scholarly journals A simple size-tailored algorithm for the removal of chest drain following minimally invasive lobectomy: a prospective randomized study

2021 ◽  
Author(s):  
Davor Stamenovic ◽  
Michael Dusmet ◽  
Thomas Schneider ◽  
Eric Roessner ◽  
Antje Messerschmidt
Keyword(s):  
Hospital Stay ◽  
Current Practice ◽  
Randomized Study ◽  
Length Of Hospital Stay ◽  
Pleural Space ◽  
Chest Drain ◽  
Chest Drainage ◽  
Vats Lobectomy ◽  
Drain Removal ◽  
Registration Number

Abstract Background The pleural space can resorb 0.11–0.36 ml/kg of body weight/hour (h) per hemithorax. There are only a limited number of studies on thresholds for chest drain removal (CDR) and all are based on arbitrary amounts, for example, 300 ml/day. We studied an individualized size-based threshold for CDR–specifically 5 ml/kg, a simple, easily applicable measure. Methods This is a single-center prospective randomized trial enrolling 80 patients undergoing VATS lobectomy. There were two groups: an experimental (E) group, in which once the daily output went down to 5 ml/kg the chest drain was removed and a control (C) group, with chest drain removal as per our current practice of less than 250 ml/day. Results The groups did not differ in pre- and peri- and postoperative characteristics, except for chest drain duration (mean, SD 2.02 ± 0.97 vs. 3.25 ± 1.39 days, p < 0.001) and length of hospital stay (median, IQR 4.5; 3 vs. 6; 2.75 days, p = 0.008) in favor of E group. The re-intervention rate was the same in both groups (once in each group). Conclusion The new threshold for chest drain removal following thoracoscopic lobectomy of 5 ml/kg/d leads to both shorter chest drainage and hospital stay without apparent increase in morbidity. (Clinical registration number: DRKS00014252).

scholarly journals Feasibility of short term drainage for diagnostic thoracoscopy

2016 ◽  
Vol 71 (2) ◽  
Author(s):  
D.P. Breen ◽  
S. Mallawathantri ◽  
A. Fraticelli ◽  
L. Greillier ◽  
P. Astoul
Keyword(s):  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Economic Benefits ◽  
Optimal Time ◽  
Chest Drain ◽  
Complication Rates ◽  
Short Term ◽  
Drainage Time ◽  
Drain Removal ◽  
Significant Difference

Background and Aim. Thoracoscopy is a diagnostic tool superior to other available techniques for the assessment of pleural effusions. There are numerous publications that describe the technique in detail but there is very little published on the optimal time of chest drain removal post procedure. Our aim was to retrospectively study all cases of diagnostic thoracoscopy and to ascertain the time of chest drain removal, length of hospital stay and associated complications. Methods. All patients who underwent thoracoscopy during a 6-year period were identified from a computerised database. Patients who received talc for pleurodesis were excluded as they required longer drainage time. A review of the remaining patients’ charts and radiology was performed to ascertain the predefined outcomes. Results. 124 patients had a diagnostic thoracoscopy. The time to chest drain removal was documented as less than four hours, four to 24 hours, 24 to 48 hours and greater than 48 hours in 66 (53.2%), 29 (23.4%), 12 (9.7%) and 17 (13.7%) of patients respectively. The median length of stay for all patients was one day (interquartile range, 1-4 days). There was a statistically significant difference in overall length of hospital stay between the early (48 hours) chest drain removal groups, p=0.0028. The overall complication rate was 15.9%. There was no statistical difference in complication rates between the two groups. Conclusion. This retrospective series demonstrates that early chest drain removal post diagnostic thoracoscopy is possible and safe. This is likely to confer economic benefits.

The Effect of Omentoplasty on the Rate of Anastomotic Leakage after Intestinal Resection: A Randomized Controlled Trial

2017 ◽  
Vol 83 (2) ◽  
pp. 157-160 ◽  
Author(s):  
Shirzad Nasiri ◽  
Babak Mirminachi ◽  
Reyhaneh Taherimehr ◽  
Roya Shadbakhsh ◽  
Mohsen Hojat
Keyword(s):  
Hospital Stay ◽  
Anastomotic Leakage ◽  
Controlled Trial ◽  
Randomized Study ◽  
Intestinal Resection ◽  
Length Of Hospital Stay ◽  
Fistula Formation ◽  
Intestinal Surgery ◽  
Increased Risk ◽  
Significant Difference

