scholarly journals 978 Acute Appendicitis in The Age of COVID-19 – How Changing Standards Affect Patient Outcomes

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
G Karagiannidis ◽  
Omar Toma
Keyword(s):  
Length Of Stay ◽  
Acute Appendicitis ◽  
Patient Outcomes ◽  
Time Frame ◽  
Operative Intervention ◽  
Primary Study ◽  
Routine Practice ◽  
Admission Rates ◽  
Retrospective Data Collection ◽  
The Mean

Abstract Introduction The COVID-19 -19 pandemic has forced changes in the management of Acute Appendicitis (AA), such as prioritising conservative management and avoiding laparoscopic procedures. We aim to assess how these changes affected patient outcomes in comparison to routine practice during the same time frame in 2019. The primary study outcomes are operative intervention, length of stay and hospital re-admission within 30 days. Method Retrospective data collection for all patients admitted to Ipswich Hospital with suspicion of AA since lockdown came into effect in England on March 23 up to May 10th, 2020 and the same time frame in 2019. Results 23 patients were admitted during the lockdown period. 39%(N = 9) were treated conservatively.14 (61%) operatively, of which 71% (N = 10) had open appendicectomy while 29% (N = 4) underwent laparoscopic appendicectomies. The mean Length of Stay(LOS) was 3.83 days. In 2019,21 patients were admitted. 33%(N = 7) were treated conservatively. All appendicectomies were laparoscopic. Mean LOS was 2 days. Re-admission rates were similar in both groups. Conclusions Due to Covid19 a majority of patients requiring surgery underwent open appendicectomies. We noted a significant increase in both length of stay and progression from non-operative to operative intervention rates compared to 2019. The general case load was similar.

Delaying an Appendectomy: Is it Safe?

2012 ◽  
Vol 78 (8) ◽  
pp. 897-900 ◽  
Author(s):  
Kamal Nagpal ◽  
Navalkishor Udgiri ◽  
Niraj Sharma ◽  
Ernesto Curras ◽  
John Morgan Cosgrove ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Patient Outcomes ◽  
Early Group ◽  
Perforation Rate ◽  
Exclusion Criteria ◽  
Open Conversion ◽  
Urgent Operation ◽  
The Mean ◽  
The Relationship ◽  
Late Group

Appendicitis has always been an indication for an urgent operation, as delay is thought to lead to disease progression and therefore worse outcomes. Recent studies suggest that appendectomy can be delayed slightly without worse outcomes, however the literature is contradictory. The goal of our study was to examine the relationship between this delay to surgery and patient outcomes. We reviewed all patients that underwent an appendectomy in our institution from January 2009 to December 2010. We recorded the time of surgical diagnosis from when both the surgical consult and the CT scan (if done) were completed. The delay from surgical diagnosis to incision was measured, and patients were divided into two groups: early (≤6 hours delay) and late (>6 hours delay). Outcome measures were 30-day complication rate, length of stay, perforation rate, and laparoscopic to open conversion rate. Three hundred and seventy-seven patients had appendectomies in the study period, and 35 patients were excluded as per the exclusion criteria leaving 342 in the study: 269 (78.7%) in the early group and 73 (21.3%) in the late group. Complications occurred in 21 patients (6.1%) with no difference between the groups: 16/253 (5.9%) in the early group and 5/73 (6.8%) in the late group ( P = 0.93, χ2). The mean (± standard deviation) length of stay was 86.1 ± 67.1 hours in the early group, and 95.9 ± 73.0 hours in the late group. This difference was not significant ( P = 0.22). Delaying an appendectomy more than 6 hours, but less than 24 hours from diagnosis is safe and does not lead to worse outcomes. This can help limit the disruption to the schedules of both the surgeon and the operating room.

scholarly journals Impact of a specialist service in the Emergency Department on admission, length of stay and readmission of patients presenting with falls, syncope and dizziness

QJM ◽  
2020 ◽  
Author(s):  
K Jusmanova ◽  
C Rice ◽  
R Bourke ◽  
A Lavan ◽  
C G McMahon ◽  
...  
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Admission Rate ◽  
Readmission Rates ◽  
Specialist Service ◽  
Admission Rates ◽  
Potential Benefits ◽  
Bed Days ◽  
The Mean ◽  
The Impact

