ERAS reduces postoperative hospital stay and complications after bariatric surgery

Anastomotic leakage with abscess is a rare but severe complication of bariatric surgery. However, there is currently a lack of attention regarding this complication. This study aimed to investigate the risk factors for this complication and relevant treatment strategies to call attention to this severe complication. We retrospectively reviewed the patients who were rehospitalized for anastomotic leakage with abscess after bariatric surgeries in West China Hospital of Sichuan University from November 2017 to November 2018. The clinical profiles analyzed included body mass index, body weight before and after surgery, postoperative hospital stay, diet prescriptions, treatment strategies, and outcomes. A total of six patients (two men and four women) were included. The mean baseline body mass index was 37.52 (29.84–43.37), and the mean weight was 104.95 kg (74.5–127.5). The chief complaints leading to rehospitalization were fever and dull abdominal pain. The average postoperative hospital stay was 3.3 (3–4) days, and the onset time ranged from 7 to 15 days. Finally, revision surgeries were performed in two of the six patients (33%), and they were all cured by percutaneous drainage-based treatments. The postoperative fever and abdominal pain were the signs of leakage and abscess. Similar patients should be followed up once a week for 3 weeks after bariatric surgery to facilitate the early recognition of this complication. A longer hospital stay and sufficient parenteral nutrition plus a later implementation of diet should be helpful to minimize this severe complication. Percutaneous drainage played a significant role in the treatment of these patients.

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The retrospective study of perioperative application of dexamethasone and furosemide for postoperative anti-inflammation in patients undergoing percutaneous nephrolithotomy

International Urology and Nephrology ◽

10.1007/s11255-020-02718-1 ◽

2021 ◽

Author(s):

Taiguo Qi ◽

Xia Qi ◽

Xiude Chen ◽

Xunbo Jin

Keyword(s):

Clinical Outcome ◽

Hospital Stay ◽

Percutaneous Nephrolithotomy ◽

Inflammatory Markers ◽

Serum Levels ◽

Postoperative Hospital Stay ◽

Lower Serum ◽

Combined Application ◽

Furosemide Administration ◽

Anti Inflammation

Abstract Objectives To investigate whether the perioperatively combined application of dexamethasone and furosemide could alleviate the inflammation in patients undergoing percutaneous nephrolithotomy (PCNL). Patients and methods 147 patients undergoing PCNL between November 2018 and October 2019 were enrolled in the study. 77 patients accepted a single dose of dexamethasone and furosemide administration (EXP group, n = 77), and 70 patients did not (CON group, n = 70). Demographic and perioperative data, inflammatory markers including interleukin-6 (IL-6) and procalcitonin (PCT), and clinical outcomes were compared between the two groups. Results Compared with the CON group, the incidence rate of urosepsis of the EXP group were significantly lower (11.69% vs. 24.29%, p = 0.046). 3 patients developed severe urosepsis in the EXP group, while 5 patients developed severe urosepsis in the CON group. Compared with those in the CON group, the patients with postoperative urosepsis in the EXP group showed lower serum levels of IL-6 at postoperative hour two (p = 0.045) and at postoperative day one (p = 0.031) and lower serum levels of PCT at postoperative day one (p = 0.015). There was a better clinical outcome of a shorter postoperative hospital stay (p = 0.015) in patients with postoperative urosepsis in the EXP group than in those in the CON group. Conclusion The perioperatively combined application of dexamethasone and furosemide was beneficial for alleviating postoperative inflammatory reaction and caused a better clinical outcome of a shorter postoperative hospital stay.

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Early oral feeding is safe and useful after rectosigmoid resection with anastomosis during cytoreductive surgery for primary ovarian cancer

World Journal of Surgical Oncology ◽

10.1186/s12957-021-02186-6 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Kazuyoshi Kato ◽

Kohei Omatsu ◽

Sanshiro Okamoto ◽

Maki Matoda ◽

Hidetaka Nomura ◽

...

