Surgery for the Very Old: Are Nonagenarians Different?

2020 ◽  
Vol 86 (1) ◽  
pp. 56-64 ◽  
Author(s):  
Tanner I. Kim ◽  
Anand Brahmandam ◽  
Laura Skrip ◽  
Timur Sarac ◽  
Alan Dardik ◽  
...  
Keyword(s):  
Hospital Stay ◽  
General Surgery ◽  
Postoperative Hospital Stay ◽  
Surgical Patients ◽  
Perioperative Mortality ◽  
Very Old ◽  
Acs Nsqip ◽  
Acs Nsqip Database ◽  
The Impact

Octogenarians and nonagenarians are considered the “very old” and are often viewed as one group. Americans are aging, with the proportion of the very old expected to increase from 1.9 per cent of the population to 4.3 per cent in 2050. This study aimed to underscore the differences in surgical trends, demographics, and outcomes between octogenarians and nonagenarians. The ACS-NSQIP database (2007–2012) was used to derive the type of surgeries, demographics, and outcomes of octogenarian and nonagenarians undergoing nonemergent vascular, orthopedic, and general surgery procedures. Between 2007 and 2012, nonagenarians accounted for an increasing percentage of surgeries (85 to 121 per 10,000 surgeries, relative risk = 1.42; 95% CI: 1.30–1.54) across surgical specialties, including vascular, general, and orthopedic surgery, whereas the percentage of octogenarians undergoing surgery remained unchanged. Nonagenarians had a higher 30-day perioperative mortality and a longer hospital stay than octogenarians after vascular, orthopedic, and general surgery procedures. Nonagenarians are a rapidly growing group of surgical patients with significantly higher perioperative mortality and longer postoperative hospital stay. The impact of surgery on the quality of life of nonagenarians needs to be studied to justify the increasing healthcare costs.

Sustaining Improvement: Implementation and Spread of a Surgical Site Infection Bundle

2018 ◽  
Vol 84 (10) ◽  
pp. 1665-1669 ◽  
Author(s):  
Tara A. Russell ◽  
Hallie Chung ◽  
Christina Riad ◽  
Sarah Reardon ◽  
Kevork Kazanjian ◽  
...  
Keyword(s):  
General Surgery ◽  
Odds Ratio ◽  
Surgical Site Infections ◽  
Surgical Patients ◽  
Infection Rates ◽  
Process Measures ◽  
Quality Metric ◽  
Effective Implementation ◽  
Acs Nsqip ◽  
Significant Challenge

Surgical site infections (SSIs) are considered a quality metric across surgical specialties and are a major cause of increased readmissions and overall costs to surgical patients. Bundled interventions have demonstrated efficacy in reducing SSIs in various surgical fields, yet the ability to sustain and spread interventions while continuing to reduce infection rates is a significant challenge. This study assessed the implementation and sustainability of an SSI bundle, which was initially piloted within the colorectal surgery division and then spread to additional general surgery services. Outcomes (risk-adjusted ACS-NSQIP odds ratio and observed to expected (O:E) SSI rates) and process measures were monitored on run charts throughout the course of the intervention. By the end of the study period, ACS-NSQIP risk-adjusted odds ratios for SSIs decreased from 1.22 to 0.95 for colorectal procedure targeted and 1.32 to 1.04 for all general surgery procedures ( P < 0.05). O:E ratios showed similar reductions. SSI reductions were associated with process measure compliance. This study demonstrates that effective implementation within a single surgical division provides the foundation for spread of a SSI bundle, which results in continued and sustained reductions in SSI rates.

scholarly journals A case study: Applying quality improvement methods to reduce pre-operative length of stay in a resource-constrained setting in Rwanda

2015 ◽  
Vol 5 (1) ◽  
pp. 41 ◽  
Author(s):  
Ssebuufu Robinson ◽  
Victor Pawelzik ◽  
Abraham Megentta ◽  
Oswald Benimana ◽  
Damascene Mazimpaka ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Problem Solving ◽  
Length Of Stay ◽  
Work Group ◽  
Surgical Patients ◽  
P Value ◽  
Post Intervention ◽  
Quality Of Surgery ◽  
The Impact