Anastomotic leakage is a major postoperative complication after intestinal surgery leading to increased risk of morbidity and mortality. Omentoplasty has been evaluated to prevent anastomotic leakage in several studies. However, there is no consensus regarding whether or not omentoplasty should be used to decrease the rate of anastomotic leakage after intestinal resection. A prospective, randomized study was conducted to evaluate the influence of omentoplasty on anastomotic leakage after intestinal resection. A total of 124 patients who underwent intestinal resection were enrolled in this prospective study. Patients were randomly assigned to receive either the omentoplasty or nonomentoplasty. In the omentoplasty group, the omentum was wrapped around the anastomotic region. Age, gender, site and type of anastomosis, duration of hospital stay, and performance of omentoplasty were recorded. This study was registered in Iranian Registry of clinical trial (number: IRCT201412316925N3). The rate of anastomotic leakage was significantly lower in the omentoplasty group (P = 0.04). Patients in the omentoplasty group developed a significantly lower rate of postoperative infection and peritonitis (P < 0.05). There was no significant difference of abscess and fistula formation between the two groups (P > 0.05). The length of hospital stay was longer in the nonomentoplasty group, compared with that for omentoplasty patients (P < 0.05). No death occurred in the omentoplasty subjects, while six nonomentoplasty patients died (P < 0.05). Our data demonstrated that omentoplasty is useful to lower the rate of postoperative complications in patients underwent intestinal surgery.

EVALUATION OF CLINICAL DATA IN PATIENTS THAT UNDERWENT DIFFERENT SURGICAL TREATMENTS FOR SPONTANEOUS PNEUMOTHORAX

2021 ◽  
pp. 62-65
Author(s):  
Jakupi N. ◽  
Yankov G. ◽  
Stevic M ◽  
Jovanovski -Srceva M
Keyword(s):  
Surgical Technique ◽  
Hospital Stay ◽  
Spontaneous Pneumothorax ◽  
Laboratory Data ◽  
Length Of Hospital Stay ◽  
Chest Drain ◽  
Open Thoracotomy ◽  
Recurrent Pneumothorax ◽  
Surgical Treatments ◽  
The University

Introduction: Spontaneous pneumothorax (SPT) is surgically treated with two different techniques: Video Assisted Thoracoscopy (VATS) or open thoracotomy (OT). Despite the different invasiveness of the techniques, literature gives controversial results in correlation of the techniques to the clinical outcomes (like length of hospital stay (LOHS), recurrences of the pneumothorax, duration, collection of the drains and etc). of our study was to analyze perioperativ The aim e clinical features in patients that underwent SPT treatment surgically. Materials and methods: prospectively, we evaluated data of patients treated for SPT in two-year period at the University clinic for thoracic surgery in Skopje. Patients were divided into VATS group and OT group, according to the surgical technique used for treatment. In both groups we analyzed demographical, laboratory data, duration of the chest drains presence, early inammatory markers and total LOHS. Patients with recurrent pneumothorax, older than 70 years with severe cardiological impairment were excluded. Results: The study included 42 patients, 23 patients (54.8%) underwent VATS treatment and 19 patients (45.2%) underwent OT. In both groups more patients were male. VATS group of patients showed nonsignicant difference in postoperative laboratory and inammatory ndings, nonsignicantly lower presence of the drains in terms of days, signicantly lower drain uid collections for the rst 3 days and signicantly shorter LOHS compared to the OT group. Conclusion: Our study has showed that patients treated for spontaneous pneumothorax with VATS have shorter length of hospital stay, shorter chest drain presence and overall show better outcome.

scholarly journals Study comparing the stroke unit outcome and conventional ward treatment: a randomized study in Joinville, Brazil

2003 ◽  
Vol 61 (2A) ◽  
pp. 188-193 ◽  
Author(s):  
Norberto L. Cabral ◽  
Carla Moro ◽  
Giana R. Silva ◽  
Rosana Herminia Scola ◽  
Lineu César Werneck
Keyword(s):  
Hospital Stay ◽  
Stroke Unit ◽  
Survival Curve ◽  
Clinical Status ◽  
Randomized Study ◽  
Length Of Hospital Stay ◽  
General Ward ◽  
Number Of Patients ◽  
Significant Difference ◽  
The Impact