Keyword(s):

Ovarian Cancer ◽

Hospital Stay ◽

Anastomotic Leakage ◽

Cytoreductive Surgery ◽

Group Versus ◽

Postoperative Hospital Stay ◽

Oral Feeding ◽

Early Oral Feeding ◽

Rectosigmoid Resection ◽

Primary Ovarian Cancer

Abstract Background The aim of this study was to investigate the safety and clinical usefulness of early oral feeding (EOF) after rectosigmoid resection with anastomosis for the treatment of primary ovarian cancer. Methods We performed a retrospective review of all consecutive patients who had undergone rectosigmoid resection with anastomosis for primary ovarian, tubal, or peritoneal cancer between April 2012 and March 2019 in a single institution. Patient-related, disease-related, and surgery-related data including the incidence of anastomotic leakage and postoperative hospital stay were collected. EOF was introduced as a postoperative oral feeding protocol in September 2016. Before the introduction of EOF, conventional oral feeding (COF) had been used. Results Two hundred and one patients who underwent rectosigmoid resection with anastomosis, comprised of 95 patients in the COF group and 106 patients in the EOF group, were included in this study. The median number of postoperative days until the start of diet intake was 5 (range 2–8) in the COF group and 2 (range 2–8) in the EOF group (P < 0.001). Postoperative morbidity was equivalent between the groups. The incidence of anastomotic leakage was similar (1%) in both groups. The median length of the postoperative hospital stay was reduced by 6 days for the EOF group: 17 (range 9–67) days for the COF group versus 11 (8–49) days for the EOF group (P < 0.001). Conclusion EOF provides a significant reduction in the length of the postoperative hospital stay without an increased complication risk after rectosigmoid resection with anastomosis as a part of cytoreductive surgery for primary ovarian cancer.

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Neurological Complications After Bariatric Surgery in Turkish People

SN Comprehensive Clinical Medicine ◽

10.1007/s42399-021-00789-4 ◽

2021 ◽

Author(s):

Esra Eruyar ◽

Oktay Banli

Keyword(s):

Bariatric Surgery ◽

Neurological Complications ◽

Turkish People ◽

Complications After Bariatric Surgery

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Dorsal approach with Glissonian approach for laparoscopic right anatomic liver resections

BMC Gastroenterology ◽

10.1186/s12876-021-01726-4 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Shaohe Wang ◽

Yang Yue ◽

Wenjie Zhang ◽

Qiaoyu Liu ◽

Beicheng Sun ◽

...

Keyword(s):

Blood Loss ◽

Hospital Stay ◽

Hepatic Vein ◽

Pringle Maneuver ◽

Caudate Lobe ◽

Postoperative Hospital Stay ◽

Dorsal Approach ◽

Glissonian Approach ◽

The Mean ◽

Major Hepatic Vein

Abstract Background Laparoscopic anatomic hepatectomy (LAH) has gradually become a routine surgical procedure. However, how to expose the whole hepatic vein and avoid the hepatic vein laceration is still a challenge because of the caudate lobe, particularly in right hepatectomy. We adopted a dorsal approach combined with Glissionian appraoch to perform laparoscopic right anatomic hepatectomy (LRAH). Methods Twenty patients who underwent LRAH from January 2017 to November 2018 were retrospectively analysed. Of these patients, seven patients underwent laparoscopic right hemihepatectomy (LRH group), seven patients who underwent laparoscopic right posterior hepatectomy (LRPH group), and six patients who underwent laparoscopic hepatectomy for segment 7 (LS7 group). The paracaval portion of caudate lobe could be transected firstly through dorsal approach and the corresponding major hepatic vein could be exposed from its root to the peripheral branches safely. Due to exposure along the major hepatic vein trunk, the remaining liver parenchyma could be quickly transected from dorsal to cranial side. Results The mean age of the patients was 53.8 years and the male: female ratio was 8:12. The median operation time was 306.0 ± 58.2 min and the mean estimated volume of blood loss was 412.5 ± 255.4 mL. The mean duration of postoperative hospital stay was 10.2 days. The mean Pringle maneuver time was 64.8 ± 27.7 min. Five patients received transfusion of 2–4 U of red blood cells. Two patients suffered from transient hepatic dysfunction and one suffered from pleural effusion. None of the patients underwent conversion to an open procedure. The operative duration, volume of the blood loss, Pringle maneuver time, and postoperative hospital stay duration did not differ significantly among the LRH, LRPH, and LS7 groups (P > 0.05). Conclusions Dorsal approach combined with Glissonian approach for right lobe is feasible and effective in laparoscopic right anatomic liver resections.

