Factors Predicting Increased Length of Stay in Abdominal Wall Reconstruction

2021 ◽  
pp. 000313482110475
Author(s):  
Sharbel A. Elhage ◽  
Sullivan A. Ayuso ◽  
Eva B. Deerenberg ◽  
Jenny M. Shao ◽  
Tanushree Prasad ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Length Of Stay ◽  
Abdominal Wall ◽  
Operative Time ◽  
Enhanced Recovery ◽  
Abdominal Wall Reconstruction ◽  
Mesh Infection ◽  
Inclusion Criteria ◽  
Increased Risk ◽  
Eras Protocol

Background Enhanced recovery after surgery (ERAS) programs have become increasingly popular in general surgery, yet no guidelines exist for an abdominal wall reconstruction (AWR)–specific program. We aimed to evaluate predictors of increased length of stay (LOS) in the AWR population to aid in creating an AWR-specific ERAS protocol. Methods A prospective, single institution hernia center database was queried for all patients undergoing open AWR (1999-2019). Standard statistical methods and linear and logistic regression were used to evaluate for predictors of increased LOS. Groups were compared based on LOS below or above the median LOS of 6 days (IQR = 4-8). Results Inclusion criteria were met by 2,505 patients. On average, the high LOS group was older, with higher rates of CAD, COPD, diabetes, obesity, and pre-operative narcotic use (all P < .05). Longer LOS patients had more complex hernias with larger defects, higher rates of mesh infection/fistula, and more often required a component separation (all P < .05). Multivariate analysis identified age (β0.04,SE0.02), BMI (β0.06,SE0.03), hernia defect size (β0.003,SE0.001), active mesh infection or mesh fistula (β1.8,SE0.72), operative time (β0.02,SE0.002), and ASA score >4 (β3.6,SE1.7) as independently associated factors for increased LOS (all P < .05). Logistic regression showed that an increased length of stay trended toward an increased risk of hernia recurrence ( P = .06). Conclusions Multiple patient and hernia characteristics are shown to significantly affect LOS, which, in turn, increases the odds of AWR failure. Weight loss, peri-operative geriatric optimization, prehabilitation of comorbidities, and operating room efficiency can enhance recovery and shorten LOS following AWR.

scholarly journals O44 ENHANCED RECOVERY AFTER SURGERY (ERAS) IN PATIENTS UNDERGOING COMPLEX ABDOMINAL WALL RECONSTRUCTION (AWR)

2021 ◽  
Vol 108 (Supplement_8) ◽  
Author(s):  
Michael Katzen ◽  
Sullivan Ayuso ◽  
Bola Aladegbami ◽  
Raageswari Nayak ◽  
Paul Colavita ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Patient Outcomes ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Abdominal Wall Reconstruction ◽  
Transversus Abdominis ◽  
Hospital Length Of Stay ◽  
Smoking History ◽  
Wound Complications ◽  
Increased Risk

Abstract Aim Enhanced Recovery After Surgery (ERAS) is often conceptually associated with hospital length of stay (LOS), but its true purpose is the application of best science to achieve best patient outcomes. We hypothesized that the implementation of the ERAS program would improve outcomes while possibly leading to a decreased LOS. Material and Methods Prospective institutional hernia database queried for patients who underwent open AWR between 2010–2014 (pre-ERAS) and 2016-2020 (ERAS). Demographics, operative characteristics and postoperative outcomes were compared between pre-ERAS and ERAS patients. Standard descriptive statistics and logistic regression were used. Results 1713 patients were analyzed (ERAS-802, pre-ERAS-911). ERAS patients were similar in terms of age (58.9±12.1vs58.4±12.5;p=0.29) and diabetes (24.6%vs25.9%;p=0.53) compared to pre-ERAS patients, but ERAS patients had lower BMI (31.2±6.3vs33.3±8.1 kg/m2;p&lt;0.01) and increased smoking history (35.8%vs16.1%;p&lt;0.01). The percentage of ERAS patients with CDC 3 and 4 wound classes was higher (12.7%/11.9%vs10.4%/7.4%;p&lt;0.01) as was the use of biologic mesh (30.0% vs 17.4%; p &lt; 0.01). There were no significant differences in defect (208.3±165.4 cm2 vs 216.4 ±254.2cm2; p=0.16) or mesh size (824.1±477.7 cm2 vs 769.1±426.2cm2; p=0.99). ERAS patients had fewer panniculectomies (21.7%vs28.0%;p=0.02) and shorter operative time (176.3±81.6 vs 186.3±87.5min; p=0.01). Mean LOS shorter for ERAS patients (6.5±4.8vs7.2±7.1;p&lt;0.01). When transversus abdominis plane block was added (2018), LOS decreased further (6.0±6.0 days) and narcotic use decreased by 65.1% (each:p&lt;0.05). ERAS had fewer wound complications (14.1%vs32.3%;p&lt;0.01), mesh infections (0.6 %vs2.5%; p&lt;0.01), and 30-day readmissions (2.5%vs11.4%;p&lt;0.01). In logistic regression, BMI, operation time, and panniculectomy increased risk for wound complications. Conclusions ERAS measures improve multiple aspects of AWR patient outcomes including LOS, wound complications and readmissions.

