A Quantified Scoring System for Postoperative Complication Severity Compared to the Clavien-Dindo Classification

2015 ◽  
Vol 32 (5) ◽  
pp. 361-366 ◽  
Author(s):  
Annelijn E. Slaman ◽  
Sjoerd M. Lagarde ◽  
Suzanne S. Gisbertz ◽  
Mark I. van Berge Henegouwen
Keyword(s):  
Length Of Stay ◽  
Postoperative Complication ◽  
Scoring System ◽  
Reoperation Rate ◽  
Severe Complication ◽  
Surgical Patient ◽  
High Morbidity ◽  
Comprehensive Complication Index ◽  
Patient Groups ◽  
Prospective Database

Background/Aims: Esophagectomies are associated with high morbidity. To assess the complication severity, the Clavien-Dindo classification (CDC) grades the most severe complication. However, it ignores additional complications that are equal or less severe. The comprehensive complication index (CCI) incorporates all complication severities. It might therefore be a better system to assess the severities. The aim of this study was to validate the CCI compared to the CDC. Methods: A prospective database was used to analyze 621 patients, who underwent an esophagectomy between 1993 and 2005. The CCI was calculated and the relation with traditional parameters was assessed and compared to the relation of the CDC with these parameters. Results: Complications occurred in 429 patients (69.1%). The correlation between the CCI and the CDC was r = 0.987, p < 0.01. The relation of the CCI with 3 out of 7 parameters was not significantly different compared to the relation of the CDC (p > 0.05). There was a significantly stronger relation (p < 0.05) of the CCI with length of stay (LOS) (r = 0.663 vs. 0.646), a prolonged LOS (r = 0.542 vs. 0.530), reintervention, (r = 0.437 vs. 0.422) and reoperation rate (0.489 vs. 0.471) than the CDC. Conclusion: Therefore, the CCI could be a promising scoring system that could be used to identify risks in surgical patient groups.

scholarly journals Does a prior hysterectomy complicate transvaginal/transumbilical hybrid NOTES cholecystectomy?—a comparative analysis of prospectively collected data

2021 ◽  
Author(s):  
Dirk R. Bulian ◽  
Axel Sauerwald ◽  
Panagiotis Thomaidis ◽  
Claudia S. Seefeldt ◽  
Dana C. Richards ◽  
...  
Keyword(s):  
Urinary Bladder ◽  
Length Of Stay ◽  
Postoperative Complication ◽  
Complication Rate ◽  
Hospital Length Of Stay ◽  
Complication Rates ◽  
Comprehensive Complication Index ◽  
Asa Classification ◽  
Bladder Catheterization ◽  
Hybrid Notes

Abstract Purpose Hysterectomy alters the anatomy of the posterior vaginal vault used as access for transvaginal/transumbilical hybrid NOTES cholecystectomy (NC), creating potential consequences for the feasibility and complication rate of the procedure. Therefore, the aim of our retrospective analysis of prospectively collected data was to analyze the postoperative course after NC in previously hysterectomized (PH) patients compared with patients who had not undergone hysterectomy (NH). Methods A total of 126 NH patients and 50 PH patients aged over 42 who had an NC from 12/2008 to 04/2021 were compared regarding age, body mass index (BMI), ASA classification, number of percutaneous trocars, need for intraoperative urinary bladder catheterization, length of procedure, conversion rate, and intraoperative and postoperative complication rate according to the Clavien/Dindo classification, Comprehensive Complication Index (CCI), mortality, and hospital length of stay. Results PH patients were older than NH patients (63.0 vs 51.5 years; P < 0.001) but did not differ significantly in ASA classification (P = 0.595) and BMI (26.8 vs 27.9 kg/m2; P = 0.480). They required more percutaneous trocars (P = 0.047) and longer procedure time (66.0 vs. 58.5 min; P = 0.039). Out of all 287 scheduled NC only one had to be “converted” to traditional laparoscopic cholecystectomy. Intraoperative and postoperative complication rates, Clavien/Dindo classification, CCI, need for intraoperative urinary bladder catheterization, and length of stay did not differ significantly. Conclusion Our results indicate an increased degree of difficulty of NC in PH patients, although there is no major impact on intraoperative and postoperative complication rates. Urinary bladder perforation is a specific access-related complication in PH patients.

