TP6.1.9 Prolonged post-operative stay following emergency and elective laparoscopic cholecystectomies and its contributing factors

Abstract Aims Patients who undergo laparoscopic cholecystectomy (LC) for gallstone disease are a heterogenous population with many variables involved in their management. The aim was to identify the proportion of patients who have a prolonged post-operative stay (PPS; >3days) following elective and emergency LC and the variables that most contribute to PPS. Methods We retrospectively collected data for all patients who underwent an elective and emergency LC across three surgical units from 2015 to 2020. Rates of PPS were compared between elective and emergency groups and variables associated with PPS were identified using multivariate logistic regression models. Results 2769 patients were included in the study (median age, 53years(range, 13-92); M:F,1:2.7; emergency:elective,1:3.6) The rate of PPS was higher in the emergency versus elective group (25.1% versus 6.6%; p<0.0001). Pain was one of the major causes in both groups. In the elective group, factors associated with PPS included cholecystitis (OR,1.96; p=0.008), previous gallstone related admissions (OR,1.48; p=0.008), pre-operative ERCP (OR,3.58;p<0.0001), ASA (OR,1.82; p=0.001) and age (years) (OR,1.03;p=0.001). In the emergency group, factors associated with PPS include cholecystitis (OR,5.3;p<0.0001), ASA (OR,1.96; p = 0.01) and pre-operative ERCP (OR,4.44;p=0.001). Conclusions The rate of PPS following laparoscopic cholecystectomy is significant, particularly in the emergency group. Although the possibility of PPS cannot be avoided, patient information regarding the possibility of PPS is important, particularly for those at risk. The risk factors for PPS should be used to guide surgical decision making and should be followed by targeted management of these patients including optimised pain relief.

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398 Outcome of Laparoscopic Cholecystectomy in Patients Over 80 Years Old

British Journal of Surgery ◽

10.1093/bjs/znab259.046 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

D Gumaa ◽

A Hunt ◽

D Karunaratne ◽

S Shresta ◽

B Al-Robaie

Keyword(s):

Laparoscopic Cholecystectomy ◽

Gallstone Disease ◽

District General Hospital ◽

The Elderly ◽

Biliary Colic ◽

Old Patients ◽

Medical Background ◽

Admission Data ◽

Emergency Group ◽

Elective Group

Abstract Background Gallstone disease is a common cause of morbidity in old patients. Conservative treatment is usually the first line of treatment due to concerns about the risk of surgery. In our study we are trying to assess the outcome of laparoscopic cholecystectomy in patients over 80 years old. Method Retrospective cohort study done in a large district general hospital where good number of laparoscopic cholecystectomy is done every year. Main outcome is Mortality, return to theatre and post op ITU admission. Data collected from patients records. Results 74 patients in total were operated on. 14 operations were done as emergency (during the same inpatient admission). Indication for surgery varied between cholecystitis, pancreatitis and biliary colic. But the main indication in the emergency group was acute cholecystitis. 55 % of the patients had significant medical background with ASA 3. 30 days mortality was 0 in both emergency and elective groups. 2 patients required ITU admission post op, mainly for premorbid status, and both were in the emergency group. There was only one return to theatre in the emergency group for washout. 90% of the elective group patients were done as day case with no post op complications. Conclusions Laparoscopic cholecystectomy is safe operation to be done in the elderly population. ITU admission is mainly because of the patient’s co-morbidities so patients should be selected carefully and have proper pre op assessment.

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A laparoszkópia szerepe a 80 évesnél idősebb betegek epekövességének megoldásában

Orvosi Hetilap ◽

10.1556/650.2016.30368 ◽

2016 ◽

Vol 157 (5) ◽

pp. 185-190 ◽

Cited By ~ 3

Author(s):

Tímea Kakucs ◽

László Harsányi ◽

Péter Kupcsulik ◽

Péter Lukovich

Keyword(s):

