P394 Preoperative factors associated with prolonged postoperative in-hospital length of stay in patients with Crohn’s disease undergoing intestinal resection or strictureplasty

Abstract Background Postoperative complications might not be accurately registered, leading to weakness in registry data studies. Aim To investigate factors that influence postoperative in-hospital length of stay (LOS) in patients with Crohn’s disease (CD) undergoing bowel surgery. Furthermore, the study aimed to evaluate LOS as a surrogate for postoperative outcome. Methods A multicentre retrospective cohort study. Inclusion criteria were adult patients with CD who underwent bowel surgery with either anastomosis or stricturoplasty. All timings of surgeries are regardless of the method of access to the abdominal cavities. Patients with stoma were excluded. Demographic data, preoperative medications, previous operations for CD, preoperative sepsis, and operation was recorded. The primary outcome was LOS while the secondary outcome variable was postoperative complications. Results 449 patients who underwent abdominal surgery for CD were included. 265/449 (59%) were female. Median age was 37 years (IQR =20), median LOS was seven days (IQR =6). Patients with longer LOS had higher rates of re-laparotomy/re-laparoscopy (45/228 (19.7%) vs. 9/219 (4.1%) p = 0.01). In multivariate analysis, age (OR = 1.024 [CI 95% 1.007–1.041], p = 0.005), preoperative intra-abdominal abscess (OR =0.39 [CI 95% 0.185–0.821], p = 0.013), and previous laparotomy/laparoscopy (Or = 0.57 [CI 95% 0.334–0.918], p = 0.021) were associated with prolonged LOS. LOS correlated with postoperative complications after adjustment for age, gender, previous laparotomy/laparoscopy, and preoperative intra-abdominal abscesses (OR = 1.28 [CI 95% 1.199–1.366], p < 0.0001). Conclusion Age, preoperative intra-abdominal abscess, and previous laparotomy/laparoscopy significantly prolonged LOS. LOS correlated with postoperative complications and can, therefore, act as a surrogate for the postoperative outcome.

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Preoperative factors associated with prolonged postoperative in-hospital length of stay in patients with Crohn’s disease undergoing intestinal resection or strictureplasty

International Journal of Colorectal Disease ◽

10.1007/s00384-019-03418-8 ◽

2019 ◽

Vol 34 (11) ◽

pp. 1925-1931 ◽

Cited By ~ 1

Author(s):

Thien Vinh Luong ◽

Sanne Dich Grandt ◽

Ionut Negoi ◽

Saulius Palubinskas ◽

Alaa El-Hussuna

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Length Of Stay ◽

Intestinal Resection ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Factors Associated ◽

Preoperative Factors

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Anaemia in patients undergoing major bowel surgery – Prevalence and current practice: A public and private institution experience

Journal of Perioperative Practice ◽

10.1177/1750458920934321 ◽

2020 ◽

pp. 175045892093432 ◽

Cited By ~ 1

Author(s):

Edgar Poon ◽

David Pache ◽

Alana Delaforce ◽

Lemya Abdalla ◽

Treasure McGuire

Keyword(s):

Length Of Stay ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Transfusion Rate ◽

Preoperative Treatment ◽

National Guidelines ◽

Biochemical Tests ◽

Bowel Surgery ◽

The Impact ◽

Preoperative Anaemia

Aim The study aimed to compare the frequency and alignment of preoperative anaemia screening and treatment with Australian guidelines in elective bowel surgery and determine the impact on clinical outcomes. Methods We performed a retrospective observational study, with an audit of 559 adult patients who underwent major elective bowel surgery in an Australian metropolitan hospital, January 2016–December 2018. Outcome measures included rate of anaemia, guideline compliance, hospital length of stay, and transfusion rate. Results Preoperative anaemia assessment occurred in 82.6% of patients. However, only 5.2% received recommended biochemical tests at least one week before surgery. Only 25.2% of anaemic patients received preoperative treatment; they experienced a longer hospital length of stay (9.93 days versus 7.88 days, p < 0.001) and an increased rate of transfusion (OR: 3.186, p < 0.05). Conclusion The gaps between current preoperative anaemia screening, management and national guidelines may place patients at higher risk of poor surgical outcome.

