P.099 Specialty centres for MVD surgery

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.

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Surgical Volume Affects Outcomes in Laryngectomy Procedures

Otolaryngology ◽

10.1016/j.otohns.2008.05.271 ◽

2008 ◽

Vol 139 (2_suppl) ◽

pp. P84-84

Author(s):

Brenda Mast ◽

Guy J Petruzzelli ◽

Tricia J Johnson

Keyword(s):

Length Of Stay ◽

Complication Rate ◽

High Volume ◽

Surgical Volume ◽

Total Cost ◽

Significant Difference ◽

Dependent Variables ◽

Kolmogorov Smirnov ◽

The University ◽

Smirnov Test

Objective To determine whether statistical differences occur in total cost, length of stay, ICU days, and surgical complications, depending on the volume of laryngectomy procedures performed. Methods Secondary laryngectomy data from 108 hospitals participating in the University Health System Consortium was examined. All laryngectomy surgical cases occurring from July 1, 2001, through June 30, 2005, with an ICD-9 code of 30.3 or 30.4 were analyzed (N=4,551). The cases were divided into 3 categories based on the number of surgical laryngectomy cases performed by hospital. Those volume categories were high, as defined by organizations with 100–233 cases (n=1712); medium, between 60–99 cases (n=1353); and low, between 4–59 cases (n=1458). 4 dependent variables were examined including total cost, length of stay, ICU days, and complications. Results The 4 dependent variables were analyzed for normality by performing a Kolmogorov-Smirnov test. All 4 variables were non-normally distributed. A Kruskal-Wallis test was then performed on each variable to determine if a statistically significant difference appeared between the 3 volume categories. Each variable was found to have statistical significant differences between the groups, with the high volume hospitals having the lowest cost, shortest length of stay, shortest ICU days, and smallest complication rate. Conclusions This study showed that hospitals with higher surgeon volume for total laryngectomies had reduced total cost, length of stay, number of ICU days, and complication rate for their patients.

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Day of surgery: the impact on patient length of stay in a tertiary vascular unit

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2019.0075 ◽

2020 ◽

Vol 102 (2) ◽

pp. 98-103 ◽

Cited By ~ 1

Author(s):

NC Holford ◽

C Ní Ghuidhir ◽

L Hands

Keyword(s):

Length Of Stay ◽

Hospital Stay ◽

Support Services ◽

Length Of Hospital Stay ◽

Abdominal Aortic Aneurysm Repair ◽

Significant Difference ◽

Postoperative Length ◽

The Difference ◽

Aneurysm Repair ◽

The Impact

Background Our hypothesis was that patients undergoing surgery earlier in the week would have better access to physiotherapy and other discharge services after surgery and, as a result, would have a shorter length of hospital stay compared with patients undergoing surgery later in the week. This study aimed to assess whether there is a significant difference in postoperative length of hospital stay between the groups with secondary assessment by operation subtype. Methods We identified all patients admitted for vascular surgery in 2015 from a prospectively collected database and divided the week into Monday to Wednesday and Thursday to Friday. Endovascular cases were included but day cases were excluded. Further analysis was performed with a breakdown in both groups by operation type. Statistical analysis was performed using SPSS version 16.0. Results We identified 652 patients who met our criteria. Within the elective patient group, there was a significantly longer length of stay of three days for the late-week group compared with two days for the early-week group (P = 0.016). Femoral artery procedures had a median length of stay of two days for those operated on early in the week compared with four days later in the week (P < 0.005). Open abdominal aortic aneurysm repair showed a trend to longer length of stay in the late-week group (P = 0.06). Conclusion Day of surgery appears to impact on patients’ length of stay following vascular procedures, with the greatest impact on medium-sized procedures. This difference could be explained by the difference in weekend support services, but further evaluation is required following introduction of weekend support services to assess this.

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Self-administered succus entericus reinfusion before ileostomy closure improves short-term outcomes

BMC Surgery ◽

10.1186/s12893-021-01444-4 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Zhen Liu ◽

Liang Fang ◽

Liang Lv ◽

Zhaojian Niu ◽

Litao Hou ◽

...