Laparoscopic Cholecystectomy ◽

Hospital Stay ◽

Elective Surgery ◽

Length Of Hospital Stay ◽

Common Bile Duct Stones ◽

Age Group ◽

Type Conversion ◽

Emergency Group ◽

Elective Group ◽

Elective Cholecystectomy

Introduction: The incidence of cholelithiasis increases with age, however, there is still little data about the outcomes of cholecystectomy in patients with age of 80 and above. Population ageing presents tremenduous challenges for surgeons. Aim: The aim of the authors was to compare emergency and elective cholecystectomies performed in these elderly patients. Method: This retrospective study was based on the analysis of operation type, conversion rate, complications, mortality, length of hospital stay of all patients over 80 who underwent cholecystectomy in the last 6 years at the 1st Department of Surgery, Semmelweis University. Results: 69 elective and 51emergency operations were performed. In the emergency group pancreatitis was found in 9.8%, liver abscess in 14%, and common bile duct stones in 27% of the patients on admission. Laparoscopic cholecystectomy could be performed in 84% of patients in the elective group, while in 17.7% of patients in the emergency group. The length of stay at the intensive care unit was 9.1 and 1 days, while the total length of hospital stay was 12 and 3.6 days for the elective and emergency groups, respectively. In the emergency group mortality was 20% and reoperation was performed in 16% of patients, while at the elective group none of these occured. Conclusion: Laparoscopic cholecystectomy is safe as elective surgery for patients with age of 80 and above. For this reason the authors recommend elective cholecystectomy in this age group. Orv. Hetil., 2016, 157(5), 185–190.

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A Multilevel Analysis of Factors Associated with Childhood Diarrhea in Ethiopia

Environmental Health Insights ◽

10.1177/11786302211009894 ◽

2021 ◽

Vol 15 ◽

pp. 117863022110098

Author(s):

Biniyam Sahiledengle ◽

Zinash Teferu ◽

Yohannes Tekalegn ◽

Demisu Zenbaba ◽

Kenbon Seyoum ◽

...

Keyword(s):

Data Analysis ◽

Formal Education ◽

National Level ◽

Secondary Data ◽

Childhood Diarrhea ◽

Contributing Factors ◽

Lower Odds ◽

Logistic Regression Models ◽

Factors Associated ◽

The Individual

Background: Childhood diarrhea is the major contributor to the deaths of children under the age of 5 years in Ethiopia, but evidence at the national level to identify the contributing factors associated with diarrhea by considering the clustering effects is limited. Hence, this study aimed to identify factors associated with childhood diarrhea at the individual and community levels. Methods: A secondary data analysis was conducted using the 2011 and 2016 Ethiopian Demographic and Health Survey (EDHS) data. A total of 23 321 children with their mothers were included in this study, and multilevel logistic regression models were applied for the data analysis. Results: The odds of diarrhea among female children were 13% lower (AOR = 0.87; 95% CI: 0.79-0.94) compared with male children. The odds of diarrhea among children aged between 13 and 24 months were 31% higher than (AOR = 1.31; 95% CI: 1.17-1.47) their younger counter parts. Children aged ⩾25 months (AOR = 0.50; 95% CI: 0.45-0.56), those whose mothers were unemployed (AOR = 0.79; 95% CI: 0.73-0.87), and children live in households between 2 and 3 under-5 children (AOR = 0.87; 95% CI: 0.79-0.96) were associated with lower odds of experiencing diarrhea. The odds of diarrhea among children whose mother had no formal education were 49% higher than (AOR = 1.49; 95% CI: 1.08-2.07) their counterparts. Besides, children residing in city administrations (AOR = 0.69; 95% CI: 0.58-0.82) had lower odds of experiencing diarrhea than children living in agrarian regions. Conclusions: At the individual level (sex and age of the child, mother’s employment status, and educational level, and the number of under-5 children) and the community-level (contextual region) were found to be significant factors associated with childhood diarrhea in Ethiopia.

