scholarly journals Diagnosis and Management of Intraoperative Colorectal Anastomotic Leaks: A Global Retrospective Patient Chart Review Study

2017 ◽  
Vol 2017 ◽  
pp. 1-9
Author(s):  
A. Schiff ◽  
S. Roy ◽  
M. Pignot ◽  
S. K. Ghosh ◽  
E. J. Fegelman
Keyword(s):  
Healthcare System ◽  
Chart Review ◽  
Length Of Hospital Stay ◽  
Patient Characteristics ◽  
Anastomotic Leaks ◽  
Potential Cost ◽  
Review Study ◽  
Cost Of Time ◽  
Circular Anastomosis ◽  
The Impact

Background. This targeted chart review study reports the first ever detailed global account of clinical approaches adopted to detect and manage anastomotic leaks identified during surgery in routine clinical practice. Method. 156 surgeons from eight countries retrospectively extracted data from surgical records of 458 patients who underwent colorectal surgery with an identified intraoperative leak at the circular anastomosis. Demographic details, procedures, and outcomes were analyzed descriptively, by country. Results. Most surgeries were performed laparoscopically (57.6%), followed by open surgeries (35.8%). The burden of intraoperative leaks on the healthcare system is driven in large part by the additional interventions such as using a sealant, recreating the anastomosis, and diverting the anastomosis to a colostomy bag, undertaken to manage the leak. The mean duration of hospitalization was 19.9 days. Postoperative anastomotic leaks occurred in 62 patients (13.5%), most frequently 4 to 7 days after surgery. Overall, country-specific differences were observed in patient characteristics, surgical procedures, method of diagnosis of intraoperative leak, interventions, and length of hospital stay. Conclusion. The potential cost of time and material needed to repair intraoperative leaks during surgery is substantial and often hidden to the healthcare system, potentially leading to an underestimation of the impact of this complication.

scholarly journals What is the impact of multimorbidity on the risk of hospitalisation in older adults? A systematic review study protocol

BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e049974
Author(s):  
Luciana Pereira Rodrigues ◽  
Andréa Toledo de Oliveira Rezende ◽  
Letícia de Almeida Nogueira e Moura ◽  
Bruno Pereira Nunes ◽  
Matias Noll ◽  
...  
Keyword(s):  
Systematic Review ◽  
Older Adults ◽  
Study Protocol ◽  
Average Length ◽  
Length Of Hospital Stay ◽  
Case Control Studies ◽  
Cross Sectional ◽  
Increased Risk ◽  
Review Study ◽  
The Impact

IntroductionThe development of multiple coexisting chronic diseases (multimorbidity) is increasing globally, along with the percentage of older adults affected by it. Multimorbidity is associated with the concomitant use of multiple medications, a greater possibility of adverse effects, and increased risk of hospitalisation. Therefore, this systematic review study protocol aims to analyse the impact of multimorbidity on the occurrence of hospitalisation in older adults and assess whether this impact changes according to factors such as sex, age, institutionalisation and socioeconomic status. This study will also review the average length of hospital stay and the occurrence of hospital readmission.Methods and analysisA systematic review of the literature will be carried out using the PubMed, Embase and Scopus databases. The inclusion criteria will incorporate cross-sectional, cohort and case–control studies that analysed the association between multimorbidity (defined as the presence of ≥2 and/or ≥3 chronic conditions and complex multimorbidity) and hospitalisation (yes/no, days of hospitalisation and number of readmissions) in older adults (aged ≥60 years or >65 years). Effect measures will be quantified, including ORs, prevalence ratios, HRs and relative risk, along with their associated 95% CI. The overall aim of this study is to widen knowledge and to raise reflections about the association between multimorbidity and hospitalisation in older adults. Ultimately, its findings may contribute to improvements in public health policies resulting in cost reductions across healthcare systems.Ethics and disseminationEthical approval is not required. The results will be disseminated via submission for publication to a peer-reviewed journal when complete.PROSPERO registration numberCRD42021229328.

scholarly journals Does Number of Ports Affect Outcomes in Patients Undergoing Laparoscopic Pyloromyotomy? Retrospective Chart-Review Study

ISRN Surgery ◽  
2012 ◽  
Vol 2012 ◽  
pp. 1-3
Author(s):  
Tariq O. Abbas ◽  
Adel Ismail
Keyword(s):  
Medical Records ◽  
Chart Review ◽  
Hypertrophic Pyloric Stenosis ◽  
Length Of Hospital Stay ◽  
Operation Time ◽  
Retrospective Chart Review ◽  
Infantile Hypertrophic Pyloric Stenosis ◽  
Surgical Interventions ◽  
Review Study ◽  
Laparoscopic Pyloromyotomy

Background. Although open Ramstedt's pyloromyotomy is the gold standard for the surgical management of infantile hypertrophic pyloric stenosis, laparoscopic pyloromyotomy has been found highly successful. Various factors, however, can affect the outcomes of surgical interventions in these patients. We observed a relationship between the number of ports used and outcome in patients undergoing laparoscopic pyloromyotomies. Methods. We retrospectively assessed the medical records of selected group of patients who underwent laparoscopic pyloromyotomy in our institution. Factors analyzed included operation time, length of hospital stay, postoperative complications, and time to postoperative full feeding. Results. We observed failure of myotomy in both two patients who underwent laparoscopic pyloromyotomy using only two working ports compared to successful myotomies in the remaining patients. Conclusion. Laparoscopy provides good results in terms of intraoperative exposure and cosmesis. However, standardized surgical technique with two working ports is advisable, and this can trigger further research to be ascertained.

