Routine Nasogastric Decompression in Small Bowel Obstruction: Is it Really Necessary?

2013 ◽  
Vol 79 (4) ◽  
pp. 422-428 ◽  
Author(s):  
Annabelle L. Fonseca ◽  
Kevin M. Schuster ◽  
Adrian A. Maung ◽  
Lewis J. Kaplan ◽  
Kimberly A. Davis
Keyword(s):  
Respiratory Failure ◽  
Small Bowel ◽  
Length Of Stay ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Retrospective Chart Review ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Increased Risk ◽  
Nasogastric Decompression

Bowel rest, nasogastric (NG) decompression, and intravenous hydration are used to treat small bowel obstruction (SBO) conservatively; however, there are no data to support nasogastric tube (NGT) use in patients without active emesis. We aim to evaluate the use of nasogastric decompression in SBO and the safety of managing patients with SBO without the use of a NGT. A retrospective chart review was conducted of adult patients admitted to Yale New Haven Hospital over five years with the diagnosis of SBO. We compared patients who received NG decompression with those who did not. Outcome variables assessed were days to resolution, associated complications, hospital length of stay, and disposition. Of 290 patients who fit the criteria, 190 patients (65.52%) were managed conservatively. Fifty-five patients (18.97%) did not receive NGTs. Sixty-eight patients (23.45%) did not present with emesis; however, nearly 75 per cent of these patients received NGTs. Development of pneumonia and respiratory failure was significantly associated with NGT placement. Time to resolution and hospital length of stay were significantly higher in patients with NGTs. Patients with NG decompression had a significantly increased risk of pneumonia and respiratory failure as well as increased time to resolution and hospital length of stay.

Impact of Frailty on Outcomes Following Spine Surgery: A Prospective Cohort Analysis of 668 Patients

Neurosurgery ◽  
2020 ◽  
Author(s):  
Nitin Agarwal ◽  
Ezequiel Goldschmidt ◽  
Tavis Taylor ◽  
Souvik Roy ◽  
Stefanie C Altieri Dunn ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Spine Surgery ◽  
Cohort Analysis ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Quality Improvement Initiative ◽  
Exact Test ◽  
Frail Patients ◽  
Increased Risk ◽  
Venous Thromboembolic

Abstract BACKGROUND With an aging population, elderly patients with multiple comorbidities are more frequently undergoing spine surgery and may be at increased risk for complications. Objective measurement of frailty may predict the incidence of postoperative adverse events. OBJECTIVE To investigate the associations between preoperative frailty and postoperative spine surgery outcomes including mortality, length of stay, readmission, surgical site infection, and venous thromboembolic disease. METHODS As part of a system-wide quality improvement initiative, frailty assessment was added to the routine assessment of patients considering spine surgery beginning in July 2016. Frailty was assessed with the Risk Analysis Index (RAI), and patients were categorized as nonfrail (RAI 0-29) or prefrail/frail (RAI ≥ 30). Comparisons between nonfrail and prefrail/frail patients were analyzed using Fisher's exact test for categorical data or by Wilcoxon rank sum tests for continuous data. RESULTS From August 2016 through September 2018, 668 patients (age of 59.5 ± 13.3 yr) had a preoperative RAI score recorded and underwent scheduled spine surgery. Prefrail and frail patients suffered comparatively higher rates of mortality at 90 d (1.9% vs 0.2%, P < .05) and 1 yr (5.1% vs 1.2%, P < .01) from the procedure date. They also had longer in-hospital length of stay (LOS) (3.9 d ± 3.6 vs 3.1 d ± 2.8, P < .001) and higher rates of 60 d (14.6% vs 8.2%, P < .05) and 90 d (15.8% vs 9.8%, P < .05) readmissions. CONCLUSION Preoperative frailty, as measured by the RAI, was associated with an increased risk of readmission and 90-d and 1-yr mortality following spine surgery. The RAI can be used to stratify spine patients and inform preoperative surgical decision making.

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.