Objective: While several studies have focused on improving the quality of surgery, less attention has been paid to reducing pre-operative delays in care. We undertook a hospital quality improvement (QI) effort to reduce pre-operative delays in a teaching hospital in Rwanda. Without a coordinated admission schedule, many surgical patients arriving at the hospital for admissions were turned away because of unavailable beds. For those admitted for surgery, the pre-operative waits were long.Methods: A pre- and post-intervention study was conducted to examine the impact of a QI effort on two metrics: 1) pre-operative length-of-stay (LOS) for elective surgical patients, and 2) the number of elective surgical patients who were turned away on the scheduled admission date. Intervention: A multi-disciplinary work group utilized a Strategic Problem Solving Approach and implemented a centralized patient wait list and new schedule process utilizing the existing resources available at the hospital.Results: The percentage of elective surgical patients with a pre-operative LOS of more than two days was significantly lower in the post-intervention compared with the pre-intervention period (80% versus 26.8%, p-value < .001). The percentage of scheduled patients who were turned away due unavailable inpatient beds significantly decreased from 63.4% to 5.3%, p-value < .001.Conclusions: By following a methodical strategic problem solving approach, the pre-operative LOS was reduced, elective surgical patients turned away due to unavailable beds was decreased at very low financial cost.

The Impact of Critical Illness on Perceived Health-Related Quality of Life During ICU Treatment, Hospital Stay, and After Hospital Discharge

CHEST Journal ◽  
2008 ◽  
Vol 133 (2) ◽  
pp. 377-385 ◽  
Author(s):  
Jose G.M. Hofhuis ◽  
Peter E. Spronk ◽  
Henk F. van Stel ◽  
Guus J.P. Schrijvers ◽  
Johannes H. Rommes ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Critical Illness ◽  
Hospital Stay ◽  
Hospital Discharge ◽  
Health Related Quality ◽  
Related Quality ◽  
Health Related ◽  
The Impact ◽  
Icu Treatment

scholarly journals The Impact of Enhanced Recovery after Surgery Protocol on Postoperative Hospital Stay

2013 ◽  
Vol 74 (8) ◽  
pp. 2043-2050
Author(s):  
Yoshihide NANNO ◽  
Fumitaka NAKAMURA ◽  
Minori ISHII ◽  
Toru SHIMIZU ◽  
Naoya OKADA ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Postoperative Hospital Stay ◽  
The Impact

scholarly journals The Impact of Surgery Resident Participation on the Outcome of Carotid Endarterectomy

2020 ◽  
Vol 13 (1) ◽  
pp. 6-8
Author(s):  
Alex Ammar
Keyword(s):  
Hospital Stay ◽  
Carotid Endarterectomy ◽  
General Surgery ◽  
Death Rate ◽  
Stroke Rate ◽  
Vascular Surgeon ◽  
Resident Participation ◽  
Significant Difference ◽  
Surgery Resident ◽  
The Impact

Introduction. The purpose of this study was to determine whether the in-hospital stroke rate plus deaths (SD) was adversely impacted by the participation of surgery residents during carotid endarterectomy. Methods. A single board-certified vascular surgeon performed 5,663 carotid endarterectomies (CEAs) from September 1982 through December 2016. The surgeon prospectively recorded the data used in this report during the patient’s hospital stay. These cases were done at five hospitals, three of which had general surgery residents participating in procedures and two that did not. Results. Of the 5,663 CEAs, residents participated at three hospitals in 4,974 CEAs. In the two hospitals that did not have surgery residents participating, 689 CEAs were performed. Fifty-seven strokes and 12 deaths occurred in hospitals with resident participation (SD 1.39%). Six strokes (0.9%) and no deaths occurred in hospitals without resident participation. No significant difference in stroke rate, death rate, or combined stroke plus death rate (SD) were identified in comparing hospitals with or without resident participation. Conclusion. This report corroborates others that senior general surgery residents did not have a significant impact on SD in patients undergoing CEA.

scholarly journals SP3.2.4 Creating sub-specialty emergency surgical care and changing consultant working patterns improves consultant morale and stress levels

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Edward Hardy ◽  
Thomas Smart ◽  
Jacob Hatt ◽  
Jon Lund
Keyword(s):  
Length Of Stay ◽  
Perceived Stress ◽  
General Surgery ◽  
Surgical Care ◽  
Emergency General Surgery ◽  
Quality Of Patient Care ◽  
Stress Levels ◽  
General Surgeons ◽  
The Impact

