scholarly journals P-OGC84 Impact of routine feeding via jejunostomy after oesophagectomy

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Rachel A Khaw ◽  
Jill Macdonald ◽  
Samuel Munro ◽  
Alexander W Phillips
Keyword(s):  
Weight Loss ◽  
Hospital Stay ◽  
Survival Data ◽  
Enhanced Recovery ◽  
Length Of Hospital Stay ◽  
Post Discharge ◽  
Postoperative Weight Loss ◽  
Severe Weight Loss ◽  
Reduce Weight Loss ◽  
The Impact

Abstract Background Oesophageal cancer is the 8th most common cancer worldwide, with oesophagectomy remaining the mainstay curative treatment, despite significant associated morbidity and mortality. Postoperative weight loss remains a significant problem and is directly correlated to poor prognosis. Measures such as the Enhanced Recovery After Surgery (ERAS) programme and intraoperative jejunostomy feed placement have looked to tackle this. Our aim was to investigate the impact of supplemental jejunostomy feed in practice on mortality, length of hospital stays and postoperative weight loss in a high-volume regional centre. Methods Patients undergoing oesophagectomy between January 2012 - December 2014 and January 2016 - December 2019 in a national tertiary oesophagogastric unit were included retrospectively. Variables measured included comorbidities, operation, histopathology, weights (pre- and post-operatively), length of hospital stay, postoperative complications and mortality. Survival data were analysed using R Studio, Inc. Results 566 patients were included. Median age at diagnosis was 66 years (30-85). Majority of cases included were adenocarcinoma (72.6%), or squamous cell carcinoma (22.3%). Within the two study groups, severe weight loss > 10% of pre-operative weight was seen in 38.6% and 4.87% of patients discharged without and with jejunostomy feeds at 3 months, respectively. At 6 months, severe weight-loss was seen in 47.6% and 0.64% of patients discharged without and with jejunostomy feeds, respectively. Median length of stay was 15 days (7-92) and 12 days (6-338) for patients discharged without and with jejunostomy feeds, respectively. Overall median survival in patients discharged without jejunostomy was 52 months (p = 0.035), and in those discharged with jejunostomy, 48 months (p = 0.044). Conclusions Postoperative malnutrition has associated poor outcomes. Perioperative nutritional support, to include postoperative jejunal feeding post-discharge can reduce weight loss, and influence survival as well as length of hospital stay. Further randomised trials are needed in order to optimise recovery and morbidity in patients post-oesophagectomy.

565 POST-OPERATIVE WEIGHT LOSS AND OUTCOMES FOLLOWING ESOPHAGECTOMY

2020 ◽  
Vol 33 (Supplement_1) ◽  
Author(s):  
R Khaw ◽  
S Munro ◽  
J Sturrock ◽  
H Jaretzke ◽  
S Kamarajah ◽  
...  
Keyword(s):  
Weight Loss ◽  
Length Of Stay ◽  
Hospital Stay ◽  
Enhanced Recovery ◽  
Length Of Hospital Stay ◽  
Failure To Thrive ◽  
Post Discharge ◽  
Postoperative Weight Loss ◽  
Poor Outcomes ◽  
The Impact

