RIB fracture triage pathway decreases ICU utilization, pulmonary complications and hospital length of stay

Abstract Background Sugammadex is associated with few postoperative complications. Postoperative pulmonary complications (PPC) are related to prolonged hospitalizations. Present study explored whether the use of sugammadex could reduce PPCs and thereby reduce hospital length of stay (LOS) after lung surgery. Methods We reviewed the medical records of patients who underwent elective open lobectomy for lung cancer from January 2010 to December 2015. Patients were divided into the sugammadex group and pyridostigmine group. The primary outcome was hospital LOS and secondary outcomes were postoperative complications and overall survival at 1 year. The cohort was subdivided into patients with and without prolonged LOS to explore the effects of sugammadex on outcomes in each group. Risk factors for LOS were determined via multivariate analyses. After propensity score matching, 127 patients were assigned to each group. Results Median hospital LOS was shorter (10.0 vs. 12.0 days) and the incidence of postoperative atelectasis was lower (18.1 vs. 29.9%) in the sugammadex group. However, no significant difference in overall survival between the groups was seen over 1 year (hazard ratio, 0.967; 95% confidence interval, 0.363 to 2.577). Sugammadex was a predictor related to LOS (exponential coefficient 0.88; 95% CI 0.82–0.95). Conclusions Our data suggest that sugammadex is a preferable agent for neuromuscular blockade (NMB) reversal than cholinesterase inhibitors in this patient population. Trial registration This study registered in the Clinical Research Information Service of the Korea National Institute of Health (approval number: KCT0004735, Date of registration: 21 January 2020, Retrospectively registered).

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Risk Factors for Postoperative Pulmonary Complications after Abdominal Surgery

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2016.059 ◽

2016 ◽

Vol 4 (2) ◽

pp. 259-263 ◽

Cited By ~ 11

Author(s):

Nertila Kodra ◽

Vjollca Shpata ◽

Ilir Ohri

Keyword(s):

Risk Factors ◽

Length Of Stay ◽

Clinical Laboratory ◽

Multivariate Regression Analysis ◽

Hospital Length ◽

Pulmonary Complications ◽

Hospital Length Of Stay ◽

Postoperative Pulmonary Complications ◽

Increased Risk ◽

Surgical Ward

BACKGROUND: Incidence of postoperative pulmonary complications (PPC) in patients undergoing non-cardiothoracic surgery remains high and the occurrence of these complications has enormous implications for the patient and the health care system.AIM: The aim of the study was to identify risk factors for PPC in patients undergoing abdominal surgical procedures.MATERIALS AND METHODS: A prospective cohort study in abdominal surgical patients, admitted to the emergency and surgical ward of the UHC of Tirana, Albania, was conducted during the period: March 2014-March 2015. We collected data on the occurrence of a symptomatic and clinically significant PPC using clinical, laboratory, and radiology data. We evaluated the relations between PPCs and various pre-operative or intra-operative factors to identify risk factors.RESULTS: A total of 450 postoperative patients admitted to the surgical emergency and surgical ward were studied. The mean age were 59.85 Â±13.64 years with 59.3% being male. Incidence of PPC was 27.3% (123 patients) and hospital length of stay was 4.93 Â± 4.65 days. Length of stay was substantially prolonged for those patients who developed PPC (7.48 Â± 2.89 days versus 3.97Â± 4.83 days, p < 0.0001. PPC were identified as risk factors for mortality, OR: 21.84; 95%CI: 11.66-40.89; P < 0.0001. The multivariate regression analysis identified as being independently associated with an increased risk of PPC: age â‰¥ 65 years (OR 11.41; 95% CI: 4.84-26.91, p < 0.0001), duration of operation â‰¥ 2.5 hours (OR 8.38; 95%CI: 1.52-46.03, p = 0.01, history of previous pulmonary diseases (OR 11.12; 95% CI: 3.28-37.65, P = 0.0001) and ASA > 2 (OR 6.37; 95% CI: 1.54-26.36, P = 0.01). CONCLUSION: We must do some efforts in reducing postoperative pulmonary complications, firstly to identify which patients are at increased risk, and then following more closely high-risk patients because those patients are most likely to benefit.

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The Effect of High-Flow Nasal Oxygen Therapy on Postoperative Pulmonary Complications and Hospital Length of Stay in Postoperative Patients: A Systematic Review and Meta-Analysis

Journal of Intensive Care Medicine ◽

10.1177/0885066618817718 ◽

2018 ◽

Vol 35 (10) ◽

pp. 1129-1140 ◽

Cited By ~ 2

Author(s):

Zhonghua Lu ◽

Wei Chang ◽

Shanshan Meng ◽

Ming Xue ◽

Jianfeng Xie ◽

...