Summary Background Up to half of patients presenting with falls, syncope or dizziness are admitted to hospital. Many are discharged without a clear diagnosis for their index episode, however, and therefore a relatively high risk of readmission. Aim To examine the impact of ED-FASS (Emergency Department Falls and Syncope Service) a dedicated specialist service embedded within an ED, seeing patients of all ages with falls, syncope and dizziness. Design Pre- and post-cohort study. Methods Admission rates, length of stay (LOS) and readmission at 3 months were examined for all patients presenting with a fall, syncope or dizziness from April to July 2018 (pre-ED-FASS) inclusive and compared to April to July 2019 inclusive (post-ED-FASS). Results There was a significantly lower admission rate for patients presenting in 2019 compared to 2018 [27% (453/1676) vs. 34% (548/1620); X2 = 18.0; P < 0.001], with a 20% reduction in admissions. The mean LOS for patients admitted in 2018 was 20.7 [95% confidence interval (CI) 17.4–24.0] days compared to 18.2 (95% CI 14.6–21.9) days in 2019 (t = 0.98; P = 0.3294). This accounts for 11 344 bed days in the 2018 study period, and 8299 bed days used after ED-FASS. There was also a significant reduction in readmission rates within 3 months of index presentation, from 21% (109/1620) to 16% (68/1676) (X2 = 4.68; P = 0.030). Conclusion This study highlights the significant potential benefits of embedding dedicated multidisciplinary services at the hospital front door in terms of early specialist assessment and directing appropriate patients to effective ambulatory care pathways.

TP6.2.13 A PEG insertion pathway for Motor Neurone Disease patients improves efficiency and patient outcomes

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Benjamin Rossi ◽  
Rola Salem ◽  
Stuart Andrews ◽  
Kirk Bowling
Keyword(s):  
Length Of Stay ◽  
Patient Outcomes ◽  
Motor Neurone ◽  
Motor Neurone Disease ◽  
Admission Rates ◽  
Palliative Procedure ◽  
Endoscopic Gastrostomy ◽  
Chi Squared ◽  
Swallowing Difficulties ◽  
Anaesthetic Assessment

Abstract Aims Patients with Motor Neurone Disease (MND) often require a Percutaneous Endoscopic Gastrostomy (PEG) as a palliative procedure during the later stages of their illness, due to swallowing difficulties. More recently these are being inserted earlier before the inevitable decrease in nutritional intake and subsequent fall in albumin levels. This allows patients to eat food they enjoy rather than concentrating on maintaining intake. Insertion has traditionally been done with local anaesthetic and OGD, which can be difficult and traumatic. We propose a method of insertion using TIVA (Totally Intravenous Anaesthetic) in theatre with no intubation, performed by the surgical team, with a pathway including pre-operative anaesthetic assessment. Methods Data was collected from all PEG insertions performed in theatre from 1/1/2011 to 1/9/2019. MND patients following our pathway were compared to all other indications for PEG insertions. Length of stay (LOS), 30-day re-admission rates, 30-day, 90-day and 1-year mortality were analysed. Results 98 patients were identified. Median LOS was 3 days (mean 12.2) with a 3% 30-day mortality, 12.2% 90-day mortality and 34.7% 1-year mortality. In the MND group there were 27 patients. Median LOS was 2 days (mean 8.6) with a 7.4% (2 patients) 30-day mortality, which remained 7.4% at 90 days. There were 13 re-admissions (13.3%) overall compared to 0% in the MND group (p = 0.04 (Chi-squared test)). Conclusions PEG insertion under TIVA for MND patients is safe. A set pathway for admission and pre/post-insertion care increases efficiency with reduced length of stay and improves patient outcomes with no re-admissions.

