scholarly journals O33: PROSPECTIVE RISK ASSESSMENT ALONE DOES NOT IMPROVE 30-DAY MORTALITY IN EMERGENCY LAPAROTOMY PATIENTS

2021 ◽  
Vol 108 (Supplement_1) ◽  
Author(s):  
S Vavilov ◽  
P Pockney
Keyword(s):  
Risk Assessment ◽  
Length Of Stay ◽  
New England ◽  
Favourable Effect ◽  
Mortality Data ◽  
Emergency Laparotomy ◽  
Icu Length Of Stay ◽  
Possum Score ◽  
Prospective Risk ◽  
American Society

Abstract Introduction Emergency laparotomy still carries a high mortality risk. According to the latest National Emergency Laparotomy Audit (NELA) report, half of the patients without pre-operative risk scoring had a higher observed than predicted mortality. Data from Perth, Australia also suggests that pre-operative scoring improves mortality. The aim of this study was to determine if a prospective risk assessment has an independent favourable effect on outcomes. Method A retrospective review of all emergency abdominal surgeries meeting NELA inclusion criteria undertaken at four different-sized Australian surgical centres was performed between April 2015 and December 2018. A predicted and observed mortality was assessed in prospectively and retrospectively risk-stratified patients. Result There were 852 patients charts reviewed during the study period. Patient demographics included 404 males (47.4%), mean age: 69 years, median American Society of Anaesthesiologists score: 3, mean length of stay: 14.0 days and mean ICU length of stay: 1.8 days. There were 72 patients who died within 30 days (8.5%). Median preoperative P-POSSUM score was 6.9%, median preoperative NELA score – 5.2%. A total of 27/133 (20.3%) patients who were scored prospectively died within 30 days; 45/719 (6.3%) retrospectively scored patients died within 30 days. Neither of these rates was very different from the predicted. Conclusion 30-day mortality in emergency laparotomy patients in Hunter New England region, Australia, compares favourably with the latest mortality figures reported by NELA. However, contrary to other publications, prospective scoring alone did not have any beneficial effect on 30-day mortality in our cohort Take-home message Patients undergoing emergency abdominal surgery require preoperative risk assessment to improve outcomes. However, just the fact of assigning a risk score preoperatively alone does not help to improve mortality.

Vitamin C, Thiamine, and Hydrocortisone in the Treatment of Sepsis: A Meta-Analysis and Trial Sequential Analysis of Randomized Controlled Trials

2021 ◽  
pp. 088506662098780
Author(s):  
Yazan Zayed ◽  
Bashar N. Alzghoul ◽  
Momen Banifadel ◽  
Hima Venigandla ◽  
Ryan Hyde ◽  
...  
Keyword(s):  
Septic Shock ◽  
Length Of Stay ◽  
Vitamin C ◽  
Sofa Score ◽  
Sequential Analysis ◽  
Trial Sequential Analysis ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Icu Length Of Stay ◽  
Significant Difference

Background: There is a conflicting body of evidence regarding the benefit of vitamin C, thiamine, and hydrocortisone in combination as an adjunctive therapy for sepsis with or without septic shock. We aimed to assess the efficacy of this treatment among predefined populations. Methods: A literature review of major electronic databases was performed to include randomized controlled trials (RCTs) evaluating vitamin C, thiamine, and hydrocortisone in the treatment of patients with sepsis with or without septic shock in comparison to the control group. Results: Seven studies met our inclusion criteria, and 6 studies were included in the final analysis totaling 839 patients (mean age 64.2 ± 18; SOFA score 8.7 ± 3.3; 46.6% female). There was no significant difference between both groups in long term mortality (Risk Ratio (RR) 1.05; 95% CI 0.85-1.30; P = 0.64), ICU mortality (RR 1.03; 95% CI 0.73-1.44; P = 0.87), or incidence of acute kidney injury (RR 1.05; 95% CI 0.80-1.37; P = 0.75). Furthermore, there was no significant difference in hospital length of stay, ICU length of stay, and ICU free days on day 28 between the intervention and control groups. There was, however, a significant difference in the reduction of SOFA score on day 3 from baseline (MD −0.92; 95% CI −1.43 to −.41; P < 0.05). In a trial sequential analysis for mortality outcomes, our results are inconclusive for excluding lack of benefit of this therapy. Conclusion: Among patients with sepsis with or without septic shock, treatment with vitamin C, thiamine, and hydrocortisone was not associated with a significant reduction in mortality, incidence of AKI, hospital and ICU length of stay, or ICU free days on day 28. There was a significant reduction of SOFA score on day 3 post-randomization. Further studies with a larger number of patients are needed to provide further evidence on the efficacy or lack of efficacy of this treatment.

