P006 Initiation of Continuous Positive Airway Pressure as an inpatient in Patients with Obesity Hypoventilation Syndrome admitted to General Medical Unit

Abstract Background With higher rates of obesity in regional and rural Australian population, there will be higher rates of Obesity Hypoventilation Syndrome (OHS). The cornerstone of the treatment of OHS is Positive Airways Pressure. We studied the initiation of Continuous Positive Airways Pressure (CPAP) in an inpatient setting in patients with OHS in the regional population of Ballarat and subsequent impact on their hospital stay/readmission. Methods We performed a retrospective study of 22 patients with OHS during the 6-month study period (01/07/2021–31/12/2021) admitted into General Medical Unit at Ballarat Base Hospital. Progress Complete Outcome/Impact The mean age in the cohort was 60 with average weight of 139.5 kg. The mean pCO2 and pH were 68.1 and 7.33 respectively. CPAP was initiated in 9 of 22 patients (40.1%) with mean of 7.3 days. Mean days of oxygen use was 4.7 days with mean length of hospital stay 10 days. We did not find any statistical difference in length of hospital stay, ICU stay, supplemental oxygen use or readmission rates between CPAP and non-CPAP group. Subgroup analysis showed that CPAP group had higher rates of COPD (44.4% vs 30.8%) and diabetes (44.4% vs 30.8%) with trend to lower FEV1 (mean FEV1 47.6% vs 57.2%). There were 4 deaths (16.7%), 3 of them did not have CPAP initiated. The longer duration to CPAP initiation is likely to explain the non-significant difference between the groups. Proactive measures to increase initiation of CPAP is likely to improve patient outcome in terms of their morbidity and mortality.

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Cost-effectiveness of positive airway pressure modalities in obesity hypoventilation syndrome with severe obstructive sleep apnoea

Thorax ◽

10.1136/thoraxjnl-2019-213622 ◽

2020 ◽

Vol 75 (6) ◽

pp. 459-467 ◽

Cited By ~ 4

Author(s):

Juan F Masa ◽

Babak Mokhlesi ◽

Iván Benítez ◽

Francisco Javier Gómez de Terreros Caro ◽

M-Ángeles Sánchez-Quiroga ◽

...

Keyword(s):

Cost Effectiveness ◽

Primary Outcome ◽

Cost Effective ◽

Sleep Apnoea ◽

Obesity Hypoventilation Syndrome ◽

Obstructive Sleep ◽

The Mean ◽

Hypoventilation Syndrome ◽

Obesity Hypoventilation

BackgroundObesity hypoventilation syndrome (OHS) is treated with either non-invasive ventilation (NIV) or CPAP, but there are no long-term cost-effectiveness studies comparing the two treatment modalities.ObjectivesWe performed a large, multicentre, randomised, open-label controlled study to determine the comparative long-term cost and effectiveness of NIV versus CPAP in patients with OHS with severe obstructive sleep apnoea (OSA) using hospitalisation days as the primary outcome measure.MethodsHospital resource utilisation and within trial costs were evaluated against the difference in effectiveness based on the primary outcome (hospitalisation days/year, transformed and non-transformed in monetary term). Costs and effectiveness were estimated from a log-normal distribution using a Bayesian approach. A secondary analysis by adherence subgroups was performed.ResultsIn total, 363 patients were selected, 215 were randomised and 202 were available for the analysis. The median (IQR) follow-up was 3.01 (2.91–3.14) years for NIV group and 3.00 (2.92–3.17) years for CPAP. The mean (SD) Bayesian estimated hospital days was 2.13 (0.73) for CPAP and 1.89 (0.78) for NIV. The mean (SD) Bayesian estimated cost per patient/year in the NIV arm, excluding hospitalisation costs, was €2075.98 (91.6), which was higher than the cost in the CPAP arm of €1219.06 (52.3); mean difference €857.6 (105.5). CPAP was more cost-effective than NIV (99.5% probability) because longer hospital stay in the CPAP arm was compensated for by its lower costs. Similar findings were observed in the high and low adherence subgroups.ConclusionCPAP is more cost-effective than NIV; therefore, CPAP should be the preferred treatment for patients with OHS with severe OSA.Trial registration numberNCT01405976

