Target-Based Care: An Intervention to Reduce Variation in Postoperative Length of Stay

2021 ◽  
Vol 228 ◽  
pp. 208-212
Author(s):  
Andrew Y. Shin ◽  
Isabelle J. Rao ◽  
Hannah K. Bassett ◽  
Whitney Chadwick ◽  
Joseph Kim ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Postoperative Length

Impact of preoperative cachexia on postoperative length of stay in elderly patients with gastrointestinal cancer

Nutrition ◽  
2019 ◽  
Vol 58 ◽  
pp. 65-68 ◽  
Author(s):  
Akimasa Fukuta ◽  
Takashi Saito ◽  
Shunsuke Murata ◽  
Daisuke Makiura ◽  
Junichiro Inoue ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Elderly Patients ◽  
Gastrointestinal Cancer ◽  
Postoperative Length

An Expanded Preoperative Component within an Enhanced Recovery Protocol Improves Outcomes in Colorectal Surgery

2017 ◽  
Vol 83 (8) ◽  
pp. 928-934
Author(s):  
Nathan M. Johnson ◽  
Sandy L. Fogel
Keyword(s):  
Colorectal Surgery ◽  
Length Of Stay ◽  
Enhanced Recovery ◽  
Statistical Significance ◽  
Current Evidence ◽  
P Value ◽  
Postoperative Length ◽  
Enhanced Recovery Protocol ◽  
Recovery Protocols ◽  
Colorectal Procedures

Enhanced Recovery Protocols (ERPs) have been shown to lead to quicker recovery in colorectal surgery, with reduced postoperative length of stay (LOS). ERPs could potentially be improved with an expanded preoperative component reflecting current evidence. We hypothesize that an ERP with an expanded preoperative component will reduce LOS consistent with or exceeding that seen with traditional ERPs. Our ERP was implemented in June of 2014. Data was collected for two full years from July 2014 through June 2016. The protocol was employed in colorectal cases, both elective and emergent. Data from ERP cases were compared with contemporaneous controls that did not go through the ERP. Patients who underwent colorectal procedures and participated in the ERP with the expanded preoperative component had an average LOS of 5.33 days, whereas controls stayed for an average of 7.93 days (P value, <0.01). ERP cases also experienced fewer read-missions and complications, although statistical significance could not be established. The results demonstrate that an ERP with an enhanced preoperative component significantly reduces LOS and potentially decreases the rate of readmissions and total complications.

scholarly journals Tourniquet use in routine primary total knee arthroplasty is associated with a higher transfusion rate and longer postoperative length of stay: a real-world study

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Hong Xu ◽  
Jingli Yang ◽  
Jinwei Xie ◽  
Zeyu Huang ◽  
Qiang Huang ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Length Of Stay ◽  
Knee Arthroplasty ◽  
Enhanced Recovery ◽  
Primary Total Knee Arthroplasty ◽  
Transfusion Rate ◽  
Partial Regression Coefficient ◽  
Postoperative Length ◽  
Total Knee ◽  
The Impact

Abstract Background In an enhanced recovery after surgery program, a growing number of orthopedists are reconsidering the necessity of tourniquet use in total knee arthroplasty (TKA). However, the impact of tourniquet use on transfusion rate and postoperative length of stay (PLOS) in TKA remains controversial. Therefore, we carried out a study to investigate the effect of tourniquet application in routine primary TKA on transfusion rate and PLOS. Methods We analyzed data from 6325 patients who underwent primary unilateral TKA and divided them into two groups according to whether a tourniquet was applied during the procedure, and a tourniquet was used in 4902 and not used in 1423. The information for transfusion and PLOS was extracted from patients’ electronic health records, and the data were analyzed with logistic and linear regression analyses. Results Following TKA, the transfusion rate and PLOS were 14.52% and 7.72 ± 3.54 days, respectively, in the tourniquet group, and 6.47% and 6.44 ± 3.48 days, respectively, in the no-tourniquet group. After adjusting for the different related variables, tourniquet use was significantly correlated with a higher transfusion rate (risk ratio = 1.888, 95% confidence interval (CI) 1.449–2.461, P < 0.001) and a longer PLOS (partial regression coefficient (B) = 0.923, 95%CI 0.690–1.156, P < 0.001). Conclusions Our findings suggested that tourniquet use in routine primary TKA was related to a higher transfusion rate and a longer PLOS. The impact of tourniquet use on transfusion rate and PLOS should be taken into account in clinical practice.

scholarly journals Shortening Postoperative Stay after Parathyroidectomy - A District General Hospital Experience

2019 ◽  
Vol 24 (03) ◽  
pp. e313-e318
Author(s):  
Sidhartha Sinha ◽  
Matthew Fok ◽  
Ijaz Ahmad ◽  
Mustafa Al-Sheikh ◽  
Christopher Backhouse
Keyword(s):  
Patient Education ◽  
Length Of Stay ◽  
District General Hospital ◽  
Unplanned Readmission ◽  
Short Stay ◽  
Retrospective Audit ◽  
Parathyroid Adenomas ◽  
Biochemical Cure ◽  
Postoperative Length ◽  
Preoperative Patient

