Costs and Perioperative Outcomes Associated with Open versus Endoscopic Resection of Sinonasal Malignancies with Skull Base Involvement

Objective To compare financial and perioperative outcomes between endoscopic and open surgical approaches in the surgical management of sinonasal malignancies. Design Retrospective chart review. Setting Tertiary care hospital. Participants Patients undergoing surgical resection of a sinonasal malignancy from January 2000 to December 2014. Main Outcome Measures In-hospital costs, complications, and length of stay (LOS). Results Of 106 patients, 91 received open surgery (19 free flap and 72 non-free flap) and 15 were treated with purely endoscopic approaches. Free flaps had a significantly higher average cost, operative time, and LOS compared to both non-free flap (p < 0.001, < 0.001, and < 0.01) and endoscopic (p = 0.01, 0.04, and < 0.01) groups. There were no significant differences in average costs between endoscopic and non-free flap groups ($19,157 vs. $14,806, p = 0.20) or LOS (5.7 vs. 6.4 days, p = 0.72). Compared with the non-free flap group, the endoscopic group had a longer average operative time (8.3 vs. 5.5 hours, p < 0.01) and higher rates of cerebrospinal fluid (CSF) leak (13 vs. 0%, p = 0.01) and intensive care unit (ICU) admission (80 vs. 36%, p < 0.01). Surgical approach (open vs. endoscopic) was not a significant predictor of any financial or perioperative outcome on multivariable analysis. Conclusion Hospital costs are comparable between endoscopic and open approaches when no free tissue reconstruction is required. Longer operative times, higher CSF leak rates, and our institutional protocol necessitating ICU admission for endoscopic cases may account for the failure to demonstrate cost savings with endoscopic surgery.

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The association of chest radiographic findings and severity scoring with clinical outcomes in patients with COVID-19 presenting to the emergency department of a tertiary care hospital in Pakistan

PLoS ONE ◽

10.1371/journal.pone.0244886 ◽

2021 ◽

Vol 16 (1) ◽

pp. e0244886

Author(s):

Raima Kaleemi ◽

Kiran Hilal ◽

Ainan Arshad ◽

Russell Seth Martins ◽

Avinash Nankani ◽

...

Keyword(s):

Emergency Department ◽

Clinical Outcomes ◽

Tertiary Care Hospital ◽

Imaging Modality ◽

Tertiary Care ◽

Multivariable Analysis ◽

Care Hospital ◽

X Rays ◽

Radiographic Findings ◽

Icu Admission

Introduction While chest x-rays (CXRs) represent a cost-effective imaging modality for developing countries like Pakistan, their utility for the prognostication of COVID-19 has been minimally explored. Thus, we describe the frequency and distribution of CXR findings, and their association with clinical outcomes of patients with COVID-19. Methods All adult (≥ 18 years) patients presenting between 28th February-31st May to the emergency department of a tertiary care hospital in Pakistan, who were COVID-19 positive on RT-PCR with CXR done on presentation, were included. A CXR Severity Score (CXR-SS) of 0–8 was used to quantify the extent of pulmonary infection on CXR, with a score of 0 being negative and 1–8 being positive. The patients’ initial CXR-SS and their highest CXR-SS over the hospital course were used for analysis, with cut-offs of 0–4 and 5–8 being used to assess association with clinical outcomes. Results A total of 150 patients, with 76.7% males and mean age 56.1 years, were included in this study. Initial CXR was positive in 80% of patients, and 30.7% of patients had an initial CXR-SS between 5–8. The mortality rate was 16.7% and 30.6% patients underwent ICU admission with intubation (ICU-Int). On multivariable analysis, initial CXR-SS (1.355 [1.136–1.616]) and highest CXR-SS (1.390 [1.143–1.690]) were predictors of ICU-Int, and ICU-Int was independently associated with both initial CXR-SS 5–8 (2.532 [1.109–5.782]) and highest CXR-SS 5–8 (3.386 [1.405–8.159]). Lastly, age (1.060 [1.009–1.113]), initial CXR-SS (1.278 [1.010–1.617]) and ICU-Int (5.047 [1.731–14.710]), were found to be independent predictors of mortality in our patients. Conclusion In a resource-constrained country like Pakistan, CXRs may have valuable prognostic utility in predicting ICU admission and mortality. Additional research with larger patient samples is needed to further explore the association of CXR findings with clinical outcomes.

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Incidence of valvular regurgitation and leaflet perforation by using automated titanium fasteners (CORKNOT®) in heart valve repair or replacement: less usual than reported

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-021-01512-z ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Faizus Sazzad ◽

Ong Zhi Xian ◽

Ashlynn Ler ◽

Chang Guohao ◽

Kang Giap Swee ◽

...

