scholarly journals 936 Outcomes of A Single Site Receiving Model for General Surgery During the COVID-19 Pandemic in A Scottish NHS Board

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
R Kilpatrick ◽  
A MacDonald
Keyword(s):  
Mortality Rate ◽  
General Surgery ◽  
Conservative Management ◽  
Average Length ◽  
Operative Management ◽  
Single Site ◽  
University Hospital ◽  
Average Length Of Stay ◽  
Time Period ◽  
Surgical Conditions

Abstract Aim: To assess overall patient outcomes of converting to a single-site receiving unit for general surgery during the height of the covid-19 pandemic. Method Prospective study of all general surgery inpatients, who would normally be looked after at University Hospital Monklands, between 17/04/20-06/06/20, the beginning and end of a single-site receiving model within NHS Lanarkshire. Results There was a 32% reduction in admissions from 278 to 188, from the same time period in 2019. The 30-day mortality rate was 3.2% in comparison to 2.8% in 2019. Of 59 patients (31.4%) who had surgery, 13.5% had a complication of varying degree. The post-operative 30-day mortality rate was 0%. Only 4 patients (2%) were diagnosed with covid-19, none of which died. Laparoscopic appendicectomy was favoured over conservative management, with average length of stay (LoS) being 3.2 days and 5 days respectively. Acute cholecystitis was overall managed conservatively with average LoS being 8.8 days for operative management, compared to 4.1 days for conservative management. Conclusions Overall outcomes during this time were not found to be significantly worse when compared to the previous year. The rate of contracting covid-19 in the unit was low. Laparoscopic surgery can still be carried out safely for selected acute surgical conditions.

scholarly journals INDICATORS OF MORBIDITY AND MORTALITY BY FEMUR FRACTURES IN OLDER PEOPLE: A DECADE-LONG STUDY IN BRAZILIAN HOSPITALS

2020 ◽  
Vol 28 (3) ◽  
pp. 142-148
Author(s):  
VIVIANE CRISTINA ULIANA PETERLE ◽  
JOÃO CARLOS GEBER JUNIOR ◽  
WILLIAN DARWIN JUNIOR ◽  
ALEXANDRE VASCONCELOS LIMA ◽  
PAULO EMILIANO BEZERRA JUNIOR ◽  
...  
Keyword(s):  
Older Adults ◽  
Mortality Rate ◽  
Average Length ◽  
Federal District ◽  
Population Based ◽  
Northern Region ◽  
Level Of Evidence ◽  
Average Length Of Stay ◽  
Femur Fractures ◽  
Unified Health System

ABSTRACT Objective: To evaluate the profile of femur fractures in older adults in Brazil between 2008 and 2018. Methods: Population-based time series study with data from the Department of Informatics of the Unified Health System (Datasus), including 480,652 hospitalizations, of adults from 60 years and over, with hip fracture (ICD10-S72). Results: There was an increase of 76.9% in the hospitalization register (mean 5.87%/year) and an average incidence rate of 19.46 fractures for every 10,000 older adults. In total, 68% of hospitalizations were female, 28% from São Paulo. The average length of stay was 8.9 days, being higher in the Northern Region (11.8) and in the Federal District (18.7). Average mortality rate was 5%, being higher in men (5.45%) and over 80 years old. Northeast Region had the lowest mortality rate (3.54%). Southeast Region had the highest rate (5.53%). Total cost of hospitalizations was R$ 1.1 billion, with an average of R$ 100 million/year. Average cost per hospitalization was higher in the Southern Region (R$ 2,491.00). Conclusion: Femoral fracture is an important cause of mortality among older adults, with a higher incidence in women but higher mortality in men, with high cost to the system and regional differences. Level of Evidence II, Economic and decision analyses - developing an economic or decision model.

