Prolonged preoperative hospital stay is a risk factor for complications after emergency colectomy for severe colitis

Background.Pseudomonas aeruginosa is one of the most common gram-negative hospital-acquired pathogens. Resistance of this organism to imipenem complicates treatment.Objective.To elucidate the risk factors for imipenem-resistant P. aeruginosa (IRPA) infection or colonization and to identify the effect of resistance on clinical and economic outcomes.Methods.Longitudinal trends in prevalence of IRPA from 2 centers were characterized during the period from 1989 through 2006. For P. aeruginosa isolates obtained during the period from 2001 through 2006, a case-control study was conducted to investigate the association between prior carbapenem use and IRPA infection or colonization, and a cohort study was performed to identify the effect of IRPA infection or colonization on mortality, length of stay after culture, and hospital cost after culture.Results.From 1989 through 2006, the proportion of P. aeruginosa isolates demonstrating resistance to imipenem increased from 13% to 20% (P< .001, trend). During the period from 2001 through 2006, there were 2,542 unique patients with P. aeruginosa isolates, and 253 (10.0%) had IRPA isolates. Prior carbapenem use was independently associated with IRPA infection or colonization (adjusted odds ratio [OR], 7.92 [95% confidence interval {CI}, 4.78-13.11]). Patients with an IRPA isolate recovered had higher in-hospital mortality than did patients with an imipenem-susceptible P. aeruginosa isolate (17.4% vs 13.4%; P = .01). IRPA infection or colonization was an independent risk factor for mortality among patients with isolates recovered from blood (adjusted OR, 5.43 [95% CI, 1.72-17.10]; P = .004) but not among patients with isolates recovered from other anatomic sites (adjusted OR, 0.78 [95% CI, 0.51-1.21]; P = .27). Isolation of IRPA was associated with longer hospital stay after culture (P<.001) and greater hospital cost after culture (P<.001) than was isolation of an imipenem-susceptible strain. In multivariable analysis, IRPA infection or colonization remained an independent risk factor for both longer hospital stay after culture (coefficient, 0.20 [95% CI, 0.04-0.36]; P = .02) and greater hospital cost after culture (coefficient, 0.30 [95% CI, 0.06-0.54]; P = .02).Conclusions.The prevalence of IRPA infection or colonization has increased significantly, with important implications for both clinical and economic outcomes. Interventions to curb this continued increase and strategies to optimize therapy are urgently needed.

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Elevated triglycerides level in hospital stay as a risk factor of mortality in patients with severe acute pancreatitis

PLoS ONE ◽

10.1371/journal.pone.0207875 ◽

2018 ◽

Vol 13 (11) ◽

pp. e0207875

Author(s):

Qin Wu ◽

Min Fu ◽

Kexin Zheng ◽

Hong Bo ◽

Hao Yang ◽

...

Keyword(s):

Acute Pancreatitis ◽

Risk Factor ◽

Hospital Stay ◽

Severe Acute Pancreatitis

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Preoperative Hyponatremia Is Associated with Reoperation and Prolonged Length of Hospital Stay following Total Knee Arthroplasty

The Journal of Knee Surgery ◽

10.1055/s-0038-1641156 ◽

2018 ◽

Vol 32 (04) ◽

pp. 344-351 ◽

Cited By ~ 3

Author(s):

Matthew Abola ◽

Joseph Tanenbaum ◽

Thomas Bomberger ◽

Derrick Knapik ◽

Steven Fitzgerald ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Risk Factor ◽

Hospital Stay ◽

Knee Arthroplasty ◽

Length Of Hospital Stay ◽

Adverse Outcomes ◽

Limited Information ◽

Improvement Program ◽

Prolonged Length ◽

Total Knee

AbstractHyponatremia is a risk factor for adverse surgical outcomes, but limited information is available on the prognosis of hyponatremic patients who undergo total knee arthroplasty (TKA). The purpose of this investigation was to compare the incidence of major morbidity (MM), 30-day readmission, 30-day reoperation, and length of hospital stay (LOS) between normonatremic and hypontremic TKA patients.The American College of Surgeons National Surgical Quality Improvement Program database was used to identify all primary TKA procedures. Hyponatremia was defined as <135 mEq/L and normonatremia as 135 to 145 mEq/L; hypernatremic patients (>145 mEq/L) were excluded. Multivariable logistic regression was used to determine the association between hyponatremia and outcomes after adjusting for demographics and comorbidities. An α level of 0.002 was used and calculated using the Bonferroni correction. Our final analysis included 88,103 patients of which 3,763 were hyponatremic and 84,340 were normonatremic preoperatively. In our multivariable models, hyponatremic patients did not have significantly higher odds of experiencing an MM (odds ratio [OR]: 1.05; 99% confidence interval [CI] 0.93–1.19) or readmission (OR: 1.12; 99% CI: 1–1.24). However, patients with hyponatremia did experience significantly greater odds for reoperation (OR: 1.24; 99% CI: 1.05–1.46) and longer hospital stay (OR: 1.15; 99% CI: 1.09–1.21). We found that hyponatremic patients undergoing TKA had increased odds of reoperation and prolonged hospital stay. Preoperative hyponatremia may be a modifiable risk factor for adverse outcomes in patients undergoing TKA, and additional prospective studies are warranted to determine whether preoperative correction of hyponatremia can prevent complications.