Abstract   Oesophageal cancer is the 11th most common cancer worldwide, with oesophagectomy remaining the mainstay curative treatment, despite significant associated morbidity and mortality. Postoperative weight loss remains a significant problem and is directly correlated to poor prognosis. Measures such as the Enhanced Recovery After Surgery (ERAS) programme and intraoperative jejunostomy feed have looked to tackle this. This study investigates the impact of these on mortality, length of hospital stay and postoperative weight loss. Methods Patients undergoing oesophagectomy between January 1st 2012—December 2014 and 28th October 2015–December 31st 2019 in a national tertiary oesophagogastric unit were included retrospectively. Variables measured included comorbidities, operation, histopathology, weights (pre- and post-operatively), length of hospital stay, postoperative complications and mortality. Pre-operative body weight was measured at elective admission, and further weights were identified from a prospectively maintained database, during further clinic appointments. Other data was collected through patient notes. Results 594 patients were included. Mean age at diagnosis was 65.9 years (13–65). Majority of cases were adenocarcinoma (63.3%), with varying stages of disease (TX-4, NX-3). Benign pathology accounted for 8.75% of cases. Mean weight loss post-oesophagectomy exceeded 10% at 6 months (SD 14.49). Majority (60.1%) of patients were discharged with feeding jejunostomy, and 5.22% of these required this feed to be restarted post-discharge. Length of stay was mean 16.5 days (SD 22.3). Complications occurred in 68.9% of patients, of which 13.8% were infection driven. Mortality occurred in 26.6% of patients, with 1.83% during hospital admission. 30-day mortality rate was 1.39%. Conclusion Failure to thrive and prolonged weight-loss following oesophagectomy can contribute to poor recovery, with associated complications and poor outcomes, including increased length of stay and mortality. Further analysis of data to investigate association between weight loss and poor outcomes for oesophagectomy patients will allow for personalised treatment of high-risk patients, in conjunction with members of the multidisciplinary team, including dieticians.

Compliance with enhanced recovery after surgery program in gynecology: are all items of equal importance?

2019 ◽  
Vol 29 (4) ◽  
pp. 810-815 ◽  
Author(s):  
Basile Pache ◽  
Jonas Jurt ◽  
Fabian Grass ◽  
Martin Hübner ◽  
Nicolas Demartines ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Gynecologic Oncology ◽  
Length Of Hospital Stay ◽  
Gynecologic Surgery ◽  
Complication Rates ◽  
Prolonged Length ◽  
Academic Center ◽  
The Impact

IntroductionEnhanced recovery after surgery (ERAS) guidelines in gynecologic surgery are a set of multiple recommendations based on the best available evidence. However, according to previous studies, maintaining high compliance is challenging in daily clinical practice. The aim of this study was to assess the impact of compliance to individual ERAS items on clinical outcomes.MethodsRetrospective cohort study of a prospectively maintained database of 446 consecutive women undergoing gynecologic oncology surgery (both open and minimally invasive) within an ERAS program from 1 October 2013 until 31 January 2017 in a tertiary academic center in Switzerland. Demographics, adherence, and outcomes were retrieved from a prospectively maintained database. Uni- and multivariate logistic regression was performed, with adjustment for confounding factors. Main outcomes were overall compliance, compliance to each individual ERAS item, and impact on post-operative complications according to Clavien classification.ResultsA total of 446 patients were included, 26.2 % (n=117) had at least one complication (Clavien I–V), and 11.4 % (n=51) had a prolonged length of hospital stay. The single independent risk factor for overall complications was intra-operative blood loss > 200 mL (OR 3.32; 95% CI 1.6 to 6.89, p=0.001). Overall compliance >70% with ERAS items (OR 0.15; 95% CI 0.03 to 0.66, p=0.12) showed a protective effect on complications. Increased compliance was also associated with a shorter length of hospital stay (OR 0.2; 95% CI 0.435 to 0.93, p=0.001).ConclusionsCompliance >70% with modifiable ERAS items was significantly associated with reduced overall complications. Best possible compliance with all ERAS items is the goal to achieve lower complication rates after gynecologic oncology surgery.

Decline of nutritional status in the first week of hospitalisation predicts longer length of stay and hospital readmission during 6-month follow-up

2020 ◽  
pp. 1-8
Author(s):  
Júlia Lima ◽  
Paula Portal Teixeira ◽  
Igor da Conceição Eckert ◽  
Camila Ferri Burgel ◽  
Flávia Moraes Silva
Keyword(s):  
Weight Loss ◽  
Nutritional Status ◽  
Hospital Readmission ◽  
Multivariable Analysis ◽  
Length Of Hospital Stay ◽  
Care Process ◽  
Post Discharge ◽  
Severe Weight Loss ◽  
Nutritional Monitoring ◽  
Nutrition Care Process