scholarly journals Outcomes of non-COVID-19 critically ill patients during the COVID-19 pandemic

2021 ◽  
Author(s):  
Răzvan Bologheanu ◽  
Mathias Maleczek ◽  
Daniel Laxar ◽  
Oliver Kimberger
Keyword(s):  
Intensive Care ◽  
Length Of Stay ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Medical Specialty ◽  
Routine Care ◽  
Treatment Pathways ◽  
Icu Length Of Stay ◽  
Matched Study ◽  
The Impact

Summary Background Coronavirus disease 2019 (COVID-19) disrupts routine care and alters treatment pathways in every medical specialty, including intensive care medicine, which has been at the core of the pandemic response. The impact of the pandemic is inevitably not limited to patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and their outcomes; however, the impact of COVID-19 on intensive care has not yet been analyzed. Methods The objective of this propensity score-matched study was to compare the clinical outcomes of non-COVID-19 critically ill patients with the outcomes of prepandemic patients. Critically ill, non-COVID-19 patients admitted to the intensive care unit (ICU) during the first wave of the pandemic were matched with patients admitted in the previous year. Mortality, length of stay, and rate of readmission were compared between the two groups after matching. Results A total of 211 critically ill SARS-CoV‑2 negative patients admitted between 13 March 2020 and 16 May 2020 were matched to 211 controls, selected from a matching pool of 1421 eligible patients admitted to the ICU in 2019. After matching, the outcomes were not significantly different between the two groups: ICU mortality was 5.2% in 2019 and 8.5% in 2020, p = 0.248, while intrahospital mortality was 10.9% in 2019 and 14.2% in 2020, p = 0.378. The median ICU length of stay was similar in 2019: 4 days (IQR 2–6) compared to 2020: 4 days (IQR 2–7), p = 0.196. The rate of ICU readmission was 15.6% in 2019 and 10.9% in 2020, p = 0.344. Conclusion In this retrospective single center study, mortality, ICU length of stay, and rate of ICU readmission did not differ significantly between patients admitted to the ICU during the implementation of hospital-wide COVID-19 contingency planning and patients admitted to the ICU before the pandemic.

scholarly journals Relationship Between ICU Length of Stay and Long-Term Mortality for Elderly ICU Survivors*

2016 ◽  
Vol 44 (4) ◽  
pp. 655-662 ◽  
Author(s):  
Vivek K. Moitra ◽  
Carmen Guerra ◽  
Walter T. Linde-Zwirble ◽  
Hannah Wunsch
Keyword(s):  
Length Of Stay ◽  
Icu Length Of Stay ◽  
Long Term Mortality

USING A NEURAL NETWORK TO PREDICT CARDIAC SURGERY ICU LENGTH OF STAY

1995 ◽  
Vol 23 (Supplement) ◽  
pp. A137 ◽  
Author(s):  
William N. Kantor ◽  
Richard K. Orr ◽  
Baltej S. Maini ◽  
Frank D. Sottile
Keyword(s):  
Neural Network ◽  
Cardiac Surgery ◽  
Length Of Stay ◽  
Icu Length Of Stay

Disagreement between emergency department admission diagnosis and hospital discharge diagnosis: mortality and morbidity

Diagnosis ◽  
2016 ◽  
Vol 3 (1) ◽  
pp. 23-30 ◽  
Author(s):  
James Eames ◽  
Arie Eisenman ◽  
Richard J. Schuster
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Medical Center ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Admission Diagnosis ◽  
Mortality And Morbidity ◽  
Emergency Department Admission ◽  
Icu Length Of Stay ◽  
Discordant Group