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Depression and Cognitive Impairment in Patients on Hemodialysis: A cross-sectional study

Environment-Behaviour Proceedings Journal ◽

10.21834/ebpj.v5i15.2468 ◽

2020 ◽

Vol 5 (15) ◽

pp. 185-192

Author(s):

Nor Jannah Nasution Raduan ◽

Mohd Razali Salleh ◽

Ghazali Ahmad ◽

Zaleha Ismail

Keyword(s):

Cognitive Impairment ◽

Publishing House ◽

Cross Sectional Study ◽

Hemodialysis Patients ◽

Education Level ◽

Sectional Study ◽

Contributing Factors ◽

Cross Sectional ◽

Factors Associated ◽

Low Education

Depression and cognitive impairment are the most common complications of patients on hemodialysis. The objective of this study is to identify contributing factors to depression and cognitive impairment in hemodialysis patients. This is a cross-sectional study involving 110 hemodialysis patients in Hospital Kuala Lumpur. The samples were recruited through universal sampling. Patients were assessed with the Beck Depression Inventory and Montreal Cognitive Assessment. This study found that 18.2% of patients had depression, and 48.2% had cognitive impairment. Factors associated with depression were unmarried status, low education level, and cognitive impairment. Factors associated with cognitive impairment were low education level, depression, and unemployment. Keywords: hemodialysis, depression, cognitive, ESRD eISSN: 2398-4287© 2020. The Authors. Published for AMER ABRA cE-Bs by e-International Publishing House, Ltd., UK. This is an open access article under the CC BYNC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Peer–review under responsibility of AMER (Association of Malaysian Environment-Behaviour Researchers), ABRA (Association of Behavioural Researchers on Asians) and cE-Bs (Centre for Environment-Behaviour Studies), Faculty of Architecture, Planning & Surveying, Universiti Teknologi MARA, Malaysia. DOI: https://doi.org/10.21834/ebpj.v5i15.2468.

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Demographic factors associated with missed follow-up among solid tumor patients treated at a large multi-site academic institution

Future Oncology ◽

10.2217/fon-2020-0425 ◽

2020 ◽

Vol 16 (32) ◽

pp. 2635-2643

Author(s):

Samantha L Freije ◽

Jordan A Holmes ◽

Saleh Rachidi ◽

Susannah G Ellsworth ◽

Richard C Zellars ◽

...

Keyword(s):

Cancer Patients ◽

Odds Ratio ◽

Regression Models ◽

Tumor Patients ◽

Logistic Regression Models ◽

Factors Associated ◽

Follow Up Care ◽

Risk Patients ◽

African American Race

Aim: To identify demographic predictors of patients who miss oncology follow-up, considering that missed follow-up has not been well studies in cancer patients. Methods: Patients with solid tumors diagnosed from 2007 to 2016 were analyzed (n = 16,080). Univariate and multivariable logistic regression models were constructed to examine predictors of missed follow-up. Results: Our study revealed that 21.2% of patients missed ≥1 follow-up appointment. African–American race (odds ratio [OR] 1.33; 95% CI: 1.17–1.51), Medicaid insurance (OR 1.59; 1.36–1.87), no insurance (OR 1.66; 1.32–2.10) and rural residence (OR 1.78; 1.49–2.13) were associated with missed follow-up. Conclusion: Many cancer patients miss follow-up, and inadequate follow-up may influence cancer outcomes. Further research is needed on how to address disparities in follow-up care in high-risk patients.

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Mass School Shootings in the United States: A Novel Root Cause Analysis Using Lay Press Reports

Clinical Pediatrics ◽

10.1177/0009922819873650 ◽

2019 ◽

Vol 58 (13) ◽

pp. 1423-1428 ◽

Cited By ~ 2

Author(s):

Chris A. Rees ◽

Lois K. Lee ◽

Eric W. Fleegler ◽

Rebekah Mannix

Keyword(s):

United States ◽

Environmental Factors ◽

Root Cause Analysis ◽

The United States ◽

School Shootings ◽

Contributing Factors ◽

Mass Shootings ◽

Cause Analysis ◽

Factors Associated ◽

Root Cause

School shootings comprise a small proportion of childhood deaths from firearms; however, these shootings receive a disproportionately large share of media attention. We conducted a root cause analysis of 2 recent school shootings in the United States using lay press reports. We reviewed 1760 and analyzed 282 articles from the 10 most trusted news sources. We identified 356 factors associated with the school shootings. Policy-level factors, including a paucity of adequate legislation controlling firearm purchase and ownership, were the most common contributing factors to school shootings. Mental illness was a commonly cited person-level factor, and access to firearms in the home and availability of large-capacity firearms were commonly cited environmental factors. Novel approaches, including root cause analyses using lay media, can identify factors contributing to mass shootings. The policy, person, and environmental factors associated with these school shootings should be addressed as part of a multipronged effort to prevent future mass shootings.