Preoperative nutritional status impacts clinical outcome and hospital length of stay in pelvic exenteration patients – a retrospective study

2021 ◽  
pp. 026010602110090
Author(s):  
Sophie Hogan ◽  
Daniel Steffens ◽  
Kenneth Vuong ◽  
Anna Rangan ◽  
Michael Solomon ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Nutritional Status ◽  
Pelvic Exenteration ◽  
Postoperative Outcomes ◽  
Hospital Length Of Stay ◽  
Major Surgery ◽  
High Morbidity ◽  
Nutrition Screening ◽  
Patient Cohort ◽  
Post Surgery

Background: Preoperative malnutrition is common in surgical oncology patients and can have negative effects on postoperative outcomes. Pelvic exenteration is major surgery associated with high morbidity rates. Associations between preoperative malnutrition, determined using the patient-generated subjective global assessment, and postoperative outcomes in this patient cohort has not yet been investigated. Aim: To determine if preoperative nutritional status is associated with postoperative surgical and quality of life (QoL) outcomes after pelvic exenteration surgery. Methods: A retrospective cohort study was conducted at a quaternary hospital investigating 123 patients who had pelvic exenteration surgery from January 2017 to August 2019. Preoperative nutritional status and postoperative surgical and QoL outcomes were collected and analysed to determine any associations. Results: Overall, 49.6% of patients were female with a median age of 59 years. Forty patients (32.5%) were malnourished and 83 (67.5%) were well nourished before surgery. Well-nourished patients had a shorter length of hospital stay ( p = 0.034) and at 6 months post-surgery, presented with a significantly better physical and mental QoL score ( p = 0.038 and p = 0.001 respectively). The regression analyses showed that intensive care unit (ICU) readmission rates were 7.19 times more likely to occur in malnourished patients ( p = 0.022). Conclusions: Preoperative malnutrition is associated with increased length of stay, ICU readmissions and poorer QoL following pelvic exenteration. Nutrition screening, assessment and optimisation of management are essential in this patient cohort to improve patient outcomes. Future studies are needed to measure the effect of interventions and identify the most beneficial model of care for this complex patient group.

scholarly journals Lymphocyte Count and Serum PCT L ev els  Improve the Sensitivity of CURB-65 in Prediction of 30-day Mortality of Patients with Community-acquired Pneumonia

2019 ◽  
Author(s):  
Jin Zhang ◽  
Rui Tao ◽  
Pengcheng Liu ◽  
Dahai Zhao ◽  
Jiegou Xu
Keyword(s):  
Logistic Regression ◽  
Lymphocyte Count ◽  
Scoring System ◽  
Community Acquired Pneumonia ◽  
Hospitalized Patients ◽  
Diagnostic Model ◽  
High Morbidity ◽  
Operating Characteristics ◽  
Blood Biomarkers ◽  
Combined Models

Abstract Background Community-acquired pneumonia (CAP) is an infectious disease with high morbidity and mortality worldwide. The CURB-65 score and other blood biomarkers were used to evaluate prognosis of hospitalized patients with CAP. The aim of our study is t o evaluate the prognostic values of other blood biomarkers and the CURB-65 score in hospitalized patients with community-acquired pneumonia (CAP). Methods A retrospective study of clinical data of in-hospitalized adult CAP patients who fulfilled the CAP criteria and were admitted to the Second Affiliated Hospital of Anhui medical university between January 2015 and December 2018 was conducted. The CURB-65 score was calculated, and other biomarkers including blood lymphocyte countat and serum PCT (a propeptide of calcitonin) level were collected at enrolment. Logistic regression analysis was performed to develop combined models to predict 30-day mortality in overall hospitalized and/or the ICU admission of CAP patients. Then, receiver operating characteristics curve (ROC) analysis was conducted to measure and compare the prognostic values of the CURB-65 score and biomarkers in the combined models.Results The ROC curve analysis using logistic regression of the new combined models showed that the CURB-65 score combined with lymphocyte count and serum PCT level (designated as CURB-65L P) improved the predictive value and was sensitive diagnostic model in predicting the 30-day mortality of CAP patients.Conclusion Serum level of lymphocytes or PCT alone is a strong prognostic factor for evaluation of 30-day mortality of CAP patients. Incorporation of both factors improves the sensitivity of the CURB-65 scoring system in the prediction of the 30-day mortality. This new CURB-65LP scoring system is simple, but more accurate for evaluating the severity of CAP with higher sensitivity and specificity than the current CURB-65 scoring system.

scholarly journals Benefits of the Subdural Evacuating Port System (SEPS) Procedure Over Traditional Craniotomy for Subdural Hematoma Evacuation

