Laparoscopic Distal Pancreatic Resection

2005 ◽  
Vol 71 (9) ◽  
pp. 744-749
Author(s):  
Jeff Root ◽  
Ninh Nguyen ◽  
Blanding Jones ◽  
Scott Mccloud ◽  
John Lee ◽  
...  
Keyword(s):  
Operative Time ◽  
Average Length ◽  
Intraoperative Ultrasound ◽  
Laparoscopic Distal Pancreatectomy ◽  
The United States ◽  
Pancreatic Tumors ◽  
Cystic Neoplasm ◽  
Distal Pancreatic Resection ◽  
Average Length Of Stay ◽  
Average Operative Time

Laparoscopic resection is not an established treatment for pancreatic tumors. Previous reports, mainly in Europe and Japan, have demonstrated the potential utility of laparoscopic distal pancreatectomy (LDP). However, few reports have been published from the United States. We instituted a pilot program to assess LDP. A total of 11 patients were included from December 2003 to December 2004. All patients were staged with preoperative endoscopic ultrasound and received vaccinations for possible splenectomy. The indications for surgery were as follows: neuroendocrine tumor (n = 7), unspecified tumor (n = 1), and cystic neoplasm (n = 3). All procedures began with diagnostic laparoscopy and intraoperative ultrasound. Three patients underwent laparoscopic enucleation of a discrete pancreatic nodule. In eight patients, LDP was attempted. One patient required conversion to an open procedure. In the other seven patients, the procedure was completed laparoscopically, two with hand-assist. The average operative time was 5 hours and 3 minutes; average length of stay was 5 days; and the splenectomy rate was 57 per cent (n = 4). There was one complication of an infected hematoma. There were no pancreatic leaks, deaths, nor readmissions. LDP with or without splenectomy is feasible and can be performed with minimum morbidity and only slightly increased operative time.

Awake Surgical Management of Third Ventricular Tumors: A Preliminary Safety, Feasibility, and Clinical Applications Study

2019 ◽  
Vol 17 (2) ◽  
pp. 208-226 ◽  
Author(s):  
Srikant S Chakravarthi ◽  
Amin B Kassam ◽  
Melanie B Fukui ◽  
Alejandro Monroy-Sosa ◽  
Nichelle Rothong ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Average Length ◽  
Third Ventricle ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Cognitive Outcomes ◽  
Cognitive Changes ◽  
Average Length Of Stay ◽  
Intraoperative Management ◽  
Average Operative Time

AbstractBACKGROUNDEndoscopic and microneurosurgical approaches to third ventricular lesions are commonly performed under general anesthesia.OBJECTIVETo report our initial experience with awake transsulcal parafascicular corridor surgery (TPCS) of the third ventricle and its safety, feasibility, and limitations.METHODSA total of 12 cases are reviewed: 6 colloid cysts, 2 central neurocytomas, 1 papillary craniopharyngioma, 1 basal ganglia glioblastoma, 1 thalamic glioblastoma, and 1 ependymal cyst. Lesions were approached using TPCS through the superior frontal sulcus. Pre-, intra-, and postoperative neurocognitive (NC) testing were performed on all patients.RESULTSNo cases required conversion to general anesthesia. Awake anesthesia changed intraoperative management in 4/12 cases with intraoperative cognitive changes that required port re-positioning; 3/4 recovered. Average length of stay (LOS) was 6.1 d ± 6.6. Excluding 3 outliers who had preoperative NC impairment, the average LOS was 2.5 d ± 1.2. Average operative time was 3.00 h ± 0.44. Average awake anesthesia time was 5.05 h ± 0.54. There were no mortalities.CONCLUSIONThis report demonstrated the feasibility and safety of awake third ventricular surgery, and was not limited by pathology, size, or vascularity. The most significant factor impacting LOS was preoperative NC deficit. The most significant risk factor predicting a permanent NC deficit was preoperative 2/3 domain impairment combined with radiologic evidence of invasion of limbic structures – defined as a “NC resilience/reserve” in our surgical algorithm. Larger efficacy studies will be required to demonstrate the validity of the algorithm and impact on long-term cognitive outcomes, as well as generalizability of awake TPCS for third ventricular surgery.