Introduction Historically, concerns about complications following parathyroid surgery, such as airway compromise, bleeding and hypocalcemia, have precluded its consideration as a short-stay surgical procedure. Recent advancements in perioperative care have resulted in several publications demonstrating that parathyroidectomy can be safely performed as a short-stay procedure. Objectives The aim of the present study was to describe the process of implementing a short-stay protocol focusing on preoperative patient education and postoperative calcium management for those undergoing surgery for primary hyperparathyroidism (PHP). Method A retrospective audit of consecutive parathyroidectomies performed for PHP over the period between 2010 and 2013 was performed. A short-stay protocol (SSP) was introduced focusing on postoperative calcium management. Results were reaudited over the period between 2013 and 2015. Results Consecutive parathyroidectomies in 76 patients were included in the study. A total of 42 patients underwent parathyroidectomy prior to the introduction of the protocol. A total of 26.2% of these patients were symptomatic from hypercalcemia. A total of 40 out of 42 (95.2%) patients had a biochemical cure. A total of 36 out of 42 (85.7%) cases were due to parathyroid adenomas. A total of 34 patients underwent surgery following the introduction of the protocol. A total of 13 out of 34 (38.2%) of the patients had symptomatic hypercalcemia. A total of 33 out of 34 (97.1%) had a biochemical cure. A total of 32 out of 34 (94.1%) cases were due to parathyroid adenomas.The length of stay decreased from a median of 3 days (range 2–9 days; mean 3.32) preprotocol to a median of 2 days (range 2–3 days; mean 2.16) postprotocol (p < 0.0001) with no difference in the 30-day unplanned readmission rate (4.8 versus 2.9%; p = 0.999). Conclusions The postoperative length of stay after parathyroidectomy for PHP can be safely reduced through patient education and by rationalizing postoperative calcium management without adversely affecting outcomes.

scholarly journals P.099 Specialty centres for MVD surgery

2018 ◽  
Vol 45 (s2) ◽  
pp. S42-S42
Author(s):  
A Montazeripouragha ◽  
AM Kaufmann
Keyword(s):  
Length Of Stay ◽  
Trigeminal Neuralgia ◽  
Disease Onset ◽  
High Volume ◽  
Referral Process ◽  
Time Intervals ◽  
Patient’S Satisfaction ◽  
Significant Difference ◽  
Postoperative Length ◽  
Delays In Diagnosis

Background: The aim of this study is comparing the waiting time and patient’s satisfaction of microvascular decompression (MVD) surgery between local Manitoba (MB) and out of province (OOP) patients, treated at our Centre for Cranial Nerve Disorder (CCND). Methods: Data from 100 consecutive patients (average age: 56.8±10.6 years), undergoing MVD surgery for Trigeminal Neuralgia (TN) and Hemifacial Spasm (HFS) were reviewed. The outcome measures included the time intervals between disease onset, diagnosis and referral to CCND, postoperative discharge, satisfaction with surgical outcome and referral process. Results: The preoperative time leading to CCND referral were longer for OOP patients, (onset to diagnosis/diagnosis to referral: 2.6±3.8/4.2±4.7 (OOP) versus 1.2±2.1/2.5±4.1 (MB) years; p=0.04/0.04), and referrals were more likely self-directed in OOP patients (62% (OOP), 21% (MB); p=0.007). Postoperative satisfaction with MVD outcome were 8.6/10 for OOP and 8.3/10 for MB patients. There was no significant difference in postoperative length of stay (38±50 (OOP)/43±42 (MB) hours); however, OOP patients were more likely discharged on the first postoperative day (58% (OOP), 31% (MB); p=0.17). Conclusions: Delays in diagnosis and surgical referral of TN/HFS are common, and many patients seek specialist’s opinion in high volume surgical centers. For those OOP patients, travelling for treatment, MVD outcome were at least as good as for local patients.

The Utility and Timing of Surgical Intervention for Parapneumonic Empyema in the Era of Video-Assisted Thoracoscopy

2005 ◽  
Vol 71 (6) ◽  
pp. 512-514 ◽  
Author(s):  
William W. Hope ◽  
William D. Bolton ◽  
James E. Stephenson
Keyword(s):  
Length Of Stay ◽  
Treatment Algorithm ◽  
Ct Scanning ◽  
Morbidity And Mortality ◽  
Tube Placement ◽  
Open Thoracotomy ◽  
Video Assisted ◽  
Preoperative Ct ◽  
Postoperative Length ◽  
Parapneumonic Empyema

Empyema, a pyogenic or suppurative infection of the pleural space, continues to cause significant morbidity and mortality in patients with pneumonia. The advent of video-assisted thoracoscopy has placed the treatment algorithm of empyema in flux. We retrospectively reviewed all patients who underwent surgical treatment for parapneumonic empyema from January 1, 1999, through December 31, 2003. Data collected included demographic information, preoperative CT scanning/thoracostomy tube placement, morbidity/mortality, days from admission to surgery, and postoperative length of stay. We compared patients undergoing video-assisted thoracoscopy to those requiring conversion to open thoracotomy and those who had initial open thoracotomy. Morbidity and mortality rates were similar among all groups. Conversion rate to open thoracotomy was 21 per cent. We found patients operated on within 11 days of admission had a shorter postoperative length of stay with similar morbidity and mortality. Our data supports early aggressive surgery treatment for parapneumonic empyema.

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