The impact of nerve blocks on opioid use and hospital length of stay in patients with traumatic lower-extremity injury

2011 ◽  
Vol 213 (3) ◽  
pp. S72-S73
Author(s):  
Stephen M. Tourjee ◽  
William T. Obremskey ◽  
Kristin R. Archer
Keyword(s):  
Length Of Stay ◽  
Lower Extremity ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Lower Extremity Injury ◽  
Extremity Injury ◽  
Opioid Use ◽  
Nerve Blocks ◽  
The Impact

scholarly journals The Impact of NSAID Use After Lumbar Fusion Surgery on Fusion Rate and Complications: A Meta-Analysis

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Yahya Othman ◽  
Avani Vaishnav ◽  
Steven Mcanany ◽  
Sravisht Iyer ◽  
Todd Albert ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Spine Surgery ◽  
Spinal Surgery ◽  
Meta Analysis ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Opioid Use ◽  
Pain Scores ◽  
Patient Reported ◽  
The Impact

Abstract INTRODUCTION The purpose of this study is to compile data presented in literature regarding the efficacy of incorporating NSAIDs in the postoperative course for patients undergoing spine surgery, in particular its impact on pain levels, opioid use, complications, and hospital length of stay METHODS This is a meta-analysis and systematic review. A literature search was conducted using the backbone search [spinal surgery] [Nsaid] [complications]. Criteria for inclusion are as follows: use of NSAIDs for postoperative pain management of spinal surgery, comparison between NSAID and NSAID-free cohort, and reporting on any of pain scores, hospital opioid use, hospital length of stay, complications rate, and operative outcomes. RESULTS Out of 799 studies, 19 studies met the inclusion criteria. A total of 1522 patient were included in this analysis. The studies included randomized controlled trials, Prospective and retrospective cohorts. Operations included discectomies, laminectomies, and fusions. Most commonly regimens included the NSAID Ketorelac, as in injection given immediately postoperatively. Patients that received NSAID analgesia postoperatively had significantly lower VAS pain scores at 1 and 12 h postoperatively. This group also had a significantly lower opioid consumption and shorter hospital length of stay. A total of 7 fusion studies reported on arthrodesis, showing a significantly lower odds of fusion after NSAIDs use, however after subgrouping according to smoking, this difference proves to be no longer significant. CONCLUSION Incorporation of NSAIDs into the postoperative regimen for analgesia in patients undergoing spine surgery is an effective approach in reducing hospital length of stay, patient reported pain scores, hospital opioid use, and has no increased risk of complications. Furthermore, use of NSAIDs in the nonsmoking population does not seem to affect arthrodesis rates in patients undergoing spine surgery.

scholarly journals Association of Emergency Department Waiting Times With Patient Experience in Admitted and Discharged Patients

2021 ◽  
Vol 8 ◽  
pp. 237437352110114
Author(s):  
Andrew Nyce ◽  
Snehal Gandhi ◽  
Brian Freeze ◽  
Joshua Bosire ◽  
Terry Ricca ◽  
...  
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Patient Experience ◽  
Waiting Times ◽  
Hospital Length ◽  
Short Length ◽  
Hospital Length Of Stay ◽  
Patient’S Experience ◽  
Discharged Patients ◽  
The Impact

Prolonged waiting times are associated with worse patient experience in patients discharged from the emergency department (ED). However, it is unclear which component of the waiting times is most impactful to the patient experience and the impact on hospitalized patients. We performed a retrospective analysis of ED patients between July 2018 and March 30, 2020. In all, 3278 patients were included: 1477 patients were discharged from the ED, and 1680 were admitted. Discharged patients had a longer door-to-first provider and door-to-doctor time, but a shorter doctor-to-disposition, disposition-to-departure, and total ED time when compared to admitted patients. Some, but not all, components of waiting times were significantly higher in patients with suboptimal experience (<100th percentile). Prolonged door-to-doctor time was significantly associated with worse patient experience in discharged patients and in patients with hospital length of stay ≤4 days. Prolonged ED waiting times were significantly associated with worse patient experience in patients who were discharged from the ED and in inpatients with short length of stay. Door-to-doctor time seems to have the highest impact on the patient’s experience of these 2 groups.