Abstract Aims General surgery consultants have some of the highest rates of burnout. Ever increasing emergency general surgery (EGS) admissions playing a major role in this. A move to create split sub-speciality cover consisting of upper GI/HPB (UGI) and colorectal (CR) consultants has been suggested to improve EGS outcomes. We assessed the impact changing on-call working patterns had on perceived consultant stress levels, manageability of their workload and patient length of stay (LOS). Methods Consultant on call patterns changed from an individual consultant covering four consecutive weekdays to two consultants (one UGI/HPB, one CR) sharing four consecutive weekdays. Consultants were surveyed to assess the impact of this change on the manageability of their workload and their perceived stress levels. Admission numbers and LOS were also analysed for all EGS admissions over a 6-month period either side of the rota change. Results 89% of consultants who responded chose to work the new on call format. 78% felt it had improved the manageability of their workload, decreased perceived stress levels and improved quality of patient care. There was no change in the number of EGS admissions (862 vs 866) or EGS patient length over the time periods studied (Pre: 0D: 8%, 1 – 2D 38%, 3 – 4D 19%, &gt;4D 34%. vs Post: 0D 8%, 1 – 2D 40%, 3 – 4D 17%, &gt; 4D 35%). Conclusions A move to shorter and sub-specialty on call duties reduced stress and improved manageability for consultant general surgeons without adverse impact on patient’s length of stay.

scholarly journals Comparison of Intestinal Stent Placement Followed By Laparoscopic Surgery and Emergency Surgery in Obstructive Colorectal Cancer: A Retrospective Analysis and Meta-analysis

2022 ◽  
Author(s):  
Zhengwei Li ◽  
Yan Lu ◽  
Kang Wang ◽  
Tianyou Liao ◽  
Yongle Ju ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Laparoscopic Surgery ◽  
Hospital Stay ◽  
Stent Placement ◽  
Emergency Surgery ◽  
Operating Time ◽  
Postoperative Hospital Stay ◽  
Postoperative Wound Infection ◽  
Intraoperative Blood Loss ◽  
Perioperative Mortality

Abstract Background: For patients with colorectal cancer and malignant intestinal obstruction, it is still controversial to perform endoscopic intestinal stent placement followed by laparoscopic surgery. This study compares the endoscopic intestinal stent placement followed by laparoscopic surgery and emergency surgery in patients with colorectal cancer and malignant intestinal obstruction.Method: 11 compliant publications from Pubmed, Cochrane and Embase databases were analyzed using Revies Manager 5.2 software. SPSS 21 was used to retrospectively analyze 99 patients admitted to our center from 2014 to 2019.Results: There were significant differences between the two groups in three of the five criteria. In the SBTS group, the perioperative mortality rate was lower, with an OR of 0.46 (95% CI: 0.22-0.95, P=0.04), the incidence of postoperative wound infection was lower; OR was 0.44 (95% CI: 0.24-0.82, P=0.009); Postoperative hospital stay was shorter, MD was -2.07 (95% CI: -2.55--1.59, P<0.00001).Retrospective analysis of the clinical outcome differences between the SBTS group and ES group in our center: Compared to the ES group, the SBTS group displayed lower infection rate of surgical incision (χ2=3.94,P =0.04) ); no difference in the frequency of occurrence of anastomotic leakage (χ2=0.18,P=0.67), did not reduce perioperative mortality (χ2=0.94,P=0.33);shorter operating time (204.13±37.35 min) (t=5.08,P=0.000), lower intraoperative blood loss (155.65±94.90 ml) (t=3.90,P=0.001); and shorter postoperative hospital stay (12.91±5.47 d) (t=2.64, P=0.01).Conclusion: Compared the emergency surgery group, endoscopic intestinal stent placement followed by the laparoscopic surgery can reduce perioperative mortality, postoperative wound infection, intraoperative blood loss, and the length of postoperative hospital stay. There was no difference between the two methods as far as the incidence of posterior anastomotic leakage and operating time were concerned.

scholarly journals SP4.1.4 Stay at home, protect the NHS, Save lives? The impact of the COVID-19 pandemic on acute surgical services

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Oliver Brewster ◽  
Dale Thompson ◽  
Emma Sewart ◽  
Sarah Richards
Keyword(s):  
Abdominal Pain ◽  
General Surgery ◽  
District General Hospital ◽  
Surgical Patients ◽  
Emergency Admissions ◽  
Emergency Operations ◽  
Surgical Services ◽  
The Mean ◽  
The Impact ◽  
Second Wave

