73 An Audit Evaluating the Management of Pre-Operative Anaemia in Elective Bowel Resections at Frimley Park Hospital

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
M Coyle ◽  
K Rangarajan ◽  
S G Celera ◽  
H Dowson ◽  
A S Nizar
Keyword(s):  
Length Of Stay ◽  
Bowel Resection ◽  
Inclusion Criteria ◽  
Female Population ◽  
Operative Outcomes ◽  
Intravenous Treatment ◽  
Mild Anaemia ◽  
Post Infusion ◽  
Iron Replacement ◽  
Park Hospital

Abstract Introduction Pre-operative anaemia is common within the surgical population, particularly those scheduled for elective bowel resections. National and local guidelines recommend the treatment of pre-operative anaemia, as it is an independent risk factor for poor post-operative outcomes, including length of stay in hospital. Method A retrospective study of all NHS patients over the age of 18 scheduled for an elective bowel resection at Frimley Park Hospital between 1st May-31st October 2019. Results 85 patients met the inclusion criteria, with 29 recorded as anaemic. Of these patients, 55% (n = 16) received iron replacement, all of which were intravenous and did not include mildly anaemic patients. The median rise in haemoglobin post-infusion was 14g/L, with only one patient achieving a normal haemoglobin. The median length of stay for patients with a normal haemoglobin was six days, which increased to eight for those with anaemia of any severity. A statistically significant relationship was found between severity of anaemia and increased length of stay, particularly in the female population. Conclusions Pre-operative anaemia was linked to increased length of stay in hospital. The findings support the intravenous treatment of all severities of anaemia pre-operatively and therefore suggest treating mild anaemia patients, as normalising their haemoglobin will improve outcomes.

scholarly journals THE PANC 3 SCORE PREDICTING SEVERITY OF ACUTE PANCREATITIS

2016 ◽  
Vol 29 (1) ◽  
pp. 5-8 ◽  
Author(s):  
Murilo Gamba BEDUSCHI ◽  
André Luiz Parizi MELLO ◽  
Bruno VON-MÜHLEN ◽  
Orli FRANZON
Keyword(s):  
Acute Pancreatitis ◽  
Intensive Care ◽  
Length Of Stay ◽  
Severe Acute Pancreatitis ◽  
Predictive Value ◽  
High Specificity ◽  
Daily Practice ◽  
Severe Form ◽  
Inclusion Criteria ◽  
Positive Score

Background: About 20% of cases of acute pancreatitis progress to a severe form, leading to high mortality rates. Several studies suggested methods to identify patients that will progress more severely. However, most studies present problems when used on daily practice. Objective: To assess the efficacy of the PANC 3 score to predict acute pancreatitis severity and its relation to clinical outcome. Methods: Acute pancreatitis patients were assessed as to sex, age, body mass index (BMI), etiology of pancreatitis, intensive care need, length of stay, length of stay in intensive care unit and mortality. The PANC 3 score was determined within the first 24 hours after diagnosis and compared to acute pancreatitis grade of the Revised Atlanta classification. Results: Out of 64 patients diagnosed with acute pancreatitis, 58 met the inclusion criteria. The PANC 3 score was positive in five cases (8.6%), pancreatitis progressed to a severe form in 10 cases (17.2%) and five patients (8.6%) died. Patients with a positive score and severe pancreatitis required intensive care more often, and stayed for a longer period in intensive care units. The PANC 3 score showed sensitivity of 50%, specificity of 100%, accuracy of 91.4%, positive predictive value of 100% and negative predictive value of 90.6% in prediction of severe acute pancreatitis. Conclusion: The PANC 3 score is useful to assess acute pancreatitis because it is easy and quick to use, has high specificity, high accuracy and high predictive value in prediction of severe acute pancreatitis.

scholarly journals Parkinson Disease Associated Differences in Elective Orthopedic Surgery Outcomes: A National Readmissions Database Analysis