Laparoscopic Repair of Gastrointestinal Leaks after Laparoscopic Gastric Bypass

2006 ◽  
Vol 72 (7) ◽  
pp. 586-591 ◽  
Author(s):  
Atul K. Madan ◽  
Brock Lanier ◽  
David S. Tichansky
Keyword(s):  
Gastric Bypass ◽  
Laparoscopic Repair ◽  
Average Length ◽  
Gastric Pouch ◽  
Retrospective Chart Review ◽  
Multiple Organ ◽  
Open Approach ◽  
Significant Morbidity ◽  
Average Length Of Stay ◽  
Average Operative Time

Gastrointestinal (GI) leak after gastric bypass is a cause of significant morbidity and a mortality that may exceed 50%. This study was performed to review our experience with laparoscopic repair of GI leaks after laparoscopic Roux-en-Y gastric bypass (LRYGB). A retrospective chart review of all patients who underwent LRYGB over a 25-month period was performed. Patients who had any operation for a GI leak after LRYGB were included in this study. There were 300 patients who underwent LRYGB. No intraoperative conversions occurred. Eight (2.7%) patients underwent operative repair of a GI leak. Another patient had a gastrojejunostomy leak that was managed nonoperatively. The rate of GI leaks reduced from 5.3 per cent in the first 150 cases to 0.7 per cent in the last 150 cases (P < 0.05). One patient was converted to an open approach. Average operative time for the laparoscopic repairs was 133 minutes (range, 75–182 minutes). Sources of leak found at operation were gastrojejunostomy (3), enterotomy (3), jejunojejunostomy (2), gastric pouch (1), and cystic duct stump (1). Two patients had a GI leak from two sources. Average length of stay was 28 days (range, 4–78 days). Three patients whose stay was greater than a month were the result of sepsis and ventilator dependence. Further reoperations were required in two patients (laparoscopic) for abdominal washout and one patient (open) for enterotomy repair. One patient required computed tomography-guided drainage of an abscess. Mortality was 22 per cent (2) in patients who developed GI leaks. One patient died from sepsis-induced multiple organ failure and the other patient from a presumed pulmonary embolus. GI leaks cause significant morbidity and mortality. GI leak rates decrease with experience. Laparoscopic repair of GI leaks should be used judiciously. Conversions and further reoperations may be necessary.

Characteristics and factors affecting mortality of patients admitted for chemotherapy in the United States during the year 2017.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e19025-e19025
Author(s):  
Arya Mariam Roy ◽  
Manojna Konda ◽  
Akshay Goel ◽  
Rashmi Verma
Keyword(s):  
Average Length ◽  
Private Insurance ◽  
Progression Free Survival ◽  
The United States ◽  
Factors Affecting ◽  
Beneficial Effects ◽  
Average Length Of Stay ◽  
Icd 10 ◽  
Life Threatening

e19025 Background: Over the past two decades, there has been a tremendous increase in the chemotherapy options available to cancer patients. In terms of overall, progression-free survival, and temporary suppression of cancer-related symptoms, chemotherapy has shown beneficial effects. However, the side effects of chemotherapy are sometimes life threatening which affects an individual’s physical health, emotional state and quality of life. There is a considerable increase in the prevention, early identification and timely management of toxicities associated with chemotherapy; however, chemotherapy-related deaths still occur. Methods: We conducted a retrospective analysis of the National Inpatient Sample Database for the year 2017. Patients who were admitted for the administration of chemotherapy are identified using ICD- 10 codes. The epidemiology, the role of insurance providers in the treatment outcome were studied. Results: A total of 29,018 hospitalizations for the administration of chemotherapy were there in 2017. The median age of patients who received chemotherapy was 48. The overall mortality related to chemotherapy admissions was 0.80% (n = 233). The mortality of females who were admitted for chemotherapy did not vary much when compared to males admitted for chemotherapy (0.89% vs 0.73%, p = 0.132). It was found that admissions for chemotherapy during weekend had 85 % higher odds of dying as compared to admission during weekdays (1.6% vs 0.76%, OR = 1.85, p = 0.001, CI = 1.16 – 2.95). Patients who were admitted electively for chemotherapy were 74% less likely to die in hospital when compared to those who were admitted emergently for chemotherapy (1.4 % vs 0.49% OR = 0.36, p = 0.001, CI = 0.266 – 0.49). Interestingly, patients who had Medicare and Medicaid had higher mortality than those who had private insurance and self-pay when admitted for chemotherapy (2.08 % vs 0.58% vs 0.36%, p = 0.00). Those who had private insurance were 60% less likely to die in hospital while admitted for chemotherapy. The average length of stay for chemotherapy admissions were 5.92 ± 7.9%. Conclusions: Medicare and Medicaid patients, weekend admissions and emergent admissions were more likely to die in hospital while admitted for chemotherapy. Further studies are needed to reveal the disparities in the mortality of chemotherapy admissions, based on the socioeconomic status and the insurance payers.