937 Is the Dog Still Man's Best Friend?

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
S Ashraf ◽  
M Waseem
Keyword(s):  
Average Length ◽  
Financial Burden ◽  
District General Hospital ◽  
The Elderly ◽  
Operative Management ◽  
Search Term ◽  
Patient Demographics ◽  
Best Friend ◽  
Average Length Of Stay ◽  
The Impact

Abstract Introduction It is colloquially known that dogs are man’s best friend. However, animal attacks cause a large number of injuries and deaths worldwide, with 70% of injuries being caused by pets. This study highlights the impact of dog related injuries. Method Data was collected retrospectively over 1 year in a small district general hospital. The search term “dog” was used to find patients who had attended A&E or fracture clinic. This data was analysed for patient demographics, injury type and severity, management, and cost to the NHS. Results The majority (77%) of patients were female and elderly, with the modal age group being 70-79. Of the 38% of patients requiring admission, average length of stay was 6.7 days. Fractures made up the majority of injuries (56%) and 17% of patients required operative management. A further 2% suffered from post-operative complications. The average cost to the NHS was £1,695 per patient. Conclusions Dog related injuries disproportionately affected women and the elderly, with a large portion requiring operative management. Some patients developed further complications. As well as health burden there was also a financial burden associated with these injuries. These health and financial detriments are not often considered when deciding on pet ownership.

scholarly journals Spectrum of surgical trauma and associated head injuries at a university hospital in eastern Nepal

2010 ◽  
Vol 01 (01) ◽  
pp. 02-08 ◽  
Author(s):  
A Bajracharya ◽  
A Agrawal ◽  
B R Yam ◽  
C S Agrawal ◽  
Owen Lewis
Keyword(s):  
Road Traffic ◽  
Average Length ◽  
Case Series ◽  
Operative Management ◽  
Health Sciences ◽  
University Hospital ◽  
Surgical Trauma ◽  
Eastern Region ◽  
Female Ratio ◽  
Case Series Study

ABSTRACT Background: Trauma is one of the common surgical emergencies presenting at B. P. Koirala Institute of Health Sciences (BPKIHS), Nepal, a tertiary referral center catering to the needs of the population of Eastern Nepal and nearby districts of India. Objective: The objective of this study is to analyze the magnitude, epidemiological, clinical profile and outcome of trauma at B P Koirala Institute of Health Sciences. Materials and Methods: This descriptive case series study includes all patients with history of trauma coming to BPKIHS emergency and referred to the surgery department. We noted the detailed clinical history and examination, demographics, mechanism of injury, nature of injury, time of reporting in emergency, treatment offered (operative or non operative management) and analyzed details of operative procedure (i.e. laparotomy, thoracotomy, craniotomy etc.), average length of hospital stay, morbidity and outcome (according to Glasgow outcome scale). Collected data were analyzed using EpiInfo 2000 statistical software. Results: There were 1848 patients eligible to be included in the study. The mean age of the patients was 28.9 ± 19.3 years. Majority of the patients (38%) belonged to the age group of 21 - 40 years and the male to female ratio was 2.7:1. Most of the trauma victims were students (30%) followed by laborers (27%) and farmers (22%) respectively. The commonest causes of injury were fall from height (39%), road traffic accident (38%) and physical assault (18%); 78% of the patients were managed conservatively and 22% underwent operative management. Postoperative complications were seen in 18%. Wound infection 7.5%, neurological deficit including cerebrospinal fluid (CSF) otrorrhea was seen in 2.2% patients. Good recovery was seen in 84%, moderate disability in 5.2% patients and severe disability in 1.4% patients. The mortally was 6.3% and most of the deaths were related to traumatic brain injuries. Conclusions: In Nepal, trauma-related injury contributes significantly to morbidity and mortality and is the third leading cause of death. There are very few studies on trauma from this country and hence this study will help in understanding the etiology and outcome particularly in the Eastern region of Nepal.

Comparing Nosocomial Infection Rates Among Surgical Intensive-Care Units: The Importance of Separating Cardiothoracic and General Surgery Intensive-Care Units

1998 ◽  
Vol 19 (4) ◽  
pp. 260-261
Author(s):  
Olivia Keita-Perse ◽  
Jonathan R. Edwards ◽  
David H. Culver ◽  
Robert P. Gaynes
Keyword(s):  
Intensive Care ◽  
Nosocomial Infection ◽  
Intensive Care Units ◽  
General Surgery ◽  
Average Length ◽  
National Nosocomial Infection Surveillance ◽  
Infection Rates ◽  
Surgical Intensive Care ◽  
Average Length Of Stay ◽  
Infection Surveillance

ABSTRACTAmong surgical intensive-care units (ICUs), we assessed differences in risk-adjusted nosocomial infection rates between cardiothoracic (CT) and general surgery ICUs, using National Nosocomial Infection Surveillance data from 1987 to 1995. Device-associated rates and average length of stay were significantly lower in CT ICUs. Comparisons of risk-adjusted nosocomial infection rates among CT ICUs should be made separately from rates from general surgery ICUs.

