Retrospective Data Review Comparing Complication Rates and Hospital Length of Stay in the Elderly

2016 ◽  
Vol 12 (7) ◽  
pp. S134-S135
Author(s):  
Van Leavitt ◽  
David Podkameni ◽  
Joseph Heller ◽  
Albert Chen ◽  
Flavia Soto ◽  
...  
Keyword(s):  
Length Of Stay ◽  
The Elderly ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Complication Rates ◽  
Retrospective Data

EARLY TRACHEOSTOMY IN THE ELDERLY SURGICAL ICU (SICU) PATIENT IS ASSOCIATED WITH DECREASED ICU AND HOSPITAL LENGTH OF STAY.

2006 ◽  
Vol 34 ◽  
pp. A124 ◽  
Author(s):  
Richard H Savel ◽  
Evan Goldstein ◽  
Deborah Riedinger ◽  
Herbert E Lehman ◽  
Yizhak Kupfer
Keyword(s):  
Length Of Stay ◽  
The Elderly ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Early Tracheostomy ◽  
Surgical Icu

Perioperative complication rates following neoadjuvant therapy in pancreatic adenocarcinoma.

2020 ◽  
Vol 38 (4_suppl) ◽  
pp. 688-688
Author(s):  
Christopher R. Deig ◽  
Blake Beneville ◽  
Amy Liu ◽  
Aasheesh Kanwar ◽  
Alison Grossblatt-Wait ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Neoadjuvant Therapy ◽  
Pancreatic Adenocarcinoma ◽  
Locally Advanced ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Complication Rates ◽  
Significant Difference ◽  
Perioperative Complication ◽  
The Impact

688 Background: Whether upfront resection or total neoadjuvant therapy is superior for the treatment of potentially resectable pancreatic adenocarcinoma (PDAC) remains controversial. The impact of neoadjuvant treatment on major perioperative complication rates for patients (pts) undergoing resection for PDAC is commonly debated. We hypothesized that rates would be comparable among patients receiving neoadjuvant chemoradiation (neo-CRT), neoadjuvant chemotherapy alone (neo-CHT), or upfront surgery. Methods: This is a retrospective study of 208 pts with PDAC who underwent resection within a multidisciplinary pancreatico-biliary program at an academic tertiary referral center between 2011-2018. Data were abstracted from the medical record, an institutional cancer registry and NSQIP databases. Outcomes were assessed using χ2, Fisher’s exact test and two-tailed Student’s t-tests. Results: 208 pts were identified: 33 locally advanced, borderline or upfront resectable pts underwent neo-CRT, 35 borderline or resectable pts underwent neoadjuvant-CHT, and 140 resectable pts did not undergo neoadjuvant therapy. There were no statistically significant differences in major perioperative complication rates between groups. Overall rates were 36.4%, 34.3%, and 26.4% for pts who underwent neo-CRT, neo-CHT alone, or upfront resection, respectively (p = 0.38). No significant difference were observed in complication rates (35.3% v. 26.4%; p = 0.19) or median hospital length of stay (10 days v. 10 days; p = 0.87) in pts who received any neoadjuvant therapy versus upfront resection. There were two perioperative deaths in the neo-CRT group (6.1%), zero in the neo-CHT group, and four in the upfront resection group (2.9%); p = 0.22. Conclusions: There were no significant differences in major perioperative complication rates, hospital length of stay, or post-operative mortality in pts who underwent neoadjuvant therapy (neo-CRT or neo-CHT alone) versus upfront surgery. Notably, neo-CRT had comparable perioperative complication rates to neo-CHT alone, which suggests neoadjuvant radiation therapy may not pose additional surgical risk.

