Catastrophic Outcomes in Free Tissue Transfer: A Six-Year Review of the NSQIP Database

Background. No studies report robust data on the national incidence and risk factors associated with catastrophic medical outcomes following free tissue transfer. Methods. The American College of Surgeons (ACS) multicenter, prospective National Surgical Quality Improvement Program (NSQIP) database was used to identify patients who underwent free tissue transfer between 2006 and 2011. Multivariable logistic regression was used for statistical analysis. Results. Over the 6-year study period 2,349 patients in the NSQIP database underwent a free tissue transfer procedure. One hundred and twenty-two patients had at least one catastrophic medical outcome (5.2%). These 122 patients had 151 catastrophic medical outcomes, including 93 postoperative respiratory failure events (4.0%), 14 pulmonary emboli (0.6%), 13 septic shock events (0.5%), 12 myocardial infarctions (0.5%), 6 cardiac arrests (0.3%), 4 strokes (0.2%), 1 coma (0.0%), and 8 deaths (0.3%). Total length of hospital stay was on average 14.7 days longer for patients who suffered a catastrophic medical complication (P<0.001). Independent risk factors were identified. Conclusions. Free tissue transfer is a proven and safe technique. Catastrophic medical complications were infrequent but added significantly to length of hospital stay and patient morbidity.

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Postoperative monitoring in free tissue transfer patients: Effective use of nursing and resident staff

Otolaryngology ◽

10.1016/j.otohns.2009.07.008 ◽

2009 ◽

Vol 141 (5) ◽

pp. 621-625 ◽

Cited By ~ 5

Author(s):

Ryan S. Jackson ◽

Ronald J. Walker ◽

Mark A. Varvares ◽

Michael J. Odell

Keyword(s):

Hospital Stay ◽

Nursing Staff ◽

Length Of Hospital Stay ◽

Free Tissue Transfer ◽

Free Flaps ◽

Monitoring Protocol ◽

Tissue Transfer ◽

Flap Viability ◽

Group A ◽

Group B

Objectives: To compare the outcomes of two different free flap monitoring protocols and determine whether nursing staff can safely and effectively monitor free flaps. Study Design: Historical cohort study on all head and neck free tissue transfer patients from August 2003 to August 2007. Setting: Tertiary care teaching institution. Subjects and Methods: The patients were divided into two groups according to monitoring protocol. Group A (n = 49) had free flaps monitored primarily by resident physicians, while Group B patients (n = 45) were evaluated primarily by nursing staff. Demographic and outcomes data, including complications, reoperations, length of hospital stay, and flap viability, were then compared. Results: Overall, 28 (57%) patients in Group A and 16 (37%) in Group B had at least one complication ( P = 0.05). Only eight patients in each group had major complications. There were 25 (27%) patients who required further intervention in the operating room: 18 (37%) in Group A and seven (16%) in Group B ( P = 0.03). Only 12 (13%) patients returned to the operating room for concerns of flap viability: seven from Group A and five from Group B. The median length of hospital stay was 11 days for both groups ( P = 0.76). The flap success rate was 95 percent, with three failures in Group A and two in Group B ( P = 0.72). Conclusions: A monitoring protocol utilizing trained nursing staff has no detrimental effect on free tissue transfer outcomes. This may be used to optimize resident time within the current duty-hour restrictions.

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The impact of a post-operative clinical care pathway on head and neck microvascular free tissue transfer outcomes

The Journal of Laryngology & Otology ◽

10.1017/s0022215120000080 ◽

2020 ◽

Vol 134 (2) ◽

pp. 150-158 ◽

Cited By ~ 2

Author(s):

R Mhawej ◽

B M Harmych ◽

J J Houlton ◽

M E Tabangin ◽

J Meinzen-Derr ◽

...