AbstractPrevious studies have shown that changes in diagnoses from admission to discharge are associated with poorer outcomes. The aim of this study was to investigate how diagnostic discordance affects patient outcomes.: The first three digits of ICD-9-CM codes at admission and discharge were compared for concordance. The study involved 6281 patients admitted to the Western Galilee Medical Center, Naharyia, Israel from the emergency department (ED) between 01 November 2012 and 21 January 2013. Concordant and discordant diagnoses were compared in terms of, length of stay, number of transfers, intensive care unit (ICU) admission, readmission, and mortality.: Discordant diagnoses was associated with increases in patient mortality rate (5.1% vs. 1.5%; RR 3.35, 95% CI 2.43, 4.62; p<0.001), the number of ICU admissions (6.7% vs. 2.7%; RR 2.58, 95% CI 2.07, 3.32; p<0.001), hospital length of stay (3.8 vs. 2.5 days; difference 1.3 days, 95% CI 1.2, 1.4; p<0.001), ICU length of stay (5.2 vs. 3.8 days; difference 1.4 days, 95% CI 1.0, 1.9; p<0.001), and 30 days readmission (14.11% vs. 12.38%; RR 1.14, 95% CI 1.00, 1.30; p=0.0418). ED length of stay was also greater for the discordant group (3.0 vs. 2.9 h; difference 8.8 min; 95% CI 0.1, 0.2; p<0.001): These findings indicate discordant admission and discharge diagnoses are associated with increases in morbidity and mortality. Further research should identify modifiable causes of discordance.

scholarly journals Hartmann’s procedure, reversal and rate of stoma-free survival

2018 ◽  
Vol 100 (4) ◽  
pp. 301-307 ◽  
Author(s):  
S Hallam ◽  
BS Mothe ◽  
RMR Tirumulaju
Keyword(s):  
Length Of Stay ◽  
Complication Rate ◽  
Major Complication ◽  
Wound Dehiscence ◽  
Hartmann’S Procedure ◽  
Hartmann's Procedure ◽  
Retrospective Audit ◽  
Audit Period ◽  
American Society ◽  
American Society Of Anesthesiologists

Background Hartmann’s procedure is a commonly performed operation for complicated left colon diverticulitis or malignancy. The timing for reversal of Hartmann’s is not well defined as it is technically challenging and carries a high complication rate. Methods This study is a retrospective audit of all patients who underwent Hartmann’s procedure between 2008 and 2014. Reversal of Hartmann’s rate, timing, American Society of Anesthesiologists grade, length of stay and complications (Clavien–Dindo) including 30-day mortality were recorded. Results Hartmann’s procedure (n = 228) indications were complicated diverticular disease 44% (n = 100), malignancy 32% (n = 74) and other causes 24%, (n = 56). Reversal of Hartmann’s rate was 47% (n = 108). Median age of patients was 58 years (range 21–84 years), American Society of Anesthesiologists grade 2 (range 1–4), length of stay was eight days (range 2–42 days). Median time to reversal of Hartmann’s was 11 months (range 4–96 months). The overall complication rate from reversal of Hartmann’s was 21%; 3.7% had a major complication of IIIa or above including three anastomotic leaks and one deep wound dehiscence. Failure of reversal and permanent stoma was less than 1% (n = 2). Thirty-day mortality following Hartmann’s procedure was 7% (n = 15). Where Hartmann’s procedure wass not reversed, for 30% (n = 31) this was the patient’s choice and 70% (n = 74) were either high risk or unfit. Conclusions Hartmann’s procedure is reversed less frequently than thought and consented for. Only 46% of Hartmann’s procedures were stoma free at the end of the audit period. The anastomotic complication rate of 1% is also low for reversal of Hartmann’s procedure in this study.