Incidence and Outcomes of Ventilator-Associated Pneumonia in Japanese Intensive Care Units: The Japanese Nosocomial Infection Surveillance System

2007 ◽  
Vol 28 (3) ◽  
pp. 307-313 ◽  
Author(s):  
Machi Suka ◽  
Katsumi Yoshida ◽  
Hideo Uno ◽  
Jun Takezawa
Keyword(s):  
Mechanical Ventilation ◽  
Intensive Care ◽  
Length Of Stay ◽  
Nosocomial Infection ◽  
Patient Outcomes ◽  
Ventilator Associated Pneumonia ◽  
Drug Resistant ◽  
Icu Patients ◽  
The Mean ◽  
The Impact

Objectives.To determine the incidence of ventilator-associated pneumonia (VAP) among intensive care unit (ICU) patients in Japan and to assess the impact of VAP on patient outcomes, including mortality, length of stay, and duration of mechanical ventilation.Design.Multicenter cohort study.Setting.Twenty-eight ICUs in multidisciplinary Japanese hospitals with more than 200 beds.Patients.A total of 21,909 patients 16 years or older who were admitted to an ICU between June 2002 and June 2004, stayed in the ICU for 24 to 1,000 hours, and were not transferred to another ICU.Results.The overall infection rates for nosocomial pneumonia and VAP were 6.5 cases per 1,000 patient-days and 12.6 cases per 1,000 ventilator-days, respectively. The standardized mortality rates for the patients with VAP was 1.3 (95% confidence interval [CI], 1.1-1.6): 1.1 (95% CI, 0.9-1.4) for the cases due to drug-susceptible pathogens and 1.5 (95% CI, 1.1-1.9) for the cases due to drug-resistant pathogens. After adjusting for Acute Physiology and Chronic Health Evaluation II score, the mean length of stay for the patients with VAP caused by drug-susceptible pathogens (15.2 days [95% CI, 14.6-15.8]) and by drug-resistant pathogens (17.8 days [95% CI, 17.0-18.6]) was significantly longer than that in the patients without nosocomial infection (6.8 days [95% CI, 6.7-6.9]). The mean duration of mechanical ventilation in the patients with VAP caused by drug-susceptible pathogens (12.0 days [95% CI, 11.5-12.5]) and drug-resistant pathogens (14.1 days [95% CI, 13.5-14.8]) was significantly longer than that in the patients without nosocomial infection (4.7 days [95% CI, 4.6-4:8]).Conclusion.The incidence of VAP is substantial among ICU patients in Japan. The potential impact of VAP on patient outcomes emphasizes the importance of preventive measures against VAP, especially for VAP caused by drug-resistant pathogens.

scholarly journals 1128 Fracture Neck of Femur Patients in The Age of Covid-19

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
G Karagiannidis ◽  
O Toma
Keyword(s):  
Mortality Rate ◽  
Length Of Stay ◽  
Conservative Management ◽  
Care Home ◽  
Operative Management ◽  
Time Frame ◽  
Post Injury ◽  
Neck Of Femur ◽  
Fracture Neck Of Femur ◽  
The Mean

Abstract Aim The current climate of the COVID19 pandemic has forced various changes in the function of Trauma & Orthopaedic department and the management of fracture neck of femur (NOF) patients.We aim to assess the effect of reduced theatre capacity and delayed time to operative management due to the COVID19 outbreak on the 30-day mortality rate of fracture neck of femur (NOF) patients admitted to our trust. Method Retrospective data collection for all patients admitted to a single centre with NOF fractures since lockdown came into effect in England on March 23rd up to July 31st 2020 and the same time frame in 2019. Results During that period 129 patients were admitted with NOF fracture and of those 110 (85%) had outdoor injury and 19 (15%) were care home residents. The mean Length of Stay (LOS) was 8 days. In 2019, 121 patients were admitted, of whom 87 (72%) had outdoor injury and 34 (28%) were care home residents and the mean LOS was 22 days. In 2019 84% of patients went into theatre before 36 hours post-injury while only 70% in 2020. In 2020 8 patients treated conservatively while only 1 patient received conservative management in 2019.In total, during the COVID19 period there were 14 (11%) inpatient deaths, while only 2 (2%) inpatients deaths in 2019. The 30-day mortality rate was similar in both periods. Conclusions Due to COVID19 we noted a significant decrease in length of stay and increase in the conservative management of NOF fractures and inpatient deaths compared to 2019.