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Organization of microsurgical treatment of patients with senile cataracts

Kazan medical journal ◽

10.17816/kazmj64237 ◽

1980 ◽

Vol 61 (4) ◽

pp. 50-51

Author(s):

M. B. Vurgaft

Keyword(s):

Hospital Stay ◽

Quality Indicators ◽

Surgical Intervention ◽

Cataract Extraction ◽

Postoperative Hospital Stay ◽

Microsurgical Treatment ◽

Improved Technique

Rational organizational measures and an improved technique of surgical intervention for cataracts are described, which contributed to an improvement in the quality indicators of cataract extraction outcomes and a decrease in the duration of postoperative hospital stay of patients to 5-6 days.

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Normothermic versus hypothermic cardiopulmonary bypass in low-risk paediatric heart surgery: a randomised controlled trial

Heart ◽

10.1136/heartjnl-2018-313567 ◽

2018 ◽

Vol 105 (6) ◽

pp. 455-464 ◽

Cited By ~ 3

Author(s):

Massimo Caputo ◽

Katie Pike ◽

Sarah Baos ◽

Karen Sheehan ◽

Kathleen Selway ◽

...

Keyword(s):

Cardiopulmonary Bypass ◽

Hospital Stay ◽

Heart Surgery ◽

Open Heart Surgery ◽

Postoperative Hospital Stay ◽

Low Risk ◽

Open Heart ◽

Intubation Time ◽

Organ Systems ◽

Randomised Controlled

ObjectiveTo compare normothermic (35°C–36°C) versus hypothermic (28°C) cardiopulmonary bypass (CPB) in paediatric patients undergoing open heart surgery to test the hypothesis that normothermic CPB perfusion maintains the functional integrity of major organ systems leading to faster recovery.MethodsTwo single-centre, randomised controlled trials (known as Thermic-1 and Thermic-2, respectively) were carried out to compare the effectiveness and acceptability of normothermic versus hypothermic CPB in children with congenital heart disease undergoing open heart surgery. In both studies, the co-primary clinical outcomes were duration of inotropic support, intubation time and postoperative hospital stay.ResultsIn total, 200 participants were recruited; 59 to the Thermic-1 study and 141 to the Thermic-2 study. 98 patients received normothermic CPB and 102 patients received hypothermic CPB. There were no significant differences between the treatment groups for any of the co-primary outcomes: inotrope duration HR=1.01, 95% CI (0.72 to 1.41); intubation time HR=1.14, 95% CI (0.86 to 1.51); postoperative hospital stay HR=1.06, 95% CI (0.80 to 1.40). Differences favouring normothermia were found in urea nitrogen at 2 days geometric mean ratio (GMR)=0.86 95% CI (0.77 to 0.97); serum creatinine at 3 days GMR=0.89, 95% CI (0.81 to 0.98); urinary albumin at 48 hours GMR=0.32, 95% CI (0.14 to 0.74) and neutrophil gelatinase-associated lipocalin at 4 hours GMR=0.47, 95% CI (0.22 to 1.02), but not at other postoperative time points.ConclusionsNormothermic CPB is as safe and effective as hypothermic CPB and can be routinely adopted as a perfusion strategy in low-risk infants and children undergoing open heart surgery.Trial registration numberISRCTN93129502.