BACKGROUND AND PURPOSE: To assess the impact of a stroke unit (SU) on acute phase treatment when compared to a conventional general ward treatment (GW). METHOD: Seventy-four patients with acute stroke were randomized between a SU and conventional general ward (GW). We compared both groups regarding the length of hospital stay, lethality and functional and clinical status within 6 months, using the Scandinavian scale and Barthel index. RESULTS: Thirty-five and thirty-nine patients were allocated at SU and GW, respectively. Lethality on the 10th day at SU and GW achieved 8.5% and 12.8% respectively (p= 0.41), whereas 30-days mortality rates achieved 14.2% and 28.2% (p= 0.24), 17.4% and 28.7% on the 3rd month (p= 0.39), and 25.7% and 30.7% on the 6th month (p= 0.41). Thirty-day survival curve achieved 1.8 log rank (p= 0.17), with a trend for lower lethality in the SU. In order to save one death in 6 months in SU, NNT (the number need to treat) was 20; to get one more home independent patient NNT was 15. No significant difference was found between the length of hospital stay and morbidity. CONCLUSION: No significant benefit was found in SU patients compared to GW group. However,an evident benefit in absolute numbers was observed in lethality, survival curve and NNT in thirty days period after stroke. Further collaborative studies or incresead number of patients are required to define the role of SU.

scholarly journals Comparative prospective randomized study of minimally invasive transpiriformis approach versus conventional posterolateral approach in total hip arthroplasty as measured by biology markers

2021 ◽  
Author(s):  
Cong Xiao ◽  
Zhixiang Gao ◽  
Shaoyun Zhang ◽  
Nengji Long ◽  
Kai Yao ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Minimally Invasive ◽  
Hospital Stay ◽  
Hip Arthroplasty ◽  
Controlled Trial ◽  
Randomized Study ◽  
Length Of Hospital Stay ◽  
Posterolateral Approach ◽  
Harris Hip Score ◽  
Total Hip

Abstract Background Minimally invasive surgery is becoming increasingly common, but evidence of the advantages of the minimally invasive transpiriformis approach in total hip arthroplasty is limited. Therefore, our single-centre randomized controlled trial evaluated the benefits of this approach versus the posterolateral approach. Methods Forty-nine patients undergoing the minimally invasive transpiriformis approach and 57 patients undergoing the posterolateral approach total hip arthroplasty were analyzed. The operative time, length of hospital stay, incision length, and peri-operative data related to the surgery were recorded. In both groups, serum CRP, IL-6, HGb, Hct, MB, CK-MB, and CK levels, Harris hip scores, and VAS scores were recorded. Results Patients who underwent the minimally invasive transpiriformis approach had a smaller surgical incision (9.10 ± 0.94 vs. 15.56 ± 1.20 cm, P = 0.00) and shorter hospital stay (6.20 ± 1.54 vs. 12.26 ± 2.97 days, P = 0.00) than those who underwent the posterolateral approach. Serum levels of CRP, IL-6, MB, CK-MB, and CK were also lower. According to the Harris hip score, the minimally invasive transpiriformis group showed significant improvement at one week and one month after surgery. Conclusion Compared to the posterolateral approach, the minimally invasive transpiriformis approach for total hip arthroplasty provided rapid functional recovery, elicited a significantly reduced post-operative inflammatory response, and caused less muscle damage.

scholarly journals Randomized Trial of Sternal Closure for Low Risk Patients: Rigid Fixation versus Wire Closure

2017 ◽  
Vol 20 (4) ◽  
pp. 164 ◽  
Author(s):  
Graham Graham ◽  
Jeevan Kumar ◽  
Shinya Unai ◽  
Diehl T James ◽  
Hitoshi Hirose, MD
Keyword(s):  
Cardiac Surgery ◽  
Postoperative Pain ◽  
Hospital Stay ◽  
Rating Scale ◽  
Randomized Study ◽  
Length Of Hospital Stay ◽  
Numeric Rating Scale ◽  
Female Group ◽  
Rigid Fixation ◽  
Intubation Time

Background: A previous retrospective analysis of our cardiac surgery patients showed shortened ventilation time and hospital stay among patients receiving rigid sternal fixation compared to sternal wire fixation. We performed a prospective randomized study to further investigate these outcomes and determine if rigid closure can provide reduced pain after cardiac surgery.Methods: Patients undergoing cardiac surgery between July 2011 and May 2014 were prospectively randomized into wire closure (Group C) or rigid fixation using sternal plates (Group R) groups. Age above 80, emergency surgery, redo sternotomy, and immunosuppression were among major exclusion criteria precluding randomization.  Intubation time was recorded for all patients. Pain scores were determined daily from postoperative day 1 until day 5 at 6 a.m. using a numeric rating scale. Narcotic pain medication requirements from day 1 to 5 were collected and converted into intravenous morphine equivalents.Results: Of 80 patients, 39 patients were in Group R (average age 65 ± 8; 31 male and 8 female) and 41 patients were in Group C (average age 66 ± 9; 34 male and 7 female).  Group R patients had a higher body mass index than patients in Group C (Group R: 31 ± 5; Group C: 29 ± 5; P = .04). No significant differences in the end points of intubation time and postoperative pain were observed. Conclusion: This randomized study of cardiac surgery patients showed no significant benefits of rigid fixation over conventional sternal wire closure with regard to intubation time, postoperative pain, or length of hospital stay.