Aktivitätskonzentration der vom Personal einer Radiojodtherapiestation eingeatmeten Luft

1987 ◽  
Vol 26 (03) ◽  
pp. 143-146 ◽  
Author(s):  
H. Fill ◽  
M. Oberladstätter ◽  
J. W. Krzesniak
Keyword(s):  
Nuclear Medicine ◽  
Length Of Stay ◽  
Activity Concentration ◽  
Threshold Value ◽  
Whole Body ◽  
Therapeutic Activity ◽  
External Radiation ◽  
Oral Application ◽  
Exhaled Air ◽  
The Mean

The mean activity concentration of1311 during inhalation by the nuclear medicine personnel was measured at therapeutic activity applications of 22 GBq (600 mCi) per week. The activity concentration reached its maximum in the exhaled air of the patients 2.5 to 4 hours after oral application. The normalized maximum was between 2 • 10−5 and 2 • 10−3 Bq-m−3 per administered Bq. The mean activity concentration of1311 inhaled by the personnel was 28 to 1300 Bq-m−3 (0.8 to 35 nCi-rrf−3). From this the1311 uptake per year was estimated to be 30 to 400 kBq/a (x̄ = 250, SD = 50%). The maximum permitted uptake from air per year is, according to the German and Austrian radiation protection ordinances 22/21 µiCi/a (= 8 • 105 Bq/a). At maximum 50% and, on the average, 30% of this threshold value are reached. The length of stay of the personnel in the patient rooms is already now limited to such an extent that 10% of the maximum permissible whole-body dose for external radiation is not exceeded. Therefore, increased attention should be paid also to radiation exposure by inhalation.

scholarly journals Noise in Otolaryngology – Head and Neck Surgery operating rooms: a systematic review

2021 ◽  
Vol 50 (1) ◽  
Author(s):  
Gianluca Sampieri ◽  
Amirpouyan Namavarian ◽  
Marc Levin ◽  
Justine Philteos ◽  
Jong Wook Lee ◽  
...  
Keyword(s):  
Systematic Review ◽  
Head And Neck ◽  
Patient Outcomes ◽  
Noise Level ◽  
Neck Surgery ◽  
Operating Rooms ◽  
Head And Neck Surgery ◽  
Noise Levels ◽  
Surgical Performance ◽  
The Mean

Abstract Objective Noise in operating rooms (OR) can have negative effects on both patients and surgical care workers. Noise can also impact surgical performance, team communication, and patient outcomes. Such implications of noise have been studied in orthopedics, neurosurgery, and urology. High noise levels have also been demonstrated in Otolaryngology-Head and Neck Surgery (OHNS) procedures. Despite this, no previous study has amalgamated the data on noise across all OHNS ORs to determine how much noise is present during OHNS surgeries. This study aims to review all the literature on noise associated with OHNS ORs and procedures. Methods Ovid Medline, EMBASE Classic, Pubmed, SCOPUS and Cochrane databases were searched following PRISMA guidelines. Data was collected on noise measurement location and surgery type. Descriptive results and statistical analysis were completed using Stata. Results This search identified 2914 articles. Final inclusion consisted of 22 studies. The majority of articles analyzed noise level exposures during mastoid surgery (18/22, 82%). The maximum noise level across all OHNS ORs and OHNS cadaver studies were 95.5 a-weighted decibels (dBA) and 106.6 c-weighted decibels (dBC), respectively (P = 0.2068). The mean noise level across all studies was significantly higher in OHNS cadaver labs (96.9 dBA) compared to OHNS ORs (70.1 dBA) (P = 0.0038). When analyzed together, the mean noise levels were 84.9 dBA. Conclusions This systematic review demonstrates that noise exposure in OHNS surgery exceeds safety thresholds. Further research is needed to understand how noise may affect team communication, surgical performance and patient outcomes in OHNS ORs. Graphical abstract

scholarly journals Seasonal Influenza and Low Flu Vaccination Coverage as Important Factors Modifying the Costs and Availability of Hospital Services in Poland: A Retrospective Comparative Study