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Infusion-related angioedema associated with infliximab-abda: Case report

American Journal of Health-System Pharmacy ◽

10.1093/ajhp/zxaa321 ◽

2020 ◽

Vol 78 (2) ◽

pp. 108-112

Author(s):

Kyle Herndon ◽

Alexandra Dewitt ◽

Amanda Gillion ◽

Debendra Pattanaik

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Supportive Care ◽

White Male ◽

General Medicine ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Tongue Swelling ◽

Medical Intensive Care ◽

Time Of Presentation

Abstract Purpose A case of infusion-related angioedema associated with the use of an infliximab biosimilar (infliximab-abda) is reported in order to bring awareness that this adverse effect is still highly possible in biosimilars, similar to the reference infliximab biologic. Summary A 37-year-old white male with a past medical history significant for ileocolonic fistulizing Crohn’s disease, depression, and gastroesophageal reflux disease (GERD) presented to an emergency department with shortness of breath, urticaria, and tongue swelling that had developed shortly after initiation of an infusion of infliximab-abda. The patient had no documented allergies at the time of presentation. The patient was taking oral budesonide 9 mg daily and oral azathioprine 50 mg daily for treatment of Crohn’s disease. Other medications included oral omeprazole 40 mg every morning for GERD and oral sertraline 100 mg daily for depression. The patient’s tongue swelling worsened, and he was intubated for airway protection. The patient received supportive care treatment for angioedema with intravenous (IV) dexamethasone 8 mg every 8 hours, IV diphenhydramine 50 mg every 8 hours, and IV famotidine 20 mg every 12 hours. He was extubated approximately 43 hours later and observed overnight in a medical intensive care unit. He was transferred to a general medicine unit the next day for further care. The total hospital length of stay was 4 days. Conclusion A 37-year-old man developed infusion-related angioedema with use of infliximab-abda. Discontinuation of the biosimilar product along with supportive care brought about resolution of angioedema. There are no prior published reports of infusion-related angioedema reactions secondary to infliximab-abda use.

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Impact of COVID-19 Outbreak on the Emergency Presentation of Acute Appendicitis

The American Surgeon ◽

10.1177/0003134820972098 ◽

2020 ◽

Vol 86 (11) ◽

pp. 1508-1512

Author(s):

Mariana Kumaira Fonseca ◽

Eduardo N. Trindade ◽

Omero P. Costa Filho ◽

Miguel P. Nácul ◽

Artur P. Seabra

Keyword(s):

Postoperative Complications ◽

Length Of Stay ◽

Acute Appendicitis ◽

Symptom Onset ◽

Hospital Admissions ◽

Average Length ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Time Interval ◽

Emergency Presentation

Background The global crisis resulting from the coronavirus pandemic has imposed a large burden on health systems worldwide. Nonetheless, acute abdominal surgical emergencies are major causes for nontrauma-related hospital admissions and their incidences were expected to remain unchanged. Surprisingly, a significant decrease in volume and a higher proportion of complicated cases are being observed worldwide. Methods The present study assesses the local impact of the coronavirus pandemic on the emergency presentation of acute appendicitis in a Brazilian hospital. A retrospective analysis was conducted on patients undergoing emergency surgery for the clinically suspected diagnosis of acute appendicitis during the 2-month period of March and April 2020 and the same time interval in the previous year. Data on demographics, timing of symptom onset and hospital presentation, intraoperative details, postoperative complications, hospital length of stay, and histological examination of the specimen were retrieved from individual registries. Results The number of appendectomies during the pandemic was 36, which represents a 56% reduction compared to the 82 patients operated during the same period in 2019. The average time of symptom onset to hospital arrival was significantly higher in 2020 (40.6 vs. 28.2 hours, P = .02). The classification of appendicitis revealed a significant higher proportion of complicated cases than the previous year (33.3% vs. 15.2%, P = .04). The rate of postoperative complications and the average length of stay were not statistically different between the groups. Conclusion Further assessment of patients’ concerns and systematic monitoring of emergency presentations are expected to help us understand and adequately address this issue.

