two reviewers and analyzed. The literature search yielded 2743 abstracts. Twenty-one articles were selected for analysis. The study design was heterogenous, with only one randomized controlled study. The symptoms resolved in 92% [95% CI (88; 96)] of the nonoperatively treated patients. Meta-analysis showed that an additional 16% (95% CI 10; 22) of patients underwent appendectomy after discharge from initial hospital stay. Complications and length of hospital stay was not different among patients treated with antibiotics compared with those who underwent appendectomy. Nonoperative treatment of nonperforated acute appendicitis children is safe and efficient. There is a lack of large randomized controlled trials to compare outcomes of nonoperative treatment with appendectomy.

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Is Endoscopic Discectomy the Next Gold Standard in the Management of Lumbar Disc Disease? Systematic Review and Superiority Analysis

Global Spine Journal ◽

10.1177/2192568220948814 ◽

2020 ◽

pp. 219256822094881

Author(s):

Sathish Muthu ◽

Eswar Ramakrishnan ◽

Girinivasan Chellamuthu

Keyword(s):

Systematic Review ◽

Hospital Stay ◽

Gold Standard ◽

Lumbar Disc ◽

Meta Analysis ◽

Length Of Hospital Stay ◽

Disc Disease ◽

Lumbar Disc Disease ◽

Endoscopic Discectomy ◽

Duration Of Surgery

Study Design: Systematic review and meta-analysis. Objectives: We performed this meta-analysis to evaluate whether endoscopic discectomy (ED) shows superiority compared with the current gold standard of microdiscectomy (MD) in management of lumbar disc disease. Materials and Methods: We conducted independent and duplicate electronic database search including PubMed, Embase, and Cochrane Library from 1990 till April 2020 for studies comparing ED and MD in the management of lumbar disc disease. Analysis was performed in R platform using OpenMeta[Analyst] software. Results: We included 27 studies, including 11 randomized controlled trials (RCTs), 7 nonrandomized prospective, and 9 retrospective studies involving 4018 patients in the meta-analysis. We stratified the results based on the study design. Considering the heterogeneity in some results between study designs, we weighed our conclusion essentially based on results of RCTs. On analyzing the RCTs, superiority was established at 95% confidence interval for ED compared with MD in terms of functional outcomes like Oswestry Disability Index (ODI) score ( P = .008), duration of surgery ( P = .023), and length of hospital stay ( P < .001) although significant heterogeneity was noted. Similarly, noninferiority to MD was established by ED in other outcomes like visual analogue scale score for back pain ( P = .860) and leg pain ( P = .495), MacNab classification ( P = .097), recurrences ( P = .993), reoperations ( P = .740), and return-to-work period ( P = .748). Conclusion: Our meta-analysis established the superiority of endoscopic discectomy in outcome measures like ODI score, duration of surgery, overall complications, length of hospital stay and noninferiority in other measures analyzed. With recent advances in the field of ED, the procedure has the potential to take over the place of MD as the gold standard of care in management of lumbar disc disease.

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Laparoscopic versus open surgical approach of cholecystectomy in patients with symptomatic cholelithiasis: a systematic review of comparative trials

International Journal of Scientific Reports ◽

10.18203/issn.2454-2156.intjscirep20210545 ◽

2021 ◽

Vol 7 (3) ◽

pp. 167

Author(s):

Omer A. Marzoug

Keyword(s):