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The Influence of Preoperative Hematocrit Levels on Early Outcomes in Patients undergoing Cardiac Surgery

10.53350/pjmhs2115102817 ◽

2021 ◽

Vol 15 (10) ◽

pp. 2817-2819

Author(s):

Ajwad Farogh ◽

Asma Hassan ◽

Saira Gull ◽

Muhammad Irfan Khan ◽

Gohar Bashir ◽

...

Keyword(s):

Cardiac Surgery ◽

Risk Factor ◽

Hospital Stay ◽

Heart Surgery ◽

Common Risk Factor ◽

Duration Of Hospital Stay ◽

Increased Risk ◽

The Impact ◽

Written Informed Consent ◽

Preoperative Anaemia

Background: Anemia is a common risk factor for cardiovascular disease. The impact of preoperative anaemia is unclear in cardiac surgery. Preoperative anaemia affects early findings in patients undergoing cardiac surgery. Aim and Objective: The main objective of current research was to investigate the impact of preoperative anaemia on early outcomes in heart surgery patients. Material and Methods: A prospective randomized clinical research was undertaken after obtaining written informed consent from patients for cardiac surgery at the PIC, Lahore between Apr 2020 and Feb 2021. A total of 120 individuals between the ages of 20 and 60 were chosen for the research. Preoperative anaemia was described as Hb levels of <13 g/dl for males and <12 g/dl in female patients undergoing cardiac surgery. Results: Total 120 patients were enrolled and stratified into two groups (60 patients each) with average age 5 ± 5.75 years. Early outcomes after surgery such as postoperative stroke (6.67 % versus 1.6 %), AF (37 % versus32 %), and duration of hospital stay > 7 days (50 % vs 41.67 %) were found to be different between anaemic and normal Hb groups. Conclusion: Preoperative anaemia can be increased risk of morbidity and mortality in patients after surgery. Low preoperative Hb found as advanced risk factor for death, renal impairment, stroke, AF and long hospital stay in our research. Keywords: Anemia, CABG, AF, MI, IABP, CPB

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Postoperative anaemia might be a risk factor for postoperative delirium and prolonged hospital stay: A secondary analysis of a prospective cohort study

PLoS ONE ◽

10.1371/journal.pone.0229325 ◽

2020 ◽

Vol 15 (2) ◽

pp. e0229325 ◽

Cited By ~ 1

Author(s):

Julius Valentin Kunz ◽

Claudia D. Spies ◽

Anna Bichmann ◽

Miriam Sieg ◽

Anika Mueller

Keyword(s):

Risk Factor ◽

Cohort Study ◽

Hospital Stay ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Postoperative Delirium ◽

Secondary Analysis ◽

Prolonged Hospital Stay ◽

Prolonged Hospital

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How to manage: acute severe colitis

Frontline Gastroenterology ◽

10.1136/flgastro-2020-101710 ◽

2021 ◽

pp. flgastro-2020-101710

Author(s):

Thomas Edward Conley ◽

Joseph Fiske ◽

Sreedhar Subramanian

Keyword(s):

Medical Therapy ◽

Medical Emergency ◽

Timely Manner ◽

Joint Management ◽

Operative Outcomes ◽

Emergency Colectomy ◽

Colorectal Surgeons ◽

Management Approaches ◽

Acute Severe Colitis ◽

Severe Colitis

Acute severe ulcerative colitis (ASUC) is a medical emergency which is associated with significant morbidity and a mortality rate of 1%. ASUC requires prompt recognition and treatment. Optimal management includes admission to a specialist gastrointestinal unit and joint management with colorectal surgeons. Patients need to be screened for concomitant infections and thromboprophylaxis should be administered to mitigate against the elevated risk of thromboembolism. Corticosteroids are still the preferred initial medical therapy but approximately 30%–40% of patients fail steroid therapy and require rescue medical therapy with either infliximab or cyclosporine. Emergency colectomy is required in a timely manner for patients who fail rescue medical therapy to minimise the risk of adverse post-operative outcomes. We discuss current and emerging evidence in the management of ASUC and outline management approaches for clinicians involved in managing ASUC.

