scholarly journals Multimodal Analgesia in Lumbar Fusion Surgery: Impact Amidst the Opioid Epidemic

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Yi Lu ◽  
Erica Bertoncini
Keyword(s):  
Length Of Stay ◽  
Lumbar Fusion ◽  
Multimodal Analgesia ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Control Group ◽  
P Value ◽  
Standard Group ◽  
Fusion Surgery ◽  
Hospital Stays

Abstract INTRODUCTION Spine surgery traditionally relies on opioid analgesics for postoperative pain management. Opioids are associated with prolonged hospital stays and opioid use disorders. Opioid-focused prescribing habits in surgery have partially contributed to the opioid epidemic. METHODS A retrospective analysis was performed comparing patients receiving a multimodal analgesia regimen after lumbar fusion surgery vs control group receiving standard analgesia regimen. The multimodal regimen consisted of Acetaminophen 975 mg TID, Toradol 7.5 mg Q6 hours for 24-ho followed by Celebrex 100 mg BID for 7-d, Robaxin 500 mg Q6 hours prn for muscle spasms, Gabapentin 300 mg/100 mg TID for 4-wk, and prn narcotic. The standard regimen consisted of Acetaminophen 975 mg TID, narcotic prn, and muscle relaxant prn. There were 12 patients in the multimodal group and 26 patients in the control group evaluated over 3-mo and 6-mo time periods respectively. Primary outcomes included hospital length-of-stay, total and IV narcotic requirements in Morphine Milligram Equivalent (MME), and VASS pain scores. RESULTS Study results demonstrate differences between patient populations when focusing on the opioid-naïve participants. Opioid-naïve patients in the multimodal group were found to have significantly lower IV narcotic requirement than the control (0.22+/−0.67 mg/d for multimodal vs 5.36+/−5.56 mg/d for standard group, P-value = .001). These patients also had shorter hospital stays than the control (2.78+/−0.83 d for multimodal vs 3.53+/−1.17 d for standard group) but the difference was just below our threshold for significance (P-value = .066). Including both opioid-naïve and opioid-tolerant patients, no significant differences were found in hospital length-of-stay, MME, IV narcotic requirement nor VASS score between the multimodal group and the control groups (P-values of .46, .81, .36, and .91, respectively). CONCLUSION Overall, the study favors using multimodal analgesia in those undergoing lumbar spinal fusion surgeries as evident by considerably reduced IV narcotic requirement and nearly significant shortened hospital length-of-stay in opioid-naïve patients compared to control.

Controlled Study of Decision-Making Algorithms for Kidney Replacement Therapy Initiation in Acute Kidney Injury

2021 ◽  
pp. CJN.02060221
Author(s):  
Yvelynne Kelly ◽  
Kavita Mistry ◽  
Salman Ahmed ◽  
Shimon Shaykevich ◽  
Sonali Desai ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Length Of Stay ◽  
Kidney Injury ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Controlled Study ◽  
Control Group ◽  
Inpatient Mortality ◽  
Icu Length Of Stay ◽  
Kidney Replacement Therapy

Background: Acute kidney injury (AKI) requiring kidney replacement therapy (KRT) is associated with high mortality and utilization. We evaluated the use of an AKI-Standardized Clinical Assessment and Management Plan (SCAMP) on patient outcomes including mortality, hospital and ICU length of stay. Methods: We conducted a 12-month controlled study in the ICUs of a large academic tertiary medical center. We alternated use of the AKI-SCAMP with use of a "sham" control form in 4-6-week blocks. The primary outcome was risk of inpatient mortality. Pre-specified secondary outcomes included 30-day mortality, 60-day mortality and hospital and ICU length of stay. Generalized estimating equations were used to estimate the impact of the AKI-SCAMP on mortality and length of stay. Results: There were 122 patients in the AKI-SCAMP group and 102 patients in the control group. There was no significant difference in inpatient mortality associated with AKI-SCAMP use (41% vs 47% control). AKI-SCAMP use was associated with significantly reduced ICU length of stay (mean 8 (95% CI 8-9) vs 12 (95% CI 10-13) days; p = <0.0001) and hospital length of stay (mean 25 (95% CI 22-29) vs 30 (95% CI 27-34) days; p = 0.02). Patients in the AKI-SCAMP group less likely to receive KRT in the context of physician-perceived treatment futility than those in the control group (2% vs 7%, p=0.003). Conclusions: Use of the AKI-SCAMP tool for AKI-KRT was not significantly associated with inpatient mortality but was associated with reduced ICU and hospital length of stay and use of KRT in cases of physician-perceived treatment futility.