Keyword(s):

Heart Valve ◽

Operative Time ◽

Tertiary Care ◽

Paravalvular Leak ◽

Valvular Regurgitation ◽

Care Hospital ◽

Valve Repair ◽

Replacement Surgery ◽

Triple Valve

Abstract Background CORKNOT® facilitates a reduction in cardiopulmonary bypass (CPB) time, aortic cross clamp (ACC) time and operative time, but reported to be associated with other complications. We aim to quantify the incidence of valvular complications related to CORKNOT® and determine the feasibility of its use between different valvular surgeries. Methods Patients who underwent heart valve repair or replacement surgery via the use of automated titanium suture fasteners (CORKNOT®) in a tertiary care hospital were included in the study. This single-centre retrospective study was conducted on 132 patients between January 2016 and June 2018. Results In our study, the overall mean operative time was 320.0 ± 97.0 min, mean CPB time was 171.4 ± 76.0 min and the calculated mean ACC time was 105.9 ± 54.0 min. Fifty-eight patients (43.9%) underwent minimally invasive valve replacement or repair surgery and 66 patients (50.0%) underwent concomitant procedures. A total of 157 valves were operated on, with 112 (84.8%) single valve surgeries, 15 (11.4%) double valve surgeries and 5 (3.8%) triple valve surgeries. After reviewed by the cardiologist blinded towards the study, we report trivial and/or mild paravalvular leak (PVL) in immediate post-operative echocardiography was found in 1 (1.01%) patients. There were no reported cases of valvular thrombosis, leaflet perforation, device dislodgement or embolization, moderate and/or severe PVL during hospitalization and follow-up echocardiography within 1 year. Single mitral valve and aortic surgeries had comparable incidences of post surgical complications. Conclusion We conclude the feasibility of CORKNOT® utilisation in mitral and aortic valve surgeries. Additionally, incidence of CORKNOT® related complications in heart valve repair or replacement surgery is less usual in our setting than previously reported. These results motivate the use of CORKNOT® as a valid alternative with complete commitment.

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Prognostic Factors for the Outcome of Salivary Gland Holmium: YAG Laser Intraductal Lithotripsy

Ear Nose & Throat Journal ◽

10.1177/01455613211010075 ◽

2021 ◽

pp. 014556132110100

Author(s):

Shuo-Jen Wang ◽

Lung-Che Chen ◽

Yi-Chih Lin ◽

Yen-Chun Chen ◽

Luong Huu Dang ◽

...

Keyword(s):

Logistic Regression ◽

Salivary Gland ◽

Success Rate ◽

Operative Time ◽

Tertiary Care ◽

Operation Time ◽

Laser Lithotripsy ◽

Successful Outcome ◽

Care Hospital ◽

Yag Laser

Objectives: Holmium: YAG laser has gained its popularity throughout the years and is used to treat sialolithiasis, which helps to overcome the limitations of traditional sialendoscopic lithotripsy for larger-sized salivary stones. However, little information is available regarding factors predicting the success rate of Holmium: YAG laser intraductal lithotripsy. The purpose of this study is to investigate the factors affecting the success rates of Holmium: YAG laser lithotripsy for salivary stones treatment in a tertiary care hospital. Methods: A retrospective study conducted in patients receiving sialolithiasis surgery under sialendoscopy from May 2013 to March 2015 at Mackay Memorial Hospital, Taiwan. Data on various factors, including patients’ age, gender, glands, size of largest stone, multiple stones (≥2 stones), location of the stone (distal duct, middle duct, proximal duct, and hilum), and operative time. The success of the surgery defined as patients without any complaints such as swelling or tenderness. Logistic regression and Fisher exact tests were employed to examine these factors on the success rate. Results: Fifty-four patients who received sialendoscopy surgery with a mean age of 35.74 years old recruited. Logistic regression identified the operation time exceeding 210 minutes showed 23.497 folds higher odd ratio of having a result of operation failure ( P < .05). Conclusion: The prolonged operation time is the sole independent factor affecting the successful outcome for salivary gland intraductal laser lithotripsy. We recommend operative time be no more than 210 minutes to increase the success rate in salivary gland Holmium: YAG laser intraductal lithotripsy.

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A Comparative Analysis of Outcomes of Conventional Cold Dissection Versus Laser Tonsillectomy in Pediatric Cases in a Tertiary Care Hospital in Haryana

Indian Journal of Otolaryngology and Head & Neck Surgery ◽

10.1007/s12070-020-02301-1 ◽

2021 ◽

Author(s):

Amit Kumar ◽

Surender Kumar ◽

Anand Krishnan ◽

Manish Verma ◽

Uma Garg ◽

...