scholarly journals The Impact of Selenium Supplementation on Trauma Patients—Systematic Review and Meta-Analysis

Nutrients ◽  
2022 ◽  
Vol 14 (2) ◽  
pp. 342
Author(s):  
Jen-Fu Huang ◽  
Chih-Po Hsu ◽  
Chun-Hsiang Ouyang ◽  
Chi-Tung Cheng ◽  
Chia-Cheng Wang ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Meta Analysis ◽  
Infectious Complications ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Current Evidence ◽  
Trauma Patients ◽  
Positive Effects ◽  
Standard Difference ◽  
The Impact

This study aimed to assess current evidence regarding the effect of selenium (Se) supplementation on the prognosis in patients sustaining trauma. MEDLINE, Embase, and Web of Science databases were searched with the following terms: “trace element”, “selenium”, “copper”, “zinc”, “injury”, and “trauma”. Seven studies were included in the meta-analysis. The pooled results showed that Se supplementation was associated with a lower mortality rate (OR 0.733, 95% CI: 0.586, 0.918, p = 0.007; heterogeneity, I2 = 0%). Regarding the incidence of infectious complications, there was no statistically significant benefit after analyzing the four studies (OR 0.942, 95% CI: 0.695, 1.277, p = 0.702; heterogeneity, I2 = 14.343%). The patients with Se supplementation had a reduced ICU length of stay (standard difference in means (SMD): −0.324, 95% CI: −0.382, −0.265, p < 0.001; heterogeneity, I2 = 0%) and lesser hospital length of stay (SMD: −0.243, 95% CI: −0.474, −0.012, p < 0.001; heterogeneity, I2 = 45.496%). Se supplementation after trauma confers positive effects in decreasing the mortality and length of ICU and hospital stay.

scholarly journals Association of Herpes Simplex Virus Testing with Hospital Length of Stay for Infants ≤60 Days of Age Undergoing Evaluation for Meningitis

2019 ◽  
Vol 14 (8) ◽  
pp. 492-495 ◽  
Author(s):  
Paul L Aronson ◽  
Andrea T Cruz ◽  
Stephen B Freedman ◽  
Fran Balamuth ◽  
Kendra L Grether-Jones ◽  
...  
Keyword(s):  
Herpes Simplex Virus ◽  
Herpes Simplex ◽  
Length Of Stay ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Incident Rate ◽  
Neonatal Herpes Simplex ◽  
Simplex Virus ◽  
The Impact ◽  
Pcr Test

Although neonatal herpes simplex virus (HSV) causes significant morbidity, utilization of the cerebrospinal fluid (CSF) HSV polymerase chain reaction (PCR) test remains variable. Our objective was to examine the association of CSF HSV PCR testing with length of stay (LOS) in a 20-center retrospective cohort of hospitalized infants aged ≤60 days undergoing evaluation for meningitis after adjustment for patient-level factors and clustering by center. Of 20,496 eligible infants, 7,399 (36.1%) had a CSF HSV PCR test performed, and 46 (0.6% of those tested) had a positive test. Infants who had a CSF HSV PCR test performed had a 23% longer hospital LOS (incident rate ratio 1.23; 95% CI: 1.14-1.33). Targeted CSF HSV PCR testing may mitigate the impact on LOS for low-risk infants.

Abstract 4603: Home Surveillance Results in Improved Interstage Weight Gain in Infants following the Norwood Operation

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Karen Uzark ◽  
Paula Eldridge ◽  
William Border ◽  
Mary Pat Alfaro ◽  
Megan Donley ◽  
...  
Keyword(s):  
Weight Gain ◽  
Length Of Stay ◽  
Hospital Length ◽  
Stage I ◽  
Stage Ii ◽  
Hospital Length Of Stay ◽  
Complex Congenital Heart Disease ◽  
Norwood Operation ◽  
Weight Monitoring ◽  
The Impact