Abstract 15776: Outcomes of Atrioventricular Septal Defects in Patients With and Without Trisomy 21: Analysis of the Inpatient Sample Database

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Safwat A Aly ◽  
Ibrahim Qattea ◽  
Hany Z Aly
Keyword(s):  
Pulmonary Hypertension ◽  
Trisomy 21 ◽  
Heart Diseases ◽  
Length Of Hospital Stay ◽  
Patient Characteristics ◽  
Atrioventricular Septal Defect ◽  
National Database ◽  
Transposition Of Great Arteries ◽  
The Us ◽  
The Impact

Introduction: Atrioventricular septal defect (AVSD) is among the most common congenital heart diseases especially in infants with trisomy 21 (T21). However, the clinical outcomes of AVSD are largely limited to institutional reports. Aim: Using U.S.A. national database, the purpose of this study was to a) to assess the prevalence, mortality and outcomes of AVSD, and b) to determine the impact of T21 on its outcomes. Methods: We queried The US National Inpatient Sample from the Healthcare Cost and Utilization Project for patients with AVSD with and without T21 in the period 2002-2017. Patient characteristics, comorbidities, mortality, and healthcare utilization were evaluated for AVSD comparing those with and without T21. Results: During the study period, a total of 20,628,538 infants were born in the in the US, of them 67,020 (0.3%) had AVSD. T21 was diagnosed in 34,825 (52%). The incidence of AVSD ranged from 4.5-7.4/year. Common associated CHD were transposition of great arteries, tetralogy of Fallot, and truncus arteriosus at 10.9%, 4%, 0.4% respectively. The association with CHD was not different between AVSD with and without T21. During study period, 92% of patients underwent surgical repair. AVSD patients with T21 had greater mortality (4.4% vs 1.1%, p<0.001) more frequent pulmonary hypertension (4.8% vs 2.7%, p<0.001), longer median length of hospital stay (7 vs 3 days), and less incidence of arrhythmia (2.8% vs 6%, p<0.001). Comparisons between AVSD with and without T21 are outlined in table 1. Conclusion: Almost half of infants with AVSD had T21. T21 is associated with greater mortality and pulmonary hypertension, longer hospitalization and less arrhythmia.

scholarly journals 291. Epidemiology of Candidemia Rates during COVID-19 and Comparison of Outcomes in Candidemia Between COVID-19 and Non-COVID-19 Patients

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S253-S254
Author(s):  
Angela Beatriz Cruz ◽  
Jennifer LeRose ◽  
Kenisha J Evans ◽  
Monica Meyer ◽  
Teena Chopra ◽  
...  
Keyword(s):  
Length Of Hospital Stay ◽  
Patient Characteristics ◽  
Continuous Variables ◽  
Central Venous ◽  
Chi Square ◽  
Patient Demographics ◽  
Icu Length Of Stay ◽  
Tertiary Healthcare ◽  
Chi Square Analysis ◽  
The Impact

Abstract Background Fungemia is associated with high rates of morbidity, mortality and increase in length of hospital stay. Several studies have recognized increased rates of candidemia since the COVID-19 pandemic. Methods A retrospective cohort study was conducted at a tertiary healthcare system in Detroit, Michigan to evaluate the impact of the COVID-19 pandemic on incidence of candidemia. The “pre COVID-19” timeframe was defined as January – May 2019 while the “during COVID-19” timeframe was January – May 2020. To compare incidence and patient characteristics between cohorts, t-tests and chi-square analysis was used. Additional sub-analysis was performed in candidemia patients during COVID-19 timeframe comparing outcomes of patients based on COVID-19 status. A Fisher Exact and Satterthwaite Test were used for analysis of categorical and continuous variables, respectively. Results Overall, 46 cases of candidemia were identified in both the pre COVID-19 and during COVID-19 periods. Pre COVID-19, the average number of cases was 3.0 ± 1.2 per month. The incidence more than doubled during COVID-19 to 6.2 ± 4.2 cases per month (p = 0.14) (Figure 1). No significant differences in patient demographics were detected between cohorts, however, patients in the COVID-19 cohort had higher rates of corticosteroid use, mechanical ventilation and vasopressors (Table 1). In the 2020 period, 31 patients developed candidemia and 12 (38.7%) patients tested SARS-CoV-2 positive. On average, COVID-19 patients developed candidemia 12.1 days from admission, compared to 17.8 days in the COVID-19 negative cohort (p = 0.340). Additionally, COVID-19 patients with candidemia coinfection were significantly more likely to expire; 83.3% (n=10) COVID-19 patients expired compared to 36.8 (n=7) in the COVID-19 negative cohort (p = 0.025) (Table 2). Figure 1. Incidence of Candidemia in the Pre-COVID-19 (January 2019 – May 2019) and During COVID-19 (January 2020-May 2020) periods Table 1. Characteristics of Candidemia patients in the pre-COVID (January 2019-May 2019) and during-COVID periods (January 2020-May 2020) Table 2. Characteristics of Candidemia patients in the SARS-COV-2 negative and SARS-COV-2 positive cohorts from January 2020-May 2020 Conclusion The prevalence of fungemia markedly increased during the COVID-19 surge. Increased use of corticosteroids and broad spectrum antimicrobials, prolonged use of central venous catheters and prolonged ICU length of stay likely contributed to this increase. Patients who developed candidemia co-infection with COVID-19 were found to have poorer outcomes as compared to those who were SARS-CoV-2 negative or untested. Disclosures All Authors: No reported disclosures

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