2020 ◽  
Vol 10 (4) ◽  
pp. 257-265
Author(s):  
Danielle Golub ◽  
Kimberly Ashayeri ◽  
Siddhant Dogra ◽  
Ariane Lewis ◽  
Donato Pacione
Keyword(s):  
Length Of Stay ◽  
Subdural Hematoma ◽  
Retrospective Cohort ◽  
Reoperation Rate ◽  
Hematoma Volume ◽  
Postoperative Hematoma ◽  
Hospitalization Costs ◽  
Port System ◽  
History Presentation ◽  
Substantial Morbidity

Background: There remains no consensus on the optimal primary intervention for subdural hematoma (SDH). Although historically favored, craniotomy carries substantial morbidity and incurs significant costs. Contrastingly, the subdural evacuating port system (SEPS) is a minimally invasive bedside procedure. We assessed the benefits of SEPS over traditional craniotomy for SDH evacuation. Methods: A single-center retrospective cohort study of SDH patients receiving craniotomy or SEPS between 2012 and 2017 was performed. Information regarding demographics, medical history, presentation, surgical outcomes, cost, and complications was collected. Pre- and postoperative hematoma volumes were calculated using 3D image segmentation using Vitrea software. Multivariate regression models were employed to assess the influence of intervention choice. Results: Of 107 patients, 68 underwent craniotomy and 39 underwent SEPS. There were no differences in age, sex, blood thinner use, platelet count, INR, hematoma lateralization, age, volume, or midline shift at presentation between intervention groups. Although there was no difference in percent residual hematoma volume 24-hour postintervention (44.1% vs 45.1%, P = .894), SEPS was associated with lower hospitalization costs ($108 391 vs $166 318, * P = .002), shorter length of stay (4.0 vs 5.8 days, * P = .0002), and fewer postoperative seizures (2.6% vs 17.7%, * P = .048). Reoperation rate was higher after SEPS overall (33.3% vs 13.2%, * P = .048) but comparable to craniotomy in chronic SDH (12.50% vs 7.69%, P = 1.000). Conclusion: In this retrospective cohort, SEPS was noninferior to craniotomy at reducing SDH hematoma volume. The SEPS procedure was also associated with decreased length of stay hospitalization costs, and postoperative seizures and demonstrated a comparable recurrence rate to craniotomy for chronic SDH in particular.

scholarly journals Treatment of Aspergillosis

2018 ◽  
Vol 4 (3) ◽  
pp. 98 ◽  
Author(s):  
Jeffrey Jenks ◽  
Martin Hoenigl
Keyword(s):  
Neutropenic Patient ◽  
Treatment Options ◽  
Primary Treatment ◽  
Antifungal Prophylaxis ◽  
Successful Outcome ◽  
High Morbidity ◽  
Oral Itraconazole ◽  
Chronic Pulmonary Aspergillosis ◽  
Patient Groups

Infections caused by Aspergillus spp. remain associated with high morbidity and mortality. While mold-active antifungal prophylaxis has led to a decrease of occurrence of invasive aspergillosis (IA) in those patients most at risk for infection, breakthrough IA does occur and remains difficult to diagnose due to low sensitivities of mycological tests for IA. IA is also increasingly observed in other non-neutropenic patient groups, where clinical presentation is atypical and diagnosis remains challenging. Early and targeted systemic antifungal treatment remains the most important predictive factor for a successful outcome in immunocompromised individuals. Recent guidelines recommend voriconazole and/or isavuconazole for the primary treatment of IA, with liposomal amphotericin B being the first alternative, and posaconazole, as well as echinocandins, primarily recommended for salvage treatment. Few studies have evaluated treatment options for chronic pulmonary aspergillosis (CPA), where long-term oral itraconazole or voriconazole remain the treatment of choice.

Effect of hyponatremia on cancer patients' in-patient rehabilitation length of stay.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e20626-e20626
Author(s):  
Megan Nelson ◽  
J. Lynn Palmer ◽  
Jack Brian Fu ◽  
Janet L. Williams ◽  
Rajesh R. Yadav ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Cancer Patients ◽  
Functional Independence Measure ◽  
Inpatient Rehabilitation ◽  
Functional Independence ◽  
Cancer Rehabilitation ◽  
Cancer Center ◽  
Rehabilitation Unit ◽  
Increased Risk ◽  
Patient Groups