Systematic Review ◽

Hospital Stay ◽

Operative Time ◽

Open Cholecystectomy ◽

Laparoscopic Approach ◽

Length Of Hospital Stay ◽

P Value ◽

Symptomatic Cholelithiasis ◽

Pain Duration ◽

Comparative Trials

<p class="abstract">Symptomatic cholelithiasis (gallstone disease) is the most common biliary pathology that affects women predominantly around the world. Earlier open cholecystectomy was the gold standard of treatment of this disease before introduction of laparoscopic cholecystectomy. The aim of this study is to systematically review the most recent published data that compared laparoscopic with open cholecystectomy in symptomatic cholelithiasis in terms of operative and post-operative morbidity, mortality, operative time, length of hospital stay, and conversion rates. The Medline, Cochrane library, Embase, and PubMed databases were vigorously searched for trials that compared laparoscopic with open cholectstectomy in patients with symptomatic cholelithiasis, a systematic review of these comparative trials was performed. No mortality was detected in both groups; the conversion rate was 6.75%. The laparoscopic approach associated with significantly shorter hospital stay (2.31 versus 4.42 days, p value>0.001), lower post-operative pain duration (30.5 versus 66.9 hours, p value>0.001) and lower rate of post-operative wound infection (2.8% versus 10.5%, p value>0.001). Regarding operative time it was significantly longer in laparoscopic approach (77.3 versus 67.1 min, p value>0.001), there were no significant differences in the rates of bile duct injury (0.84% versus 0.25%, p value=0.08) and intra-operative bleeding (4.2% versus 3.5%, p value=0.81) between the two procedures. Post-operative wound infection and pain duration in addition to length of hospital stay in patients with symptomatic cholelithiasis were reduced with laparoscopic cholecystectomy. However, the laparoscopic approach associated with longer duration of surgery. No significant differences between the two procedures in the rates of bile duct injury and intra-operative bleeding.</p>

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Efficacy and safety of abdominal paracentesis drainage on patients with acute pancreatitis: a systematic review and meta-analysis

BMJ Open ◽

10.1136/bmjopen-2020-045031 ◽

2021 ◽

Vol 11 (8) ◽

pp. e045031

Author(s):

Zongqing Lu ◽

Xingxing Zhu ◽

Tianfeng Hua ◽

Jin Zhang ◽

Wenyan Xiao ◽

...

Keyword(s):

Systematic Review ◽

Acute Pancreatitis ◽

Cohort Studies ◽

Hospital Stay ◽

Meta Analysis ◽

Length Of Hospital Stay ◽

Infectious Complications ◽

Efficacy And Safety ◽

All Cause Mortality ◽

Abdominal Paracentesis

ObjectivesTo conduct a systematic review and meta-analysis of the efficacy and safety of abdominal paracentesis drainage (APD) in patients with acute pancreatitis (AP) when compared with conventional ‘step-up’ strategy based on percutaneous catheter drainage (PCD).DesignSystematic review and meta-analysis.MethodsPubMed, EMBASE, Cochrane Library, MEDLINE (OVID), China National Knowledge Infrastructure and Wanfang Database were electronically searched to collect cohort studies and randomised controlled trials (RCTs) from inception to 25 July 2020. Studies related to comparing APD with conventional ‘step-up’ strategy based on PCD were included.OutcomesThe primary outcome was all-cause mortality. The secondary outcomes were the rate of organ dysfunction, infectious complications, hospitalisation expenses and length of hospital stay.ResultsFive cohort studies and three RCTs were included in the analysis. Compared with the conventional ‘step-up’ method, pooled results suggested APD significantly decreased all-cause mortality during hospitalisation (cohort studies: OR 0.48, 95% CI 0.26 to 0.89 and p=0.02), length of hospital stay (cohort studies: standard mean difference (SMD) −0.31, 95% CI −0.53 to –0.10 and p=0.005; RCTs: SMD −0.45, 95% CI −0.64 to –0.26 and p<0.001) and hospitalisation expenses (cohort studies: SMD −2.49, 95% CI −4.46 to –0.51 and p<0.001; RCTs: SMD −0.67, 95% CI −0.89 to –0.44 and p<0.001). There was no evidence to prove that APD was associated with a higher incidence of infectious complications. However, the incidence of organ dysfunction between cohort studies and RCTs subgroup slightly differed (cohort studies: OR 0.66, 95% CI 0.34 to 1.28 and p=0.22; RCTs: OR 0.58, 95% CI 0.35 to 0.98 and p=0.04).ConclusionsThe findings suggest that early application of APD in patients with AP is associated with reduced all-cause mortality, expenses during hospitalisation and the length of stay compared with the ‘step-up’ strategy without significantly increasing the risk of infectious complications. These results must be interpreted with caution because of the limited number of included studies as well as a larger dependence on observational trials.PROSPERO registration numberCRD42020168537.