Keyword(s):

Operative Time ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Paediatric Population ◽

Care Hospital ◽

Secondary Complications ◽

Post Operative Pain ◽

Secondary Bleeding ◽

Paediatric Age ◽

Cold Dissection

AbstractTonsillectomy is one of the commonest ENT procedures done in paediatric population, the technique of which has evolved over years to decrease the morbidity associated with the surgery. This prospective randomized comparative study is done to evaluate the efficacy of two different techniques of this surgery, conventional cold dissection and laser tonsillectomy based on operative time, blood loss, post-operative pain and occurrence of secondary complications. The study was done in 68 patients of paediatric age group, 34 in each group underwent cold dissection and laser tonsillectomy. Operative time and bleeding were significantly low for laser group. Pain score was comparable in early post-operatives days, but was high towards the end of first week. Our study reported only one incidence of complication in the form of a secondary bleeding.

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Outpatient Follow-up Care After Hospital Discharge of Children With Complex Chronic Conditions at a Rural Tertiary Care Hospital

Clinical Pediatrics ◽

10.1177/00099228211047242 ◽

2021 ◽

pp. 000992282110472

Author(s):

Andrew Brown ◽

Mary Quaile ◽

Hannah Morris ◽

Dmitry Tumin ◽

Clayten L. Parker ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Hospital Discharge ◽

Care Coordination ◽

Chronic Conditions ◽

Tertiary Care ◽

Care Hospital ◽

Icu Admission ◽

Complex Chronic Conditions

Objective To determine factors associated with completion of recommended outpatient follow-up visits in children with complex chronic conditions (CCCs) following hospital discharge. Methods We retrospectively identified children aged 1 to 17 years diagnosed with a CCC who were discharged from our rural tertiary care children’s hospital between 2017 and 2018 with a diagnosis meeting published CCC criteria. Patients discharged from the neonatal intensive care unit and patients enrolled in a care coordination program for technology-dependent children were excluded. Results Of 113 eligible patients, 77 (68%) had outpatient follow-up consistent with discharge instructions. Intensive care unit (ICU) admission ( P = .020) and prolonged length of stay ( P = .004) were associated with decreased likelihood of completing recommended follow-up. Conclusions Among children with CCCs who were not already enrolled in a care coordination program, ICU admission was associated with increased risk of not completing recommended outpatient follow-up. This population could be targeted for expanded care coordination efforts.

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Influence of Reported Penicillin Allergy on Mortality in MSSA Bacteremia

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy042 ◽

2018 ◽

Vol 5 (3) ◽

Cited By ~ 2

Author(s):

Nicholas A Turner ◽

Rebekah Moehring ◽

Christina Sarubbi ◽

Rebekah H Wrenn ◽

Richard H Drew ◽

...

Keyword(s):

Tertiary Care ◽

Multivariable Analysis ◽

Mortality Rates ◽

Penicillin Allergy ◽

Care Hospital ◽

Beta Lactam ◽

Beta Lactams ◽

Appropriate Treatment ◽

Large Tertiary Care ◽

Multivariable Regression Models

Abstract Background Penicillin allergy frequently impacts antibiotic choice. As beta-lactams are superior to vancomycin in treating methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia, we examined the effect of reported penicillin allergy on clinical outcomes in patients with MSSA bacteremia. Methods In this retrospective cohort study of adults with MSSA bacteremia admitted to a large tertiary care hospital, outcomes were examined according to reported penicillin allergy. Primary outcomes included 30-day and 90-day mortality rates. Multivariable regression models were developed to quantify the effect of reported penicillin allergy on mortality while adjusting for potential confounders. Results From 2010 to 2015, 318 patients with MSSA bacteremia were identified. Reported penicillin allergy had no significant effect on adjusted 30-day mortality (odds ratio [OR], 0.73; 95% confidence interval [CI], 0.29–1.84; P = .51). Patients with reported penicillin allergy were more likely to receive vancomycin (38% vs 11%, P < .01), but a large number received cefazolin regardless of reported allergy (29 of 66, 44%). Mortality rates were highest among nonallergic patients receiving vancomycin (22.6% vs 7.4% for those receiving beta-lactams regardless of reported allergy, P < .01). In multivariable analysis, beta-lactam receipt was most strongly associated with survival (OR, 0.26; 95% CI, 0.12–0.54). Conclusions Reported penicillin allergy had no significant effect on 30- or 90-day mortality. Non-penicillin-allergic patients receiving vancomycin for treatment of MSSA bacteremia had the highest mortality rates overall. Receipt of a beta-lactam was the strongest predictor of survival. These results underscore the importance of correct classification of patients with penicillin allergy and appropriate treatment with a beta-lactam when tolerated.