ERAS Protocols for Thyroid and Parathyroid Surgery: A Systematic Review and Meta-analysis

2021 ◽  
pp. 019459982110196
Author(s):  
Kevin Chorath ◽  
Neil Luu ◽  
Beatrice C. Go ◽  
Alvaro Moreira ◽  
Karthik Rajasekaran
Keyword(s):  
Length Of Stay ◽  
Odds Ratio ◽  
Perioperative Management ◽  
Meta Analysis ◽  
Hospital Costs ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Complication Rates ◽  
Parathyroid Surgery ◽  
Inclusion Criteria

Objective Enhanced recovery after surgery (ERAS) protocols are evidenced-based multidisciplinary programs implemented in the perioperative setting to improve postoperative recovery and attenuate the surgical stress response. However, evidence on their effectiveness in thyroid and parathyroid surgery remains sparse. Therefore, our goal was to investigate the clinical benefits and cost-effectiveness of ERAS protocols for the perioperative management of thyroidectomy and parathyroidectomy. Data Source A systematic review of Medline, Scopus, Embase, and gray literature was performed to identify studies of ERAS or clinical care protocols for thyroidectomy and parathyroidectomy. Review Methods Two reviewers screened studies using predetermined inclusion criteria. Our primary outcomes included hospital length of stay and hospital costs. Readmission and postoperative complication rates composed our secondary outcomes. Meta-analysis was performed to compare outcomes for patients enrolled in the ERAS protocol versus standard of care. Results A total of 450 articles were identified; 7 (1.6%) met inclusion criteria with a total of 3082 patients. Perioperative components in ERAS protocols varied across the studies. Nevertheless, patients enrolled in ERAS protocols had reduced hospital length of stay (mean difference, –0.64 days [95% CI, −0.92 to −0.37]) and hospital costs (in US dollars; mean difference, –307.70 [95% CI, −346.49 to −268.90]), without an increase in readmission (odds ratio, 0.75 [95% CI, 0.29-1.94]) or complication rates (odds ratio, 1.14 [95% CI, 0.82-1.57]). Conclusion There is growing literature supporting the role of ERAS protocols for the perioperative management of thyroidectomy and parathyroidectomy. These protocols significantly reduce hospital length of stay and costs without increasing complications or readmission rates.

A multidisciplinary effort to decrease time from admission to chemotherapy on an inpatient oncology unit.

2017 ◽  
Vol 35 (8_suppl) ◽  
pp. 96-96
Author(s):  
Louise Ming-Wai Man ◽  
Jeremy Sen ◽  
Jeanne Cahan ◽  
Kathlene Degregory ◽  
Tanya Thomas ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Census Data ◽  
Medical Center ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Retrospective Data ◽  
Post Intervention ◽  
Pareto Chart ◽  
Pdsa Cycle ◽  
Oncology Unit

96 Background: Patients with established cancer diagnoses often experience delays in starting scheduled inpatient chemotherapy (CTX) after arrival on the University of Virginia (UVA) Medical Center oncology unit. These delays negatively impact hospital resource utilization. We formed a multidisciplinary team of physicians, nurses, and pharmacists to investigate these delays. We aim to decrease time-to-CTX (TTC) by 30% from baseline. Methods: From 340 planned inpatient CTX encounters in calendar year 2015, 100 were randomly reviewed to establish baseline retrospective data. The following were collected for each encounter: patient demographics; oncologic diagnosis; admitting team; CTX regimen and cycle; procedures and urinary parameters required prior to CTX start; times of lab orders and results, CTX signature and release, and start of intravenous fluid (IVF), premedications, and CTX; unit census data; available nursing staff; and length of stay. With guidance from ASCO’s Quality Training Program, we constructed a process map of the current state, an Ishikawa cause-and-effect diagram, a Pareto chart to assess causes of delays, and a priority matrix of potential interventions. XmR charts compared baseline and post-intervention data. Results: Baseline median TTC was 6.7 hours (range 1.5-105.3 h). Patients with pre-admission outpatient appointments started CTX 2.4 h earlier than those without appointments. Patients without urine parameters for treatment started CTX 3 h earlier than those with parameters. The Pareto chart indicated the longest delays occurred in pre-medicating patients, starting IVF, and signing CTX orders. In the first Plan-Do-Study-Act (PDSA) cycle, the CTX consent process was reformed. Post-intervention data showed no change in median TTC (7.2 h). Other PDSA cycles (setting patient arrival times and pre-admission pharmacy review of treatment plans) are ongoing; prospective data collection is pending. Conclusions: Retrospective data validate concerns that delays in starting inpatient CTX are longer than acceptable. They affect hospital length of stay, cost, and patient satisfaction. Our first PDSA cycle showed no change in TTC but additional interventions are ongoing.