Abstract Aims Several centres described a ‘lockdown effect’: a reduction in emergency surgical admissions during national lockdown (23/03/20-01/06/20). The extent and reproducibility of this is unclear. We evaluated the impact of the COVID-19 pandemic on emergency general surgical activity in a district general hospital. Methods We conducted a retrospective analysis of patients admitted under general surgery and urology between 01/01/2017-31/12/2020 using coding data. Unpaired t-tests were used to compare the total monthly admissions, admissions by diagnosis and monthly operations performed between the ‘first wave’ (April-May 2020) and ‘average’ (all months 2017-2019), and between the ‘second wave’ (November-December 2020) and average. Results Overall emergency admissions in 2020 were reduced compared to the mean 2017-2019 (4498 vs 5037). Monthly admissions were significantly reduced in the first wave compared to 2017-2019 (mean monthly admissions=284.5 vs 419.8; p &lt; 0.001) with the greatest reduction in patients with non-specific abdominal pain (mean=58 vs 109; p = &lt;0.001). A significant reduction in monthly admissions with pancreatitis (mean=8.0 vs 14.6; p = 0.010) and diverticulitis (mean=10.5 vs 18.8; p = 0.028) were also observed. This effect was less apparent during the second wave (mean total admissions=384.5 vs 419.8; p = 0.249). Monthly emergency operations were reduced in both the first wave compared to average (68 vs 101.9; p = 0.007) and the second wave (74.5 vs 101.9; p = 0.025). Conclusions We found strong evidence of a ‘lockdown effect’ in our centre during the first wave. The cause is unclear and likely to be multifactorial. Further research is needed to evaluate whether surgical patients came to harm as a result.

scholarly journals Clinical Factors Associated with Longer Hospital Stay Following Ovarian Cancer Surgery

Healthcare ◽  
2019 ◽  
Vol 7 (3) ◽  
pp. 85 ◽  
Author(s):  
Christopher G. Smith ◽  
Daniel L. Davenport ◽  
Justin Gorski ◽  
Anthony McDowell ◽  
Brian T. Burgess ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Blood Transfusion ◽  
Hospital Stay ◽  
Improvement Program ◽  
Related Factors ◽  
Factors Associated ◽  
Acs Nsqip ◽  
Postoperative Blood Transfusion ◽  
Platinum Based Chemotherapy ◽  
Acs Nsqip Database

Background: Ovarian cancer (OC) is the leading cause of death from gynecologic malignancy and is treated with a combination of cytoreductive surgery and platinum-based chemotherapy. Extended length of stay (LOS) after surgery can affect patient morbidity, overall costs, and hospital resource utilization. The primary objective of this study was to identify factors contributing to prolonged LOS for women undergoing surgery for ovarian cancer. Methods: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was queried to identify women from 2012–2016 who underwent hysterectomy for ovarian, fallopian tube and peritoneal cancer. The primary outcome was LOS >50th percentile. Preoperative and intraoperative variables were examined to determine which were associated with prolonged LOS. Results: From 2012–2016, 1771 women underwent elective abdominal surgery for OC and were entered in the ACS-NSQIP database. The mean and median LOS was 4.6 and 4.0 days (IQR 0–38), respectively. On multivariate analysis, factors associated with prolonged LOS included: American Society of Anesthesiologists (ASA) Classification III (aOR 1.71, 95% CI 1.38–2.13) or IV (aOR 1.88, 95% CI 1.44–2.46), presence of ascites (aOR 1.88, 95% CI 1.44–2.46), older age (aOR 1.23, 95% CI 1.13–1.35), platelet count >400,000/mm3 (aOR 1.74, 95% CI 1.29–2.35), preoperative blood transfusion (aOR 11.00, 95% CI 1.28–94.77), disseminated cancer (aOR 1.28, 95% CI 1.03–1.60), increased length of operation (121–180 min, aOR 1.47, 95% CI 1.13-1.91; >180 min, aOR 2.78, 95% CI 2.13–3.64), and postoperative blood transfusion within 72 h of incision (aOR 2.04, 95% CI 1.59–2.62) (p < 0.05 for all). Conclusions: Longer length of hospital stay following surgery for OC is associated with many patient, disease, and treatment-related factors. The extent of surgery, as evidenced by perioperative blood transfusion and length of surgical procedure, is a factor that can potentially be modified to shorten LOS, improve patient outcomes, and reduce hospital costs.

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