e20626 Background: The incidence of hyponatremia in cancer patients has been reported as high as 47%. Hyponatremia is associated with gait and attention impairments, increased falls, increased risk of fractures, and osteoporosis. Our aim is to determine if hyponatremia impact cancer patients’ rehabilitation length of stay, functional outcome, and survival. Methods: Retrospective study was conducted in a tertiary cancer center on two hundreds and ninty-five patients who underwent inpatient cancer rehabilitation between January 27, 2009 through July, 31, 2010. Hyponatremia incidence, rehabilitation length of stay (LOS), functional independence measure (FIM) for ambulation and transfers, and survival information were collected. Results: The incidence of hyponatremia in cancer patients admitted to our inpatient rehabilitation unit was 41.4%. Median rehabilitation LOS for patients with mild (Na 130-134 mEq/L) and moderate-severe (Na<130 mEq/L) hyponatremia was 11 and 15 days, respectively, which was significantly longer than patients with eunatremia (10 days; P = .03). FIM change for ambulation and transfers during inpatient rehabilitation stay was not significantly different, nor was survival significantly different, between different patient groups. Conclusions: A high percentage of patients have hyponatremia upon admission to our inpatient cancer rehabilitation unit, and this is associated with a prolonged rehabilitation LOS.

scholarly journals Childhood Nephrotic Syndrome Management and Outcome: A Single Center Retrospective Analysis

2017 ◽  
Vol 2017 ◽  
pp. 1-7 ◽  
Author(s):  
Chia-shi Wang ◽  
Jia Yan ◽  
Robert Palmer ◽  
James Bost ◽  
Mattie Feasel Wolf ◽  
...  
Keyword(s):  
Nephrotic Syndrome ◽  
Length Of Stay ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
High Morbidity ◽  
Metropolitan Statistical Area ◽  
Childhood Nephrotic Syndrome ◽  
Steroid Dependent ◽  
Increased Risk ◽  
Serious Disease

There is a paucity of information on outpatient management and risk factors for hospitalization and complications in childhood nephrotic syndrome (NS). We described the management, patient adherence, and inpatient and outpatient usage of 87 pediatric NS patients diagnosed between 2006 and 2012 in the Atlanta Metropolitan Statistical Area. Multivariable analyses were performed to examine the associations between patient characteristics and disease outcome. We found that 51% of the patients were treated with two or more immunosuppressants. Approximately half of the patients were noted to be nonadherent to medications and urine protein monitoring. The majority (71%) of patients were hospitalized at least once, with a median rate of 0.5 hospitalizations per patient year. Mean hospital length of stay was 4.0 (3.8) days. Fourteen percent of patients experienced at least one serious disease complication. Black race, frequently relapsing/steroid-dependent and steroid-resistant disease, and the first year following diagnosis were associated with higher hospitalization rates. The presence of comorbidities was associated with longer hospital length of stay and increased risk of serious disease complications. Our results highlight the high morbidity and burden of NS and point to particular patient subgroups that may be at increased risk for poor outcome.

scholarly journals 184. Staphylococcus aureus Bacteremia Management and Outcomes Following Infectious Disease Consult Over Time at a Tertiary Care Center in Canada

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S200-S201
Author(s):  
Mark McAllister ◽  
Justin Chen ◽  
Stephanie Smith ◽  
Arienne King ◽  
Tanis C Dingle ◽  
...  
Keyword(s):  
Infectious Disease ◽  
Staphylococcus Aureus ◽  
Length Of Stay ◽  
Care Center ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
High Morbidity ◽  
University Of Alberta ◽  
Staphylococcus Aureus Bacteremia ◽  
Over Time

Abstract Background Staphylococcus aureus bacteremia (SAB) is associated with high morbidity and mortality. Infectious disease consultation (IDC) is associated with increased adherence to guideline management and improved patient outcomes. We describe the IDC rate over time and impact of IDC on the management and outcomes of patients with SAB. Methods This retrospective chart review includes adult patients (≥ 18 years) hospitalized at the University of Alberta Hospital, Edmonton, Canada who had at least 1 blood culture growing Staphylococcus aureus during two time periods (A: Jan 2010 to Dec 2012; B: Jan to Oct 2020). Patients who died or were made palliative within 48hrs following bacteremia were excluded. Descriptive statistics were used to compare appropriateness of SAB management and outcomes in patients receiving IDC and those who did not (NIDC). Results 325 patients in period A and 129 in period B were included. Baseline demographics were similar. IDC rate increased from 63% to 88% (p&lt; 0.001) between the study periods. IDC was associated with increased odds of receiving an echocardiogram (OR=3.56, 95% CI 2.22 – 5.57; OR=20.4, 95% 4.13 – 110.6, p&lt; 0.001) and appropriate duration of antimicrobial therapy (OR=6.74, 95% 3.93 – 11.54; OR=43.2, 95% 5.72 – 529.5, p&lt; 0.001) between study periods. Mean length of stay decreased in patients receiving IDC (44.8 vs 28.1 days, p=0.005) and increased in NIDC patients (19.9 vs 28.7 days, p=0.216). IDC was associated with lower 30-day mortality in period A (OR=3.53, 95% 1.95 – 6.36), however this association was not observed in period B (OR=1.43, 95% 0.40 – 5.56). There was a trend towards decreased odds of mortality in patients receiving early IDC (≤2 days from bacteremia, n=65) compared to late IDC (≥3 days from bacteremia, n=45) (OR=2.59, 95% 0.95 – 7.10, p=0.077). Conclusion Our centre’s IDC rate for SAB increased over time without specific intervention. IDC increased the odds of appropriate SAB management and was associated with decreased length of stay in period B. IDC was associated with lower 30-day mortality in period A and trended towards lower mortality in period B. Specifically, early IDC decreased odds of 30-day mortality compared to late IDC. These results suggest that routine early IDC be part of SAB management. Disclosures All Authors: No reported disclosures