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The impact of nutritional status and appetite on the hospital length of stay and postoperative complications in elderly patients with severe aortic stenosis before aortic valve replacement

Polish Journal of Cardio-Thoracic Surgery ◽

10.5114/kitp.2016.61042 ◽

2016 ◽

Vol 2 ◽

pp. 105-112 ◽

Cited By ~ 2

Author(s):

Dariusz Jagielak ◽

Edyta Wernio ◽

Radosław Kozaryn ◽

Peter Bramlage ◽

Marta Gruchała-Niedoszytko ◽

...

Keyword(s):

Postoperative Complications ◽

Aortic Valve ◽

Length Of Stay ◽

Aortic Stenosis ◽

Aortic Valve Replacement ◽

Elderly Patients ◽

Severe Aortic Stenosis ◽

Hospital Length ◽

Hospital Length Of Stay ◽

The Impact

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Sugammadex is associated with shorter hospital length of stay after open lobectomy for lung cancer: a retrospective observational study

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-021-01427-9 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Seung Won Song ◽

Kyung Yeon Yoo ◽

Yong Sung Ro ◽

Taehee Pyeon ◽

Hong-Beom Bae ◽

...

Keyword(s):

Lung Cancer ◽

Overall Survival ◽

Postoperative Complications ◽

Length Of Stay ◽

Hospital Length ◽

Pulmonary Complications ◽

Hospital Length Of Stay ◽

Research Information ◽

Significant Difference ◽

Open Lobectomy

Abstract Background Sugammadex is associated with few postoperative complications. Postoperative pulmonary complications (PPC) are related to prolonged hospitalizations. Present study explored whether the use of sugammadex could reduce PPCs and thereby reduce hospital length of stay (LOS) after lung surgery. Methods We reviewed the medical records of patients who underwent elective open lobectomy for lung cancer from January 2010 to December 2015. Patients were divided into the sugammadex group and pyridostigmine group. The primary outcome was hospital LOS and secondary outcomes were postoperative complications and overall survival at 1 year. The cohort was subdivided into patients with and without prolonged LOS to explore the effects of sugammadex on outcomes in each group. Risk factors for LOS were determined via multivariate analyses. After propensity score matching, 127 patients were assigned to each group. Results Median hospital LOS was shorter (10.0 vs. 12.0 days) and the incidence of postoperative atelectasis was lower (18.1 vs. 29.9%) in the sugammadex group. However, no significant difference in overall survival between the groups was seen over 1 year (hazard ratio, 0.967; 95% confidence interval, 0.363 to 2.577). Sugammadex was a predictor related to LOS (exponential coefficient 0.88; 95% CI 0.82–0.95). Conclusions Our data suggest that sugammadex is a preferable agent for neuromuscular blockade (NMB) reversal than cholinesterase inhibitors in this patient population. Trial registration This study registered in the Clinical Research Information Service of the Korea National Institute of Health (approval number: KCT0004735, Date of registration: 21 January 2020, Retrospectively registered).

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Poor Performance on a Preoperative Cognitive Screening Test Predicts Postoperative Complications in Older Orthopedic Surgical Patients

Anesthesiology ◽

10.1097/aln.0000000000001859 ◽

2017 ◽

Vol 127 (5) ◽

pp. 765-774 ◽

Cited By ~ 64

Author(s):

Deborah J. Culley ◽

Devon Flaherty ◽

Margaret C. Fahey ◽

James L. Rudolph ◽

Houman Javedan ◽

...