Keyword(s):

Length Of Stay ◽

Anterior Resection ◽

Low Anterior Resection ◽

Ileostomy Closure ◽

Control Group ◽

Short Term ◽

Function Recovery ◽

Significant Difference ◽

Postoperative Length

Abstract Objective The study aims to assess whether reinfusion of succus entericus prior to ileostomy closure can decrease postoperative length of stay and ameliorate low anterior resection score. Methods This study is a retrospective analysis based on prospectively collected data. Patients were screened from May 2016 to November 2019. A total of 30 patients who underwent reinfusion with succus entericus (SER) were enrolled in the SER group and 42 patients without SER were enrolled in the non-SER group. Results There was no significant difference in the incidence of postoperative ileus between succus entericus reinfusion (SER) group and the control group. Time to first passage of flatus or stool after surgery in the SER group (27.9 ± 6.02 h) is significantly shorter than the control group (32.3 ± 6.26, hours p = 0.004). Compared with the control group (5.52 (4.0–7.0) days), postoperative length of stay in the SER group was 4.90 (3.0–7.0)days (p = 0.009). As for low anterior resection score(LARS), the SER group had a lower score 1 week after discharge than the control group (p = 0.034). However, 1 month after discharge, the LARS in the two groups had no significant difference. Conclusions Self-administered succus entericus reinfusion is a feasible prehabilitation management for outpatients and can improve better outcomes. Compared with non-reinfusion group, succus enterius reinfusion group displays significantly shorter time for gastrointestinal function recovery and postoperative hospital stay without increasing complication, and it can bring better quality of life in a short term.

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Self-administered Succus Entericus Reinfusion before Ileostomy Closure improves short-term outcomes

10.21203/rs.3.rs-140207/v1 ◽

2021 ◽

Author(s):

Zhen Liu ◽

Liang Fang ◽

Liang Lv ◽

Zhaojian Niu ◽

Litao Hou ◽

...

Keyword(s):

Length Of Stay ◽

Anterior Resection ◽

Low Anterior Resection ◽

Ileostomy Closure ◽

Control Group ◽

Short Term ◽

Function Recovery ◽

Significant Difference ◽

Postoperative Length

Abstract Objective: The study aims to assess whether reinfusion of succus entericus prior to ileostomy closure can decrease postoperative length of stay and ameliorate low anterior resection score. Methods: This study is a retrospective analysis based on prospectively collected data. Patients were screened from May 2016 to November 2019. A total of 30 patients who underwent Reinfusion with Succus Entericus (SER) were enrolled in the SER group and 42 patients without SER were enrolled in the non-SER group. Results: There was no significant difference in the incidence of postoperative ileus between Succus Entericus Reinfusion (SER) group and the control group. Time to first passage of flatus or stool after surgery in the SER group (27.9 ± 1.10 hours) is significantly shorter than the control group (32.3 ± 0.97, hours p= 0.004). Compared with the control group (5.52 (4.0-7.0)days), postoperative length of stay in the SER group was 4.90 (3.0-7.0)days (p= 0.009). As for low anterior resection score(LARS), the SER group had a lower score 1 week after discharge than the control group (p=0.034). However, 1 month after discharge, the LARS in the two groups had no significant difference. Conclusions: Self-administered succus entericus reinfusion is a feasible prehabilitation management for outpatients and can improve better outcomes. Compared with non-reinfusion group, succus enterius reinfusion group displays significantly shorter time for gastrointestinal function recovery and postoperative hospital stay without increasing complication, and it can bring better quality of life in a short term.

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Outcomes of Emergent Incisional Hernia Repair

The American Surgeon ◽

10.1177/000313481107700812 ◽

2011 ◽

Vol 77 (8) ◽

pp. 971-976 ◽

Cited By ~ 32

Author(s):

Laura K. Altom ◽

Christopher W. Snyder ◽

Stephen H. Gray ◽

Laura A. Graham ◽

Catherine C. Vick ◽

...