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A comparative analysis of hysterectomies

Medicina ◽

10.3390/medicina43020014 ◽

2007 ◽

Vol 43 (2) ◽

pp. 118 ◽

Cited By ~ 4

Author(s):

Rosita Aniulienė ◽

Laima Varžgalienė ◽

Manvydas Varžgalis

Keyword(s):

Blood Loss ◽

Hospital Stay ◽

Complication Rate ◽

Vaginal Hysterectomy ◽

Length Of Hospital Stay ◽

Laparoscopic Hysterectomy ◽

Abdominal Hysterectomy ◽

Obstetrics And Gynecology ◽

Significant Difference ◽

The Mean

The objective of this study was to evaluate and compare operative and postoperative results and differences among laparoscopic, vaginal, and abdominal hysterectomies performed at the Department of Obstetrics and Gynecology of Kaunas University of Medicine Hospital. Methods. A retrospective review of medical histories was performed for women who had undergone three different types of hysterectomies (laparoscopic, vaginal, and abdominal) at the Department of Obstetrics and Gynecology of Kaunas University of Medicine Hospital during 2004–2005. Results. A total of 602 hysterectomies were performed: 51 (8.5%) laparoscopic, 203 (33.7%) vaginal, and 348 (57.8%) abdominal. The lowest complication rate occurred in patients who underwent laparoscopic hysterectomy (n=5, 9.8%) and the highest – abdominal hysterectomy (n=88, 25.2%) (P<0.05). More complication occurred after abdominal as compared to vaginal hysterectomy (n=88, 25.2% vs. n=20, 9.9%, respectively; P<0.05). There was no statistically significant difference in complication rate comparing laparoscopic and vaginal hysterectomies (P=0.26). The amount of blood loss depended on the type of hysterectomy – less blood was lost during laparoscopic and more during abdominal hysterectomy (123.4 vs. 308.5 mL, respectively; P<0.01). A significantly higher blood loss was observed during abdominal hysterectomy as compared to vaginal (195.3 mL) and vaginal as compared to laparoscopic hysterectomy (P<0.01). The mean length of hospital stay differed comparing all three types of hysterectomies: the shortest stay of 8.6 days was after laparoscopic, the longest of 13.7 days – after abdominal hysterectomy. The mean hospital stay was statistically significant shorter for vaginal hysterectomy compared to abdominal hysterectomy (9.1 vs. 13.7 days, P<0.01). The difference in mean length of hospital stay was insignificant comparing laparoscopic and vaginal hysterectomies (P>0.05). Conclusions. Abdominal hysterectomy was the most common procedure performed. The type of hysterectomy influenced the rate of complications – the lowest complication rate was after laparoscopic and vaginal hysterectomies. The amount of blood loss depended on the type of hysterectomy – the lowest was during laparoscopic hysterectomy. Abdominal hysterectomy required on average a longer hospital stay compared with laparoscopic and vaginal hysterectomies.

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Clinical Outcomes of Modified versus Traditional Technique for the Surgery of Hydatid Cyst of the Liver: A Case Control Study

Middle East Journal of Digestive Diseases ◽

10.15171/mejdd.2019.142 ◽

2019 ◽

Vol 11 (3) ◽

pp. 152-157 ◽

Cited By ~ 1

Author(s):

Asieh Sadat Fattahi ◽

Seyed Hossein Fattahi Masoom ◽

Farjad Lorestani ◽

Mehrdad Fakhlai ◽

Fatemeh Sadat Abtahi Mehrjerdi ◽

...