scholarly journals Characteristics of patients hospitalised in an emergency department observation unit in Japan

2018 ◽  
Vol 14 (2) ◽  
Author(s):  
Toshiya Mitsunaga ◽  
Yuhei Ohtaki ◽  
Nobuaki Kiriyama ◽  
Kei Ohtani ◽  
Wataru Yajima ◽  
...  
Keyword(s):  
Emergency Department ◽  
Elderly Patients ◽  
Emergency Departments ◽  
Average Length ◽  
Developed Countries ◽  
The United States ◽  
University Hospital ◽  
Medical Systems ◽  
Average Length Of Stay ◽  
Emergency Medical Systems

In Japan, transporting elderly patients to emergency departments has recently posed serious problems, including a longer average time from patients’ initial emergency calls to their arrival at hospitals. To manage emergency departments more efficiently, many hospitals in the United States and some other developed countries, including Japan, introduced emergency department observation units (EDOU). However, because the usefulness of EDOUs in managing elderly patients remains uncertain, we analysed data of patients admitted to a Japanese university hospital’s EDOU to gauge its efficacy. We followed 1,426 patients admitted to the hospital’s EDOU from 1 January 2011 to 31 December 2014. The average age of patients who stayed in the EDOU increased, whereas the average length of time that they spent there decreased. Although the percentage of patients older than 65 years increased slightly, from 36.42% (2011–2012) to 37.73% (2013–2014), the proportion of those patients between the two periods did not significantly change (P = .61). Moreover, their average length of stay was 2.16 ± 0.91 days, whereas patients younger than 65 years stayed for significantly less time (1.92 ± 0.82 days). By condition, approximately 36% of patients older than 65 years presented with non-neurosurgical trauma, approximately 59% presented with other forms of trauma, but proportions of both categories of trauma were significantly smaller in patients younger than 65 years (nonneurosurgical trauma, 23%; all trauma, 47%). Most elderly patients with limb trauma prepped for surgery were transferred to other hospitals after a few days. Results suggest that the EDOU at the university hospital has served to as a buffer for regional emergency medical systems in Japan, especially given the continued ageing of the Japanese population.

Is a Diagnosis-Based Classification System Appropriate for Funding Psychiatric Care in Alberta?

1995 ◽  
Vol 40 (9) ◽  
pp. 507-513 ◽  
Author(s):  
Chantelle M Wellock
Keyword(s):  
Length Of Stay ◽  
Classification System ◽  
Negative Impact ◽  
Average Length ◽  
The United States ◽  
Classification Systems ◽  
Short Stay ◽  
Average Length Of Stay ◽  
Variation Explained ◽  
Better Than

Objective This study evaluated the appropriateness of the Refined Group Number (RGN) classification system for funding psychiatric discharges in Alberta. Method Multiple regression was used to calculate the amount of variation explained (R2) in length of stay by RGNs for psychiatric discharges. The distribution of short-stay cases (less than 5 days) was also reviewed. Results The R2 value was higher than those from American studies (0.284 versus less than 0.10) for psychiatric discharges. The length of stay distribution by RGN indicated that the mean was not representative of typical cases. Short-stay cases made up the majority of cases from rural hospitals and had a negative impact on the average length of stay. Conclusions The RGN methodology performed better than diagnosis-based classification systems in the United States. However, there were significant weaknesses in the classification system which suggest that a funding system using the RGN grouper would result in inequitable funding for psychiatric discharges.

scholarly journals 65 & Thrive: Improving Patient Length of Stay, Readmission, and Quality of Care by Becoming an Age-Friendly Hospital