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Evaluation of maternal admission to intensive care unit in a tertiary care hospital of Kashmir valley

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20214347 ◽

2021 ◽

Vol 10 (11) ◽

pp. 4283

Author(s):

Rehana Rashid ◽

Saniyah Khan Galzie ◽

Javid Ahmed

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Tertiary Care ◽

Health Care Facilities ◽

Near Miss ◽

Care Hospital ◽

Kashmir Valley ◽

Mortality And Morbidity ◽

Icu Admission ◽

Obstetric Haemorrhage

Background: Management of critically ill obstetric women at an ICU is a challenge to both physicians and obstetricians due to physiological adaptations and progress of diseases during pregnancy and puerperium. There has been a striking association between the number of maternal deaths and the accessibility to ICU care. Obstetric patients get admitted to the ICU approximately at 0.1-0.9% times of all deliveries. Objective was to evaluate the occurrence, indication and outcome of patients admitted in the ICU of an obstetric tertiary care hospital.Methods: This retrospective study was carried out from August 2020 to January 2021 at Lalla Ded Hospital, a tertiary care Obstetrics and Gynaecology Hospital of Kashmir valley. Data for this study was collected retrospectively from hospital records. The demographic details, indication for ICU admission, co-morbidities, ante natal care records were noted on admission to the ICU.Results: The total ICU admission during this time period was 212 (1.44%) with obstetric patients being 194 (91.5%) and gynaecologic patients 18 (8.5%). Obstetric haemorrhage (38.2) followed by hypertensive disorders of pregnancy (24.1%) were the most common indications for ICU admission. 26.9% patients needed mechanical ventilation during ICU admission.Conclusions: Analysing intensive care unit utilization during pregnancy can be an accepted approach to identify severe and near miss maternal morbidity. Development and upliftment of primary health care facilities with involvement of multi-disciplinary teams and referral of high risk pregnancies to higher health centres is the key to decrease maternal mortality and morbidity.

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Perioperative outcomes in human immunodeficiency virus-infected patients – the PRO HIV study

International Journal of STD & AIDS ◽

10.1177/0956462418764485 ◽

2018 ◽

Vol 29 (10) ◽

pp. 968-973 ◽

Cited By ~ 2

Author(s):

Divyashree Shanthamurthy ◽

Abi Manesh ◽

Naveena GP Zacchaeus ◽

Lisa R Roy ◽

Priscilla Rupali

Keyword(s):

Surgical Procedures ◽

Median Duration ◽

Surgical Outcomes ◽

Surgical Outcome ◽

Tertiary Care ◽

Perioperative Outcomes ◽

Care Hospital ◽

Cell Counts ◽

Cd4 Cell Counts ◽

Cd4 Cell

It is estimated that a quarter of patients with HIV/AIDS undergo at least one surgical procedure in their life time. Surgical outcomes in these patients from developing countries are poorly characterized and surgeons are often concerned about poor surgical outcomes, especially when their CD4 cell counts are less than 200 cells/µl. This study evaluated the surgical outcomes of HIV-infected patients undergoing various surgical procedures over a six-year period in a large tertiary care hospital from South India. Two hundred and ninety-three patients underwent 374 surgical procedures during the study period. The median duration of HIV prior to surgery was 1.9 years (range 0–18.8 years). Two-thirds (58%) were on highly active antiretroviral therapy (HAART) at the time of surgery with the median duration of this treatment being 38 months (n = 194). About one-third (35%) of surgical procedures were performed as an emergency. Abdomino-pelvic surgeries were the most common (225, 60%). Adverse surgical outcome defined as death or post-operative infection was seen in 25 (6.6%). The post-operative infection rate was 5% (20/374). The most common of these was surgical site infection observed in nine (60%) followed by pneumonia in five patients (33%) and urinary tract infection in one patient. Day 30 mortality was 2% (n = 8) and a quarter of these were reported to be related to post-operative infectious complications. On multivariate analysis, only preoperative haemoglobin of less than 10 g/dl was significantly associated with a poor surgical outcome. HIV-related parameters such as CD4 cell counts, duration of HIV infection and HAART regimen did not seem to contribute towards an adverse surgical outcome.

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P5477Usefulness of hypocalcemia at admission as a prognostic marker in patients with acute coronary syndromes

European Heart Journal ◽

10.1093/eurheartj/ehz746.0431 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

J C Gomez Polo ◽

C F Ferrera ◽

V Ruiz-Pizarro ◽

Z Gomez-Alvarez ◽

T Romero-Delgado ◽

...