Keyword(s):

Hospital Stay ◽

Patient Care ◽

Head And Neck ◽

Care Pathway ◽

Clinical Care ◽

Length Of Hospital Stay ◽

Free Tissue Transfer ◽

Tissue Transfer ◽

Clinical Care Pathway ◽

The Impact

AbstractObjectiveTo study the impact of a clinical care pathway and computerised order set on short-term post-operative outcomes for patients undergoing head and neck free tissue transfer.MethodsIn this retrospective cohort study, patients who underwent head and neck free tissue transfer by a single reconstructive surgeon between January 2007 and July 2009 were assigned to one of two cohorts based on the timing of their surgery: pre- or post-clinical care pathway implementation. Measured outcomes included peri-operative complications and mortality, length of hospital stay and costs, unplanned reoperations, and readmissions within 30 days of discharge.ResultsThe pre-clinical care pathway cohort included 81 patients and the post-clinical care pathway cohort comprised 46. Implementation of the clinical care pathway was associated with decreased variability in length of hospital stay (median (interquartile range) = 8 (6, 11) vs 7 (6, 9) days). The post-clinical care pathway cohort also had a significantly lower unplanned reoperation rate (15.2 vs 35.8 per cent, p = 0.01).ConclusionA clinical care pathway is a successful means of standardising and improving complex patient care. In this study, care pathway implementation in head and neck free tissue transfer patients improved efficiency and the quality of patient care.

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Indications and practice of enteral nutrition

Orvosi Hetilap ◽

10.1556/oh.2014.30066 ◽

2014 ◽

Vol 155 (51) ◽

pp. 2028-2033 ◽

Cited By ~ 1

Author(s):

Judit Hallay ◽

Dániel Nagy ◽

Béla Fülesdi

Keyword(s):

Risk Factors ◽

Treatment Outcome ◽

Enteral Nutrition ◽

Hospital Stay ◽

Length Of Hospital Stay ◽

Nutrition Therapy ◽

Present Review ◽

Hospitalised Patients ◽

Impact On Treatment ◽

Efficacy Of Treatment

Malnutrition in hospitalised patients has a significant and disadvantageous impact on treatment outcome. If possible, enteral nutrition with an energy/protein-balanced nutrient should be preferred depending on the patient’s condition, type of illness and risk factors. The aim of the nutrition therapy is to increase the efficacy of treatment and shorten the length of hospital stay in order to ensure rapid rehabilitation. In the present review the authors summarize the most important clinical and practical aspects of enteral nutrition therapy. Orv. Hetil., 2014, 155(51), 2028–2033.

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O0011 AN ASSESSMENT OF RISK FACTORS FOR PROGNOSIS AND LENGTH OF HOSPITAL STAY IN COMMUNITY ACQUIRED PNEUMONIA – A DISTRICT GENERAL HOSPITAL, U.K. EXPERIENCE

European Journal of Internal Medicine ◽

10.1016/s0953-6205(09)60013-3 ◽

2009 ◽

Vol 20 ◽

pp. S4

Author(s):

Munish Batra ◽

Poonam Batra

Keyword(s):

Risk Factors ◽

Hospital Stay ◽

General Hospital ◽

Length Of Hospital Stay ◽

District General Hospital ◽

Community Acquired Pneumonia

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Risk factors for high length of hospital stay and in-hospital mortality in hip fractures in the elderly

Revista Española de Cirugía Ortopédica y Traumatología (English Edition) ◽

10.1016/j.recote.2021.05.009 ◽

2021 ◽

Vol 65 (5) ◽

pp. 322-330

Author(s):

J. Salvador Marín ◽

F.J. Ferrández Martínez ◽

C. Fuster Such ◽

J.M. Seguí Ripoll ◽

D. Orozco Beltrán ◽

...