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 594-595
Author(s):  
Tracey Vien ◽  
Stella Bobroff ◽  
Ricardo de Ocampo
Keyword(s):  
Los Angeles ◽  
Length Of Stay ◽  
Average Length ◽  
The United States ◽  
Holistic Care ◽  
Kaiser Permanente ◽  
Average Length Of Stay ◽  
Telemetry Unit ◽  
Management Staff

Abstract Data indicates that older persons will increase in numbers along with having an increase of life expectancy in the United States. Kaiser Permanente Los Angeles Medical Center’s Utilization Department developed “65 & Thrive”—an age-specialized initiative to provide holistic care that preserves independence, quality of life, prevents functional and cognitive decline, and promotes both patients and their families to continue thriving. The initiative’s focus is guided by the 5 M’s model on mobility, medication, mentation, multi-morbidity, and what matters. Case management staff were given age-sensitivity trainings, improved workflows and made assessments that identified, addressed, and secured resources for patients throughout their hospitalization. Silver Angel volunteers were specially trained to prevent physical and mental decline and focused on activities to prevent delirium, depression and falls. The volunteers visited with patients daily for these interactions. The initiative was piloted in April 2020 on a stroke telemetry unit and since then the hospital has seen a significant decrease in the overall annual readmission rates by 3.1% when compared to 2019. The average length of stay for older adult patients; however, increased from 4.05 to 4.83 days unfortunately due to COVID-19. This initiative demonstrates the necessity to expand “65 & Thrive” throughout the hospital and ultimately to other Kaiser Permanente medical centers to best provide holistic care to older adults.

Robotic Swenson Pull-Through for Hirschsprung's Disease in Infants

2011 ◽  
Vol 77 (7) ◽  
pp. 937-941 ◽  
Author(s):  
André Hebra ◽  
Valerie A. Smith ◽  
Aaron P. Lesher
Keyword(s):  
Hirschsprung's Disease ◽  
Hirschsprung’S Disease ◽  
Average Length ◽  
Robotic Technology ◽  
Average Length Of Stay ◽  
Young Infants ◽  
Bowel Movements ◽  
Da Vinci Robotic System ◽  
Average Operative Time ◽  
Pull Through

It has been demonstrated that infants with Hirschsprung's disease can be treated with a one-stage laparoscopic resection and coloanal pull-through. However, the feasibility and benefits of performing this operation using robotic technology have not yet been evaluated. We reviewed our experience with 12 infants diagnosed with Hirschsprung's disease and treated with laparoscopic-robotic assisted colonic resection with proctectomy and pull-through using the da Vinci robotic system. Patients were treated at a mean age/weight of 16 weeks/5.5 kg. The average operative time for the robotic procedure was 230 minutes, and average length of stay was 3 days. At discharge, all patients were having regular bowel movements and tolerating a completely oral diet. All patients received early postoperative anorectal dilation and six patients required dilations for an average of 12 weeks after surgery for management of minor rectal strictures. Only two patients developed postoperative enterocolitis with a mean follow-up of 36 months. A robotic approach for performing a Swenson-type resection and pull-through procedure can be performed safely and successfully in young infants. Robotic technology provided superior dexterity and visualization, essential in performing a more complete rectal dissection, thus allowing for a complete proctectomy and eliminating the risk of leaving a segment of aganglionic rectum behind.

scholarly journals Hospital Resource Utilization and Costs Associated With Warfarin Versus Apixaban Treatment Among Patients Hospitalized for Venous Thromboembolism in the United States

2018 ◽  
Vol 24 (9_suppl) ◽  
pp. 261S-268S ◽  
Author(s):  
Steven Deitelzweig ◽  
Jennifer D. Guo ◽  
Patrick Hlavacek ◽  
Jay Lin ◽  
Gail Wygant ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Resource Utilization ◽  
Real World ◽  
Average Length ◽  
The United States ◽  
Hospital Resource ◽  
Average Length Of Stay ◽  
Hospitalization Costs ◽  
Hospital Stays

