965: SUGAMMADEX VERSUS NEOSTIGMINE AND THE IMPACT ON POST-ANESTHESIA CARE UNIT LENGTH OF STAY

Objectives: (1) To identify clinical factors and perioperative practices that correlate with longer length of stay (LOS) in the post-anesthesia care unit (PACU) after adenotonsillectomy (T&A) in pediatric populations. (2) To understand the relationship between family presence and PACU LOS for pediatric patients after T&A. Methods: Pediatric patients (ages 3-17) who underwent T&A between February 2016 and December 2016 were retrospectively reviewed. Factors assessed for impact on PACU LOS included BMI, preoperative medications, intraoperative medications/narcotics, postoperative medications/narcotics, method of postoperative medication administration, and family presence in the PACU. Kruskal–Wallis and Spearman tests were used to assess correlations. Statistical significance was set a priori at P < .05. Results: Our cohort included 500 patients. Patients were in the PACU for an average of 135.4 minutes (±65.8). Subset analyses of the type of medications administered intra-operatively and in the PACU show that the intraoperative administration of sedatives is associated with increased LOS ( P = .014). Postoperative administration of any medications ( P < .001), and specifically, postoperative administration of narcotics ( P < .001), analgesics ( P = .043), antihistamines ( P < .001), and dopamine antagonists ( P = .011), are associated with increased LOS. Administration of PACU medications by IV was also correlated with shorter LOS compared to oral administration of PACU medications ( P = .016). A comparison of patients who received PACU medications to those who did not demonstrated that intraoperative administration of acetaminophen was associated with a reduced need for PACU medication administration ( P = .012). Shorter waiting times for family arrival in the PACU was also associated with shorter LOS ( P < .001). Conclusion: Our results suggest that postoperative medication administration and time until family arrival in the PACU are associated with significant differences in LOS. We also find that intraoperative administration of acetaminophen is correlated with reduced need for postoperative medication administration. Standardizing postoperative practices to minimize PACU LOS could result in a more efficient recovery for pediatric patients undergoing T&A.

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Pilot study comparing post-anesthesia care unit length of stay in moderately and severely obese children

Journal of Anesthesia ◽

10.1007/s00540-017-2326-2 ◽

2017 ◽

Vol 31 (4) ◽

pp. 510-516 ◽

Cited By ~ 1

Author(s):

Hina Walia ◽

Onur Balaban ◽

Megan Jacklen ◽

Dmitry Tumin ◽

Vidya Raman ◽

...

Keyword(s):

Pilot Study ◽

Length Of Stay ◽

Unit Length ◽

Anesthesia Care ◽

Post Anesthesia Care Unit ◽

Obese Children ◽

Severely Obese

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Effects of pre-emptive pregabalin and multimodal anesthesia on postoperative opioid requirements in patients undergoing robot-assisted laparoscopic prostatectomy

BMC Urology ◽

10.1186/s12894-021-00785-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

K. Sisa ◽

S. Huoponen ◽

O. Ettala ◽

H. Antila ◽

T. I. Saari ◽

...

Keyword(s):

Postoperative Nausea And Vomiting ◽

Multimodal Analgesia ◽

Opioid Consumption ◽

Anesthesia Induction ◽

Anesthesia Care ◽

Post Anesthesia Care Unit ◽

Robot Assisted ◽

Ctrl Group ◽

Laparoscopic Prostatectomy ◽

The Impact

Abstract Background Previous findings indicate that pre-emptive pregabalin as part of multimodal anesthesia reduces opioid requirements compared to conventional anesthesia in patients undergoing robot-assisted laparoscopic prostatectomy (RALP). However, recent studies show contradictory evidence suggesting that pregabalin does not reduce postoperative pain or opioid consumption after surgeries. We conducted a register-based analysis on RALP patients treated over a 5-year period to evaluate postoperative opioid consumption between two multimodal anesthesia protocols. Methods We retrospectively evaluated patients undergoing RALP between years 2015 and 2019. Patients with American Society of Anesthesiologists status 1–3, age between 30 and 80 years and treated with standard multimodal anesthesia were included in the study. Pregabalin (PG) group received 150 mg of oral pregabalin as premedication before anesthesia induction, while the control (CTRL) group was treated conventionally. Postoperative opioid requirements were calculated as intravenous morphine equivalent doses for both groups. The impact of pregabalin on postoperative nausea and vomiting (PONV), and length of stay (LOS) was evaluated. Results We included 245 patients in the PG group and 103 in the CTRL group. Median (IQR) opioid consumption over 24 postoperative hours was 15 (8–24) and 17 (8–25) mg in PG and CTRL groups (p = 0.44). We found no difference in postoperative opioid requirement between the two groups in post anesthesia care unit, or within 12 h postoperatively (p = 0.16; p = 0.09). The length of post anesthesia care unit stay was same in each group and there was no difference in PONV Similarly, median postoperative LOS was 31 h in both groups. Conclusion Patients undergoing RALP and receiving multimodal analgesia do not need significant amount of opioids postoperatively and can be discharged soon after the procedure. Pre-emptive administration of oral pregabalin does not reduce postoperative opioid consumption, PONV or LOS in these patients.