Keyword(s):

Risk Factors ◽

Hospital Mortality ◽

Hospital Stay ◽

Hip Fractures ◽

Length Of Hospital Stay ◽

The Elderly ◽

High Length

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Locked intramedullary nailing technique of the femur without brilliance amplifier at the trauma and orthopedics department of the university hospital of peace series on 35 cases during 1 year

MOJ Orthopedics & Rheumatology ◽

10.15406/mojor.2021.13.00556 ◽

2021 ◽

Vol 13 (5) ◽

pp. 95-97

Author(s):

Augustin Delange Hendrick ◽

Almenord Pharol ◽

Khawly Clifford PG ◽

Augustin Delange ◽

Pierre Marie Woolley

Keyword(s):

Hospital Stay ◽

Intramedullary Nailing ◽

Femoral Fractures ◽

Length Of Hospital Stay ◽

University Hospital ◽

Patient Morbidity ◽

Duration Of Hospitalization ◽

The Cost ◽

The University

Femoral fractures increase the length of hospital stay for our patients for several reasons such as lack of blood, economic resources, and lack of infrastructure. The use of a C-arm has been shown to reduce patient morbidity due to early functional recovery and reduced hospital stay. Objective: To develop an intramedullary nailing technique without c-arm with a closed focus to reduce the duration of hospitalization of its patients as well as the cost related to the equipment used for follow-up. Methodology: prospective study on 35 patients for 1 year August 2020 to August 2021 Results: We followed 35 patients in which the mean age was 37.83 years with extremes of 18 and 78 years. The male sex predominates 21 against 14 women or 60% against 40% respectively. The sex ratio is 1.5. A total of 19 diaphyseal fractures (54.3%) were nailed, 9 supracondylar (25.7%) and 7 subtrochanteric (20%). Twenty-seven were closed fractures (71.1%), and 8 were open fractures (22.9%). The length of hospitalization was less than 3 days for 30 patients (85.7%), and more than 3 days for 5 patients (14.3%). Conclusion: We recommend that we promote this closed-hearth technique because it improves the postoperative follow-up of patients. Additionally, it would reduce exposure to radiation from c-arm in hospitals that have this equipment.

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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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Epidemiology and Outcome of Major Congenital Malformations in a Large German County

European Journal of Pediatric Surgery ◽

10.1055/s-0038-1642630 ◽

2018 ◽

Vol 29 (03) ◽

pp. 282-289 ◽

Cited By ~ 2

Author(s):

Boris Wittekindt ◽

Rolf Schloesser ◽

Nora Doberschuetz ◽

Emilia Salzmann-Manrique ◽

Jasmin Grossmann ◽

...

Keyword(s):

Risk Factors ◽

Hospital Stay ◽

Congenital Malformations ◽

Heart Defects ◽

Length Of Hospital Stay ◽

Incidence Rates ◽

Trisomy 13 ◽

Published Data ◽

Inhospital Mortality ◽

Major Congenital Malformations

Introduction Congenital malformations are associated with substantial neonatal morbidity and mortality. Furthermore, only sparse data are available on the modalities of care provided to and the associated clinical outcomes in affected neonates. In this study, we focused on five malformations that require surgery during the neonatal period: duodenal stenosis and atresia (DA), gastroschisis (GA), omphalocele (OM), congenital diaphragmatic herniation (CDH), and esophageal atresia (EA). Materials and Methods We reviewed the Hessian neonatal registry (2010–2015) to identify records including the ICD-10 (International Classification of Diseases, Tenth Edition) codes for the aforementioned diagnoses and identified 283 patients who were affected by at least one of these conditions. Multiple regression analyses were performed to further identify risk factors for mortality and extended length of hospital stay. Results The incidence rates per 10,000 live births and inhospital mortality rates were as follows: DA: 1.79 and 3.6%; GA: 1.79 and 1.8%; OM: 1.60 and 24%; CDH: 1.32 and 27.5%; and EA: 2.67 and 11.1%, respectively. Thirty-three percent of the patients had not been born in a perinatal center in which corrective surgeries were performed. The following risk factors were significantly associated with early mortality: trisomy 13 and 18, congenital heart defects, prematurity, and high-risk malformations (OM and CDH). The predictors of length of stay were as follows: gestational age, number of additional malformations, and treatment in the center with the highest patient volume. Conclusion Epidemiology and outcome of major congenital malformations in Hesse, Germany, are comparable to previously published data. In addition, our data revealed a volume–outcome association with regard to the length of hospital stay.

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