Laparoscopic Shunt Revision Avoids Many Complications of Open Shunt Revision and Has Outcomes Similar to First-time Shunt Placement

2015 ◽  
Vol 81 (3) ◽  
pp. 305-308
Author(s):  
Heather Logghe ◽  
John Maa ◽  
Michael McDermott ◽  
Michael Oh ◽  
Jonathan Carter
Keyword(s):  
Length Of Stay ◽  
Retrospective Cohort ◽  
Operative Time ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Shunt Revision ◽  
Visceral Injury ◽  
Shunt Placement ◽  
Increased Risk ◽  
First Time

Open revision of abdominal shunts is associated with increased risk of wound infection, visceral injury, hernia, and shunt complications. We hypothesized that laparoscopic revision mitigates these risks to a level similar to initial (i.e., first-time) shunt placement. This was a single-center, multisurgeon, retrospective cohort study of patients who underwent either laparoscopic initial shunt placement or laparoscopic shunt revision over a 5-year period. Outcomes were operative time, length of stay, and 30-day complication rate. Sixty-nine patients underwent laparoscopic shunt revision and 99 patients underwent laparoscopic initial shunt placement. Operative times were nearly identical (75 vs 73 minutes, P = 0.63). There were no significant differences in blood loss or hospital length of stay. Abdominal complications and total complications did not differ between groups. Laparoscopic shunt revision avoided many of the known complications of open shunt revision and had outcomes similar to initial laparoscopic shunt placement.

Could payer mix affect length of stay or readmissions among an outpatient palliative care cohort?

2017 ◽  
Vol 35 (31_suppl) ◽  
pp. 165-165
Author(s):  
Ali John Zarrabi ◽  
Karen Armstrong ◽  
Kimberly A. Curseen ◽  
Tammie E. Quest
Keyword(s):  
Palliative Care ◽  
Length Of Stay ◽  
Hospital Readmissions ◽  
Retrospective Chart Review ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Nursing Facilities ◽  
Skilled Nursing ◽  
Commercial Insurance ◽  
Discharge Disposition

165 Background: Outpatient palliative care clinics (PCC) are a developing frontier of palliative medicine. Characterizing and promoting financially viable models for payment of services are imperative to the sustainability of PCC. There is a paucity of research addressing payer mix – meaning the breakdown of individuals and organizations that pay for a provider's services – in PCC or its impact on metrics important to quality in PC such as hospital length of stay (LOS) and hospital readmissions. We seek to describe the payer mix for our academic outpatient PC practice. Furthermore, we sought to identify if payer mix (commercial, government—Medicare, Medicaid – or self-pay) influenced hospital LOS, discharge to hospice, or readmissions. Methods: After obtaining IRB approval, we conducted a retrospective chart review of supportive oncology patients from 2014-2017 (n = 3137) using data restricted to ICD10 codes for solid tumors. We performed bivariate tests and multivariable logistic regressions to examine the main effects of length of stay (LOS), readmissions, insurance status, and discharge disposition using SAS version 9.4 (Cary, NC). Results: Payer mix included 711 (24%) commercial insurance enrollees, 2357 (75%) Medicare or Medicaid recipients, and 38 (1%) self-pay. Mean LOS was 12.7 days (SD 16.38). The majority (94%) of patients had more than 5 readmissions. Commercial insurance was associated with prolonged LOS ( > = 30 days), discharge disposition to hospice, and hospital readmissions ( > 5) compared to government insurance (p < 0.05). Of the 3137 patients, 325 (10%) expired, 1328 (42%) were discharged to hospice, while 1463 (47%) were discharged to rehab, skilled nursing facilities or home care. Conclusions: The majority of patients in our academic PCC had governmental insurance and were less likely than those with commercial insurance to have prolonged LOS, discharge to hospice, or hospital readmission. These findings provide evidence that further investigation is needed to examine the effect of payer mix on PCC and patient outcomes.