Keyword(s):

Cognitive Impairment ◽

Postoperative Complications ◽

Length Of Stay ◽

Odds Ratio ◽

Poor Performance ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Surgical Patients ◽

Mortality Data ◽

Cognitive Screening

Abstract Background The American College of Surgeons and the American Geriatrics Society have suggested that preoperative cognitive screening should be performed in older surgical patients. We hypothesized that unrecognized cognitive impairment in patients without a history of dementia is a risk factor for development of postoperative complications. Methods We enrolled 211 patients 65 yr of age or older without a diagnosis of dementia who were scheduled for an elective hip or knee replacement. Patients were cognitively screened preoperatively using the Mini-Cog and demographic, medical, functional, and emotional/social data were gathered using standard instruments or review of the medical record. Outcomes included discharge to place other than home (primary outcome), delirium, in-hospital medical complications, hospital length-of-stay, 30-day emergency room visits, and mortality. Data were analyzed using univariate and multivariate analyses. Results Fifty of 211 (24%) patients screened positive for probable cognitive impairment (Mini-Cog less than or equal to 2). On age-adjusted multivariate analysis, patients with a Mini-Cog score less than or equal to 2 were more likely to be discharged to a place other than home (67% vs. 34%; odds ratio = 3.88, 95% CI = 1.58 to 9.55), develop postoperative delirium (21% vs. 7%; odds ratio = 4.52, 95% CI = 1.30 to 15.68), and have a longer hospital length of stay (hazard ratio = 0.63, 95% CI = 0.42 to 0.95) compared to those with a Mini-Cog score greater than 2. Conclusions Many older elective orthopedic surgical patients have probable cognitive impairment preoperatively. Such impairment is associated with development of delirium postoperatively, a longer hospital stay, and lower likelihood of going home upon hospital discharge.

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Unplanned Readmission Following Early Postoperative Complications After Fusion Surgery in Adult Spine Deformity: A Multicentric Study

Global Spine Journal ◽

10.1177/2192568221991101 ◽

2021 ◽

pp. 219256822199110

Author(s):

Gaston Camino-Willhuber ◽

Alfredo Guiroy ◽

Mariano Servidio ◽

Nelson Astur ◽

Fernando Nin-Vilaró ◽

...

Keyword(s):

Postoperative Complications ◽

Length Of Stay ◽

Spinal Deformity ◽

Adult Spinal Deformity ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Surgical Approaches ◽

Unplanned Readmission ◽

Multicentric Study ◽

Early Postoperative Complications

Study Design: Multicentric retrospective study, Level of evidence III. Objective: The objective of this multicentric study was to analyze the prevalence and risk factors of early postoperative complications in adult spinal deformity patients treated with fusion. Additionally, we studied the impact of complications on unplanned readmission and hospital length of stay. Methods: Eight spine centers from 6 countries in Latin America were involved in this study. Patients with adult spinal deformity treated with fusion surgery from 2017 to 2019 were included. Baseline and surgical characteristics such as age, sex, comorbidities, smoking, number of levels fused, number of surgical approaches were analyzed. Postoperative complications at 30 days were recorded according to Clavien-Dindo and Glassman classifications. Results: 172 patients (120 females/52 males, mean age 59.4 ± 17.6) were included in our study. 78 patients suffered complications (45%) at 30 days, 43% of these complications were considered major. Unplanned readmission was observed in 35 patients (20,3%). Risk factors for complications were: Smoking, previous comorbidities, number of levels fused, two or more surgical approaches and excessive bleeding. Hospital length of stay in patients without and with complications was of 7.8 ± 13.7 and 17 ± 31.1 days, respectively ( P 0.0001). Conclusion: The prevalence of early postoperative complications in adult spinal deformity patients treated with fusion was of 45% in our study with 20% of unplanned readmissions at 30 days. Presence of complications significantly increased hospital length of stay.