Keyword(s):

Length Of Stay ◽

Incisional Hernia ◽

Hernia Repair ◽

Incisional Hernia Repair ◽

Chronic Obstructive ◽

Suture Repair ◽

Obstructive Pulmonary Disease ◽

Significant Difference ◽

Postoperative Length

This study examines the effect of emergent repair on incisional hernia repair outcomes at 16 Veteran's Affairs Medical Centers between 1998 and 2002. Of the 1452 cases reviewed, 63 (4.3%) were repaired emergently. Patients undergoing emergent repair were older ( P = 0.02), more likely to be black ( P = 0.02), and have congestive heart failure ( P = 0.001) or chronic obstructive pulmonary disease ( P = 0.001). Of emergent repairs, 76.2 per cent involved intestinal incarceration versus 7.2 per cent of elective repairs ( P < 0.0001), and 17.5 per cent had concomitant bowel resection compared with 3.9 per cent of elective cases ( P < 0.0001). Patients undergoing emergent repair were also more likely to receive primary suture repair (49.2 vs 31.1%, P = 0.003), develop a postoperative complication (26.0 vs 11.3%, P = 0.002), and have increased postoperative length of stay (7 vs 4 days, P < 0.0001). There were nine (14.3%) deaths at 30 days for the emergent group compared with 10 (0.7%) in the elective group ( P < 0.001). However, there was no significant difference between emergent and elective repairs in long-term complications. Emergent hernia repair is associated with increased mortality rates, early complications, and longer length of stay; however, long-term outcomes are equivalent to elective cases. These data suggest that technical outcomes for emergent repairs approach those of elective operations.

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STARR surgery in treatment of SRUS: an observational study on clinical outcomes

International Surgery Journal ◽

10.18203/2349-2902.isj20180341 ◽

2018 ◽

Vol 5 (2) ◽

pp. 507

Author(s):

Ashwin Porwal ◽

Paresh Gandhi ◽

Deepak Kulkarni

Keyword(s):

Length Of Stay ◽

Staple Line ◽

Average Length ◽

Cost Effective ◽

Excessive Bleeding ◽

Patient’S Satisfaction ◽

Average Length Of Stay ◽

Post Surgery ◽

Postoperative Length ◽

History Of

Background: SRUS is a condition with inadequately learned pathogenesis and usually associated with disorders of pelvic floor. Commonly seen in young adults and impairs quality of life. Because of these facts the management of SRUS is difficult and there is no clear consensus over it.Methods: An observational, prospective study was planned at a single center with purposive sampling. All clinically diagnosed, histologically and endoscopically confirmed SRUS patients treated with STARR surgery and followed for two years. Data collected and analyzed to evaluate the effectiveness and patients satisfaction.Results: Total of 46 patients with median age 47.8 years; of which 27 (58.70%) were females underwent STARR surgery. The average procedure time was 40 minutes, average length of stay was 24 hours and minimum duration of follow up was about 2 years (range 2-4 years). All patients had a pre-surgery history of digitations, which resolved in 91.3% patients post-surgery. There was a significant improvement in the ODS scores at the end of 2 years (82%; P <0.001). Excessive bleeding from staple line (48.57%), staple line dehiscence in 34.28% and staple line stricture (15.71% all males) are complications observed. No recurrence reported at the end of 4 years.Conclusions: Short postoperative length of stay and the short time to return to work after the STARR procedure for management SRUS, minimal manageable complications, no recurrence and patient’s satisfaction makes STARR a cost-effective procedure.

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LO54: A descriptive analysis of ED length of stay of admitted patients ‘boarded’ in the emergency department

CJEM ◽

10.1017/cem.2017.116 ◽

2017 ◽

Vol 19 (S1) ◽

pp. S46

Author(s):

L. Salehi ◽

P. Phalpher ◽

R. Valani

Keyword(s):