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The impact of medical interventions on admission characteristics in children with congenital heart disease and cardiomyopathy

Cardiology in the Young ◽

10.1017/s1047951120004175 ◽

2020 ◽

pp. 1-8

Author(s):

Rohit S. Loomba ◽

Jacqueline Rausa ◽

Vincent Dorsey ◽

Ronald A. Bronicki ◽

Enrique G. Villarreal ◽

...

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

Length Of Stay ◽

Congenital Heart ◽

Unit Length ◽

Channel Blockers ◽

Regression Analyses ◽

Converting Enzyme Inhibitors ◽

Medical Interventions ◽

The Impact

Abstract Introduction: Children with congenital heart disease and cardiomyopathy are a unique patient population. Different therapies continue to be introduced with large practice variability and questionable outcomes. The purpose of this study is to determine the impact of various medications on intensive care unit length of stay, total length of stay, billed charges, and mortality for admissions with congenital heart disease and cardiomyopathy. Materials and methods: We identified admissions of paediatric patients with cardiomyopathy using the Pediatric Health Information System database. The admissions were then separated into two groups: those with and without inpatient mortality. Univariate analyses were conducted between the groups and the significant variables were entered as independent variables into the regression analyses. Results: A total of 10,376 admissions were included these analyses. Of these, 904 (8.7%) experienced mortality. Comparing patients who experienced mortality with those who did not, there was increased rate of acute kidney injury with an odds ratio (OR) of 5.0 [95% confidence interval (CI) 4.3 to 5.8, p < 0.01], cardiac arrest with an OR 7.5 (95% CI 6.3 to 9.0, p < 0.01), and heart transplant with an OR 0.3 (95% CI 0.2 to 0.4, p < 0.01). The medical interventions with benefit for all endpoints after multivariate regression analyses in this cohort are methylprednisolone, captopril, enalapril, furosemide, and amlodipine. Conclusions: Diuretics, steroids, angiotensin-converting enzyme inhibitors, calcium channel blockers, and beta blockers all appear to offer beneficial effects in paediatric cardiomyopathy admission outcomes. Specific agents within each group have varying effects.

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The Use of Procalcitonin as a Sepsis Marker in a Community Hospital

The Journal of Applied Laboratory Medicine ◽

10.1373/jalm.2018.026955 ◽

2019 ◽

Vol 3 (4) ◽

pp. 545-552

Author(s):

Nathalia De Oro ◽

Maria E Gauthreaux ◽

Julie Lamoureux ◽

Joseph Scott

Keyword(s):

Lactic Acid ◽

Length Of Stay ◽

Community Hospital ◽

Unit Length ◽

Hospital Setting ◽

Control Group ◽

Before And After ◽

Quasi Experimental ◽

Current Cutoff ◽

The Impact

Abstract Background Procalcitonin (PCT) is a biomarker that shows good sensitivity and specificity in identifying septic patients. Methods This study investigated the diagnostic accuracy of PCT in a community hospital setting and how it compared to that of lactic acid. It explored the impact on patient care before and after PCT implementation regarding costs and length of stay. Two comparative groups were analyzed using an exploratory descriptive case–control study with data from a 19-month period after PCT implementation and a retrospective quasi-experimental study using a control group of emergency department patients diagnosed with sepsis using data before PCT implementation. Results Post-procalcitonin implementation samples included 165 cases and pre-procalcitonin implementation sample included 69 cases. From the 165 sepsis cases who had positive blood cultures, PCT had a sensitivity of 89.7%. In comparison, lactic acid's sensitivity at the current cutoff of 18.02 mg/dL (2.0 mmol/L) was 64.9%. There was a 32% decrease in median cost before and after PCT implementation, even with the length of stay remaining at 5 days in both time periods. Conclusions There was a significant decrease after the implementation of PCT in cost of hospitalization compared to costs before implementation. This cost is highly correlated with length of stay; neither the hospital nor the intensive care unit length of stay showed a difference with before and after implementation. There was a positive correlation between lactic acid and PCT values. PCT values had a higher predictive usefulness than the lactic acid values.