2020 ◽  
Vol 10 (4) ◽  
pp. 1577-1586
Author(s):  
Michelle Fullard ◽  
Dylan Thibault ◽  
Hanan Zisling ◽  
James A. Crispo ◽  
Allison Willis
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Length Of Stay ◽  
Index Admission ◽  
Inclusion Criteria ◽  
Database Analysis ◽  
Discharge Disposition ◽  
Orthopedic Procedure ◽  
Surgery Outcomes ◽  
Clinical Conditions

Background: Advances in the treatment of Parkinson’s disease (PD) have allowed for improvements in mortality and quality survival, making the management of comorbid conditions of aging, such as osteoarthritis, crucial. Objective: To determine the extent to which PD impacts hospitalization outcomes after an elective orthopedic procedure. Methods: This retrospective cohort study used data from the National Readmissions Database and included adults ages 40 and above with and without PD. Primary outcomes included length of stay of the index admission, discharge disposition and 30-day readmission. Logistic regression was used to compare the odds of readmission for PD patients compared to non-PD. Clinical conditions associated with readmission were compared between the two groups. Results: A total of 4,781 subjects with PD and 947,475 subjects without PD met inclusion criteria. Length of stay (LOS) during the index admission was longer for PD patients. PD patients were much more likely to be discharged to inpatient post-acute care (49.3% vs 26.2%) while non-PD subjects were more likely to be discharged home with (31.9% [PD] vs 44.8% [non-PD]) or without home health (18.7% [PD] vs 28.9% [non-PD]). A total of 271 PD patients (5.66%) and 28,079 non-PD patients (2.96%) were readmitted within 30 days following surgery. After adjusting for age, sex, socioeconomic status, expected payer, comorbidities, index admission LOS, year and discharge disposition, PD subjects were 31% more likely to be readmitted than non-PD subjects (AOR 1.31, 1.07–1.62). Conclusions: Parkinson’s disease patients were readmitted more often than non-PD patients, although the rate of readmission was still low.

Hospital Length of Stay Among Patients Receiving Intermittent Versus Prolonged Piperacillin/Tazobactam Infusion in the Intensive Care Units

2017 ◽  
Vol 33 (2) ◽  
pp. 134-141 ◽  
Author(s):  
Jeannie D. Chan ◽  
Timothy H. Dellit ◽  
John B. Lynch
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Length Of Stay ◽  
Randomized Trials ◽  
Average Duration ◽  
Intermittent Infusion ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Inclusion Criteria ◽  
Prolonged Infusion

Objectives: We sought to evaluate clinical outcomes of intensive care unit (ICU) patients following a hospital-wide initiative of prolonged piperacillin/tazobactam (PIP/TAZ) infusion. Methods: Retrospective observational study of patients >18 years old who was hospitalized in the ICU receiving PIP/TAZ for >72 hours during the preimplementation (June 1, 2010 to May 31, 2011) and postimplementation (July 7, 2011 to June 30, 2014) periods. Results: There were 124 and 429 patients who met inclusion criteria with average age of 54.3 and 56.9 years, and average duration of PIP/TAZ therapy was 6.1 ± 2.8 days and 5.9 ± 3.4 days in the pre- and postimplementation period, respectively. Intensive care unit and hospital length of stay (LOS) following initiation of PIP/TAZ were 8.0 ± 8.4 days versus 6.4 ± 6.8 days and 26.3 ± 22.8 days versus 20.4 ± 16.1 days among patients in the pre- and postimplementation periods, respectively. Compared to patients who received intermittent PIP/TAZ infusion, the adjusted difference in ICU and hospital LOS was 0.6 ± 0.8 days (95% confidence interval [CI]: −0.9 to 2.1 days) and 5.6 ± 2.1 days (95% CI: 1.4 - 9.7 days) shorter among patients who received prolonged PIP/TAZ infusion. At hospital discharge, 19 (15.3%) intermittent infusion and 74 (17.2%) prolonged infusion recipients had died. In comparison to intermittent infusion recipients, the adjusted odds ratio for mortality was 1.17 (95% CI: 0.65-2.1) with prolonged infusion. Conclusion: Our study demonstrated a reduction in hospital LOS with prolonged PIP/TAZ infusion among critically ill patients. Randomized trials are needed to further validate these findings.