Abstract Nutritional status (NS) monitoring is an essential step of the nutrition care process. To assess changes in NS throughout hospitalisation and its ability to predict clinical outcomes, a prospective cohort study with patients over 18 years of age was conducted. The Subjective Global Assessment (SGA) was performed within 48 h of admission and 7 d later. For each patient, decline in NS was assessed by two different methods: changes in SGA category and severe weight loss alone (≥2 % during the first week of hospitalisation). Patients were followed up until discharge to assess length of hospital stay (LOS) and in-hospital mortality and contacted 6 months post-discharge to assess hospital readmission and death. Out of the 601 patients assessed at admission, 299 remained hospitalised for at least 7 d; of those, 16·1 % had a decline in SGA category and 22·8 % had severe weight loss alone. In multivariable analysis, decline in SGA category was associated with 2-fold (95 % CI 1·06, 4·21) increased odds of prolonged LOS and 3·6 (95 % CI 1·05, 12·26) increased odds of hospital readmission at 6 months. Severe weight loss alone was associated with 2·5-increased odds (95 % CI 1·40, 4·64) of prolonged LOS. In conclusion, deterioration of NS was more often identified by severe weight loss than by decline in SGA category. While both methods were associated with prolonged LOS, only changes in the SGA predicted hospital readmission. These findings reinforce the importance of nutritional monitoring and provide guidance for further research to prevent short-term NS deterioration from being left undetected.

Proactive versus reactive feeding tube (FT) placement in head and neck cancer patients (HNC pts) receiving chemoradiation (CRT).

2019 ◽  
Vol 37 (31_suppl) ◽  
pp. 11-11
Author(s):  
Thunnisa Sivananth ◽  
Maureen Quinn ◽  
Rae-Ann Stortz ◽  
David A. Palma ◽  
Peggy Francis ◽  
...  
Keyword(s):  
Weight Loss ◽  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Treatment Interruption ◽  
Feeding Tube ◽  
Nutritional Management ◽  
Swallowing Function ◽  
Platinum Based Chemotherapy ◽  
Optimal Approach ◽  
The Impact

11 Background: Most HNC pts treated with CRT develop severe treatment-related oropharyngeal mucositis. For pts with adequate nutritional status and swallowing function prior to CRT the optimal approach to nutritional management remains undefined. A subset of pts will require FTs to complete treatment, but at least 50% of pts with prophylactic FTs never use them (Madhoun 2011). At our center we have used a "reactive" approach which minimizes exposure to unnecessary FT placement. However, some pts suffer nutritional crises resulting in hospitalization, treatment interruption, and higher risks of complications from FT placement. We investigated the impact of a more proactive approach to FT placement in our pts. Methods: HNC pts treated with CRT who received a FT during treatment 2014-2018 were retrospectively identified from electronic medical records and clinical data extracted. "Proactive" FTs were not considered medically necessary but were placed within 15 days of starting CRT. Primary outcomes of interest were weight loss during CRT (WTL), FT complications, length of hospital stay and FT duration. Uni- and multivariate analyses were done and p values < 0.05 considered of interest. Results: 124 pts were identified: 87% male, median age 62.5 yrs (39-80) and 67% oropharyngeal primary. All received platinum-based chemotherapy or cetuximab (8 pts). 19 FTs were considered medically necessary, 94 were placed reactively and 11 placed proactively; 91% were percutaneous and 94% were used. Median weight was 79.0 kg (27.6-165.7) prior to CRT and 71.2 kg (26.8-148.2) after. Median WTL was 9.9% (-13.9 to 33.3%). Proactive FT placement was associated with less WTL (p = 0.045). WTL was greater in pts over age 65 (OR 11.6 [1.4-97.6]). Hospital stay was longer for pts who had reactive FT. Females had longer FT duration (p = 0.005). Conclusions: These data suggest that when a reactive approach to FT placement is used, earlier FT placement during CRT is more effective at reducing weight loss and hospitalization time in this population. Specific criteria for pt selection with this approach should be defined. Further research to define the optimal approach to nutritional management in HNC pts receiving CRT is needed.