Controlled Study of Decision-Making Algorithms for Kidney Replacement Therapy Initiation in Acute Kidney Injury

2021 ◽  
pp. CJN.02060221
Author(s):  
Yvelynne Kelly ◽  
Kavita Mistry ◽  
Salman Ahmed ◽  
Shimon Shaykevich ◽  
Sonali Desai ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Length Of Stay ◽  
Kidney Injury ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Controlled Study ◽  
Control Group ◽  
Inpatient Mortality ◽  
Icu Length Of Stay ◽  
Kidney Replacement Therapy

Background: Acute kidney injury (AKI) requiring kidney replacement therapy (KRT) is associated with high mortality and utilization. We evaluated the use of an AKI-Standardized Clinical Assessment and Management Plan (SCAMP) on patient outcomes including mortality, hospital and ICU length of stay. Methods: We conducted a 12-month controlled study in the ICUs of a large academic tertiary medical center. We alternated use of the AKI-SCAMP with use of a "sham" control form in 4-6-week blocks. The primary outcome was risk of inpatient mortality. Pre-specified secondary outcomes included 30-day mortality, 60-day mortality and hospital and ICU length of stay. Generalized estimating equations were used to estimate the impact of the AKI-SCAMP on mortality and length of stay. Results: There were 122 patients in the AKI-SCAMP group and 102 patients in the control group. There was no significant difference in inpatient mortality associated with AKI-SCAMP use (41% vs 47% control). AKI-SCAMP use was associated with significantly reduced ICU length of stay (mean 8 (95% CI 8-9) vs 12 (95% CI 10-13) days; p = <0.0001) and hospital length of stay (mean 25 (95% CI 22-29) vs 30 (95% CI 27-34) days; p = 0.02). Patients in the AKI-SCAMP group less likely to receive KRT in the context of physician-perceived treatment futility than those in the control group (2% vs 7%, p=0.003). Conclusions: Use of the AKI-SCAMP tool for AKI-KRT was not significantly associated with inpatient mortality but was associated with reduced ICU and hospital length of stay and use of KRT in cases of physician-perceived treatment futility.

In-Hospital Mortality and Related Outcomes for Elevated Risk Acute Pulmonary Embolism Treated With Mechanical Thrombectomy Versus Routine Care

2021 ◽  
pp. 088506662110364
Author(s):  
Jennifer R. Buckley ◽  
Brandt C. Wible
Keyword(s):  
Pulmonary Embolism ◽  
High Risk ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Routine Care ◽  
Hospital Length ◽  
Elevated Risk ◽  
Hospital Length Of Stay ◽  
Icu Length Of Stay

Purpose To compare in-hospital mortality and other hospitalization related outcomes of elevated risk patients (Pulmonary Embolism Severity Index [PESI] score of 4 or 5, and, European Society of Cardiology [ESC] classification of intermediate-high or high risk) with acute central pulmonary embolism (PE) treated with mechanical thrombectomy (MT) using the Inari FlowTriever device versus those treated with routine care (RC). Materials and Methods Retrospective data was collected of all patients with acute, central PE treated at a single institution over 2 concurrent 18-month periods. All collected patients were risk stratified using the PESI and ESC Guidelines. The comparison was made between patients with acute PE with PESI scores of 4 or 5, and, ESC classification of intermediate-high or high risk based on treatment type: MT and RC. The primary endpoint evaluated was in-hospital mortality. Secondary endpoints included intensive care unit (ICU) length of stay, total hospital length of stay, and 30-day readmission. Results Fifty-eight patients met inclusion criteria, 28 in the MT group and 30 in the RC group. Most RC patients were treated with systemic anticoagulation alone (24 of 30). In-hospital mortality was significantly lower for the MT group than for the RC group (3.6% vs 23.3%, P < .05), as was the average ICU length of stay (2.1 ± 1.2 vs 6.1 ± 8.6 days, P < .05). Total hospital length of stay and 30-day readmission rates were similar between MT and RC groups. Conclusion Initial retrospective comparison suggests MT can improve in-hospital mortality and decrease ICU length of stay for patients with acute, central PE of elevated risk (PESI 4 or 5, and, ESC intermediate-high or high risk).

Sign in / Sign up

Export Citation Format

Share Document