scholarly journals Postoperative Burden of Hospital-Acquired Clostridium difficile Infection

2015 ◽  
Vol 36 (1) ◽  
pp. 40-46 ◽  
Author(s):  
Zaid M. Abdelsattar ◽  
Greta Krapohl ◽  
Layan Alrahmani ◽  
Mousumi Banerjee ◽  
Robert W. Krell ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clostridium Difficile ◽  
Length Of Stay ◽  
Lower Extremity ◽  
Bowel Resection ◽  
Hospital Acquired Infection ◽  
Incidence Risk ◽  
Multivariable Regression Models ◽  
Hospital Acquired ◽  
The Impact

OBJECTIVEClostridium difficile infection (CDI) is a common hospital-acquired infection. Previous reports on the incidence, risk factors, and impact of CDI on resources in the surgical population are limited. In this context, we study CDI across diverse surgical settings.METHODSWe prospectively identified patients with laboratory-confirmed postoperative CDI after 40 different general, vascular, or gynecologic surgeries at 52 academic and community hospitals between July 2012 and September 2013. We used multivariable regression models to identify CDI risk factors and to determine the impact of CDI on resource utilization.RESULTSOf 35,363 patients, 179 (0.51%) developed postoperative CDI. The highest rates of CDI occurred after lower-extremity amputation (2.6%), followed by bowel resection or repair (0.9%) and gastric or esophageal operations (0.7%). Gynecologic and endocrine operations had the lowest rates (0.1% and 0%, respectively). By multivariable analyses, older age, chronic immunosuppression, hypoalbuminemia (≤3.5 g/dL), and preoperative sepsis were associated with CDI. Use of prophylactic antibiotics was not independently associated with CDI, neither was sex, body mass index (BMI), surgical priority, weight loss, or comorbid conditions. Three procedure groups had higher odds of postoperative CDI: lower-extremity amputations (adjusted odds ratio [aOR], 3.5; P=.03), gastric or esophageal operations (aOR, 2.1; P=.04), and bowel resection or repair (aOR, 2; P=.04). Postoperative CDI was independently associated with increased length of stay (mean, 13.7 d vs 4.5 d), emergency department presentations (18.9 vs 9.1%) and readmissions (38.9% vs 7.2%, all P<.001).CONCLUSIONSIncidence of postoperative CDI varies by surgical procedure. Postoperative CDI is also associated with higher rates of extended length of stay, emergency room presentations, and readmissions, which places a potentially preventable burden on hospital resources.Infect Control Hosp Epidemiol 2015;36(1): 40–46

scholarly journals O enfermeiro e o cuidado na prevenção de infecção sanguínea relacionada ao cateter de PICC em neonatos

2014 ◽  
Vol 4 (12) ◽  
pp. 26
Author(s):  
Ana Selma Pereira dos Santos ◽  
Luiz Faustino dos Santos Maia
Keyword(s):  
Quality Of Life ◽  
Length Of Stay ◽  
Bloodstream Infections ◽  
Infectious Complications ◽  
Central Catheter ◽  
Inclusion Criteria ◽  
Catheter Infection ◽  
Calidad De Vida ◽  
Safe Technique