Reduction of Inpatient Hospital Length of Stay in Lumbar Fusion Patients With Implementation of an Evidence-Based Clinical Care Pathway

Spine ◽  
2017 ◽  
Vol 42 (3) ◽  
pp. 169-176 ◽  
Author(s):  
Alison Bradywood ◽  
Farrokh Farrokhi ◽  
Barbara Williams ◽  
Mark Kowalczyk ◽  
C. Craig Blackmore
Keyword(s):  
Length Of Stay ◽  
Care Pathway ◽  
Lumbar Fusion ◽  
Clinical Care ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Evidence Based ◽  
Inpatient Hospital ◽  
Clinical Care Pathway

scholarly journals Preoperative Dexamethasone Enhances Quality of Recovery after Laparoscopic Cholecystectomy

2011 ◽  
Vol 114 (4) ◽  
pp. 882-890 ◽  
Author(s):  
Glenn S. Murphy ◽  
Joseph W. Szokol ◽  
Steven B. Greenberg ◽  
Michael J. Avram ◽  
Jeffery S. Vender ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Length Of Stay ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Postanesthesia Care Unit ◽  
Control Group ◽  
Quality Of Recovery ◽  
Pain Scores ◽  
Dexamethasone Group

Background The effect of dexamethasone on quality of recovery after discharge from the hospital after laparoscopic surgery has not been examined rigorously in previous investigations. We hypothesized that preoperative dexamethasone would enhance patient-perceived quality of recovery on postoperative day 1 in subjects undergoing laparoscopic cholecystectomy. Methods One hundred twenty patients undergoing outpatient laparoscopic cholecystectomy were randomized to receive either dexamethasone (8 mg) or placebo-saline. A 40-item quality-of-recovery scoring system (QoR-40) was administered preoperatively and on postoperative day 1 to all subjects. Nausea, vomiting, fatigue, and pain scores were recorded at the time of discharge from the postanesthesia care unit and ambulatory surgical unit. Hospital length of stay was also assessed. Results Global QoR-40 scores on postoperative day 1 were higher in the dexamethasone group (median [range], 178 [130-195]) compared with the control group (161 [113-194]) (median difference [99% CI], -18 [-26 to -8]; P &lt; 0.0001). Postoperative QoR-40 scores in the dimensions of emotional state, physical comfort, and pain were all improved in the dexamethasone group compared with the control group (P &lt; 0.001). Nausea, fatigue, and pain scores were all reduced in the dexamethasone group during the hospitalization, as were postoperative analgesic requirements (P &lt; 0.05). Total hospital length of stay was also reduced in subjects administered steroids (P = 0.003). Conclusions Among patients undergoing outpatient laparoscopic cholecystectomy surgery, the use of preoperative dexamethasone enhanced postdischarge quality of recovery and reduced nausea, pain, and fatigue in the early postoperative period.

scholarly journals Can Liposomal Bupivacaine Be Safely Utilized in Elective Spine Surgery?

2018 ◽  
Vol 9 (2) ◽  
pp. 133-137 ◽  
Author(s):  
Luke Brown ◽  
Tristan Weir ◽  
Scott Koenig ◽  
Mark Shasti ◽  
Imran Yousaf ◽  
...  
Keyword(s):  
Relative Risk ◽  
Length Of Stay ◽  
Urinary Retention ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Fusion Surgery ◽  
Liposomal Bupivacaine ◽  
Lumbar Decompression ◽  
Increased Risk ◽  
Significant Difference