Successful Transition to Robotic-Assisted Lobectomy With Previous Proficiency in Thoracoscopic Lobectomy

2019 ◽  
Vol 14 (3) ◽  
pp. 263-271 ◽  
Author(s):  
Robert E. Merritt ◽  
Peter J. Kneuertz ◽  
Desmond M. D’Souza
Keyword(s):  
Length Of Stay ◽  
Lymph Nodes ◽  
Learning Curve ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Complication Rates ◽  
Robotic Assisted ◽  
Thoracoscopic Lobectomy ◽  
Surgeon Experience ◽  
The Mean

Objective The learning curve and the advantages of transitioning to robotic-assisted lobectomy by a surgeon who is proficient in thoracoscopic lobectomy is currently unknown. The cost of robotic lobectomy has been reported to be higher than thoracoscopic lobectomy and there is no significant decrease in hospital length of stay. Methods This is a retrospective review of 228 patients diagnosed with lung carcinoma who underwent minimally invasive lobectomy from March 2014 to May 2018. A total of 114 patients underwent thoracoscopic lobectomy and 114 patients underwent robotic-assisted lobectomy. The data collected included patient demographics, tumor characteristics, morbidity, mortality, operative times, and hospital length of stay. Results A total of 114 patients underwent thoracoscopic lobectomy and 114 patients underwent robotic-assisted lobectomy. The patients in each group were similar in age, gender, smoking status, FEV-1, tumor histology, and pathologic stage. The mortality and complication rates were similar. The mean number of total lymph nodes and N2 lymph nodes were significantly higher in the robotic lobectomy group ( P < 0.0001). The mean operative time was shorter in the robotic group. The median hospital length of stay (4 days) was similar between the 2 groups ( P = 0.99). Conclusion The results of this report suggest that thoracoscopic and robotic-assisted lobectomy have similar outcomes when a surgeon proficient in the thoracoscopic technique completely transitions to the robotic-assisted technique. The learning curve was relatively accelerated in this single-surgeon experience. There may be an advantage for robotic-assisted lobectomy in the total number of lymph nodes harvested.

Do Obese Breast Cancer Patients Have More Complications and a Longer Length of Stay After Mastectomy Than Nonobese Patients?

2020 ◽  
pp. 000313482097335
Author(s):  
Melinda Wang ◽  
Julian Huang ◽  
Anees B. Chagpar
Keyword(s):  
Breast Cancer ◽  
Length Of Stay ◽  
Cancer Patients ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Wound Complications ◽  
Complication Rates ◽  
Obese Patients ◽  
Breast Cancer Patients ◽  
Nonobese Patients