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An Objective Study of the Impact of the Electronic Medical Record on Outcomes in Trauma Patients

The American Surgeon ◽

10.1177/000313481207801134 ◽

2012 ◽

Vol 78 (11) ◽

pp. 1249-1254 ◽

Cited By ~ 4

Author(s):

Paul J. Schenarts ◽

Claudia E. Goettler ◽

Michael A. White ◽

Brett H. Waibel

Keyword(s):

Length Of Stay ◽

Medical Record ◽

Electronic Medical Record ◽

Injury Severity ◽

Unit Length ◽

Traumatic Injury ◽

Hospital Length Of Stay ◽

Trauma Patients ◽

Delay In Diagnosis ◽

The Impact

It is commonly believed that the electronic medical record (EMR) will improve patient outcomes. However, there is scant published literature to support this claim and no studies in any surgical population. Our hypothesis was that the EMR would not improve objective outcome measures in patients with traumatic injury. Prospectively collected data from our university-based Level I trauma center was retrospectively reviewed. Demographic, injury severity as well as outcomes and complications data were compared for all patients admitted over a 20-month period before introduction of the EMR and a 20-month period after full, hospital-wide use of the EMR. Implementation of the EMR was associated with a decreased hospital length of stay, P = 0.02; intensive care unit length of stay, P = 0.001; ventilator days, P = 0.002; acute respiratory distress syndrome, P = 0.006, pneumonia, P = 0.008; myocardial infarction, P = 0.001; line infection, P = 0.03; septicemia, P = 0.000; renal failure, P = 0.000; drug complication, P = 0.001; and delay in diagnosis, P = 0.04. There was no difference in mortality, unexpected cardiac arrest, missed injury, pulmonary embolism/deep vein thrombosis, or late urinary tract infection. This is the first study to investigate the impact of the EMR in surgical patients. Although there was an improvement in some complications, the overall impact was inconsistent.

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The impact of COVID-19 on an inpatient mother and baby unit: a service evaluation

BJPsych Open ◽

10.1192/bjo.2021.833 ◽

2021 ◽

Vol 7 (S1) ◽

pp. S316-S316

Author(s):

Joanna Cranshaw ◽

Gertrude Seneviratne ◽

Ranga Rao ◽

Julia Ogunmuyiwa ◽

Rebecca McMillin ◽

...

Keyword(s):

Mental Health ◽

Length Of Stay ◽

Social Services ◽

Unit Length ◽

Perinatal Period ◽

Service Evaluation ◽

Psychotic Illness ◽

Mental Health Act ◽

Mother And Baby Unit ◽

The Impact

AimsUnique challenges have been faced by women in the perinatal period during the COVID-19 pandemic and the impact of this is compounded for women suffering from mental illness. This service evaluation looked at different aspects of the treatment pathway on a specialist inpatient psychiatric Mother and Baby Unit during the pandemic to identify what changes occurred.MethodData were collected for all admissions to the unit between January 2019 and October 2020, with the beginning of the pandemic being defined as on or after 1st March 2020. Information was collected retrospectively from electronic clinical notes on ethnicity, length of stay, diagnosis, mental health act use and restrictive practice, medication, psychology, occupational therapy and social services involvement.ResultThere were 114 admissions to the MBU during the study period. 4 were parenting assessments rather than acute psychiatric admissions and were excluded from the analysis, giving a sample of 110 women. 58% (62/110) were classed as “pre-pandemic” and 43.6% (48/110) were “during pandemic”. 95.45% (105/110) of women were postpartum 4.55% (5/110) were pregnant. Mean length of stay was shorter during the pandemic at 44 days, compared to 61 pre-pandemic. There was greater use of the mental health act during the pandemic: only 43.75% of patients were informal throughout admission, compared to 70.97% pre-pandemic. Mean duration of detention was shorter at 25 days (32 pre-pandemic). Psychotic illness made up a greater proportion of diagnoses during the pandemic: 56% (27/48) compared to 44% (27/62) pre-pandemic. The next most common diagnostic group was mood and anxiety disorders, which made up 29% (14/48) of diagnoses during the pandemic, but 43% (27/62) pre-pandemic. Outcomes as measured using the Health of the Nation Outcome Scale showed a mean improvement between admission and discharge of 6.65, compared to 5.15 pre-pandemic. HONOS scores were higher on admission during the pandemic (12.83, vs 10.88), suggesting a higher level of acuity.ConclusionDuring the COVID-19 pandemic on this Mother and Baby Unit, length of stay was shorter, a greater proportion of patients were detained under the mental health act (although length of detention was shorter) and psychotic illness was more prevalent. This study demonstrates that there were differences in this perinatal inpatient population during the pandemic and this may be a reflection on the wider impact of COVID-19 on perinatal mental health.

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