EP.TU.826Using Indocyanine Green (ICG) during laparoscopic bowel resections for elective cancer patients reduces anastomotic leaks and length of stay

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Anna Bleakley ◽  
Olusegun Komolafe
Keyword(s):  
Length Of Stay ◽  
Primary Outcome ◽  
Fluorescent Imaging ◽  
Fluorescence Angiography ◽  
P Value ◽  
Bowel Perfusion ◽  
Group 5 ◽  
Simple Technology ◽  
Inpatient Length Of Stay ◽  
Colorectal Resections

Abstract Introduction Anastomotic leakage (AL) after colorectal surgery is associated with significant morbidity and mortality. Poor perfusion of bowel anastomosis is a significant contributing factor. ICG is a dye administered during laparoscopic surgery to assess bowel perfusion by fluorescent imaging – the aim of this study was to determine whether its use in our centre during elective laparoscopic colorectal cancer resections led to improved patient outcomes. Method Single-centre comparative study of all patients who underwent elective colorectal laparoscopic resections for cancer January 2019- January 2021. Primary outcome investigated was AL. Secondary outcomes: in-patient length of stay, clinical suspicion of AL and post-operative ileus. Cohorts compared with χ2 test. Results 25 patients had resections with ICG, 60 without. None in ICG group, and three in non-ICG group (5%) had AL; p-value 0.29. The ICG group were less likely to have CT for suspected anastomotic leak 12% vs 23.3%, p-value 0.29; and, post-operative ileus 5.3% vs 19.6%, p-value 0.09. Statistically significant reduction in mean inpatient length of stay when ICG used (4.0 days, 95% CI 3.3-4.7) compared to when not used (6.7 days, 95% CI 5.0-8.3). Conclusion Only a small number of previous studies have compared AL rates with and without ICG, finding that its use leads to a significant reduction in AL. While sample size small, our findings supports this. Using ICG also led to a significant reduction in inpatient length of stay. ICG fluorescence angiography is now established as our normal practice for all colorectal resections as a safe, innovative, simple technology.

scholarly journals Does the Implementation of Children's Hospital in the Home affect Health Outcomes for Children with Chronic Respiratory Conditions? A non-contemporary retrospective cohort comparison study

2021 ◽  
Author(s):  
Thomas Senyard ◽  
Kelly Weir ◽  
Megan Rutherford
Keyword(s):  
Length Of Stay ◽  
Clinical Outcomes ◽  
Retrospective Cohort ◽  
P Value ◽  
Comparison Study ◽  
Respiratory Condition ◽  
Cohort Comparison ◽  
Outcomes For Children ◽  
Respiratory Conditions ◽  
Inpatient Length Of Stay

Objective To investigate whether the implementation of a Children’s Hospital in the Home (CHITH) service affects clinical and service outcomes for children with chronic respiratory conditions including cystic fibrosis and non-CF bronchiectasis. Study Design A non-contemporary retrospective cohort comparison study. Setting/Patients Children aged between 1 and 17.99 years who were admitted to Gold Coast University Hospital (GCUH) with a chronic respiratory condition for pulmonary optimisation were eligible. Methods A clinical audit was utilised to compare children with chronic respiratory conditions who were admitted to GCUH in (a) the 12 months prior to implementation of CHITH and (b) the 12-month period following the implementation of CHITH. Outcomes of interest included lung function; inpatient length of stay (days); duration on intravenous antibiotics and weight gain. Normally distributed data was compared using the t-test, while non-parametric data was analysed with the Mann-Whitney test. Results Data was analysed from 58 admissions, 27 (46.55%) of which occurred in the 12 months of traditional management and 31 (53.45%) in the 12 months following the implementation of the CHITH service. A statistically significant reduction in inpatient length of stay was noted following implementation of the CHITH service: 14.25 versus 6.0 days (p-value=0.0001). The pre-CHITH cohort had a non-significant mean improvement of 7.625% in their FEV1 (pred%) compared to 9.75% in the CHITH cohort (p-value=0.44). There was no significant difference in the secondary clinical outcomes. Conclusion The CHITH service provided equitable clinical outcomes for children with a chronic respiratory condition whilst significantly reducing inpatient length of stay.