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Surgical Site Infection In Laparotomy

Journal of Universal College of Medical Sciences ◽

10.3126/jucms.v4i1.19075 ◽

2018 ◽

Vol 4 (1) ◽

pp. 22-25

Author(s):

Pashupati N. Bhatta ◽

Umesh Kumar Yadav ◽

Gorakh Nath Mishra ◽

Randhir Jha ◽

Kumar Shrestha

Keyword(s):

Risk Factor ◽

Surgical Site Infection ◽

Hospital Stay ◽

Length Of Hospital Stay ◽

Site Infection ◽

Median Length ◽

National Medical College ◽

Medical College ◽

National Medical ◽

Duration Of Surgery

INTRODUCTION: Surgical site infection (ssi) is one of the most common surgical complications which increases the rate of morbidity and mortality and increases the health care cost by prolonging the hospital stay. AIMS AND OBJECTIVES: The main objective of the study was to find out the incidence of ssi in emergency laparotomy in general surgery and to find out the associated risk factor for ssi.MATERIAL & METHODS: Study was carried out in national medical college, Birgunj from January 2011 to June 2012 after getting ethical clearance from Institutional Review Committee National Medical College. Total 200 cases were included in study and follow up done up to 30 days postoperatively. RESULTS: Out of 200 patients, 76 patients developed ssi. The total incidence of ssi was 38%.The rate ssi in clean-contaminated, contaminated and dirty wound were 18.2%, 33.3% & 45.5% respectively. Age, type of surgical operation and prolonged duration of surgery were the significant risk factor for ssi while sex, BMI were not statistically significant. The median length of hospital stay with ssi was 16 days while the median length of hospital stay without ssi was 10 days.CONCLUSION: The rate of ssi was found to be higher in our study in comparison to western study but neariy same when comparing to study of Asian countries. so, we emphasize for the need of evidence based infection control and recommend for better surveillance program me for control of ssi in each hospital.Journal of Universal College of Medical Sciences (2016) Vol.04 No.01 Issue 13, Page: 22-25

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A retrospective study of surgical treatment and outcome among women with adnexal torsion in eastern Taiwan from 2010 to 2015

PeerJ ◽

10.7717/peerj.5995 ◽

2018 ◽

Vol 6 ◽

pp. e5995 ◽

Cited By ~ 1

Author(s):

Ci Huang ◽

Mun-Kun Hong ◽

Tang-Yuan Chu ◽

Dah-Ching Ding

Keyword(s):

Risk Factor ◽

Abdominal Pain ◽

Retrospective Study ◽

Surgical Treatment ◽

Hospital Stay ◽

Tumor Size ◽

Surgical Outcomes ◽

Radical Surgery ◽

Older Age ◽

Adnexal Torsion

Background Adnexal torsion is a gynecologic emergency that requires surgical treatment. In this study, we reviewed the surgical outcomes of women with adnexal torsion in eastern Taiwan (Hualien county, area 4,629 km2, 330,000 residents). Methods This retrospective study included 42 women diagnosed with surgically-proven adnexal torsion from January 1, 2010, to September 31, 2015. We compared the symptoms, objective findings, and surgical outcomes of patients who underwent laparotomy or laparoscopy. Results The laparoscopy and laparotomy groups included 27 and 15 patients, respectively. The most common symptom and sign was abdominal pain, followed by nausea and vomiting. In all patients, an adnexal tumor was detected through ultrasound. The median and range of time from admission to surgery was 1.5 (1–11.5) and 1.0 (1–11) hours in the laparotomy and laparoscopy groups, respectively. Compared with those undergoing laparotomy, the smaller tumor size [7 (4.2–10) vs. 10 (7–17) cm] and shorter hospital stay [4 (2–8) vs. 6 (3–9) days] in patients undergoing laparoscopy were significantly noted, respectively (P < 0.01). No differences were observed in age, operative time, and blood loss between both groups. The surgeries performed were mostly detorsion with cystectomy and adnexectomy. The most common pathology was a simple ovarian cyst, followed by teratoma. Regarding the surgical types, older age is the only risk factor for radical surgery. Discussion Acute onset of abdominal pain with a presenting ovarian tumor is the most common feature of adnexal torsion. Laparoscopic surgical group showed a small tumor size and a short ER hospital stay than laparotomy. Older age is the risk factor for radical surgery.

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