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Analysis of Postoperative Complications in Spinal Surgery, Hospital Length of Stay, and Unplanned Readmission: Application of Dindo-Clavien Classification to Spine Surgery

Global Spine Journal ◽

10.1177/2192568218792053 ◽

2018 ◽

Vol 9 (3) ◽

pp. 279-286 ◽

Cited By ~ 3

Author(s):

Gaston Camino Willhuber ◽

Cristina Elizondo ◽

Pablo Slullitel

Keyword(s):

Risk Factors ◽

Postoperative Complications ◽

Length Of Stay ◽

Spine Surgery ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Unplanned Readmission ◽

Level Of Evidence ◽

Clavien Classification ◽

Surgical Complexity

Study Design: Retrospective study. Level of evidence III. Objective: Postoperative complications in spine surgery are associated with increased morbidity, hospital length of stay, and health care costs. Registry of complications in orthopedics and the spine surgery is heterogeneous. Methods: Between July 2016 and June 2017, 274 spinal surgeries were performed, the presence of postoperative complications was analyzed at 90 days (according to the classification of Dindo-Clavien, grades I-V), hospital length of stay, surgical complexity (low, medium, and high), unplanned readmission, and risk factors were evaluated. Results: A total of 79 patients suffered a complication (28.8%), of them 21 (26.7%) were grade I, 24 (30.3%) were grade II, 4 (5.7%) were grade IIIA, and 29 (37.3%) were grade IIIB. There were no IV and V grade cases. The most frequent complication was excessive pain followed by deep wound infection and anemia. Surgical complexity and surgical time were significantly associated with the risk of developing a complication. The average number of hospital length of stay in patients without and with complications were 2.7 and 10.6, respectively, and the unplanned readmission rate was 11%. Conclusions: Registry of postoperative complications allows the correct standardization and risk factors required to establish measures to decrease them, the application of Dindo-Clavien classification was useful for the purpose of our study.

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Bleeding Outcomes Associated with Coronary Artery Bypass Graft Surgery and Recent Clopidogrel Exposure

The Heart Surgery Forum ◽

10.1532/hsf98.20121101 ◽

2015 ◽

Vol 16 (2) ◽

pp. 70 ◽

Cited By ~ 3

Author(s):

Danielle M. Blais ◽

Sarah M. Zukkoor ◽

Charles Hayes ◽

Kerry K. Pickworth ◽

Kyle Porter ◽

...

Keyword(s):

Coronary Artery ◽

Postoperative Complications ◽

Length Of Stay ◽

Coronary Artery Bypass Graft ◽

Major Bleeding ◽

Artery Bypass ◽

Bypass Graft ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Artery Bypass Graft

Background: Guidelines recommend discontinuing clopidogrel for at least 5 days before elective coronary artery bypass graft surgery (CABG) to limit blood transfusions and for at least 24 hours before urgent CABG to reduce major bleeding complications. Studies have produced conflicting results regarding whether recent exposure to clopidogrel increases bleeding, the need for intraoperative and postoperative blood products, postoperative complications, and hospital length of stay. We evaluated the effect of clopidogrel exposure on major bleeding at our institution within 5 days of CABG.Methods: We conducted a retrospective review of patients who underwent CABG at a tertiary academic medical center. The primary outcome was major bleeding, defined as transfusion of 4 units of packed red blood cells (PRBCs) and/or a need for reexploration. Secondary outcomes included non-life-threatening bleeding, defined as transfusion of 2 units but <4 units of PRBCs; postoperative complications; hospital length of stay; readmission within 30 days of the procedure; and hospital mortality. Major bleeding events were analyzed with a logistic regression model that adjusted for covariates of bleeding risk factors.Results: Of the 715 patients we reviewed, 169 patients received clopidogrel within 5 days before CABG, and 546 patients did not. A significantly higher incidence of major bleeding was observed in the clopidogrel group compared with the group not exposed to clopidogrel (32% versus 17%, P = .002). After adjusting for covariates, patients exposed to clopidogrel had significantly higher odds of major bleeding (odds ratio, 2.1; 95% confidence interval, 1.3-3.4; P = .003). The groups were similar with respect to postoperative complications, except for infection. The clopidogrel-exposed group had a significantly higher rate of leg site infections (3% versus 0.2%, P = .003).Conclusions: Clopidogrel exposure within 5 days of CABG is associated with an increased risk of major bleeding.

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