2021 ◽  
Vol 18 (10) ◽  
pp. 5173
Author(s):  
Robert Susło ◽  
Piotr Pobrotyn ◽  
Lidia Brydak ◽  
Łukasz Rypicz ◽  
Urszula Grata-Borkowska ◽  
...  
Keyword(s):  
Influenza Season ◽  
Influenza Infection ◽  
Hospital Staff ◽  
University Hospital ◽  
Control Group ◽  
Admission Rates ◽  
Risk Of Death ◽  
The Mean ◽  
Retrospective Comparative Study ◽  
The Cost

Introduction: Influenza infection is associated with potential serious complications, increased hospitalization rates, and a higher risk of death. Materials and Methods: A retrospective comparative analysis of selected indicators of hospitalization from the University Hospital in Wroclaw, Poland, was carried out on patients with confirmed influenza infection in comparison to a control group randomly selected from among all other patients hospitalized on the respective wards during the 2018–2019 influenza season. Results: The mean laboratory testing costs for the entire hospital were 3.74-fold higher and the mean imaging test costs were 4.02-fold higher for patients with confirmed influenza than for the control group; the hospital expenses were additionally raised by the cost of antiviral therapy, which is striking when compared against the cost of a single flu vaccine. During the 2018–2019 influenza season, influenza infections among the hospital patients temporarily limited the healthcare service availability in the institution, which resulted in reduced admission rates to the departments related to internal medicine; the mean absence among the hospital staff totaled approximately 7 h per employee, despite 7.3% of the staff having been vaccinated against influenza at the hospital’s expense. Conclusions: There were significant differences in the hospitalization indicators between the patients with confirmed influenza and the control group, which markedly increased the hospital care costs in this multi-specialty university hospital.

scholarly journals 1412. The utility of respiratory viral panel testing for nosocomial fever in the neonatal intensive care unit

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S713-S713
Author(s):  
Carlo Fopiano Palacios ◽  
Eric Lemmon ◽  
James Campbell
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Linear Regression ◽  
Length Of Stay ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
P Value ◽  
Fisher Exact Test ◽  
The Mean ◽  
Pcr Test

Abstract Background Patients in the neonatal intensive care unit (NICU) often develop fevers during their inpatient stay. Many neonates are empirically started on antibiotics due to their fragile clinical status. We sought to evaluate whether the respiratory viral panel (RVP) PCR test is associated with use of antibiotics in patients who develop a fever in the NICU. Methods We conducted a retrospective chart review on patients admitted to the Level 4 NICU of the University of Maryland Medical Center from November 2015 to June 2018. We included all neonates who developed a fever 48 hours into their admission. We collected demographic information and data on length of stay, fever work-up and diagnostics (including labs, cultures, RVP), and antibiotic use. Descriptive statistics, Fisher exact test, linear regression, and Welch’s ANOVA were performed. Results Among 347 fever episodes, the mean age of neonates was 72.8 ± 21.6 days, and 45.2% were female. Out of 30 total RVP samples analyzed, 2 were positive (6.7%). The most common causes of fever were post-procedural (5.7%), pneumonia (4.8%), urinary tract infection (3.5%), meningitis (2.6%), bacteremia (2.3%), or due to a viral infection (2.0%). Antibiotics were started in 208 patients (60%), while 61 neonates (17.6%) were already on antibiotics. The mean length of antibiotics was 7.5 ± 0.5 days. Neonates were more likely to get started on antibiotics if they had a negative RVP compared to those without a negative RVP (89% vs. 11%, p-value < 0.0001). Patients with a positive RVP had a decreased length of stay compared to those without a positive RVP (30.3 ± 8.7 vs. 96.8 ± 71.3, p-value 0.01). On multivariate linear regression, a positive RVP was not associated with length of stay. Conclusion Neonates with a negative respiratory viral PCR test were more likely to be started on antibiotics for fevers. Respiratory viral PCR testing can be used as a tool to promote antibiotic stewardship in the NICU. Disclosures All Authors: No reported disclosures

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