EP.FRI.274 Nasogastric decompression in small bowel obstruction

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Adewale Ayeni ◽  
Ramprasad Rajebhosale ◽  
Prabhu Ravi ◽  
Pradeep Thomas
Keyword(s):  
Small Bowel ◽  
Hospital Stay ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Optimal Timing ◽  
Palliative Intent ◽  
Duration Of Hospital Stay ◽  
History Of ◽  
Randomized Control ◽  
Nasogastric Decompression

Abstract Aim The aim of this study is to review the surgeon’s compliance and efficacy of nasogastric decompression in management of small bowel obstruction. Method This is a retrospective 6 months study from 1st January 2020 to 30th June 2020. Results 73 patients were managed for SBO during this period. Adhesions (43.8%) was identified as the most common cause of small bowel obstruction followed by hernias (27.4%).  51 (70%) patients had nasogastric decompression planned on admission, although there was history of vomiting in 85% of patients at admission. Forty two patients (58%) had nasogastric decompression. Majority (71%) of these patients had NG inserted within 24 hours, only 2 of these patients had it inserted on admission. Of the 44 patients managed conservatively for their SBO, 19 had NG decompression. Two patients died during admission (both managed with palliative intent).  Conclusion The routine use of nasogastric decompression in SBO is still common despite the lack of randomized control trial. Its use is associated with an increase in duration of hospital stay. Although the optimal timing of placement of NG tube is not known, our study shows that placement within 6 hours of admission may shorten the duration of hospital stay. 

Nasogastric decompression not associated with a reduction in surgery or bowel ischemia for acute small bowel obstruction

2017 ◽  
Vol 35 (12) ◽  
pp. 1919-1921 ◽  
Author(s):  
Daniel J. Berman ◽  
Hamza Ijaz ◽  
Mohammad Alkhunaizi ◽  
Paige E. Kulie ◽  
Khashayar Vaziri ◽  
...  
Keyword(s):  
Small Bowel ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Bowel Ischemia ◽  
Acute Small Bowel Obstruction ◽  
Nasogastric Decompression

scholarly journals Can Liposomal Bupivacaine Be Safely Utilized in Elective Spine Surgery?

2018 ◽  
Vol 9 (2) ◽  
pp. 133-137 ◽  
Author(s):  
Luke Brown ◽  
Tristan Weir ◽  
Scott Koenig ◽  
Mark Shasti ◽  
Imran Yousaf ◽  
...  
Keyword(s):  
Relative Risk ◽  
Length Of Stay ◽  
Urinary Retention ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Fusion Surgery ◽  
Liposomal Bupivacaine ◽  
Lumbar Decompression ◽  
Increased Risk ◽  
Significant Difference

Study Design: Single-blinded prospective randomized control trial. Objectives: To compare the incidence of adverse events (AEs) and hospital length of stay between patients who received liposomal bupivacaine (LB) versus a single saline injection, following posterior lumbar decompression and fusion surgery for degenerative spondylosis. Methods: From 2015 to 2016, 59 patients undergoing posterior lumbar decompression and fusion surgery were prospectively enrolled and randomized to receive either 60 mL injection of 266 mg LB or 60 mL of 0.9% sterile saline, intraoperatively. Outcome measures included the incidence of postoperative AEs and hospital length of stay. Results: The most common AEs in the treatment group were nausea (39.3%), emesis (18.1%), and hypotension (18.1%). Nausea (23%), constipation (19.2%), and urinary retention (15.3%) were most common in the control group. Patients who received LB had an increased risk of developing nausea (relative risk [RR] = 1.7; 95% confidence interval [CI] = 0.75-3.8), emesis (RR = 2.3; 95% CI = 0.51-10.7), and headaches (RR = 2.36; 95% CI = 0.26-21.4). Patients receiving LB had a decreased risk of developing constipation (RR = 0.78; 95% CI = 0.25-2.43), urinary retention (RR = 0.78; 95% CI = 0.21-2.85), and pruritus (RR = 0.78; 95% = 0.21-2.8) postoperatively. Relative risk values mentioned above failed to reach statistical significance. No significant difference in the hospital length of stay between both groups was found (3.9 vs 3.9 days; P = .92). Conclusion: Single-dose injections of LB to the surgical site prior to wound closure did not significantly increase or decrease the incidence or risk of developing AEs postoperatively. Furthermore, no significant difference was found in the hospital length of stay between both groups.

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