Emergency Department ◽

Length Of Stay ◽

Descriptive Analysis ◽

High Volume ◽

Increased Risk ◽

Significant Difference ◽

Ed Overcrowding ◽

Day Of The Week ◽

The Mean ◽

The Impact

Introduction: Previous studies have shown a link between Emergency Department (ED) overcrowding and worse clinical outcomes, increased risk of in-hospital mortality, higher costs, and longer times to treatment. Prolonged ED Length of Stay (LoS) of admitted patients awaiting a bed on in-patient units has been identified as a major driver of ED overcrowding. The purpose of this study is to provide a descriptive analysis of ED LoS among admitted patients, and determine the impact of prolonged ED LoS on total hospital in-patient length of stay (IP LoS). Methods: We conducted a single-site retrospective study for the period between January 1-December 31, 2015 at a very high volume community hospital. All patients aged ≥18 years admitted from the ED to acute in-patient Medicine units were identified. We carried out overall descriptive analysis (including analysis of day-of-the-week variability) on ED LoS. The mean total IP LoS for those patients with ED LoS<12 hours, 12-24 hours, and ≥24 hours were calculated and analyzed using ANOVA and Tukey HSD tests. Results: A total of 6,961 individuals were admitted to the medical units over the 12-month period. The median and mean ED LoS for admitted patients were 22.9 hrs (IQR: 13.9 hrs- 33.1 hrs) and 25.6 hrs respectively. Using ANOVA, there was a statistically significant difference in means of ED LoS as a function of the day of the week (p<0.0001), with Mondays having the highest mean ED LoS (27.6 hrs), and Fridays having the lowest (23.1 hrs). The mean IP LoS for those with ED LoS<12 hours, 12-24 hours, and ≥24 hours, were 6.8 days, 6.9 days, and 8.5 days respectively, with a statistically significant difference between group means (p<0.0001). Multiple pairwise comparisons of group means showed a statistically significant (p<0.05) difference between mean IP LOS of those with an EDLOS≥24 hours and those with an EDLOS<24 hours. Conclusion: Preliminary results indicate that ED LoS≥24 hours among admitted patients was associated with an increase in total IP LoS.*In the next 1-2 months, we intend to explore the role of other independent variables (age, sex, comorbidity, isolation status, and telemetry) on total ED LoS, and its association with IP LoS.

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Reversal of Diverting Loop Ileostomy Using Hand-Sewn Side-to-Side versus End-to-End Anastomosis after Low Anterior Resection for Rectal Cancer: A Single Center Experience

The American Surgeon ◽

10.1177/000313481808401128 ◽

2018 ◽

Vol 84 (11) ◽

pp. 1741-1744 ◽

Cited By ~ 1

Author(s):

Dimitrios Prassas ◽

Argyro Ntolia ◽

Jan-Dirk Spiekermann ◽

Thomas-Marten Rolfs ◽

Franz-Josef Schumacher

Keyword(s):

Length Of Stay ◽

Bowel Obstruction ◽

Low Anterior Resection ◽

Loop Ileostomy ◽

Ileostomy Reversal ◽

Significant Difference ◽

Postoperative Length ◽

Diverting Loop Ileostomy ◽

Secondary Outcomes ◽

End To End

Construction of diverting loop ileostomy has become a common adjunct to low anterior resection for rectal cancer because it substantially reduces the severity of postoperative morbidity. Various trials have compared hand-sewn with stapled anastomotic techniques, but the existing evidence regarding different configurations of hand-sewn anastomoses is scarce. The aim of this study is to compare the early postoperative outcomes of loop ileostomy reversal using the hand-sewn end-to-end or side-to-side configuration. A retrospective review was conducted on 62 consecutive patients undergoing ileostomy reversal between January 2012 and June 2017. The main outcome measure was postoperative bowel obstruction within 30 days after ileostomy reversal. Secondary outcomes included rate of anastomotic insufficiency, wound infection, reoperation, postoperative length of stay, and overall morbidity. The end-to-end (EE) anastomosis group consisted of 32 cases, whereas the side-to-side (SS) group consisted of 30 cases. Patient demographics, comorbidities, and BMI were similar between the two groups. No statistically significant difference was noted regarding postoperative bowel obstruction between the two groups [EE vs SS: 4/32 vs 0, P = 0.11]. Postoperative length of stay was longer for the EE group ( P = 0.03). Overall, 30-days morbidity was higher for the EE group (EE vs SS: 11/32 vs 3/30, P = 0.03). All other secondary outcomes did not differ between the two groups. No statistically significant difference was observed with regard to postoperative bowel obstruction. Overall, 30-days morbidity and postoperative length of stay were significantly higher for the EE group. Further randomized trials are required to verify our findings.