516 Mortality from Inhalation Injury in Oxygen Dependent Patients Exceeds Prediction from Prognostic Models

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S95-S96
Author(s):  
Kathleen Singer ◽  
Jalen Harvey ◽  
Elizabeth Dale
Keyword(s):  
Mortality Rate ◽  
Length Of Stay ◽  
Average Length ◽  
Small Sample Size ◽  
Small Sample ◽  
Chi Square ◽  
Average Length Of Stay ◽  
Risk Of Mortality ◽  
Secondary Outcomes ◽  
Chi Square Analysis

Abstract Introduction The Boston Criteria and the Abbreviated Burn Severity Index (ABSI) are two widely accepted models for predicting mortality in burn patients. We aimed to elucidate whether these models are able to accurately predict risk of mortality in patients who sustain burns while smoking on home oxygen given their overall clinical fragility. Methods We conducted a retrospective chart review of 48 patients admitted to our burn center from November 2013 to September 2017 who sustained a burn while smoking on home oxygen. Yearlong mortality was the primary outcome of the investigation; secondary outcomes included discharge to facility, length of stay, and need for tracheostomy. We then calculated the expected mortality rate for each patient based on Boston Criteria and ABSI, respectively, and compared the mortality rate observed in our cohort. Results Patients in our cohort suffered a 54% mortality rate within a year of injury, compared to a 23.5% mortality predicted by Boston Criteria, which was found to be statistically significant by chi-square analysis (p < 0.05). ABSI predicted mortality was 19.7%. While the absolute value of difference in mortality was greater, this was not found to be significant on chi-square analysis due to the small sample size. Our secondary outcomes revealed 42% discharge to facility, average length of stay of 6.2 days, and 6.25% required tracheostomy. Patients in our cohort suffered a 54% mortality rate within a year of injury, compared to a 23.5% mortality predicted by Boston Criteria, which was found to be statistically significant by chi-square analysis (p < 0.05). ABSI predicted mortality was 19.7%. While the absolute value of difference in mortality was greater, this was not found to be significant on chi-square analysis due to the small sample size. Our secondary outcomes revealed 42% discharge to facility, average length of stay of 6.2 days, and 6.25% required tracheostomy. Conclusions Patients whose burns are attributable to smoking on home oxygen may have an increased risk of mortality than prognostication models, such as the Boston Criteria and ABSI, may suggest. This bears significant clinical impact, particularly regarding family and provider decision-making in pursuing aggressive management. Applicability of Research to Practice This data indicates that these injuries are direr than expected, which may have significant impact on family and provider decision-making.

scholarly journals Designing Hospital Key Performance Indicators for Academic Centers: Measuring the Average Length of Stay

2016 ◽  
Vol 6 (1) ◽  
pp. 5-11
Author(s):  
Omar A. Ayoub ◽  
Mohamed N. AlAma ◽  
Kamal M. AlGhalayini ◽  
Wesam A. Alhejily ◽  
Mohammed S. Abdulwahab ◽  
...  
Keyword(s):  
Health Care ◽  
Length Of Stay ◽  
Performance Indicator ◽  
Average Length ◽  
Performance Measure ◽  
University Hospital ◽  
Patient Specific ◽  
Design Quality ◽  
Average Length Of Stay ◽  
Risk Patients

Background: Length of stay is an important performance indicator for hospital management and a key measure of health care efficiency. This paper aims to determine the average length of stay in our center and the factors that influence it. We also investigate whether our hospital's length of stay is a key performance measure that can be used to design quality improvement initiatives. Methods: We performed a retrospective analysis of hospitalizations at the Multi-disciplinary Internal Medicine Department of King Abdulaziz University Hospital, Jeddah between 2010 and 2013. We collected data including demographics, admitting diagnosis, admitting unit, treatments administered, and history of transfer from the Intensive Care Unit. Results: The mean length of stay was 5.9 (6.8) days. Patients admitted through the Emergency Department were more likely to have a longer hospital stay compared with those admitted through Day Care or the Outpatient Department (P < 0.001). Expatriates (P < 0.001), bedridden patients (P = 0.02), and those who received prophylaxis for deep venous thrombosis (P < 0.001) were more likely to have a longer length of stay than the rest of the sample. Furthermore, patients admitted in the morning hours had a significantly shorter length of stay than those admitted in the evening hours (P < 0.001). Conclusion: The length of stay among patients at our department is affected by hospital- or patient-specific factors. Health care can be improved by identifying and monitoring the length of stay in high-risk patients.  