Study Design: Single-blinded prospective randomized control trial. Objectives: To compare the incidence of adverse events (AEs) and hospital length of stay between patients who received liposomal bupivacaine (LB) versus a single saline injection, following posterior lumbar decompression and fusion surgery for degenerative spondylosis. Methods: From 2015 to 2016, 59 patients undergoing posterior lumbar decompression and fusion surgery were prospectively enrolled and randomized to receive either 60 mL injection of 266 mg LB or 60 mL of 0.9% sterile saline, intraoperatively. Outcome measures included the incidence of postoperative AEs and hospital length of stay. Results: The most common AEs in the treatment group were nausea (39.3%), emesis (18.1%), and hypotension (18.1%). Nausea (23%), constipation (19.2%), and urinary retention (15.3%) were most common in the control group. Patients who received LB had an increased risk of developing nausea (relative risk [RR] = 1.7; 95% confidence interval [CI] = 0.75-3.8), emesis (RR = 2.3; 95% CI = 0.51-10.7), and headaches (RR = 2.36; 95% CI = 0.26-21.4). Patients receiving LB had a decreased risk of developing constipation (RR = 0.78; 95% CI = 0.25-2.43), urinary retention (RR = 0.78; 95% CI = 0.21-2.85), and pruritus (RR = 0.78; 95% = 0.21-2.8) postoperatively. Relative risk values mentioned above failed to reach statistical significance. No significant difference in the hospital length of stay between both groups was found (3.9 vs 3.9 days; P = .92). Conclusion: Single-dose injections of LB to the surgical site prior to wound closure did not significantly increase or decrease the incidence or risk of developing AEs postoperatively. Furthermore, no significant difference was found in the hospital length of stay between both groups.

Implementation of an enhanced recovery program in pediatric laparoscopic colorectal patients does not worsen analgesia despite reduced perioperative opioids: a retrospective, matched, non-inferiority study

2019 ◽  
Vol 44 (1) ◽  
pp. 123-129 ◽  
Author(s):  
John C Edney ◽  
Humphrey Lam ◽  
Mehul V Raval ◽  
Kurt F Heiss ◽  
Thomas M Austin
Keyword(s):  
Postoperative Pain ◽  
Length Of Stay ◽  
Enhanced Recovery ◽  
Hospital Readmissions ◽  
Hospital Length Of Stay ◽  
P Value ◽  
Perioperative Morbidity ◽  
Perioperative Analgesia ◽  
Pain Scores ◽  
Hospital Stays

Background and objectivesEnhanced recovery protocols (ERPs) decrease length of stay and postoperative morbidity, but it is important that these benefits do not come at a cost of sacrificing proper perioperative analgesia. In this retrospective, matched cohort study, we evaluated postoperative pain intensity in pediatric patients who underwent laparoscopic colorectal surgeries before and after ERP implementation.MethodsPatients in each cohort were randomly matched based on age, diagnosis, American Society of Anesthesiologists classification, and surgical procedure. The primary outcome was average daily postoperative pain score, while the secondary outcomes included postoperative hospital length of stay, complication rate, and 30-day readmissions. Since our hypothesis was non-inferior analgesia in the postprotocol cohort, a non-inferiority study design was used.ResultsAfter matching, 36 pairs of preprotocol and postprotocol patients were evaluated. ERP patients had non-inferior recovery room pain scores (difference 0 (−1.19, 0) points, 95% CI −0.22 to 0.26 points, p valuenon-inferiority <0.001) and 4-day postoperative pain scores (difference −0.3±1.9 points, 95% CI −0.82 to 0.48 points, p valuenon-inferiority <0.001) while receiving less postoperative opioids (difference −0.15 [−0.21, –0.05] intravenous morphine equivalents/kg/day, p<0.001). ERP patients also had reduced postoperative hospital stays (difference −1.5 [−4.5, 0] days, p<0.001) and 30-day readmissions (2.8% vs 27.8%, p=0.008).ConclusionsImplementation of our ERP for pediatric laparoscopic colorectal patients was associated with less perioperative opioids without worsening postoperative pain scores. In addition, patients who received the protocol had faster return of bowel function, shorter postoperative hospital stays, and a lower rate of 30-day hospital readmissions. In pediatric laparoscopic colorectal patients, the incorporation of an ERP was associated with a pronounced decrease in perioperative morbidity without sacrificing postoperative analgesia.

scholarly journals Predictive modeling of hospital Length of Stay in COVID-19 patients using Artificial Neural Networks  

2021 ◽  
Author(s):  
Azam Orooji ◽  
Mostafa Shanbehzadeh ◽  
Hadi Kazemi-Arpanahi ◽  
Mohsen Shafiee
Keyword(s):  
Neural Network ◽  
Length Of Stay ◽  
Correlation Coefficient ◽  
Prediction Models ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
P Value ◽  
Bed Management ◽  
Hospital Bed ◽  
Artificial Neural