O cateter central de inserção periférica é um procedimento indicado para o recém-nascido quando existe dificuldade para punção venosa. Trata-se de um estudo de revisão bibliográfica e qualitativa, cuja fonte foi as bases de dados da BDENF e os objetos foram artigos que atenderam aos critérios de inclusão estabelecidos. Infere-se que o profissional requer conhecimento, treinamento e habilidade para executar os cuidados com o cateter de PICC e realizar prevenção e intervenção de complicações infecciosas, assegurando uma técnica asséptica e segura observando diariamente o local da punção atentando-se a incidência de flebite para identificar as possibilidades associadas das complicações com relativas variáveis de infecção, pois ao prevenir à infecção de corrente sanguínea melhora a qualidade de vida dos neonatos, gerando menor tempo de permanência na instituição e redução dos gastos.Descritores: Enfermagem, Prevenção, Infecção de Cateter. Nurses and care in preventing bloodstream infections related to PICC catheter in newbornsAbstract: The central catheter peripherally inserted is a procedure indicated for the baby when it is difficult to venipuncture. This is a bibliographic review and qualitative, whose source was the the BDENF databases and objects were articles that met the inclusion criteria established. The professional up infers requires knowledge, training and ability to perform the care of the PICC catheter and perform prevention and intervention of infectious complications, ensuring aseptic and safe technique daily observing the location of paying attention to puncture the incidence of phlebitis to identify the possibilities of complications associated with infection related variables, as to prevent the infection of the bloodstream improves the quality of life of newborns, generating shorter length of stay in the institution and reduce spending.Descriptors: Nursing, Prevention, Catheter Infection. Enfermeras y la atención en la prevención de infecciones del torrente sangupineo relacionadas con el catéter PICC en neonatosResumen: El catéter central de inserción periférica es un procedimiento indicado para el bebé cuando es difícil punción venosa. Esta es una revisión bibliográfica y cualitativa, cuya fuente era las bases de datos y objetos BDENF eran artículos que cumplieron los criterios de inclusión establecidos. Los infiere profesionales hasta requiere conocimiento, la formación y la capacidad para llevar a cabo el cuidado del catéter PICC y llevar a cabo la prevención y la intervención de las complicaciones infecciosas, aséptica asegurar y técnica segura la observación diaria del lugar de prestar atención a la punción de la incidencia de flebitis a identificar las posibilidades de complicaciones asociadas a las variables relacionadas con la infección, como para prevenir la infección del torrente sanguíneo mejora la calidad de vida de los recién nacidos, la generación de más corta duración de la estancia en la institución y reducir el gasto.Descriptores: Enfermería, Prevención, Infección del Catéter. 

scholarly journals 558. Implementation and Outcomes of a COVID-19 Monoclonal Antibody Treatment Program in an Urban Safety-net Community Hospital

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S381-S381
Author(s):  
Alfredo J Mena Lora ◽  
Stephanie L Echeverria ◽  
Fischer Herald ◽  
James McSweeney ◽  
Harshil Gumasana ◽  
...  
Keyword(s):  
Disease Burden ◽  
Fast Track ◽  
Community Hospital ◽  
Safety Net ◽  
Local Health ◽  
Inclusion Criteria ◽  
Antibody Treatment ◽  
Monoclonal Antibody Treatment ◽  
Urban Safety ◽  
Post Infusion