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Minimally Invasive Posterior Cervical Foraminotomy Versus Anterior Cervical Fusion and Arthroplasty: Systematic Review and Meta-Analysis

Global Spine Journal ◽

10.1177/21925682211055094 ◽

2021 ◽

pp. 219256822110550

Author(s):

Andrew Platt ◽

Richard G. Fessler ◽

Vincent C. Traynelis ◽

John E. O’Toole

Keyword(s):

Systematic Review ◽

Length Of Stay ◽

Minimally Invasive ◽

Operative Time ◽

Meta Analysis ◽

Reoperation Rate ◽

Significant Difference ◽

Posterior Cervical Foraminotomy ◽

Postoperative Length ◽

Cervical Foraminotomy

Study Design Systematic review and meta-analysis. Objectives Patients with lateral cervical disc and foraminal pathology can be treated with anterior and posterior approaches including anterior cervical discectomy and fusion(ACDF), cervical total disc arthroplasty(TDA), and minimally invasive posterior cervical foraminotomy(MIS-PCF). Although MIS-PCF may have some advantages over the anterior approaches, few comparative studies and meta-analyses have been done to assess superiority. Methods This study includes a systematic review of the literature and meta-analysis of studies directly comparing minimally invasive posterior cervical foraminotomy to either anterior cervical discectomy and fusion or cervical total disc arthroplasty. Results In comparing patients undergoing ACDF and MIS-PCF, operative time ranged from 68 to 97.8 minutes in the ACDF group compared to 28 to 93.9 minutes in the MIS-PCF group. Mean postoperative length of stay ranged from 33.84 to 112.8 hours in the ACDF group compared to 13.68 to 83.6 hours in the MIS-PCF group. The total complication rates were 3.72% in the ACDF group and 3.73% in the MIS-PCF group. A random-effects model meta-analysis was carried out which failed to show a statistically significant difference in the complication rate between the two procedures(OR .91; 95% CI 0.13, 6.43; P = .92, I2 = 59%). The total reoperation rate was 3.5% in the ACDF group and 5.4% in the MIS-PCF group. A random-effects model meta-analysis was carried out which failed to show a statistically significant difference in the reoperation rate between the two procedures(OR .66; 95% CI 0.33, 1.33; P = .25, I2 = 0). In comparing patients undergoing TDA and MIS-PCF, operative time ranged from 90.3 to 106.7 minutes in the TDA group compared to 77.4 to 93.9 minutes in the MIS-PCF group. Mean postoperative length of stay ranged from 103.2 to 165.6 hours in the TDA group and 93.6 to 98.4 hours in the MIS-PCF group. The complication rate ranged from 23.5 to 28.6% in the TDA group and 0 to 14.3% in the MIS-PCF group. The overall reoperation rates were 2.6% in the TDA group and 10.2% in the MIS-PCF group. Conclusions There is no clear superiority between MIS-PCF and ACDF/TDA in terms of operative time, postoperative length of stay, or rate of complications/reoperations. Further studies with increased follow-up intervals >48 months, and higher sample sizes are necessary to determine the true superiority of MIS-PCF and anterior neck approaches in treatment of lateral disc and foraminal pathology.

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Prolonged length of stay (PLOS) in a high-volume arthroplasty unit

Bone & Joint Open ◽

10.1302/2633-1462.18.bjo-2020-0047.r1 ◽

2020 ◽

Vol 1 (8) ◽

pp. 488-493

Author(s):

Hean Wu Kang ◽

Leeann Bryce ◽

Roslyn Cassidy ◽

Janet Catherine Hill ◽

Owen Diamond ◽

...

Keyword(s):

Length Of Stay ◽

Social Services ◽

Enhanced Recovery ◽

High Volume ◽

Prolonged Length ◽

Discharge Plan ◽

Postoperative Length ◽

Bed Days ◽

The Mean ◽

Day Of Surgery Admission

Introduction The enhanced recovery after surgery (ERAS) concept in arthroplasty surgery has led to a reduction in postoperative length of stay in recent years. Patients with prolonged length of stay (PLOS) add to the burden of a strained NHS. Our aim was to identify the main reasons. Methods A PLOS was arbitrarily defined as an inpatient hospital stay of four days or longer from admission date. A total of 2,000 consecutive arthroplasty patients between September 2017 and July 2018 were reviewed. Of these, 1,878 patients were included after exclusion criteria were applied. Notes for 524 PLOS patients were audited to determine predominant reasons for PLOS. Results The mean total length of stay was 4 days (1 to 42). The top three reasons for PLOS were social services, day-before-surgery admission, and slow to mobilize. Social services accounted for 1,224 excess bed days, almost half (49.2%, 1,224/2,489) of the sum of excess bed days. Conclusion A preadmission discharge plan, plus day of surgery admission and mobilization on the day of surgery, would have the potential to significantly reduce length of stay without compromising patient care. Cite this article: Bone Joint Open 2020;1-8:488–493.

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