Abstract BackgroundThe current pandemic of coronavirus disease (COVID-19) causes unexpected economic burdens to worldwide health organizations with severe shortages in hospital bed capacity and other related medical resources. Therefore, predicting the length of stay (LOS) is essential to ensure optimal allocating scarce hospital resources and inform evidence-based decision-making. Thus, the purpose of this research is to construct a model for predicting COVID-19 patients' hospital LOS by multiple multilayer perceptron-artificial neural network (MLP-ANN) algorithms. Material and MethodsUsing a single-center registry, the records of 1225 laboratory-confirmed COVID-19 hospitalized cases from February 9, 2020, to December 20, 2020, were analyzed. The correlation coefficient technique was developed to determine the most significant variables as the input of the ANN models. Only variables with a correlation coefficient at the P-value< 0.2 were used in model construction. Ultimately the prediction models were developed based on 12 ANN techniques according to selected variables. ResultsAfter implementing feature selection, a total of 20 variables was determined as the most relevant predictors to build the models. The results indicated that the best performance belongs to a neural network with 20 and 10 neurons in the hidden layer of the Bayesian Regularization classifier for whole and selected features with RMSE of 1.6213 and 2.2332, respectively. ConclusionThe developed model in this study can help in the better calculation of LOS in COVID-19 patients. This model also can be leveraged in hospital bed management and optimized resource utilization.

scholarly journals Individualized Fluid Management Using the Pleth Variability Index

2020 ◽  
Vol 133 (1) ◽  
pp. 31-40 ◽  
Author(s):  
Marc-Olivier Fischer ◽  
Sandrine Lemoine ◽  
Benoît Tavernier ◽  
Chems-Eddine Bouchakour ◽  
Vincent Colas ◽  
...  
Keyword(s):  
Length Of Stay ◽  
General Anesthesia ◽  
Orthopedic Surgery ◽  
Hospital Length ◽  
Fluid Administration ◽  
Hospital Length Of Stay ◽  
Control Group ◽  
Intermediate Risk ◽  
Variability Index ◽  
Plethysmographic Variability Index

Background The present trial was designed to assess whether individualized strategies of fluid administration using a noninvasive plethysmographic variability index could reduce the postoperative hospital length of stay and morbidity after intermediate-risk surgery. Methods This was a multicenter, randomized, nonblinded parallel-group clinical trial conducted in five hospitals. Adult patients in sinus rhythm having elective orthopedic surgery (knee or hip arthroplasty) under general anesthesia were enrolled. Individualized hemodynamic management aimed to achieve a plethysmographic variability index under 13%, and the standard management strategy aimed to maintain a mean arterial pressure above 65 mmHg during general anesthesia. The primary outcome was the postoperative hospital length of stay decided by surgeons blinded to the group allocation of the patient. Results In total, 447 patients were randomized, and 438 were included in the analysis. The mean hospital length of stay ± SD was 6 ± 3 days for the plethysmographic variability index group and 6 ± 3 days for the control group (adjusted difference, 0.0 days; 95% CI, −0.6 to 0.5; P = 0.860); the theoretical postoperative hospital length of stay was 4 ± 2 days for the plethysmographic variability index group and 4 ± 1 days for the control group (P = 0.238). In the plethysmographic variability index and control groups, serious postoperative cardiac complications occurred in 3 of 217 (1%) and 2 of 224 (1%) patients (P = 0.681), acute postoperative renal failure occurred in 9 (4%) and 8 (4%) patients (P = 0.808), the troponin Ic concentration was more than 0.06 μg/l within 5 days postoperatively for 6 (3%) and 5 (2%) patients (P = 0.768), and the postoperative arterial lactate measurements were 1.44 ± 1.01 and 1.43 ± 0.95 mmol/l (P = 0.974), respectively. Conclusions Among intermediate-risk patients having orthopedic surgery with general anesthesia, fluid administration guided by the plethysmographic variability index did not shorten the duration of hospitalization or reduce complications. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

Abstract 15580: The Impact of Sex and Gender-related Factors on Length-of-stay Following NSTEMI: A Multicountry Analysis