scholarly journals National University Hospital discharge survey in the Islamic Republic of Iran

2000 ◽  
Vol 6 (2-3) ◽  
pp. 402-408
Author(s):  
S. M. Reza Khatami ◽  
S. K. Kamrava ◽  
B. Ghatehbaghi ◽  
M. Mirzazadeh
Keyword(s):  
Health Care ◽  
Length Of Stay ◽  
Hospital Discharge ◽  
Average Length ◽  
Health Care Service ◽  
Health Care Facilities ◽  
University Hospital ◽  
Occupancy Rate ◽  
Bed Occupancy ◽  
Average Length Of Stay

We aimed to determine the rate of hospital discharge, average length of stay and bed occupancy rate in different hospital wards around the country. The survey consisted of health care service activities from 452 university-related hospitals in the country with a total of 59 348 beds. Because of missing data, the use of 56 315 of these beds was analysed. The countrywide discharge rate was 68.32 patients/1000 population per year with an average length of stay of 3.60 days and a bed occupancy rate of 57.44%. The data could be used to design a framework for prediction of inpatient health care facilities needed in the future

scholarly journals Economic impact of the Swiss Diagnosis-Related Group system on acute neurorehabilitation

2021 ◽  
Vol 10 (4) ◽  
pp. 10
Author(s):  
Loric Berney ◽  
Fabio Agri ◽  
Jean-Michel Pignat ◽  
Jean-Blaise Wasserfallen ◽  
Karin Diserens
Keyword(s):  
Economic Impact ◽  
Negative Impact ◽  
Average Length ◽  
Diagnosis Related Group ◽  
University Hospital ◽  
Accounting System ◽  
Financing System ◽  
Average Length Of Stay ◽  
Assessment Period ◽  
Related Group

Objective: To assess the economic impact of introducing the Swiss Diagnosis-Related Group (DRG)-financing system on the Acute Neurorehabilitation Unit (ANRU) of a University hospital in 2012 and to discuss the implications in 2020.Methods: A retrospective study using monocentric patient cohort and collecting anonymized data of consecutive patients admitted to the ANRU in 2012 and 2013. The characteristics, DRG A43Z, costs and revenues were retrieved from the hospital accounting system and allowed a comparison between the 2012 and 2013 groups of patients.Results: Forty-seven patients were included over the assessment period. In 2012, of the 23 patients admitted, 20 were coded A43Z, while in 2013, out of the 24 admissions, only eight had that specific code (p < .01). The average length of stay (LOS) increased from 45.5 days in 2012 to 49.5 days in 2013. Similarly, the average cost per patient increased by Swiss Franc (CHF) 19,994 over the two years, from CHF 183,634 in 2012 to CHF 194,629 in 2013. Finally, the average reimbursement per patient diminished by CHF 11,392, from CHF 193,153 in 2012 to CHF 181,760 in 2013.Conclusions: The negative impact on the cost–revenue balance is linked to both the increased cost of a longer stay and the decreased revenue due to less patients being coded A43Z. This study highlights the difficulties to justify funding of the complex care needed and to properly reflect patient burden in medico-administrative documents. Certainly, there is a need for a concerted effort to identify the services and resources needed within the DRG-system to guarantee the optimal management of acute neurorehabilitation.

scholarly journals 1475 Management of Appendicitis During COVID19 - A Shift to Conservative Management

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
P Bhattacharya ◽  
S Stonelake ◽  
E Peterknecht ◽  
S Zaman ◽  
M Budhoo
Keyword(s):  
Ct Scan ◽  
Conservative Management ◽  
Operative Management ◽  
Median Length ◽  
Conservative Group ◽  
Uncomplicated Appendicitis ◽  
Retrospective Data Collection ◽  
Surgical Conditions ◽  
Versus Risk