Background While obesity is thought to increase complication rates in general surgery procedures, its effect in mastectomy patients remains to be fully elucidated. We sought to determine if obesity is associated with a higher complication rate and length of stay after mastectomy, independent of clinicopathologic and treatment factors. Methods Medical records of breast cancer patients undergoing mastectomy at our institution between January 2010 and December 2017 were retrospectively reviewed. Patients were separated into obese (body mass index [BMI] ≥ 30) and nonobese (BMI < 30) categories and compared using nonparametric statistical analyses. Results Of 927 patients, 291 (31.2%) were obese. Obese patients had more complications (26.5% vs. 20.0%, P = 0.033) and a greater number of complications per patient ( P = 0.025) than nonobese patients. They were more likely to have infections (10.7% vs. 5.7%, P = .009), flap thrombosis/necrosis (5.5% vs. 2.4%, P = .018), and skin breakdown/wound complications (8.6% vs. 4.6%, P = .022). Additionally, obese patients had longer hospital length of stay (LOS; LOS > 2 days: 77.7% vs. 65.2%, P < .001). Controlling for potential confounders, obesity remained associated with a higher rate of thrombosis/necrosis of flap (odds ratio [OR] = 2.26; 95% confidence interval [CI] 1.01-5.08; P = .047) and LOS ≥ 2 days (OR = 1.82; 95% CI 1.23-2.69; P = .003). Conclusion Obese breast cancer patients undergoing mastectomy have more thrombosis/necrosis of flap and a longer hospital LOS than nonobese patients, regardless of other comorbidities and clinicopathologic/treatment factors.

742 Marijuana and Drugs of Abuse: Impact on Clinical Outcomes in Burn Injury

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S203-S204
Author(s):  
Anne L Lambert Wagner ◽  
Tyler M Smith ◽  
Kiran U Dyamenahalli ◽  
Patrick Duffy ◽  
Elizabeth J Kovacs ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Clinical Outcomes ◽  
Drugs Of Abuse ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Categorical Variables ◽  
Published Data ◽  
Complication Rates ◽  
Burn Patients ◽  
Wound Infections

Abstract Introduction Alcohol has been shown to increase hospital length of stay, complications and mortality in burn patients in studies examining its effects over the past 25 years. In contrast, there is a scarcity of published data on the effects of marijuana and other drugs of abuse in the burn population. The primary aim of this study is to evaluate the clinical outcomes of marijuana use on burn patients in comparison to other drugs of abuse including alcohol. Methods A retrospective cohort study was conducted on 875 burn patients admitted to a verified burn center from July 2015 to July 2019. Patients were identified from our burn registry and additional data was obtained from chart reviews. The primary comparison was between patients with and without a positive toxicology (tox) screens on admission. Contingency analysis for categorical variables was performed using Fisher’s exact test, while the Mann-Whitney U test was used to compare continuous variables, reporting two-tailed p values. Results Results of admission tox screens on all burn admissions were positive in 48% (423) of patients for drugs of abuse including: marijuana 41% (358), alcohol 16% (141), and stimulants 15% (134). Tox screens positive for alcohol were significant for increased: hospital length of stay (LOS) (p=0.0121), ICU LOS (p=0.0166), ventilator days (p=0.0324), number of operations (p=0.0341), and complication rates (p=0.0005). Patients with positive drug, but negative alcohol screens showed significant increases in: hospital LOS (p=0.029), hospital complications (p=0.0251), and wound infections (p=0.04). Patients testing positive for marijuana approached significance for an increased hospital LOS (p=0.0756) and was significant for increased wound infections (p=0.0476). Looking at median ages: tox positive patients (35) were significantly younger (p=&lt; 0.0001) than negative (49). The median age for patients testing positive for marijuana (35) was significantly younger (p=&lt; 0.0001) than those that testing negative (47). Median age regarding alcohol tox screens was insignificant. Looking at significance in median TBSA, significance was found between tox positive (4.3%) and tox negative (3.5%) patients (p=0.004). TBSA was insignificant in the other groups. Conclusions Almost half of all admitted burn patients tested positive for alcohol and other drugs of abuse. As in previous studies, patients testing positive for alcohol continue to have a more complicated hospital course and longer hospital and ICU LOS. Marijuana, positive in 41% of all burn admissions, showed significance in increased wound infections and a slight trend towards an increased hospital stay. Applicability of Research to Practice The association between burns and drugs of abuse including alcohol indicates the need for increased preventative and educational efforts especially in patients suffering from alcohol abuse/dependence and younger patients.

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