Abstract Background Neutralizing monoclonal antibodies (mAbs) bind to the receptor binding domain of the spike protein of SARS-CoV-2. In November 2020, several mAbs were issued an EUA by the FDA as single-dose intravenous (IV) infusions for treatment of mild to moderate COVID-19. mABs were allocated to local health facilities capable of administering infusions and managing side effects. Creating an outpatient infusion program during the COVID-19 winter surge can be logistically difficult. Our goal was to implement a mAb outpatient infusion program at an urban safety-net community hospital designed to serve communities most heavily impacted by COVID-19. Methods The emergency department (ED) fast-track was repurposed for the mAb program with protocols from the infectious diseases physician and antimicrobial stewardship. Education materials with indications for mAbs were distributed in surrounding clinics serving our community. The program was available to all patients meeting criteria outlined in the protocol, 24/7, including but not limited to current ED patients and referrals from facilities in the vicinity. Results Between December 1, 2020 and March 1, 2021, a total of 37 patients were treated: 51% male, 57% Hispanic or Latinx, 27% Black, and 95% (35) represented ZIP codes with high COVID-19 burden (Figure 1). Bamlanivimab was used for each instance and all infusions met criteria. Patient indications for mAb infusion are listed in Figure 2. Parenteral antibiotics were given to 10.8% and 35% received oral antibiotics upon discharge. At 30 days post-infusion, 8% (3) required hospitalization and there were no deaths. Zip codes with high COVID-19 disease burden served by our mAB infusion program Distribution of patients who received mAB infusions by indication Conclusion A mAb outpatient infusion program was successfully deployed in a safety-net community hospital. We believe strengths of the program included the flexible infusion hours and convenient referral site for patients and providers. Of importance, this program was able to provide services to minorities from ZIP codes most heavily impacted by COVID-19. Unfortunately, antibacterial use was common and may reflect broader unnecessary use in COVID-19 patients. Whilst mAb treatment was deemed appropriate in all instances via protocol inclusion criteria, antibacterial stewardship programs may need to expand to ED settings for COVID-19 management. Disclosures All Authors: No reported disclosures

Pre-operative opioid use in gynecologic oncology: a common comorbidity relevant to the peri-operative period

2019 ◽  
Vol 29 (9) ◽  
pp. 1411-1416
Author(s):  
Megan Elizabeth Ross ◽  
Lindsay J Wheeler ◽  
Dina M Flink ◽  
Carolyn Lefkowits
Keyword(s):  
Length Of Stay ◽  
Gynecologic Oncology ◽  
Oral Morphine ◽  
Opioid Use ◽  
Oncology Patients ◽  
Opioid Prescription ◽  
Operative Outcomes ◽  
Operative Planning ◽  
Opioid Users ◽  
The Relationship

ObjectivesPre-operative opioid use is common and should be considered a comorbidity among surgical candidates. Our objective was to describe the rate of pre-operative opioid use and patterns of post-operative outpatient opioid prescribing in a cohort of gynecologic oncology patients.MethodsA retrospective cohort study was conducted with 448 gynecologic oncology surgical patients undergoing surgery for a suspected or known cancer diagnosis from January 2016 to December 2016. Pre-operative opioid users (n=97) were identified. Patient and surgical characteristics were abstracted, as was post-operative opioid prescription (type of opioid, oral morphine equivalents amount) and length of stay. For pre-operative opioid users, the type of opioid prescribed post-operatively was compared with the type of pre-operative opioid. Pre-operative opioid users were compared with non-users, stratified by surgery type. Descriptive statistics were analyzed using χ2 statistic, and medians were compared using a Mann-Whitney U statistic.ResultsPre-operative opioid prescriptions were noted in 21% of patients, and 24% of these had two or more opioid prescriptions before surgery. The majority of pre-operative opioid users (51%) were maintained on the same agent post-operatively at the time of discharge, but 36% were switched to a different opioid and 7% were prescribed an additional opioid. Overall and in laparotomies, pre-operative opioid users received higher volume post-operative prescriptions than non-users. There was no difference in post-operative prescription volume for minimally invasive surgeries or in length of stay between pre-operative users and non-users.ConclusionsPre-operative opioid use is common in gynecologic oncology patients and should be considered during pre-operative planning. Pre-operative opioid use was associated with a higher volume and wider range of post-operative prescription. Over 40% of opioid users were discharged with either an additional opioid or a new opioid, highlighting a potential missed opportunity to optimize opioid safety. Further research is needed to characterize the relationship between pre-operative opioid use and peri-operative outcomes and to develop strategies to manage pain effectively in this population without compromising opioid safety.

scholarly journals Systematic Dysphagia Screening of Elderly Persons in the Emergency Department—A Feasibility Study