Abstract Introduction The COVID19 pandemic posed challenges in dealing with common surgical conditions, by causing a redirect of manpower and resources as well as having correlation of added morbidity if present in patients undergoing surgery Aim To find out the proportion of patients undergoing conservative management and their outcomes compared to operative management Method Retrospective data collection of patients admitted with appendicitis from 25/03/2020 to 15/07/2020. Results A total of 72 encounters had a discharge diagnosis of appendicitis.35 (48.6%) patients were treated with conservative management. while 37 (51.4%) patients had operative management. In the conservative group CT scan was done in 64%, which showed simple appendicitis in 78% and complicated in 17 %, whereas in the operative group CT scan was done in 59.4% , 86 % had simple appendicitis and 9% and complicated appendicitis. Median length of stay in both groups were 2 days. There were no readmissions in the operative group and 84.3% patients had no readmissions in the conservative group in the study in a follow up period up to 6 months. 2 patients initially treated conservative were eventually offered surgery on readmission. Conclusions 1. Conservative management of appendicitis has proved to be a valuable alternative to surgical management during this pandemic 2. Patients should be offered a choice of conservative management for simple appendicitis with prior discussion of benefits of avoiding surgery versus risk to recurrence (up to 39% reported in literature for uncomplicated appendicitis)

scholarly journals Clinical Characteristics of Liver Cirrhosis Patients in Internal Medicine Inpatient Ward of Fatmawati General Hospital and Factors Affecting Mortality during Hospitalization

2021 ◽  
Vol 22 (1) ◽  
pp. 3-8
Author(s):  
Nikko Darnindro ◽  
Annela Manurung ◽  
Edi Mulyana ◽  
Arnold Manurung
Keyword(s):  
Liver Cirrhosis ◽  
Mortality Rate ◽  
Hepatitis B ◽  
Creatinine Level ◽  
Mortality Risk ◽  
Average Length ◽  
Bivariate Analysis ◽  
Factors Affecting ◽  
Inpatient Ward ◽  
Average Length Of Stay

Background: liver cirrhosis is a global health problem. The mortality rate due to cirrhosis was estimated to achieve 1 million per year worldwide. The aim of this study is to elaborate the characteristics of patients  with liver cirrhosis and factors affecting mortality during hospitalization in Fatmawati General Hospital.Method: The design of this study was retrospective cohort involving patients admitted to the hospital between January and March 2019.Results: Among 41 liver cirrhosis patients, it was found that the average age was 52.9 ±13.8 years old and the percentage of male patients among participants was 75.6%. Patients who died during hospitalization was 12.2%. The average length of stay in hospital was 10.8±6.4 days. Patients were admitted to the hospital with various complaints; the most common complaint was gastrointestinal bleeding in 46.3%, decreased consciousness in 22% and massive ascites in 17.1% patients. Physical examination findings of anaemic conjunctiva, icteric sclera, and shifting dullness were found in 73.2%; 29.3% and 61% patients, respectively. Icteric condition during hospital admission has higher mortality risk with RR 9.6 (95% CI: 1.2-77.8). Approximately 53.7% cirrhosis patients were diagnosed with hepatitis B, while 22% of them  were diagnosed with hepatitis C. Coinfection of hepatitis B and C were found in 4.8% patients, while 29% patients were neither infected with hepatitis B nor C. Based on the laboratory examination, creatinine level 1.3 mg/dL had higher mortality risk with RR 8.3 (95% CI: 1.04-66.7), while natrium level ≤ 125 mmol/L had higher mortality risk with RR 26.4 (95% CI: 3.6-191). Based on Child-Pugh classification, 24.4% patients had Child-Pugh A, while 14.6% had Child Pugh C, and 39% patients could not be classified. The mean Child-Pugh score in this study was 8 ± 2.2. Through the bivariate analysis, we found the association between Child-Pugh classification and mortality; higher classification has higher mortality risk (p = 0.028). Child-Pugh C had mortality risk with RR = 9.5 (95% CI: 1.2-75.1).Conclusion: Liver cirrhosis patients were hospitalized due to the ongoing decompensation. The mortality rate during hospitalization in liver cirrhosis patients was high. Mortality in these patients was associated with icteric condition upon admission, high initial creatinine level, low sodium level, and high Child-Pugh classification.

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