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Uri Bender ◽  
Colleen M Norris ◽  
Valeria Raparelli ◽  
Tadiri Christina ◽  
Louise Pilote
Keyword(s):  
Length Of Stay ◽  
Cardiac Risk ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Bivariate Analysis ◽  
P Value ◽  
Sex And Gender ◽  
Related Factors ◽  
And Gender ◽  
The Impact

Introduction: Gender refers to psycho-socio-cultural characteristics typically ascribed to men, women and gender-diverse individuals and has been shown to be associated with adverse clinical outcomes in AMI independent of sex. Substantial heterogeneity in hospital length of stay exists among patients admitted with NSTEMI. Whether sex and gender-based differences contribute to length-of-stay (LOS) among patients with NSTEMI remains unknown. Methods: To examine the relationship between sex, gender-related factors and LOS in adults hospitalized for NSTEMI, data from the GENESIS-PRAXY (n=1,210, Canada, U.S. and Switzerland), EVA (n=430, Italy) and VIRGO (n=3,572, U.S., Spain and Australia) studies of adults hospitalized for AMI were combined and analyzed. A best-fit linear regression model was selected through incremental analysis by stepwise addition of gender-related variables thought to be different in either impact or distribution between men and women. Results: Among the overall cohort (n=5,212), 2,218 participants with a diagnosis of NSTEMI were included in the final cohort (66% women, mean age 48.5 years, 67.8% U.S.). Half of the patients had a LOS of longer than 4 days (n=1,124) and were more likely to be white and have a clustering of cardiac risk factors in comparison to those with shorter LOS. No association between sex and LOS was observed in the bivariate analysis (p=0.87). In the multivariable model adjusted for sex, age, country of hospitalization, level of education, marital status, employment status, income, and social support, age (0.062 days/year, p=0.0002), being employed (-0.63 days in workers, p=0.01) and the treatment country relative to Canada (Italy=4.1 days; Spain=1.7 days; and the U.S.=-1.0 days, all p-value<0.001) were significant predictors of LOS. Conclusions: Employed individuals are more likely to experience a shorter LOS following NSTEMI. Variation in LOS exists across different countries and is likely due to institutional policy, resource allocation, and differences in cultural and psychosocial influences.

Abstract P400: Racial Disparities in Subarachnoid Hemorrhage Outcomes-A Single Center Experience

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Jerome Deas ◽  
Eyad Almallouhi ◽  
Chirantan Banerjee
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Length Of Stay ◽  
Hospital Length ◽  
University Hospital ◽  
Hospital Length Of Stay ◽  
P Value ◽  
High Morbidity ◽  
Chi Square ◽  
Single Center Experience ◽  
Discharge Outcomes

Introduction: Subarachnoid hemorrhage (SAH) has high morbidity and mortality, and prior studies have reported outcome disparities between African American (AA) and Caucasian patients. We compared demographics, risk factors, and discharge outcomes among different ethnicities treated at our comprehensive stroke center. Methods: We used data on all SAH patients admitted between July 2014 and March 2020 to our university hospital in the Southeast United States. Race was categorized into AA, Caucasian, and “other.” Pearson chi-square test and analysis of variance were used to compare these variables between the different groups. Results: A total of 578 SAH patients were identified (39% AA patients, 54% Caucasian, and 7% other). Admission Glascow Coma Score (GCS) and Hunt & Hess scores were comparable between the 3 groups. AA patients were significantly younger (51 vs 59 in Caucasian group vs 56 years in Other, p-value <0.001) and had higher BP at admission (systolic BP 152 vs 144 vs 145, p=0.002, diastolic BP 86 vs 80 vs 81, p<0.001). AA patients were more likely to have a history of hypertension (p<0.001) and had higher BMI (30 vs 28.1 vs 26, p=0.003) and Hemoglobin A1c (5.8 vs 5.6 vs 6.1, p=0.013). Modified Rankin scale (mRS) at discharge, in-hospital mortality, and discharge destination were similar between the groups, but AA patients had a longer mean hospital length of stay (19 vs 14 vs 17 days, p=0.035). Conclusion: In our cohort, AA SAH patients were significantly younger and had more comorbidities at admission. Although they had a higher length of stay, discharge outcomes were comparable to other races.

Sign in / Sign up

Export Citation Format

Share Document