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Time to abandon the old dictum of delayed laparoscopic cholecystectomy after acute cholecystitis has settled in Caribbean practice

Tropical Doctor ◽

10.1177/00494755211010002 ◽

2021 ◽

pp. 004947552110100

Author(s):

Shamir O Cawich ◽

Avidesh H Mahabir ◽

Sahle Griffith ◽

Patrick FaSiOen ◽

Vijay Naraynsingh

Keyword(s):

Laparoscopic Cholecystectomy ◽

Acute Cholecystitis ◽

Gold Standard ◽

Standard Treatment ◽

Gallstone Disease ◽

Acute Attack ◽

Early Laparoscopic Cholecystectomy ◽

Delayed Surgery ◽

Delayed Cholecystectomy ◽

Delayed Laparoscopic Cholecystectomy

Although laparoscopic cholecystectomy is the gold standard treatment for acute cholecystitis, many Caribbean surgeons are reluctant to operate during the acute attack. We collected data for all consecutive patients who underwent laparoscopic cholecystectomy for acute cholecystitis from January 1 to 31 December 2018. Delayed cholecystectomy was done >6 weeks after acute cholecystitis settled. We compared data between early and delayed groups. Delayed laparoscopic cholecystectomy was performed in 54 patients, and 42 had early laparoscopic cholecystectomy. Delayed surgery resulted in significantly more complications requiring readmission (39% vs 0), longer operations (2.27 vs 0.94 h) and lengthier post-operative hospitalisation (1.84 vs 1.1 days). Caribbean hospitals should abandon the practice of delayed surgery after cholecystitis has settled. Early laparoscopic cholecystectomy would be financially advantageous for our institutions, and it would save patients recurrent attacks of gallstone disease.

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Prevalence and Contributing Factors Associated With Postoperative Pain in Pediatric Patients: A Cross-Sectional Follow-up Study

Perioperative Care and Operating Room Management ◽

10.1016/j.pcorm.2021.100159 ◽

2021 ◽

Vol 23 ◽

pp. 100159

Author(s):

Zemenay Ayinie Mekonnen ◽

Debas Yaregal Melesse ◽

Habitamu Getinet Kassahun ◽

Tesera Dereje Flatie ◽

Misganaw Mengie Workie ◽

...

Keyword(s):

Postoperative Pain ◽

Pediatric Patients ◽

Contributing Factors ◽

Cross Sectional ◽

Factors Associated ◽

Follow Up Study

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Predictors of chronic opioid therapy in Medicaid beneficiaries with HIV who initiated antiretroviral therapy

Scientific Reports ◽

10.1038/s41598-021-94690-8 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

GYeon Oh ◽

Emily S. Brouwer ◽

Erin L. Abner ◽

David W. Fardo ◽

Patricia R. Freeman ◽

...

Keyword(s):

Regression Models ◽

Opioid Therapy ◽

Chronic Obstructive ◽

Chronic Opioid Therapy ◽

Hepatitis C Infection ◽

Antipsychotic Therapy ◽

Obstructive Pulmonary Disease ◽

Logistic Regression Models ◽

Factors Associated ◽

Medicaid Beneficiaries

AbstractThe factors associated with chronic opioid therapy (COT) in patients with HIV is understudied. Using Medicaid data (2002–2009), this retrospective cohort study examines COT in beneficiaries with HIV who initiated standard combination anti-retroviral therapy (cART). We used generalized estimating equations on logistic regression models with backward selection to identify significant predictors of COT initiation. COT was initiated among 1014 out of 9615 beneficiaries with HIV (male: 10.4%; female: 10.7%). Those with older age, any malignancy, Hepatitis C infection, back pain, arthritis, neuropathy pain, substance use disorder, polypharmacy, (use of) benzodiazepines, gabapentinoids, antidepressants, and prior opioid therapies were positively associated with COT. In sex-stratified analyses, multiple predictors were shared between male and female beneficiaries; however, chronic obstructive pulmonary disease, liver disease, any malignancy, and antipsychotic therapy were unique to female beneficiaries. Comorbidities and polypharmacy were important predictors of COT in Medicaid beneficiaries with HIV who initiated cART.

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