scholarly journals Safe and effective protocol for discharge 3 days after cardiac surgery

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Omar Asdrúbal Vilca Mejia ◽  
Gabrielle Barbosa Borgomoni ◽  
Nilza Lasta ◽  
Mariana Yumi Okada ◽  
Mariana Silva Biason Gomes ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Surgery ◽  
Hospital Stay ◽  
Latin American ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Length Of Hospital Stay ◽  
Postoperative Stay ◽  
Eras Protocol ◽  
The Impact

AbstractThe Enhanced Recovery After Surgery (ERAS) protocol affected traditional cardiac surgery processes and COVID-19 is expected to accelerate its scalability. The aim of this study was to assess the impact of an ERAS-based protocol on the length of hospital stay after cardiac surgery. From January 2019 to June 2020, 664 patients underwent consecutive cardiac surgery at a Latin American center. Here, 46 patients were prepared for a rapid recovery through a multidisciplinary institutional protocol based on the ERAS concept, the “TotalCor protocol”. After the propensity score matching, 46 patients from the entire population were adjusted for 12 variables. Patients operated on the TotalCor protocol had reduced intensive care unit time (P < 0.025), postoperative stay (P ≤ 0.001) and length of hospital stay (P ≤ 0.001). In addition, there were no significant differences in the occurrence of complications and death between the two groups. Of the 10-central metrics of TotalCor protocol, 6 had > 70% adherences. In conclusion, the TotalCor protocol was safe and effective for a 3-day discharge after cardiac surgery. Postoperative atrial fibrillation and renal failure were predictors of postoperative stay > 5 days.

scholarly journals P23: ENHANCED RECOVERY PROGRAMME – DOES PREOPERATIVE EDUCATION REDUCE LENGTH OF HOSPITAL STAY (LOS) IN PRIMARY HIP & KNEE ARTHROPLASTY

2021 ◽  
Vol 108 (Supplement_1) ◽  
Author(s):  
M Ahmad ◽  
H Rahman ◽  
N Awan
Keyword(s):  
Hospital Stay ◽  
Knee Arthroplasty ◽  
Enhanced Recovery ◽  
Length Of Hospital Stay ◽  
Conventional Group ◽  
P Value ◽  
Consecutive Series ◽  
Preoperative Education ◽  
Educational Group ◽  
The Impact

Abstract Introduction Total knee and hip arthroplasty significantly improve quality of life in people suffering from end-stage hip & knee arthritides. Enhanced recovery programs have shown improved outcomes following elective arthroplasty by decreasing patients anxiety, postoperative pain and reducing the length of hospital stay (LOS). The aim of our study is to evaluate the impact of preoperative education programs on length of hospital stay in patients undergoing hip & knee arthroplasty. Method Retrospective data was collected from a consecutive series of 520 patients' charts and Irish National Orthopedic Register (INOR) who underwent Hip or Knee arthroplasty from January 1, 2018, to December 31, 2018, in Our Lady Hospital, Navan. The length of stay study compared two hundred and twenty-six patients in the Educational Group (EG) who attended the Hip & Knee School (Preoperative Education Class) with 294 patients in the Conventional Group (CG) who did not attend the hip and knee educational programme. Result We identified that Length of Hospital Stay decreased to 5.2 days in Educational Group from 5.5 days in Conventional Group (P-value equals to 0.26, statistically insignificant, t = 1.1093 df = 518), with a mean difference of only 0.3 days (95% confidence interval). Conclusion Preoperative education does not reduce the length of hospital stay in primary hip & knee arthroplasty. Take-home message Preoperative education has no role in reducing hospital stay in Arthroplasty patients.

scholarly journals Implementation of enhanced recovery after surgery in gynecological operations: a randomized controlled trial

2020 ◽  
Vol 12 (1) ◽  
Author(s):  
Amr Nady Abdelrazik ◽  
Ahmad Sameer Sanad
Keyword(s):  
Hospital Stay ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Controlled Trial ◽  
Length Of Hospital Stay ◽  
Gynecologic Surgery ◽  
Complication Rates ◽  
Control Groups ◽  
Analog Scale ◽  
Randomized Controlled