Keyword(s):

Hydatid Cyst ◽

Hospital Stay ◽

Parasitic Infection ◽

Length Of Hospital Stay ◽

Modified Technique ◽

Significant Difference ◽

Postoperative Length ◽

The Mean ◽

Surgical Modality ◽

Control Study

BACKGROUND Echinococcus granulosis is a parasitic infection most commonly involving the liver. Iran is a hyperendemic area for this disease according to WHO. Despite improvements in medical and interventional radiological techniques, surgery remains the gold standard of treatment; however evidence on different surgical modalities were explained. Considering the high population of referring patients presenting to Omid and Ghaem Hospitals, Mashhad, Iran, we decided to compare the complications of our modified technique with routine technique in hydatid cyst surgery. METHODS 56 patients with hydatid cyst of the liver who underwent modified and routine surgical treatment in Ghaem and Omid Hospitals Mashhad, Iran were studied during Aug 2013- Nov 2015. 27 patients underwent modified surgical technique, whereas the remaining 27 patients were treated by using routine surgical method. These two groups of patients were compared with each other according to their postoperative length of hospital stay and resulting complications. RESULTS The mean age of our patients was 41 years. 27 patients were male and 29 were female. Our results showed no statistically significant difference regarding the incidence of postoperative complications between the two groups. However, mean length of hospital stay was significantly different between the groups (4.5 ± 1.87 and 7.6 ± 2.25 days, respectively, p < 0.001). CONCLUSION The method of modified surgery with closed cyst drainage, which does not use external drains, is a safe surgical modality in the treatment of hydatid cyst disease of the liver if applied properly on appropriate patients.

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Comparison between open and laparoscopic elective cholecystectomy in elderly, in a teaching hospital

Revista do Colégio Brasileiro de Cirurgiões ◽

10.1590/0100-69912016001002 ◽

2016 ◽

Vol 43 (1) ◽

pp. 2-5 ◽

Cited By ~ 9

Author(s):

Cássio Padilha Rubert ◽

Roberta Alves Higa ◽

Fabiano Vilas Boas Farias

Keyword(s):

Hospital Stay ◽

Conversion Rate ◽

Laparoscopic Approach ◽

Length Of Hospital Stay ◽

Mato Grosso ◽

Significant Difference ◽

Stay Time ◽

Hospital Stays ◽

The Mean ◽

Mato Grosso Do Sul

Objective: to analyze the differences in mortality rates, length of hospital stay, time of surgery and the conversion rate between elective open cholecystectomies (OC) and laparoscopic ones (LC) in elderly patients. Methods : we evaluated medical records of patients 65 years of age or older undergoing open or laparoscopic cholecystectomy at the Hospital Regional de Mato Grosso do Sul between January 2008 and December 2011. We excluded individuals operated in non-elective scenarios or who underwent intraoperative cholangiography. Results : we studied 113 patients, of whom 38.1% were submitted to the OC and 61.9%, to LC. Women accounted for 69% of patients and men, for 31%. The conversion rate was 2.9%. The mean age and duration of the procudure was 70.1 and 84 minutes, respectively, with no significant difference between OC and LC. Patients undergoing LC had shorter hospital stays (2.01 versus 2.95 days, p=0.0001). We identified operative complications in sixpatients (14%) after OC and in nine (12%) after LC, with no statistical difference. Conclusion : there was no difference in morbidity and mortality when comparing OC with LC. The laparoscopic approach led to shorter hospital stay. Operative time did not differ between the two access routes. The conversion rate was similar to other studies.

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Effect of Flap Selection on the Postoperative Success of Sacral Pressure Injuries: A Retrospective Analysis

WOUNDS A Compendium of Clinical Research and Practice ◽

10.25270/wnds/091721.01 ◽

2021 ◽

Vol 33 (10) ◽

pp. 271-276

Author(s):

Serhat Şibar ◽

Kemal Findikcioglu ◽

Kirdar Guney ◽

Serhan Tuncer ◽

Suhan Ayhan

Keyword(s):