Infants with complex congenital heart disease are at increased risk for malnutrition and poor weight gain. At our institution, infants who undergo Stage I Norwood operation are discharged with a home surveillance (HomeSurv) program which includes weight monitoring. To evaluate the impact of home surveillance on interstage growth, a current cohort of patients enrolled in Home Surv (n=18) was compared to a cohort discharged immediately prior to the implementation of the Home Surv program (n=20). The cohorts were compared using parametric and non-parametric methods as appropriate. Results: Infants underwent Stage I at a median age of 3.5 days (range 1–26), and at a mean weight 3.0 ± 0.4 kg., 26 with a modified Blalock-Taussig shunt and 12 with a right ventricular-to-pulmonary artery shunt. There were 26 males and 12 females. There were no significant differences between the groups with and without HomeSurv with respect to Stage I age, sex, Stage I weight, or shunt type. Stage I discharge weights were similar between the two cohorts (p=0.23) and there was no significant difference in Stage I hospital length of stay (p=0.10). Mean age at Stage II was 5.1 mos in the HomeSurv group and 4.9 mos in the pre-HomeSurv group, (p = 0.63). Mean weight at Stage II was higher in the HomeSurv group, but not statistically significant (5.9 kg vs 5.5 kg, p=0.30). However, weight gain >15 gms/day post Stage I discharge (our minimum weight gain threshold) was achieved by 89% of infants with Home Surv in comparison to 60% of the pre-HomeSurv group, p<.05. Weight gain was not significantly correlated with weight at Stage I, Stage I hospital length of stay, or age at Stage II, and was not significantly different related to shunt type. Conclusion: Home surveillance including weight monitoring following Stage I Norwood positively impacts interstage weight gain. In particular, it appears to confer protection for at-risk infants who fall below the threshold weight gain of 15gms/day. Future studies should explore whether this improved weight gain is an important factor in interstage morbidity and mortality.

scholarly journals Anaemia in patients undergoing major bowel surgery – Prevalence and current practice: A public and private institution experience

2020 ◽  
pp. 175045892093432 ◽  
Author(s):  
Edgar Poon ◽  
David Pache ◽  
Alana Delaforce ◽  
Lemya Abdalla ◽  
Treasure McGuire
Keyword(s):  
Length Of Stay ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Transfusion Rate ◽  
Preoperative Treatment ◽  
National Guidelines ◽  
Biochemical Tests ◽  
Bowel Surgery ◽  
The Impact ◽  
Preoperative Anaemia

Aim The study aimed to compare the frequency and alignment of preoperative anaemia screening and treatment with Australian guidelines in elective bowel surgery and determine the impact on clinical outcomes. Methods We performed a retrospective observational study, with an audit of 559 adult patients who underwent major elective bowel surgery in an Australian metropolitan hospital, January 2016–December 2018. Outcome measures included rate of anaemia, guideline compliance, hospital length of stay, and transfusion rate. Results Preoperative anaemia assessment occurred in 82.6% of patients. However, only 5.2% received recommended biochemical tests at least one week before surgery. Only 25.2% of anaemic patients received preoperative treatment; they experienced a longer hospital length of stay (9.93 days versus 7.88 days, p < 0.001) and an increased rate of transfusion (OR: 3.186, p < 0.05). Conclusion The gaps between current preoperative anaemia screening, management and national guidelines may place patients at higher risk of poor surgical outcome.

Early versus Delayed Amputation in the Setting of Severe Lower Extremity Trauma

2015 ◽  
Vol 81 (6) ◽  
pp. 564-568 ◽  
Author(s):  
Zachary F. Williams ◽  
Lindsay M. Bools ◽  
Ashley Adams ◽  
Thomas V. Clancy ◽  
William W. Hope
Keyword(s):  
Length Of Stay ◽  
Lower Extremity ◽  
Limb Salvage ◽  
Length Of Hospital Stay ◽  
Hospital Length ◽  
Lower Extremity Amputation ◽  
Hospital Length Of Stay ◽  
Trauma Patients ◽  
Early Group ◽  
Extremity Amputation