Keyword(s):

Length Of Stay ◽

Oxygen Therapy ◽

Hospital Length ◽

Pulmonary Complications ◽

High Flow ◽

Hospital Length Of Stay ◽

Cochrane Library ◽

Control Group ◽

Postoperative Pulmonary Complications ◽

High Flow Oxygen

Objective: To evaluate the effect of high-flow nasal cannula oxygen (HFNO) therapy on hospital length of stay (LOS) and postoperative pulmonary complications (PPCs) in adult postoperative patients. Data Sources: PubMed, Embase, the Cochrane Library, Web of Science of Studies, China National Knowledge Index, and Wan Fang databases were searched until July 2018. Study Selection: Randomized controlled trials (RCTs) comparing HFNO with conventional oxygen therapy or noninvasive mechanical ventilation in adult postoperative patients were included. The primary outcomes were hospital LOS and PPCs; short-term mortality (defined as intensive care unit, hospital, or 28-day mortality) and intubation rate were the secondary outcomes. Data Extraction: Demographic variables, high-flow oxygen therapy application, effects, and side effects were retrieved. Data were analyzed by the methods recommended by the Cochrane Collaboration. The strength of evidence was assessed by the Grading of Recommendations Assessment, Development and Evaluation. Random errors were evaluated with trial sequential analysis. Data Synthesis: Fourteen studies (2568 patients) met the inclusion criteria and were included. Compared to the control group, the pooled effect showed that HFNO was significantly associated with a shorter hospital stay (mean difference: −0.81; 95% confidence interval [CI]: −1.34 to −0.29, P = .002), but not mortality (risk ratio [RR]: 1.0, 95% CI: 0.63 to 1.59, P = 1.0). Weak evidence of a reduction in reintubation rate (RR: 0.76, 95% CI: 0.57-1.01, P = .06) and PPC rate (RR: 0.89, 95% CI: 0.75-1.06, P = .18) with HFNO versus control group was recorded. Conclusions: The available RCTs suggest that, among the adult postoperative patients, HFNO therapy compared to the control group significantly reduces hospital LOS.

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Unexpected Diaphragmatic Hernia Among Patients Undergoing Video-Assisted Thoracic Surgery for Internal Fixation of Rib Fractures

The American Surgeon ◽

10.1177/00031348211050574 ◽

2021 ◽

pp. 000313482110505

Author(s):

John R. Murfee ◽

Kaitlin E. Pardue ◽

Paige. Farley ◽

Nathan M. Polite ◽

Maryann I. Mbaka ◽

...

Keyword(s):

Length Of Stay ◽

Thoracic Surgery ◽

Hospital Length ◽

Rib Fracture ◽

Hospital Length Of Stay ◽

Video Assisted Thoracic Surgery ◽

Video Assisted ◽

Icu Length Of Stay ◽

Diaphragm Injury ◽

Diaphragm Injuries

Traumatic blunt diaphragm injuries are a diagnostic challenge in trauma. They may be missed due to the increasing trend of non-operative management of patients. The purpose of this study was to review the rate of occult blunt diaphragm injuries in patients who underwent video assisted thoracic surgery (VATS) for rib fixation. This retrospective study included patients that received VATS as part of our institutional protocol for rib fracture management. This includes utilizing incentive spirometry, multimodal analgesia, and early consideration for VATS. Data was abstracted from the electronic medical record and included demographics, operative findings, and outcomes. Thirty patients received VATS per our rib fracture protocol. No patients had any identified diaphragm injury on pre-operative imaging. A concomitant diaphragm injury was identified in 20% (6/30) of the study population. All patients were alive at 30 days. For all patients, total hospital length of stay was 14.5 days, ICU length of stay was 8.9 days, and average ventilator days was 4.2 days. When comparing patients with and without concomitant diaphragm injuries, hospital length of stay was 16.8 days vs. 14.5 ( P = 0.59), ICU length of stay was 11.8 days vs. 8.2 ( P = 0.54), and ventilator days was 4.5 days vs. 4.2 ( P = 0.93). This study revealed that 20% of patients undergoing VATS for rib fracture fixation had a concomitant diaphragm injury. This higher-than-expected prevalence suggests that groups of patients sustaining blunt trauma may have occult diaphragmatic injuries that are otherwise unidentified. This raises the need for improved diagnostic modalities to identify these injuries.