Abstract Background To investigate the effects of enhanced recovery after surgery (ERAS) in patients undergoing gynecologic surgery on length of hospital stay, pain management, and complication rate. Results The length of hospital stay was reduced in ERAS groups when compared with the control groups (3.46 days vs 2.28 days; P < 0.0001; CI − 1.5767 to − 0.7833 for laparotomy groups and 2.18 vs 1.76 days; P = 0.0115; CI − 0.7439 to − 0.0961 for laparoscopy groups respectively). Intraoperative fluid use was reduced in both ERAS groups compared to the two control groups (934 ± 245 ml and 832 ± 197 ml vs 1747 ± 257 ml and 1459 ± 304 respectively; P < 0.0001) and postoperative fluid use was also less in the ERAS groups compared to the control groups (1606 ± 607 ml and 1210 ± 324 ml vs 2682 ± 396 ml and 1469 ± 315 ml respectively; P < 0.0001). Pain score using visual analog scale (VAS) on postoperative day 0 was 4.8 ± 1.4 and 4.1 ± 1.2 (P = 0.0066) for both laparotomy control and ERAS groups respectively, while in the laparoscopy groups, VAS was 3.8 ± 1.1 and 3.2 ± 0.9 (P = 0.0024) in control and ERAS groups respectively. Conclusion Implementation of ERAS protocols in gynecologic surgery was associated with significant reduction in length of hospital stay, associated with decrease intravenous fluids used and comparable pain control without increase in complication rates.

scholarly journals Influence of Weekday of Admission and Level of Distress on Length of Hospital Stay in Patients With Low Back Pain: A Retrospective Cohort Study

2020 ◽  
Author(s):  
Emanuel Brunner ◽  
André Meichtry ◽  
Davy Vancampfort ◽  
Reinhard Imoberdorf ◽  
David Gisi ◽  
...  
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
Back Pain ◽  
Hospital Stay ◽  
Linear Model ◽  
Length Of Hospital Stay ◽  
Complex Problem ◽  
Interdisciplinary Management ◽  
Prolonged Length ◽  
The Impact

Abstract BackgroundLow back pain (LBP) is often a complex problem requiring interdisciplinary management to address patients’ multidimensional needs. The inpatient care for patients with LBP in primary care hospitals is a challenge. In this setting, interdisciplinary LBP management is often unavailable during the weekend. Delays in therapeutic procedures may result in prolonged length of hospital stay (LoS). The impact of delays on LoS might be strongest in patients reporting high levels of psychological distress. Therefore, this study investigates which influence the weekday of admission and distress have on LoS of inpatients with LBP.MethodsRetrospective cohort study conducted between 1 February 2019 and 31 January 2020. ANOVA was used to test the hypothesized difference in mean effects of the weekday of admission on LoS. Further, a linear model was fitted for LoS with distress, categorical weekday of admission (Friday/Saturday vs. Sunday-Thursday), and their interactions.ResultsWe identified 173 patients with LBP. Mean LoS was 7.8 days (SD=5.59). Patients admitted on Friday (mean LoS=10.3) and Saturday (LoS=10.6) had longer stays but not those admitted on Sunday (LoS=7.1). Analysis of the weekday effect (Friday/Saturday vs. Sunday-Thursday) showed that admission on Friday or Saturday was associated with significant increase in LoS compared to admission on other weekdays (t=3.43, p=<0.001). 101 patients (58%) returned questionnaires, and complete data on distress was available from 86 patients (49%). According to a linear model for LoS, the effect of distress on LoS was significantly modified (t=2.51, p=0.014) by dichotomic weekdays of admission (Friday/Saturday vs. Sunday-Thursday).ConclusionsPatients with LBP are hospitalized significantly longer if they have to wait more than two days for interdisciplinary LBP management. This particularly affects patients reporting high distress. Our study provides a platform to further explore whether interdisciplinary LBP management addressing patients’ multidimensional needs reduces LoS in primary care hospitals.

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