Efficacy, Safety, and Duration of a Frameless Fiducial-Less Brain Biopsy versus Frame-based Stereotactic Biopsy: A Prospective Randomized Study

2017 ◽  
Vol 79 (01) ◽  
pp. 031-038 ◽  
Author(s):  
John Ellul ◽  
Elisabeth Chroni ◽  
Constantine Constantoyannis ◽  
Miltiadis Georgiopoulos
Keyword(s):  
Hospital Stay ◽  
Stereotactic Biopsy ◽  
Randomized Study ◽  
Length Of Hospital Stay ◽  
Brain Biopsy ◽  
Stereotactic Frame ◽  
The Mean ◽  
Frameless Biopsy ◽  
Conclusive Diagnosis ◽  
Made In

Background/Objective We compared the efficacy, duration, safety, length of hospital stay of a frameless fiducial-less brain biopsy with those of the standard frame-based stereotactic biopsy. Patients and Methods This prospective cohort study enrolled 56 adult patients: (1) for whom no conclusive diagnosis could be reached noninvasively; (2a) who had lesions involving deep-seated and eloquent areas, multifocal lesions, or lesions for which craniotomy and lesion removal was not indicated, or (2b) were poor candidates for craniotomy (> 80 years of age and/or with serious comorbidities). Frameless and frame-based biopsy were performed in 28 patients each Results A diagnosis was not made in four cases (14.3%) of the frame-based biopsy group and in three cases (10.7%) of the frameless biopsy group, in spite of accurate targeting (p = 1.0). The mean duration of the whole procedure (preparatory steps outside the operating room [OR], inside the OR, surgery) was 111.3 minutes for the frame-based biopsy and 79.1 minutes for the frameless biopsy (p = 0.001). No statistically significant differences between the two methods were found concerning new neurologic symptoms, new abnormal findings in postoperative computed tomography (CT) and length of postoperative hospital stay (LOS). The smallest diameter of a successfully biopsied lesion was 15 mm for both groups. Conclusions The frameless fiducial-less brain biopsy was equally efficacious and safe compared with the standard stereotactic frame-based biopsy. The overall duration of frameless biopsy is shorter than that of frame-based biopsy, mainly because the preparatory steps in frameless biopsy require less time. However, the overall time spent in the OR did not differ between the two groups. The LOS also did not differ significantly.

scholarly journals Evaluation of superiority of preemptive analgesia with instillation of 0.5% bupivacaine before rather than after surgery for laparoscopic cholecystectomy

2019 ◽  
Vol 6 (5) ◽  
pp. 1589
Author(s):  
Manoj A. Vasava ◽  
Jay M. Makadia
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Hospital Stay ◽  
Visceral Pain ◽  
Randomized Study ◽  
Length Of Hospital Stay ◽  
Preemptive Analgesia ◽  
Muscular Tissue ◽  
Duration Of Surgery ◽  
Group A ◽  
Group B

Background: The objective of the study was to evaluate the superiority of preemptive analgesia with instillation of 0.5% bupivacaine before rather than after surgery for laparoscopic cholecystectomy.Methods: A prospective, randomized study of 264 patients in whom laparoscopic Cholecystectomy (LC) was conducted in the department of General Surgery at the SSG and Medical College Baroda during a period of 25 months from October 2010 to October 2012. Randomization was done with prepared close enveloped which randomly allocate the patient in either group A or B. Data collected from each patient were: age, sex, ASA score, hospital stay, duration of surgery, no of trocar used, first request for analgesics, vomiting, duration of surgery, intraperitoneal drain was kept or not , length of hospital stay, any other postoperative complication.Results: During the period of 24 months total 264 patients were undergone cholecystectomy. On comparison between Group A and B, data shows that the mean  VAS is less at all assessment (4, 8 & 24 hrs) for Group A as compared to Group B. Mean parietal pain score VAS is less for Group B as compared to Group A at all assessments.Conclusions: Use of bupivacaine in optimal dose in GB bed reduced the visceral pain and use in skin, SC tissue, muscular tissue reduced the parietal pain. Use of bupivacaine before GB removal is much more cost effective than after removal of GB.