Geriatrics ◽  
2020 ◽  
Vol 5 (4) ◽  
pp. 75
Author(s):  
Dorte Melgaard ◽  
Line R. Sørensen ◽  
Diana Lund ◽  
Peter Leutscher ◽  
Marc Ludwig
Keyword(s):  
Emergency Department ◽  
Critical Illness ◽  
Length Of Stay ◽  
Elderly Patients ◽  
Elderly Persons ◽  
Inclusion Criteria ◽  
Volume Viscosity ◽  
High Prevalence ◽  
Clinical Stabilization ◽  
Risk Of Aspiration

Identification of elderly patients in risk of dysphagia as early as possible upon hospital admission seems warranted due to the risk of aspiration pneumonia, dehydration, length of stay, and increased mortality. This study aimed to evaluate the feasibility and outcome of dysphagia screening of elderly persons admitted to the emergency department (ED). Inclusion criteria were age ≥ 60 years. A nurse applied the Simple Water Swallow test within one hour of admission. Subsequent assessment was performed by an occupational therapist (OT) using Volume Viscosity Swallow Test and Minimal Eating Observation Form. Of 113 eligible participants (median age 78 years), 75 (66%) were screened in the ED by the nurse, and among those, 12 (16%) were detected with dysphagia. Twenty of the patients not screened in the ED due to critical illness were tested by the OT in the ward after clinical stabilization and 15 patients (75%) were identified with dysphagia. This study demonstrated that it is feasible to perform dysphagia screening of elderly persons by a nurse in the ED, but there are severe limitations according to screening patients with critical illness and patients fasting before surgery in the ED. These patients have a high prevalence of dysphagia and should be screened as early as possible after hospitalization, as it will rarely be possible in the ED.

Factors Predicting Increased Length of Stay in Abdominal Wall Reconstruction

2021 ◽  
pp. 000313482110475
Author(s):  
Sharbel A. Elhage ◽  
Sullivan A. Ayuso ◽  
Eva B. Deerenberg ◽  
Jenny M. Shao ◽  
Tanushree Prasad ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Length Of Stay ◽  
Abdominal Wall ◽  
Operative Time ◽  
Enhanced Recovery ◽  
Abdominal Wall Reconstruction ◽  
Mesh Infection ◽  
Inclusion Criteria ◽  
Increased Risk ◽  
Eras Protocol

Background Enhanced recovery after surgery (ERAS) programs have become increasingly popular in general surgery, yet no guidelines exist for an abdominal wall reconstruction (AWR)–specific program. We aimed to evaluate predictors of increased length of stay (LOS) in the AWR population to aid in creating an AWR-specific ERAS protocol. Methods A prospective, single institution hernia center database was queried for all patients undergoing open AWR (1999-2019). Standard statistical methods and linear and logistic regression were used to evaluate for predictors of increased LOS. Groups were compared based on LOS below or above the median LOS of 6 days (IQR = 4-8). Results Inclusion criteria were met by 2,505 patients. On average, the high LOS group was older, with higher rates of CAD, COPD, diabetes, obesity, and pre-operative narcotic use (all P < .05). Longer LOS patients had more complex hernias with larger defects, higher rates of mesh infection/fistula, and more often required a component separation (all P < .05). Multivariate analysis identified age (β0.04,SE0.02), BMI (β0.06,SE0.03), hernia defect size (β0.003,SE0.001), active mesh infection or mesh fistula (β1.8,SE0.72), operative time (β0.02,SE0.002), and ASA score >4 (β3.6,SE1.7) as independently associated factors for increased LOS (all P < .05). Logistic regression showed that an increased length of stay trended toward an increased risk of hernia recurrence ( P = .06). Conclusions Multiple patient and hernia characteristics are shown to significantly affect LOS, which, in turn, increases the odds of AWR failure. Weight loss, peri-operative geriatric optimization, prehabilitation of comorbidities, and operating room efficiency can enhance recovery and shorten LOS following AWR.

Sign in / Sign up

Export Citation Format

Share Document