A real-world US database analysis was conducted to evaluate the hospital resource utilization and costs of patients hospitalized for venous thromboembolism (VTE) treated with warfarin versus apixaban. Additionally, 1-month readmissions were evaluated. Of 28 612 patients with VTE identified from the Premier Hospital database (August 2014-May 2016), 91% (N = 26 088) received warfarin and 9% (N = 2524) received apixaban. Outcomes were assessed after controlling for key patient/hospital characteristics. For index hospitalizations, the average length of stay (LOS) was longer (3.8 vs 3.1 days, P < .001; difference: 0.7 days) and mean hospitalization cost higher (US$3224 vs US$2,740, P < .001; difference: US$484) for warfarin versus apixaban-treated patients. During the 1-month follow-up period, warfarin treatment was associated with a greater risk of all-cause readmission (odds ratio [OR]: 1.27; 95% confidence interval [CI]: 1.09-1.48, P = .003), major bleeding (MB)-related readmission (OR: 2.10; 95% CI: 1.03-4.27, P = .04), and any bleeding-related readmission (OR: 1.67; 95% CI: 1.09-2.56, P = .02) versus apixaban. The results of this real-world analysis show that compared to warfarin, apixaban treatment was associated with shorter index hospital stays, lower index hospitalization costs, and reduced risk of MB-related readmissions among hospitalized patients with VTE.

scholarly journals Impact of Hydroxychloroquine Treatment of COVID-19 on Cardiac Conduction: The Beat Goes On

COVID ◽  
2021 ◽  
Vol 1 (2) ◽  
pp. 458-464
Author(s):  
Marc Thomas Zughaib ◽  
Robby Singh ◽  
Marcel Letourneau ◽  
Marcel Elias Zughaib
Keyword(s):  
Average Length ◽  
Torsades De Pointes ◽  
The United States ◽  
Qt Prolongation ◽  
Cardiac Conduction ◽  
Drug Induced ◽  
Average Length Of Stay ◽  
Qt Intervals ◽  
Increased Risk ◽  
Medical Histories

Objectives: Our study aimed to investigate the frequency of malignant cardiac arrhythmias in hospitalized patients receiving hydroxychloroquine alone and those receiving a combination of hydroxychloroquine with azithromycin, as well as the quantitative extent of QT prolongation within Tisdale Risk Score (TRS) categories. Background: There have been over 33 million cases of SARS-CoV-2 (COVID-19) resulting in over 600,000 deaths in the United States. As the current COVID-19 pandemic continues, numerous medications have been administered to attempt to treat patients afflicted by the disease. While hydroxychloroquine has been in use for decades for rheumatologic and infectious disease processes, it does have potential cardiotoxicity related to drug-induced QT prolongation. Drug-induced QT prolongation has an increased risk of arrhythmogenicity, potentially progressing into torsades de pointes (TdP) and increased patient mortality. The relationship between QT prolongation and TdP is complex and inexact, but there remains optimism regarding the use of these medications in the treatment of COVID-19 despite limited data on their true efficacy. Methods: We retrospectively identified 75 patients who were admitted with COVID-19 and underwent treatment with hydroxychloroquine for 5 days. The hydroxychloroquine protocol was defined as an initial dose of 400 mg BID for the first day, followed by 400 mg daily for the next 4 days. Baseline demographics, medications, medical histories, lab values, ECG QT intervals, and Tisdale Risk Categories were collected for all patients. Results: Seventy-four (98.7%) patients completed the full course of hydroxychloroquine. There were 41 males (54.7%) and 34 females (45.3%). Average length of stay was 8.9 days (95% CI: 7.5, 10.2). One patient who could not complete the course due to inability to swallow medication tablets. There were no reports of new arrythmias or incidence of torsades de pointes during the study. Seventy-two patients (96%) were taking at least 2 QT prolonging medications. The average corrected QT intervals were as follows: day 1 of admission was 421.62 milliseconds (n = 66, 95% CI: 412.19, 431.05), day 2 was 431.50 ms (n = 30, 95% CI: 416.34, 446.66), day 3 was 433.48 ms (n = 23, 95% CI: 413.34, 453.61), day 4 was 427.59 ms (n = 17, 95% CI: 400.83, 454.35), and day 5 was 444.28 ms (n = 18, 95% CI: 428.43, 460.12). The corrected QT interval prolonged by 22.66 ms from day 1 to day 5 (p = 0.03) in the overall population. Conclusion: There were no patients who experienced arrhythmogenicity or Torsades de Pointes despite a statistically significant increase in QTc intervals after patients received the 5-day course of hydroxychloroquine for treatment of COVID-19.

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