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Sugammadex is associated with shorter hospital length of stay after open lobectomy for lung cancer: A retrospective observational study

10.21203/rs.3.rs-104616/v1 ◽

2020 ◽

Author(s):

Seung Won Song ◽

Kyung Yeon Yoo ◽

Yong Sung Ro ◽

Taehee Pyeon ◽

Hong-Beom Bae ◽

...

Keyword(s):

Lung Cancer ◽

Overall Survival ◽

Postoperative Complications ◽

Length Of Stay ◽

Hospital Length ◽

Pulmonary Complications ◽

Hospital Length Of Stay ◽

Research Information ◽

Significant Difference ◽

Open Lobectomy

Abstract Background: Sugammadex is associated with few postoperative complications. Postoperative pulmonary complications are related to prolonged hospitalizations. Present study explored whether the use of sugammadex could reduce postoperative complications and thereby reduce hospital length of stay (LOS) after lung surgery. Methods: We reviewed the medical records of patients who underwent elective open lobectomy for lung cancer from January 2010 to December 2015. Patients were divided into the sugammadex group and pyridostigmine group.The primary outcome was hospital LOS and secondary outcomes were postoperative complications and overall survival at 1 year. The cohort was subdivided into patients with and without prolonged LOS to explore the effects of sugammadex on outcomes in each group. Risk factors for prolonged LOS were determined via multivariate analyses. After propensity score matching, 127 patients were assigned to each group. Results: Median hospital LOS was shorter (10.0 vs. 12.0 days) and the incidence of postoperative atelectasis was lower (18.1 vs. 29.9%) in the sugammadex group. However, no significant difference in overall survival between the groups was seen over 1 year (hazard ratio, 0.967; 95% confidence interval, 0.363 to 2.577). Sugammadex was a predictor related to LOS (exponential coefficient 0.88; 95% CI 0.82–0.95) and resulted in a shorter LOS in patients without a prolonged LOS). Among patients undergoing open lung lobectomy for lung cancer, compared to pyridostigmine, neuromuscular reversal with sugammadex resulted in a short hospital LOS and a lower incidence of postoperative complications, but showed a similar mortality. Conclusions: Our data suggest that sugammadex is a preferable agent for neuromuscular blockade (NMB) reversal than cholinesterase inhibitors in this patient population.Trial registration: This study registered in the Clinical Research Information Service of the Korea National Institute of Health (approval number: KCT0004735, Date of registration: 21 January 2020, Retrospectively registered).

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Prevalence of undiagnosed mild cognitive impairment in elderly patients undergoing thoracic surgery and its relationship with postoperative outcome: a prospective cohort study

10.21203/rs.2.11321/v1 ◽

2019 ◽

Author(s):

chaoyang tong ◽

dehua wu ◽

yaofeng shen ◽

meiying Xu

Keyword(s):

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Length Of Stay ◽

Elderly Patients ◽

Thoracic Surgery ◽

Postoperative Outcome ◽

Hospital Length ◽

Pulmonary Complications ◽

Hospital Length Of Stay ◽

Moca Score

Abstract Background The prevalence of undiagnosed mild cognitive impairment (MCI) in elderly patients scheduled for thoracic surgery and its association with adverse clinical outcomes is still unproven. Methods We enrolled 170 patients 65 year of age or older who were scheduled for thoracic surgery. 82 males and 88 females with ASA grade II-III. All the elderly patients were tested with Chinese modified version of MoCA preoperatively. According to the test results, they were divided into two groups: group N (MoCA score>25) and group AN (MoCA score≤25). Outcomes included the hospital length of stay (primary outcome), the length of stay in patients with PPCs (LOS-PPCs), the pulmonary complications (atelectasis, pulmonary infection, respiratory failure) and other complications (blood transfusion, chylothorax, new arrhythmia, myocardial infarction and acute cerebral infarction) (secondary outcomes). Data were analyzed using univariate and multivariate analyses. Results Seventy-four of 154 (49%) patients screened positive for probable mild cognitive impairment (MoCA ≤ 25) in the final analyses. The hospital length of stay and LOS-PPCs in elderly patients with mild cognitive impairment preoperatively were significantly longer than those with group N (P<0.05). Multivariate stepwise regression showed that preoperative MCI was an independent risk factor for prolonging the hospital length of stay and LOS-PPCs. Patients with a MoCA score less than or equal to 25 were more likely to have a longer hospital length of stay (OR = 2.355, 95% CI =1.137 to 4.877, P=0.021) and LOS-PPCs (OR = 6.867, 95% CI =1.116 to 42.257, P=0.038), but not related to increase the incidence of postoperative pulmonary complications (OR = 0.955, 95% CI =0.280 to 3.254, P=0.941) and other complications (OR = 1.687, 95% CI =0.502 to 5.665, P=0.398) compared to those with a MoCA score greater than 25. Conclusions The prevalence of undiagnosed probably mild cognitive impairment among elderly patients scheduled for thoracic surgery is high (49%). Such impairment is associated with a longer hospital stay and LOS-PPCs, while it is not possible to conclude that it is related to the incidence of pulmonary complications and other complications after surgery.