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

Contracture Severity at Hospital Discharge in Children: A Burn Model System Database Study

2020 ◽  
Author(s):  
Miranda Yelvington ◽  
Matthew Godleski ◽  
Austin F Lee ◽  
Jeremy Goverman ◽  
Ingrid Parry ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Range Of Motion ◽  
Hospital Discharge ◽  
Injury Severity ◽  
Model System ◽  
Future Research ◽  
P Value ◽  
Local Practices ◽  
Improvement Measures ◽  
Joint Motions

Abstract Contractures can complicate burn recovery. There are limited studies examining the prevalence of contractures following burns in pediatrics. This study investigates contracture outcomes by location, injury, severity, length of stay, and developmental stage. Data were obtained from the Burn Model System between 1994 and 2003. All patients younger than the age of 18 with at least one joint contracture at hospital discharge were included. Sixteen areas of impaired movement from the shoulder, elbow, wrist, hand, hip, knee, and ankle joints were examined. Analysis of variance was used to assess the association between contracture severity, burn size, and length of stay. Age groupings were evaluated for developmental patterns. A P value of less than .05 was considered statistically significant. Data from 225 patients yielded 1597 contractures (758 in the hand) with a mean of 7.1 contractures (median 4) per patient. Mean contracture severity ranged from 17% (elbow extension) to 41% (ankle plantarflexion) loss of movement. Statistically significant associations were found between active range of motion loss and burn size, length of stay, and age groupings. The data illustrate quantitative assessment of burn contractures in pediatric patients at discharge in a multicenter database. Size of injury correlates with range of motion loss for many joint motions, reflecting the anticipated morbidity of contracture for pediatric burn survivors. These results serve as a potential reference for range of motion outcomes in the pediatric burn population, which could serve as a comparison for local practices, quality improvement measures, and future research.

scholarly journals 562. Tocilizumab for the Treatment of Severe COVID-19: A Retrospective, Multi-Center, Case-Matched Series

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S346-S346
Author(s):  
Sarah Norman ◽  
Sara Jones ◽  
David Reeves ◽  
Christian Cheatham
Keyword(s):  
Mechanical Ventilation ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Primary Outcome ◽  
Fungal Infections ◽  
Hospital Length ◽  
Hospitalized Patients ◽  
Hospital Length Of Stay ◽  
Matched Design ◽  
Median Hospital

Abstract Background At the time of this writing, there is no FDA approved medication for the treatment of COVID-19. One medication currently under investigation for COVID-19 treatment is tocilizumab, an interleukin-6 (IL-6) inhibitor. It has been shown there are increased levels of cytokines including IL-6 in severe COVID-19 hospitalized patients attributed to cytokine release syndrome (CRS). Therefore, inhibition of IL-6 receptors may lead to a reduction in cytokines and prevent progression of CRS. The purpose of this retrospective study is to utilize a case-matched design to investigate clinical outcomes associated with the use of tocilizumab in severe COVID-19 hospitalized patients. Methods This was a retrospective, multi-center, case-matched series matched 1:1 on age, BMI, and days since symptom onset. Inclusion criteria included ≥ 18 years of age, laboratory confirmed positive SARS-CoV-2 result, admitted to a community hospital from March 1st – May 8th, 2020, and received tocilizumab while admitted. The primary outcome was in-hospital mortality. Secondary outcomes included hospital length of stay, total mechanical ventilation days, mechanical ventilation mortality, and incidence of secondary bacterial or fungal infections. Results The following results are presented as tocilizumab vs control respectively. The primary outcome of in-hospital mortality for tocilizumab (n=26) vs control (n=26) was 10 (38%) vs 11 (42%) patients, p=0.777. The median hospital length of stay for tocilizumab vs control was 14 vs 11 days, p=0.275. The median days of mechanical ventilation for tocilizumab (n=21) vs control (n=15) was 8 vs 7 days, p=0.139, and the mechanical ventilation mortality was 10 (48%) vs 9 (60%) patients, p=0.463. In the tocilizumab group, for those expired (n=10) vs alive (n=16), 10 (100%) vs 7 (50%) patients respectively had a peak ferritin > 600 ng/mL, and 6 (60%) vs 8 (50%) patients had a peak D-dimer > 2,000 ng/mL. The incidence of secondary bacterial or fungal infections within 7 days of tocilizumab administration occurred in 5 (19%) patients. Conclusion These findings suggest that tocilizumab may be a beneficial treatment modality for severe COVID-19 patients. Larger, prospective, placebo-controlled trials are needed to further validate results. Disclosures Christian Cheatham, PharmD, BCIDP, Antimicrobial Resistance Solutions (Shareholder)