Hospital Stay ◽

Chronic Wounds ◽

Length Of Hospital Stay ◽

Long Term Results ◽

Drain Removal ◽

Significant Difference ◽

Group 3 ◽

The Mean ◽

Group 2

Introduction. Pressure injuries (PIs) continue to be a substantial problem and burden for the present-day health care system and are the leading cause of chronic wounds worldwide. There is no current consensus on the long-term results of the use of flaps in sacral PI reconstruction and optimal flap choice. Objective. This study aimed to evaluate whether flap selection influences postoperative results in sacral PI reconstruction. Materials and Methods. Patients who underwent surgery for PIs in the authors’ clinic between 2002 and 2016 were retrospectively analyzed. A total of 63 patients with stage 3/stage 4 sacral PIs and who underwent reconstruction with fasciocutaneous (FC) flaps (group 1), musculocutaneous (MC) flaps (group 2), or perforator (P) flaps (group 3) were included in the study. The mean duration of the follow-up period was 14.4 months, and patients were evaluated in terms of their demographic data, length of hospital stay, complications, and recurrence. Results. The mean age, sex distribution, and ambulatory status were similar between the groups. In group 2 (MC), the mean length of hospital stay and mean drain removal time were significantly longer. The mean daily drainage amount was significantly higher in group 2 (MC) than in the other groups, and long-term relapses were less frequently observed in group 3 (P). A significant difference was observed between groups 2 (FC) and 3 (MC) in terms of wound dehiscence. The authors determined that P flaps were associated with a reduced mean length of hospital stay and daily drainage. Conclusions. For these patients, P flaps appear to be the optimal flap choice for sacral area reconstruction. However, new prospective randomized studies are needed to support these findings.

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Evaluation of the Possible Risk Factors on Bronchial Closure Techniques for Bronchopleural Fistula after Lung Resection

Folia Medica ◽

10.3897/folmed.62.e47804 ◽

2020 ◽

Vol 62 (1) ◽

pp. 133-140

Author(s):

Fazli Yanik ◽

Yekta A. Karamustafaoglu ◽

Yener Yoruk

Keyword(s):

Risk Factors ◽

Hospital Stay ◽

Total Protein ◽

Length Of Hospital Stay ◽

Albumin Level ◽

High Morbidity ◽

Bronchial Stump ◽

Significant Difference ◽

The Mean ◽

Bronchial Closure

Background: Broncho-pleural fistula (BPF) can occur after pulmonary resections as a complication with high morbidity and mortality rates.    Aim: In the present study, we analyzed the relation between the possible risk factors and the two major bronchial closure techniques for BPF after lung resections, and the management methods of BPF.    Materials and methods: A total of 26 cases detected and managed with BPF diagnosis in our clinic between September 2005 and September 2017 were evaluated retrospectively. The cases were divided into two groups: Group 1 (n=14); bronchial closure performed manually and Group 2 (n=12) bronchial closure with stapler. We analyzed cases for age, gender, body mass index, pulmonary function tests, time to fistula, total protein/albumin level, length of hospital stay, bronchial stump distance, presence of bronchial stump coverage, and the mean survivals.   Results: Twenty-three of the cases were males (88.5%) with a mean age of 60.03±8.7 years (range 38-73). While BPF was detected in twenty-three (88.5%) of the cases after pneumonectomy, three (11.5%) of them were after lobectomy. There was no statistically significant correlation between the two groups in gender, age, BMI, preoperative FEV1, time to fistula, total protein/albumin level, length of hospital stay, bronchial stump distance, and presence of bronchial stump coverage (chi-square test, p>0.05). As a result of the applied Kaplan-Meier analysis, we found no statistically significant difference in the mean survival rates between the two groups (p>0.05).   Conclusions: Broncho-pleural fistulas still remains a major challenge. Although there is no statistical relationship between bronchial closure techniques and possible risk factors in our study, patients should be assessed in terms of possible risk factors. The management strategy for BPF varies according to individual patients’ clinical condition, the size of the fistula, and development time.

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Pilonidal Sinus: How to Choose Between Excision and Open Granulation Versus Excision and Primary Closure?