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Impact of dietary protein supplementation on length of hospital stay and mortality in older adults: A systematic review and meta-analysis

Clinical Nutrition ◽

10.1016/j.clnu.2018.09.003 ◽

2018 ◽

Vol 37 ◽

pp. S336

Author(s):

J. Verstappen ◽

C. van Dronkelaar ◽

M. Streppel ◽

M. Tieland ◽

G. Biolo ◽

...

Keyword(s):

Systematic Review ◽

Older Adults ◽

Hospital Stay ◽

Dietary Protein ◽

Meta Analysis ◽

Length Of Hospital Stay ◽

Protein Supplementation

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Efficacy of probiotics in the prevention of VAP in critically ill ICU patients: an updated systematic review and meta-analysis of randomized control trials

Journal of Intensive Care ◽

10.1186/s40560-020-00487-8 ◽

2020 ◽

Vol 8 (1) ◽

Author(s):

Priyam Batra ◽

Kapil Dev Soni ◽

Purva Mathur

Keyword(s):

Systematic Review ◽

Mechanical Ventilation ◽

Hospital Mortality ◽

Hospital Stay ◽

Critically Ill ◽

Meta Analysis ◽

Length Of Hospital Stay ◽

Mean Difference ◽

Icu Stay ◽

Length Of Icu Stay

Abstract Introduction Ventilator-associated pneumonia (VAP) is reported as the second most common nosocomial infection among critically ill patients with the incidence ranging from 2 to 16 episodes per 1000 ventilator days. The use of probiotics has been shown to have a promising effect in many RCTs. Our systematic review and meta-analysis were thus planned to determine the effect of probiotic use in critically ill ventilated adult patients on the incidence of VAP, length of hospital stay, length of ICU stay, duration of mechanical ventilation, the incidence of diarrhea, and the incidence of oropharyngeal colonization and in-hospital mortality. Methodology Systematic search of various databases (such as Embase, Cochrane, and Pubmed), published journals, clinical trials, and abstracts of the various major conferences were made to obtain the RCTs which compare probiotics with placebo for VAP prevention. The results were expressed as risk ratios or mean differences. Data synthesis was done using statistical software - Review Manager (RevMan) Version 5.4 (The Cochrane Collaboration, 2020). Results Nine studies met our inclusion criterion and were included in the meta-analysis. The incidence of VAP (risk ratio: 0.70, CI 0.56, 0.88; P = 0.002; I2 = 37%), duration of mechanical ventilation (mean difference −3.75, CI −6.93, −0.58; P 0.02; I2 = 96%), length of ICU stay (mean difference −4.20, CI −6.73, −1.66; P = 0.001; I2 = 84%) and in-hospital mortality (OR 0.73, CI 0.54, 0.98; P = 0.04; I2 = 0%) in the probiotic group was significantly lower than that in the control group. Probiotic administration was not associated with a statistically significant reduction in length of hospital stay (MD −1.94, CI −7.17, 3.28; P = 0.47; I2 = 88%), incidence of oro-pharyngeal colonization (OR 0.59, CI 0.33, 1.04; P = 0.07; I2 = 69%), and incidence of diarrhea (OR 0.59, CI 0.34, 1.03; P = 0.06; I2 = 38%). Discussion Our meta-analysis shows that probiotic administration has a promising role in lowering the incidence of VAP, the duration of mechanical ventilation, length of ICU stay, and in-hospital mortality.

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