To screen or not to screen? Vitamin D deficiency in chronic mental illness

2017 ◽  
Vol 26 (1) ◽  
pp. 56-59
Author(s):  
Ivana Goluza ◽  
Jay Borchard ◽  
Nalin Wijesinghe ◽  
Kishan Wijesinghe ◽  
Nagesh Pai
Keyword(s):  
Vitamin D ◽  
Length Of Stay ◽  
P Value ◽  
Hydroxyvitamin D ◽  
Psychiatric Setting ◽  
Retrospective Audit ◽  
Vitamin D Levels ◽  
Significant Difference ◽  
25 Hydroxyvitamin D ◽  
The Mean

Objectives: The objective of the current study was to examine the pathology test utilisation of 25-hydroxyvitamin D (25(OH)D) within an Australian inpatient psychiatric setting. Method: A retrospective audit of 300 random hospital files of those admitted as inpatients between Nov 2014 and Nov 2015 was undertaken. Data was quantitatively analysed and described. Results: The number of inpatients who had a vitamin D determination during their admission was 37/300 (12.33%). The mean vitamin D level of those tested was 51.63 nmol/l. Of those that were tested, 18/37 (48.6%) were mildly to moderately deficient. There was a statistically significant difference in age and length of stay between those that were and were not tested for vitamin D levels, p-value <0.001 and 0.017, respectively. In addition, a simple linear regression indicated a weak association between length of stay and vitamin D levels. Conclusion: This audit highlights vitamin D screening inadequacy. More research is recommended to establish tangible benefits of supplementation, while local practice provides valuable data for education and policy purposes.

scholarly journals Cardiac Injuries at Estonian Major Trauma Facilities: A 23-year Perspective

2018 ◽  
Vol 108 (2) ◽  
pp. 159-163 ◽  
Author(s):  
M. Einberg ◽  
S. Saar ◽  
A. Seljanko ◽  
A. Lomp ◽  
U. Lepner ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Primary Outcome ◽  
Major Trauma ◽  
Alcohol Intoxication ◽  
Cardiac Injury ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Cardiac Trauma ◽  
Icd 10 ◽  
Overall Mortality

Background and Aims: Cardiac injuries are highly lethal lesions following trauma and most of the patients decease in pre-hospital settings. However, studies on cardiac trauma in Estonia are scarce. Thus, we set out to study cardiac injuries admitted to Estonian major trauma facilities during 23 years of Estonian independence. Materials and Methods: After the ethics review board approval, all consecutive patients with cardiac injuries per ICD-9 (861.0 and 861.1) and ICD-10 codes (S.26) admitted to the major trauma facilities between 1 January 1993 and 31 July 2016 were retrospectively reviewed. Cardiac contusions were excluded. Data collected included demographics, injury profile, and in-hospital outcomes. Primary outcome was mortality. Secondary outcomes were cardiac injury profile and hospital length of stay. Results: During the study period, 37 patients were included. Mean age was 33.1 ± 12.0 years and 92% were male. Penetrating and blunt trauma accounted for 89% and 11% of the cases, respectively. Thoracotomy and sternotomy rates for cardiac repair were 80% and 20%, respectively. Most frequently injured cardiac chamber was left ventricle at 49% followed by right ventricle, right atrium, and left atrium at 34%, 17%, and 3% of the patients, respectively. Multi-chamber injury was observed at 5% of the cases. Overall hospital length of stay was 13.5 ± 16.7 days. Overall mortality was 22% (n = 8) with uniformly fatal outcomes following left atrial and multi-chamber injuries. Conclusion: Overall, 37 patients with cardiac injuries were hospitalized to national major trauma facilities during the 23-year study period. The overall in-hospital mortality was 22% comparing favorably with previous reports. Risk factors for mortality were initial Glasgow Coma Scale < 9, pre-hospital cardiopulmonary resuscitation, and alcohol intoxication.