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ACUTE CHOLECYSTITIS

The Professional Medical Journal ◽

10.29309/tpmj/2010.17.02.2342 ◽

2010 ◽

Vol 17 (02) ◽

pp. 185-192

Author(s):

TARIQ HASSAN CH ◽

ASGHAR ALI ◽

MUNAWAR JAMIL

Keyword(s):

Hospital Stay ◽

Wound Dehiscence ◽

Biliary Tree ◽

Postoperative Hospital Stay ◽

Total Hospital ◽

Acute Calculous Cholecystitis ◽

Total Hospital Stay ◽

Group A ◽

The Mean ◽

Group B

Introduction: Gallstones are common biliary pathology. The Vast majority of subjects are asymptomatic. About 0.2% of the population suffering from gallstones develop acute cholecystitis every year. In case of acute calculous cholecystitis, cholecystectomy can be performed early i.e during the same admission or interval i.e after 6 weeks of conservative management. Objective: To compare the early and interval cholecystectomy in acute calculous cholecystitis for morbidity, postoperative hospital stay, total hospital stay and complications. Study Design: Quasi-experimental study. Setting: Department of Surgery Bahawal Victoria Hospital Bahawalpur. Duration of Study: Two year study from December 2007 to December 2009. Subject and Methods: Sixty patients fulfilling the inclusion criteria were selected for this study. The patients were divided into two groups. Group A patients were managed by early cholecystectomy and group B patients by intervalcholecystectomy. Postoperatively patients were evaluated for postoperative hospital stay, total hospital stay and postoperative complications. Results: The mean age of the patients in group A was 42.2 + 10.7 years and in group B was 42.2+ 10.7 years. The Male to female ratio was 1:4 in both groups. The mean postoperative hospital stay in group A was 4.0+ 1.8days and in group B was 3.8+ 1.4 days. The mean total hospital stayin group A was 6.5 + 1.7 days and in group B was 10.2 + 1.3 days. The P value was less than 0.001, which was significant. In distribution of postoperative complications, in group A there were 1(3.3%) injury to biliary tree, 4(13.3%) wound infection,1(3.3%) wound haematoma, 3 (10%) seroma and 1(3.3%) wound dehiscence. While in group B there were 1(3.3%) injury to biliary tree, 3(10%) wound infection,2 (6.7%) wound haematoma, 2(6.7%) & no patient of wound dehiscence. Conclusion: Our study suggests that early cholecystectomy is a better treatment option than interval cholecystectomy because it has less total hospital stay, needs single hospital visit and has no risk of developing complications during wait for surgery.

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The need for nutritional assessment and interventions based on the prognostic nutritional index for patients with femoral fractures: a retrospective study

10.21203/rs.3.rs-463024/v1 ◽

2021 ◽

Author(s):

Miao He ◽

Qinghong Fan ◽

Yuhang Zhu ◽

Dexing Liu ◽

Xingxing Liu ◽

...

Keyword(s):