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Early Intravenous Ibuprofen Decreases Narcotic Requirement and Length of Stay after Traumatic Rib Fracture

The American Surgeon ◽

10.1177/000313481307901127 ◽

2013 ◽

Vol 79 (11) ◽

pp. 1207-1212 ◽

Cited By ~ 15

Author(s):

Lilly Bayouth ◽

Karen Safcsak ◽

Michael L. Cheatham ◽

Chadwick P. Smith ◽

Kara L. Birrer ◽

...

Keyword(s):

Treatment Group ◽

Length Of Stay ◽

Hospital Length ◽

Rib Fractures ◽

Rib Fracture ◽

Hospital Length Of Stay ◽

Patient Comfort ◽

Clinically Significant ◽

Control Pain ◽

Intravenous Ibuprofen

Pain control after traumatic rib fracture is essential to avoid respiratory complications and prolonged hospitalization. Narcotics are commonly used, but adjunctive medications such as non-steroidal anti-inflammatory drugs may be beneficial. Twenty-one patients with traumatic rib fractures treated with both narcotics and intravenous ibuprofen (IVIb) (Treatment) were retrospectively compared with 21 age- and rib fracture-matched patients who received narcotics alone (Control). Pain medication requirements over the first 7 hospital days were evaluated. Mean daily IVIb dose was 2070 ± 880 mg. Daily intravenous morphine-equivalent requirement was 19 ± 16 vs 32 ± 24 mg ( P < 0.0001). Daily narcotic requirement was significantly decreased in the Treatment group on Days 3 through 7 ( P < 0.05). Total weekly narcotic requirement was significantly less among Treatment patients ( P = 0.004). Highest and lowest daily pain scores were lower in the Treatment group ( P < 0.05). Hospital length of stay was 4.4 ± 3.4 versus 5.4 ± 2.9 days ( P = 0.32). There were no significant complications associated with IVIb therapy. Early IVIb therapy in patients with traumatic rib fractures significantly decreases narcotic requirement and results in clinically significant decreases in hospital length of stay. IVIb therapy should be initiated in patients with traumatic rib fractures to improve patient comfort and reduce narcotic requirement.

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Guideline-Driven Care Improves Outcomes in Patients with Traumatic Rib Fractures

The American Surgeon ◽

10.1177/000313481708300940 ◽

2017 ◽

Vol 83 (9) ◽

pp. 1012-1017 ◽

Cited By ~ 5

Author(s):

Kathleen Flarity ◽

Whitney C. Rhodes ◽

Andrew J. Berson ◽

Brian E. Leininger ◽

Paul E. Reckard ◽

...

Keyword(s):

Length Of Stay ◽

Pulmonary Function ◽

Hospital Length ◽

Rib Fractures ◽

Rib Fracture ◽

Hospital Length Of Stay ◽

National Standard ◽

Separate Analysis ◽

Fracture Management ◽

Multivariable Regression

There is no established national standard for rib fracture management. A clinical practice guideline (CPG) for rib fractures, including monitoring of pulmonary function, early initiation of aggressive loco-regional analgesia, and early identification of deteriorating respiratory function, was implemented in 2013. The objective of the study was to evaluate the effect of the CPG on hospital length of stay. Hospital length of stay (LOS) was compared for adult patients admitted to the hospital with rib fracture(s) two years before and two years after CPG implementation. A separate analysis was done for the patients admitted to the intensive care unit (ICU). Over the 48-month study period, 571 patients met inclusion criteria for the study. Pre-CPG and CPG study groups were well matched with few differences. Multivariable regression did not demonstrate a difference in LOS (B = -0.838; P = 0.095) in the total study cohort. In the ICU cohort (n = 274), patients in the CPG group were older (57 vs 52 years; P = 0.023) and had more rib fractures (4 vs 3; P = 0.003). Multivariable regression identified a significant decrease in LOS for those patients admitted in the CPG period (B = -2.29; P = 0.019). Despite being significantly older with more rib fractures in the ICU cohort, patients admitted after implementation of the CPG had a significantly reduced LOS on multivariable analysis, reducing LOS by over two days. This structured intervention can limit narcotic usage, improve pulmonary function, and decrease LOS in the most injured patients with chest trauma.

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