scholarly journals A Pay-for-Performance Initiative to Reduce Pediatric Psychiatric Inpatient Length of Stay

2019 ◽  
Vol 70 (2) ◽  
pp. 156-158 ◽  
Author(s):  
Timothy Schmutte ◽  
Laurie Van der Heide ◽  
Lori Szczygiel ◽  
Ann Phelan ◽  
Larry Davidson ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Pay For Performance ◽  
Psychiatric Inpatient ◽  
Inpatient Length Of Stay

scholarly journals Clinical outcomes of colistin in combination with either 6-g sulbactam or carbapenems for the treatment of extensively drug-resistant Acinetobacter baumannii pneumonia with high MIC to sulbactam, a prospective cohort study

2019 ◽  
Author(s):  
Chutchawan Ungthammakhun ◽  
Vasin Vasikasin ◽  
Dhitiwat Changpradub
Keyword(s):  
Cohort Study ◽  
Length Of Stay ◽  
Acinetobacter Baumannii ◽  
Clinical Outcomes ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Mortality Rates ◽  
P Value ◽  
Drug Resistant ◽  
Extensively Drug Resistant

Abstract Background: Extensively drug-resistant Acinetobacter baumannii (XDRAB) is an important cause of nosocomial pneumonia with limited therapeutic options. Colistin based regimen is recommended treatment. Which drugs should be combined with colistin remains uncertain. The aim of this study was to investigate the clinical outcomes of patients with XDRAB pneumonia who were treated with colistin, combined with either 6-g sulbactam or carbapenems, in the setting of high MIC to sulbactam. Methods: In this prospective cohort study, hospitalized patients diagnosed with XDRAB pneumonia in Phramongkutklao Hospital were enrolled. The primary outcome was the 28-day mortality. Secondary outcomes were 7 and 14-day mortality, length of stay, ventilator days and factors associated with mortality. Results: From 1 July 2016 to 30 September 2017, 192 patients were included; 92 received colistin plus sulbactam and 90 received colistin plus carbapenems. Most of the patients were male diagnosed with ventilator associated pneumonia in medical intensive care unit. Overall mortality rates at 7, 14, 28 days were 24.2%, 37.4%, 53.3%, respectively. Mortality rates did not differ between sulbactam group and carbapenems groups at 7 days (19.6% vs. 28.9%, p-value 0.424, adjusted HR 1.277; 95% CI = 0.702-2.322), 14 days (34.8% vs. 40%, p = 0.658, adjusted HR 1.109; 95% CI = 0.703-1.749) and 28 days (51.1% vs. 55.6%, p = 0.857, adjusted HR 1.038; 95% CI = 0.690-1.562). Length of stay, ICU days and ventilator days did not differ. Complications of treatment including acute kidney injury were not statistically different. Conclusions: In XDRAB pneumonia with high MIC to sulbactam, mortality rates were not statistically significant between colistin plus 6-g sulbactam and colistin plus carbapenems. Keywords: XDR A. baumannii pneumonia, mortality rate, colistin based, sulbactam, carbapenems

scholarly journals Effect of ginger extract on reparation of mucosal damage in ileal rats exposured by 5- fluorouracil

2017 ◽  
Vol 14 (1) ◽  
pp. 25-32
Author(s):  
KHUSNUL DWI TYASARI ◽  
KIYATNO KIYATNO ◽  
BALGIS BALGIS
Keyword(s):  
Dose Group ◽  
Mucosal Damage ◽  
Control Group ◽  
P Value ◽  
Ginger Extract ◽  
Control Group Design ◽  
Post Test ◽  
Male Wistar Rats ◽  
Hematoxylin And Eosin ◽  
Group 5