Keyword(s):

Myocardial Infarction ◽

Prognostic Marker ◽

Serum Calcium ◽

Tertiary Care ◽

Multivariable Analysis ◽

Care Hospital ◽

Bleeding Events ◽

Killip Class ◽

St Segment Elevation ◽

Hospital Patients

Abstract Background Few studies have focused on the role of serum calcium levels (SCa) in patients with acute myocardial infarction (AMI). Purpose This study aimed to analyze the value of SCa as a prognostic marker in patients with AMI, including both with or without ST elevation. Methods From January-2015 to December-2017, all consecutive patients with AMI admitted to a tertiary care hospital were included. For the purpose of this study, total SCa levels were recorded at admission in each patient. Blood samples were obtained at the first medical contact when the patient arrived to the hospital. Patients were classified according to quartiles depending on their SCa at admission: Q1, under 8.3 mg/dl (N=300); Q2, between 8.4–8.7 mg/dl (N=264); Q3, between 8.8–9.1 mg/dl (N=279) and Q4, over 9.1 mg/dl (N=283). Results A total cohort of 1126 patients was included, 679 (60.3%) had STEMI and 447 (39.7%) were NSTEMI patients. Patients in the Q1 had more in-hospital complications, such as heart failure, bleeding events, new onset AMI, atrioventricular block and contrast induced nephropathy. Patients in the Q1 had higher in-hospital and one-year mortality as compared to that of patients in the Q2-Q4. After multivariate adjustment (Table), low SCa (<8.3mg/dl) remained as an independent predictor of in-hospital mortality (OR 2.91, 95% CI (1.15–7.41), p=0.025). These results were consistent in STEMI and NSTEMI patients. Multivariable analysis Variable OR (95% CI) p GRACE score 1.00 (0.99–1.02) 0.727 CRUSADE score 1.03 (1.01–1.06) 0.011 Age (per year) 1.05 (1.00–1.09) 0.034 STEMI 1.35 (0.41–4.46) 0.617 Diabetes 2.57 (0.97–6.79) 0.056 Low SCa (<8.3) 2.91 (1.15–7.41) 0.025 Killip class at admission 1 Reference 2 4.73 (1.31–17.1) 0.018 3 6.83 (1.70–27.5) 0.007 4 9.83 (1.44–67.1) 0.020 STEMI: ST segment elevation myocardial infarction; SCa: Serum calcium levels; OR: Odds ratio; CI: Confidence interval. Conclusion In patients with AMI, low SCa levels at admission (<8.3mg/dl) are independently associated with higher mortality.

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Impact of Colistin Dosing on the Incidence of Nephrotoxicity in a Tertiary Care Hospital in Saudi Arabia

Antibiotics ◽

10.3390/antibiotics9080485 ◽

2020 ◽

Vol 9 (8) ◽

pp. 485 ◽

Cited By ~ 1

Author(s):

Reem Almutairy ◽

Waad Aljrarri ◽

Afnan Noor ◽

Pansy Elsamadisi ◽

Nour Shamas ◽

...

Keyword(s):

Serum Albumin ◽

Clinical Cure ◽

Clinical Cure Rate ◽

Serum Albumin Level ◽

Tertiary Care ◽

Multivariable Analysis ◽

Severity Of Illness ◽

Albumin Level ◽

Care Hospital ◽

Cure Rate

Colistin therapy is associated with the development of nephrotoxicity. We examined the incidence and risk factors of nephrotoxicity associated with colistin dosing. We included adult hospitalized patients who received intravenous (IV) colistin for >72 h between January 2014 and December 2015. The primary endpoint was the incidence of colistin-associated acute kidney injury (AKI). The secondary analyses were predictors of nephrotoxicity, proportions of patients inappropriately dosed with colistin according to the Food and Drug Administration (FDA), European Medicines Agency (EMA), and Garonzik formula and clinical cure rate. We enrolled 198 patients with a mean age of 55.67 ± 19.35 years, 62% were men, and 60% were infected with multidrug-resistant organisms. AKI occurred in 44.4% (95% CI: 37.4–51.7). Multivariable analysis demonstrated that daily colistin dose per body weight (kg) was associated with AKI (OR: 1.57, 95% CI: 1.08–2.30; p = 0.02). Other significant predictors included serum albumin level, body mass index (BMI), and severity of illness. None of the patients received loading doses, however FDA-recommended dosing was achieved in 70.2% and the clinical cure rate was 13%. The incidence of colistin-associated AKI is high. Daily colistin dose, BMI, serum albumin level, and severity of illness are independent predictors of nephrotoxicity.

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