Swiss Surgery ◽

10.1024/1023-9332.8.6.255 ◽

2002 ◽

Vol 8 (6) ◽

pp. 255-258 ◽

Cited By ~ 28

Author(s):

Perruchoud ◽

Vuilleumier ◽

Givel

Keyword(s):

Hospital Stay ◽

Pilonidal Sinus ◽

Primary Closure ◽

Average Length ◽

Length Of Hospital Stay ◽

Healing Time ◽

Incision And Drainage ◽

The Mean ◽

Primary Healing

Aims: The purpose of this study was to evaluate excision and open granulation versus excision and primary closure as treatments for pilonidal sinus. Subjects and methods: We evaluated a group of 141 patients operated on for a pilonidal sinus between 1991 and 1995. Ninety patients were treated by excision and open granulation, 34 patients by excision and primary closure and 17 patients by incision and drainage, as a unique treatment of an infected pilonidal sinus. Results: The first group, receiving treatment of excision and open granulation, experienced the following outcomes: average length of hospital stay, four days; average healing time; 72 days; average number of post-operative ambulatory visits, 40; average off-work delay, 38 days; and average follow-up time, 43 months. There were five recurrences (6%) in this group during the follow-up period. For the second group treated by excision and primary closure, the corresponding outcome measurements were as follows: average length of hospital stay, four days; average healing time, 23 days; primary healing failure rate, 9%; average number of post-operative ambulatory visits, 6; average off-work delay, 21 days. The average follow-up time was 34 months, and two recurrences (6%) were observed during the follow-up period. In the third group, seventeen patients benefited from an incision and drainage as unique treatment. The mean follow-up was 37 months. Five recurrences (29%) were noticed, requiring a new operation in all the cases. Discussion and conclusion: This series of 141 patients is too limited to permit final conclusions to be drawn concerning significant advantages of one form of treatment compared to the other. Nevertheless, primary closure offers the advantages of quicker healing time, fewer post-operative visits and shorter time off work. When a primary closure can be carried out, it should be routinely considered for socio-economical and comfort reasons.

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Effect of Chewing Gum on Bowel Motility in Women Undergoing Post-Operative Cesarean Section

International Journal of Innovative Research in Medical Science ◽

10.23958/ijirms/vol03-i06/04 ◽

2018 ◽

Vol 3 (06) ◽

Author(s):

Dr.Randa Mohammed AboBaker

Keyword(s):

Cesarean Section ◽

Hospital Stay ◽

Demographic Data ◽

Length Of Hospital Stay ◽

Chewing Gum ◽

Control Group ◽

Controlled Clinical Trial ◽

Bowel Motility ◽

Gum Chewing ◽

Significant Difference

Postoperative Ileus (POI) is one of the most common problems after obstetrics, gynecologic and abdominal surgeries. Sham feeding, such as gum chewing, accelerates the return of bowel function and the length of hospital stay. The present study aims to evaluate the effect of chewing gum on bowel motility in women undergoing post-operative cesarean section. Intervention study was used at the Postpartum Department of Maternity and Children Hospital, KSA. A randomized controlled clinical trial research design. Through a convenience technique, 80 post Caesarian Section (CS) women were included in the study. Data were collected through three tools: Tool (I): Socio-demographic data and reproductive history interview schedule. Tool (II): Postoperative Assessment Sheet. Tool (III): Outcomes of gum chewing and the length of hospital stay. Method: subjects were assigned randomly into two groups of (40) the experimental and (40) the control. Subjects in the study group were asked to chew two pieces of sugarless gum for 30 min/three times daily in the morning, noon, and evening immediately after recovery from anesthesia and in Postpartum Department; while subjects in the control group followed the hospital routine care. Each woman in both groups was tested abdominally using a stethoscope to auscultate the bowel sounds and asked to report immediately the time of either passing flatus or stool. Results: illustrated that a highly statistically significant difference was observed between the two groups concerning their gum chewing outcomes. Where, P = 0.000. The study concluded that gum chewing is safe, well tolerated and appears to be effective in reducing the incidence and consequences of POI following CS.

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