Tyasari KD, Kiyatno, Balgis. 2016. Effect of ginger extract on reparation of mucosal damage in ileal rats exposured by 5- fluorouracil. Biofarmasi 14: 24-31. This research had an objective to know the effect of ginger extract giving toward reparation of mucosal damage in ileal rats exposure by 5-fluorouracil. This research was a pure experiment with post test only control group design. We used 28 male Wistar Rats that were divided into 4 groups; control group, 5-FU group, 5-FU+ginger extract 9 mg dose group, and 5- FU+ginger extract 18 mg dose group. At days 3, 5, 7, and 9, 2 rats per day were killed by decapitation. Then the ileal rats were made to be sections and were colored by hematoxylin and eosin (HE). From each section, we measured height of 1 villi and depth of 1 cript in 3 vision field. The data obtained were analyzed by Kruskal-Wallis test with SPSS for Windows Release 16.0 program. Kruskal-Wallis test showed mean of villus height had p-value = 0,083 in day 3, p-value = 0,083 in day 5, p-value = 0,139 in day 7, and p-value = 0,160 in day 9. Whereas mean of cript depth had p-value = 0,114 in day 3, p-value = 0,198 in day 5, p-value = 0,083 in day 7, and p-value = 0,092 in day 9. All of p-values showed p > 0.05 in which there were no significant differences. From this experiment, we concluded that there was no effect of ginger extract giving toward reparation of mucosal damage of ileal rats which exposure by 5-FU.

Abstract P83: Predictors of Length of Stay for HF Patients: Results from Get With the Guidelines

2011 ◽  
Vol 4 (suppl_1) ◽  
Author(s):  
David J Whellan ◽  
Xin Zhao ◽  
Adrian F Hernandez ◽  
Eric D Peterson ◽  
Deepak L Bhatt ◽  
...  
Keyword(s):  
Heart Failure ◽  
Heart Rate ◽  
Length Of Stay ◽  
Vital Signs ◽  
P Value ◽  
Chi Square ◽  
Unit Increase ◽  
History Of ◽  
Multivariable Regression ◽  
Get With The Guidelines

Background: Heart failure (HF) admissions are frequent and result in significant expenditures. Identifying predictors of increased length of stay (LOS), particularly above the median LOS, may help providers set expectations for patients and target resources effectively. Methods: We analyzed HF admissions (n= 70,094) from January 2005 through April 2007 from 246 hospitals in the AHA's Get With The Guidelines-HF program. In a subset with BNP (n=44,535), baseline characteristics, admission vital signs and selected labs (BNP, creatinine, BUN, hemoglobin, and sodium) were included in a multivariable regression analysis to determine factors associated with LOS ≥4 days. Results: Patients were median age of 72, 45% female, 53% had ischemic etiology, and median LVEF was 35%. Median LOS was 4 days (25 th ,75 th 2,6). The most significant predictors of LOS ≥ 4 days were a higher admission BUN, higher heart rate, and lower SBP (Table 1). Age, insurance, race, creatinine, and LVEF were not. Conclusion: Upon admission for HF, certain vital signs, comorbidites, and laboratory values are associated with an increased likelihood of a LOS ≥ 4 days. These observations may be of value in the implementation of interventions aimed at reducing LOS and improving quality of care in HF. Variables Associated With Hospital LOS >/= 4 Days Variable Chi-Square OR Lower (95% CI) Upper (95% CI) P-value Admissioun BUN (/1 unit increase) 221.8 1.01 1.01 1.01 <.001 Admission SBP (/ 10-unit increase) 129.6 0.96 0.95 0.96 <.001 Heart Rate (/ 10-unit increase) 122.4 1.07 1.06 1.09 <.001 History of COPD/Asthma 45.8 1.19 1.13 1.25 <.001 Admission BNP (per 100-unit increase) 37.6 1.01 1.00 1.01 <.001 Female vs. Male 29.7 1.12 1.08 1.17 <.001 History of renal insufficiency 27.4 1.17 1.10 1.24 <.001 History of heart failure 18.0 0.89 0.85 0.94 <.001 Region: (MW vs. NE)
 (S vs NE)
 (W vs. NE) 17.3 0.71
 0.91
 0.71 0.60
 .077
 0.56 0.85
 1.08
 0.88 <.001

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