scholarly journals Pulmonary edema as a postoperative complication in two obese patients (a horse and a dog)

2014 ◽  
Vol 83 (2) ◽  
pp. 60-65
Author(s):  
S. Melis ◽  
S. Schauvliege ◽  
T. Bosmans ◽  
F. Gatshuys ◽  
I. Polis
Keyword(s):  
Pulmonary Edema ◽  
Postoperative Complication ◽  
Successful Treatment ◽  
Postoperative Period ◽  
Case Series ◽  
Severe Complication ◽  
Obese Patients ◽  
Contributing Factors

In this case series, the development and successful treatment of pulmonary edema are described in two obese animals (a horse and a dog) in the postoperative period. This rare but severe complication is normally fairly easy to diagnose, but the cause is usually multifactorial and difficult to determine. Potentially contributing factors are discussed. Both animals responded successfully to therapy and were discharged without further incidents.

scholarly journals Impact of enhanced recovery after surgery protocol compliance on patients’ outcome in benign hysterectomy and establishment of a predictive nomogram model

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yiwei Shen ◽  
Feng Lv ◽  
Su Min ◽  
Gangming Wu ◽  
Juying Jin ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Postoperative Complications ◽  
Length Of Stay ◽  
Postoperative Complication ◽  
Patient Experience ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Early Mobilization ◽  
Urinary Drainage ◽  
Eras Protocol

Abstract Background Enhanced recovery after surgery (ERAS) pathways have been shown to improve clinical outcomes after surgery. Considering the importance of patient experience for patients with benign surgery, this study evaluated whether improved compliance with ERAS protocol modified for gynecological surgery which recommended by the ERAS Society is associated with better clinical outcomes and patient experience, and to determine the influence of compliance with each ERAS element on patients’ outcome after benign hysterectomy. Methods A prospective observational study was performed on the women who underwent hysterectomy between 2019 and 2020. A total of 475 women greater 18 years old were classified into three groups according to their per cent compliance with ERAS protocols: Group I: < 60% (148 cases); Group II:≥60 and < 80% (160 cases); Group III: ≥80% (167 cases). Primary outcome was the 30-day postoperative complications. Second outcomes included QoR-15 questionnaire scores, patient satisfaction on a scale from 1 to 7, and length of stay after operation. After multivariable binary logistic regression analyse, a nomogram model was established to predict the incidence of having a postoperative complication with individual ERAS element compliance. Results The study enrolled 585 patients, and 475 completed the follow-up assessment. Patients with compliance over 80% had a significant reduction in postoperative complications (20.4% vs 41.2% vs 38.1%, P < 0.001) and length of stay after surgery (4 vs 5 vs 4, P < 0.001). Increased compliance was also associated with higher patient satisfaction and QoR-15 scores (P < 0.001),. Among the five dimensions of the QoR-15, physical comfort (P < 0.05), physical independence (P < 0.05), and pain dimension (P < 0.05) were better in the higher compliance groups. Minimally invasive surgery (MIS) (P < 0.001), postoperative nausea and vomiting (PONV) prophylaxis (P < 0.001), early mobilization (P = 0.031), early oral nutrition (P = 0.012), and early removal of urinary drainage (P < 0.001) were significantly associated with less complications. Having a postoperative complication was better predicted by the proposed nomogram model with high AUC value (0.906) and sensitivity (0.948) in the cohort. Conclusions Improved compliance with the ERAS protocol was associated with improved recovery and better patient experience undergoing hysterectomy. MIS, PONV prophylaxis, early mobilization, early oral intake, and early removal of urinary drainage were of concern in reducing postoperative complications. Trial registration Chinese Clinical Trial Registry, ChiCTR1800019178. Registered on 30/10/2018.

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