Leg-threatening injuries present patients and clinicians with the difficult decision to pursue primary amputation or attempt limb salvage. The effects of delayed amputation after failed limb salvage on outcomes, such as prosthetic use and hospital deposition, are unclear. We evaluated the timing of amputations and its effects on outcomes. We retrospectively reviewed all trauma patients undergoing lower extremity amputation from January 1,2000 through December 31, 2010 at a Level 2 trauma center. Patients undergoing early amputation (amputation within 48 hours of admission) were compared with patients undergoing late amputation (amputations >48 hours after admission). Patient demographics, injury specifics, operative characteristics, and outcomes were documented. During the 11-year study period, 43 patients had a lower extremity amputation and 21 had early amputations. The two groups were similar except for a slightly higher Mangled Extremity Severity Score in the early amputation group. Total hospital length of stay significantly differed between groups, with the late amputation group length of stay being nearly twice as long. The late amputation group had significantly more ipsilateral leg complications than the early group (77% vs 15%). There was a trend toward more prosthetic use in the early group (93%vs 57%, P = 0.07). Traumatic lower extremity injuries requiring amputation are rare at our institution (0.3% incidence). Regardless of the amputation timing, most patients were able to obtain a prosthetic. Although the late group had a longer length of hospital stay and more local limb complications, attempted limb salvage still appears to be a viable option for appropriately selected trauma patients.

scholarly journals 1247. Multicenter Study on Risk Factors for Surgical Site Infection After Exploratory Laparotomy

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S449-S449
Author(s):  
Túlio Alves Jeangregório Rodrigues ◽  
Guilherme Fernandes de Oliveira ◽  
Júlia G C Dias ◽  
Laís Souza Campos ◽  
Letícia Rodrigues ◽  
...  
Keyword(s):  
Risk Factors ◽  
Length Of Stay ◽  
Abdominal Surgery ◽  
Surgical Site Infection ◽  
Exploratory Laparotomy ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Hospital Death ◽  
Site Infection ◽  
The Impact

Abstract Background Exploratory laparotomy surgery is abdominal operations not involving the gastrointestinal tract or biliary system. The objective of our study is to answer three questions: (a) What is the risk of surgical site infection (SSI) after exploratory abdominal surgery? (b) What is the impact of SSI in the hospital length of stay and hospital mortality? (c) What are risk factors for SSI after exploratory abdominal surgery? Methods A retrospective cohort study assessed meningitis and risk factors in patients undergoing exploratory laparotomy between January 2013 and December 2017 from 12 hospitals at Belo Horizonte, Brazil. Data were gathered by standardized methods defined by the National Healthcare Safety Network (NHSN)/CDC procedure-associated protocols for routine SSI surveillance. 26 preoperative and operative categorical and continuous variables were evaluated by univariate and multivariate analysis (logistic regression). Outcome variables: Surgical site infection (SSI), hospital death, hospital length of stay. Variables were analyzed using Epi Info and applying statistical two-tailed test hypothesis with significance level of 5%. Results A sample of 6,591 patients submitted to exploratory laparotomy was analyzed (SSI risk = 4.3%): Hospital length of stay in noninfected patients (days): mean = 16, median = 6, std. dev. = 30; hospital stay in infected patients: mean = 32, median = 22, std. dev. = 30 (P < 0.001). The mortality rate in patients without infection was 14% while hospital death of infected patients was 20% (P = 0.009). Main risk factors for SSI: ügeneral anesthesia (SSI = 4.9%, relative risk – RR = 2.8, P < 0.001); preoperative hospital length of stay more than 4 days (SSI=3.9%, RR=1.8, P = 0.003); wound class contaminated or dirty (SSI = 5.4%, RR = 1.5, P = 0.002); duration of procedure higher than 3 hours (SSI = 7.1%, RR = 2.1, P < 0.001); after trauma laparotomy (SSI = 7.8%, RR = 1.9, P = 0.001). Conclusion We identified patients at high risk of surgical site infection after exploratory laparotomy: trauma patients from contaminated or dirty wound surgery, submitted to a procedure with general anesthesia that last more than 3 hours have 13% SSI. Patients without any of these four risk factors have only 1.2% SSI. Disclosures All authors: No reported disclosures.

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