Retrospective Study ◽

Hospital Stay ◽

Nutritional Assessment ◽

Femoral Fractures ◽

Prognostic Nutritional Index ◽

Postoperative Hospital Stay ◽

Adverse Outcomes ◽

Perioperative Outcomes ◽

Nutritional Index ◽

Postoperative Intensive Care

Abstract Background The incidence of adverse perioperative outcomes in surgery for femoral fractures is quite high and is associated with malnutrition. This study aimed to identify independent factors and assess the predictive value of the prognostic nutritional index (PNI) for perioperative adverse outcomes in patients with femoral fractures. Methods This retrospective study included 343 patients who underwent surgery for a single femur fracture. Demographic characteristics, surgery and anaesthesia records, and blood test results at admission, 1 day postoperatively, and before discharge were evaluated using logistic regression analysis. The discriminatory ability of the independent factors was assessed using the receiver operating characteristic curve analysis, and DeLong's test was used to compare the area under the curve (AUC). Results Overall, 159 patients (46.4%) experienced adverse perioperative outcomes. Among these, 123 (35.9%) had lower limb vein thrombus, 68 (19.8%) had hospital-acquired pneumonia, 6 (1.7%) were transferred to the postoperative intensive care unit, 4 (1.2%) had pulmonary embolism, 3 (0.9%) died during hospitalisation, and 9 (2.6%) had other adverse outcomes, including incision disunion, renal and liver function impairment, acute heart failure, acute cerebral infarction, and stress gastroenteritis. The PNI at admission, age, postoperative hospital stay, time to admission, hypertension, combined injures, and surgery type were independent factors for adverse perioperative outcomes. Based on the AUC (PNI at admission: 0.772 (0.723–0.821), P < 0.001; age: 0.678 (0.622–0.734), P < 0.001; postoperative hospital stay: 0.608 (0.548–0.668), P = 0.001; time to admission: 0.585 (0.525–0.646), P = 0.006), the PNI at admission had optimal discrimination ability, indicating its superiority over other independent factors (age vs. PNI at admission, P = 0.002; postoperative hospital stay vs. PNI at admission, P < 0.001; time to admission vs. PNI at admission, P < 0.001). Conclusions Nutritional assessment and appropriate intervention strategies on admission are necessary for patients with femoral fractures, and the PNI at admission may be a good nutritional assessment indicator.

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Laparoscopic repair of umbilical and paraumbilical hernias: a prospective and interventional study in government hospital

International Surgery Journal ◽

10.18203/2349-2902.isj20194066 ◽

2019 ◽

Vol 6 (9) ◽

pp. 3283

Author(s):

Kiren B. Patel ◽

Mithun V. Barot

Keyword(s):

Surgical Site Infection ◽

Hospital Stay ◽

Wound Infection ◽

Ventral Hernia ◽

Laparoscopic Repair ◽

Umbilical Hernia ◽

Operative Time ◽

Postoperative Hospital Stay ◽

Site Infection ◽

Drain Removal

Background: Umbilical and ventral hernia occurs as a result of weakness in musculofascial layer of anterior abdominal wall. The most important causes are congenital, acquired, incisional and traumatic. UH and VH can be repair by open surgical procedure. A successful series of laparoscopic repair of umbilical hernia and VH was done by Le blanc in 1993. The cost can be optimised by selection of mesh and optimal uses of transabdominal suture and various fixation devices. This original article reveals methods, techniques, indication, contraindication, post-op pain, operative time, surgical site infection recurrence and outcome of laparoscopic umbilical hernia and paraumbilical hernia repair.Methods: A total of 21 patients of ventral hernia (umbilical, paraumbilical and incisional), who underwent laparoscopic hernia repair from October 2014 to October 2016, were selected have taken part in study with valid consent, in B.J. Medical College Ahmedabad Gujarat. All patient study regarding operative time, postoperative pain, postoperative hospital stay, surgical site infection like wound infection, seroma, hernia defect size, mean drain removal and recurrence.Results: Out of 21 patients male are 33% and female are 67%. Mean age of patients is 45 yrs with range being 18-65 yrs. 28%, 33.33%, and 38.1% of patient had umbilical, paraumbilical and incisional hernia respectively. Mean size defect was 7.8 cm2. Mean operative time in this study is 98.6 minute. Mean drain removal is 2.80 day. Mean postoperative hospital stay was 3.3 days. 4.7% had wound infection, 9.5% had seroma formation. There is 0% recurrence in present study.Conclusions: The laparoscopic approach appears to be safe, effective and acceptable. It is also effective in those who are obese, with co morbidities (complex) and who have recurrence from prior open repair and having ascites.

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