Effect of Flap Selection on the Postoperative Success of Sacral Pressure Injuries: A Retrospective Analysis

2021 ◽  
Vol 33 (10) ◽  
pp. 271-276
Author(s):  
Serhat Şibar ◽  
Kemal Findikcioglu ◽  
Kirdar Guney ◽  
Serhan Tuncer ◽  
Suhan Ayhan
Keyword(s):  
Hospital Stay ◽  
Chronic Wounds ◽  
Length Of Hospital Stay ◽  
Long Term Results ◽  
Drain Removal ◽  
Significant Difference ◽  
Group 3 ◽  
The Mean ◽  
Group 2

Introduction. Pressure injuries (PIs) continue to be a substantial problem and burden for the present-day health care system and are the leading cause of chronic wounds worldwide. There is no current consensus on the long-term results of the use of flaps in sacral PI reconstruction and optimal flap choice. Objective. This study aimed to evaluate whether flap selection influences postoperative results in sacral PI reconstruction. Materials and Methods. Patients who underwent surgery for PIs in the authors’ clinic between 2002 and 2016 were retrospectively analyzed. A total of 63 patients with stage 3/stage 4 sacral PIs and who underwent reconstruction with fasciocutaneous (FC) flaps (group 1), musculocutaneous (MC) flaps (group 2), or perforator (P) flaps (group 3) were included in the study. The mean duration of the follow-up period was 14.4 months, and patients were evaluated in terms of their demographic data, length of hospital stay, complications, and recurrence. Results. The mean age, sex distribution, and ambulatory status were similar between the groups. In group 2 (MC), the mean length of hospital stay and mean drain removal time were significantly longer. The mean daily drainage amount was significantly higher in group 2 (MC) than in the other groups, and long-term relapses were less frequently observed in group 3 (P). A significant difference was observed between groups 2 (FC) and 3 (MC) in terms of wound dehiscence. The authors determined that P flaps were associated with a reduced mean length of hospital stay and daily drainage. Conclusions. For these patients, P flaps appear to be the optimal flap choice for sacral area reconstruction. However, new prospective randomized studies are needed to support these findings.

scholarly journals Safety and efficacy of video assisted thoracoscopic surgery for non-malignant pathologies: a prospective observational study

2021 ◽  
Vol 8 (2) ◽  
pp. 641
Author(s):  
Raj N. Gajbhiye ◽  
Bhupesh Harish Tirpude ◽  
Akshay Dhahiya ◽  
Vikrant Akulwar ◽  
Hemant Bhanarkar ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Thoracoscopic Surgery ◽  
Demographic Data ◽  
Length Of Hospital Stay ◽  
Early Recovery ◽  
Vats Lobectomy ◽  
Safety And Efficacy ◽  
Video Assisted ◽  
Thoracic Drainage ◽  
Hilar Dissection

Background: Video-assisted thoracic surgery (VATS) had been widely accepted because of its low complication rate, tolerable postoperative pain and early recovery of pulmonary function. Hence the present study was undertaken to assess safety and efficacy of VATS and also analyze the surgical outcomes of VATS procedures for non-malignant thoracic pathologies.Methods: A total of 32 patients with non-malignant pathologies of thorax to undergo VATS lobectomy and thoracotomy conversion cases initially approached by VATS lobectomy were enrolled. Demographic data and surgical information were noted and compare between infection and non-infection group. Primary outcomes were thoracotomy conversion rate, period of thoracic drainage, length of hospital stay, and complications.Results: The majority of patients were in the age group of 36-45 years (28.12%) with female predominance (62.50%). The commonest clinical presentation was hydropneumothorax (28.12%). Most common infective and non-infective aetiology was lung hydatid (28.12%) and benign nodule (18.75%) respectively. The commonest surgical procedures conducted using VATS were lobectomy (34.37%), and decortication (25%). The mean blood loss among the cases was 315.9±36.46 ml. Mean operative time was 157.18±12.37 minutes. Among 6.25% cases thoracotomy was conducted in view of difficult hilar dissection, while among 3.12% cases each of indistinct anatomy and bleeding. Mean duration of thoracic drainage was 6.78±1.69 days and mean hospital stay was 8.2±3.2 days. 6.25% cases had fatal complications while 21.87% cases had milder complications. Only one case recurred while 96.87% cases cured.Conclusions: VATS lobectomy for benign disease is feasible and effective in selected cases, regardless of the presence of infection.

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