Prevention and Treatment Strategies for Mesh Infection in Abdominal Wall Reconstruction

2018 ◽  
Vol 142 ◽  
pp. 149S-155S ◽  
Author(s):  
Angela M. Kao ◽  
Michael R. Arnold ◽  
Vedra A. Augenstein ◽  
B. Todd Heniford
Keyword(s):  
Abdominal Wall ◽  
Abdominal Wall Reconstruction ◽  
Treatment Strategies ◽  
Mesh Infection ◽  
Prevention And Treatment

Enhanced recovery after abdominal wall reconstruction reduces length of postoperative stay: An observational cohort study

Surgery ◽  
2019 ◽  
Vol 165 (2) ◽  
pp. 393-397 ◽  
Author(s):  
Kristian Kiim Jensen ◽  
Jannie Dressler ◽  
Niklas Nygaard Baastrup ◽  
Henrik Kehlet ◽  
Lars Nannestad Jørgensen
Keyword(s):  
Cohort Study ◽  
Abdominal Wall ◽  
Enhanced Recovery ◽  
Abdominal Wall Reconstruction ◽  
Observational Cohort Study ◽  
Postoperative Stay ◽  
Observational Cohort

scholarly journals Implementation of an ERAS Pathway in Colorectal Surgery

2019 ◽  
Vol 32 (02) ◽  
pp. 102-108 ◽  
Author(s):  
Liliana Bordeianou ◽  
Paul Cavallaro
Keyword(s):  
Colorectal Surgery ◽  
Length Of Stay ◽  
Postoperative Care ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Standardized Protocol ◽  
Improve Hospital ◽  
Eras Protocol

AbstractEnhanced Recovery after Surgery (ERAS) protocols have been demonstrated to improve hospital length of stay and outcomes in patients undergoing colorectal surgery. This article presents the specific components of an ERAS protocol implemented at the authors' institution. In particular, details of both surgical and anesthetic ERAS pathways are provided with explanation of all aspects of preoperative, perioperative, and postoperative care. Evidence supporting inclusion of various aspects within the ERAS protocol is briefly reviewed. The ERAS protocol described has significantly benefitted postoperative outcomes in colorectal patients and can be employed at other institutions wishing to develop an ERAS pathway for colorectal patients. A checklist is provided for clinicians to easily reference and facilitate implementation of a standardized protocol.

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.

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.

Do Patient Expectations of Discharge Affect Length of Stay after Deep Inferior Epigastric Perforator Flap for Breast Reconstruction?

2021 ◽  
Author(s):  
Ravinder Bamba ◽  
Jordan E. Wiebe ◽  
Christopher A. Ingersol ◽  
Steven Dawson ◽  
Mithun Sinha ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Breast Reconstruction ◽  
Enhanced Recovery ◽  
Perforator Flap ◽  
Patient Expectations ◽  
Outcome Variable ◽  
Diep Flap ◽  
Group I ◽  
Group Ii ◽  
Eras Protocol

Abstract Introduction Deep inferior epigastric artery perforator (DIEP) flap is a common method of breast reconstruction. Enhanced recovery after surgery (ERAS) postoperative protocols have been used to optimize patient outcomes and facilitate shorter hospital stays. The effect of patient expectations on length of stay (LOS) after DIEP has not been evaluated. The purpose of this study was to investigate whether patient expectations affect LOS. Methods A retrospective chart review was performed for patients undergoing DIEP flaps for breast reconstruction from 2017 to 2020. All patients were managed with the same ERAS protocol. Patients were divided in Group I (early expectations) and Group II (standard expectations). Group I patients had expectations set for discharge postoperative day (POD) 2 for unilateral DIEP and POD 3 for bilateral DIEP. Group II patients were given expectations for POD 3 to 4 for unilateral DIEP and POD 4 to 5 for bilateral. The primary outcome variable was LOS. Results The study included 215 DIEP flaps (45 unilateral and 85 bilateral). The average age was 49.8 years old, and the average body mass index (BMI) was 31.4. Group I (early expectations) included 56 patients (24 unilateral DIEPs, 32 bilateral). Group II (standard expectations) had 74 patients (21 unilateral, 53 bilateral). LOS for unilateral DIEP was 2.9 days for Group I compared with 3.7 days for Group II (p = 0.004). Group I bilateral DIEP patients had LOS of 3.5 days compared with 3.9 days for Group II (p = 0.02). Immediate timing of DIEP (Group I 42.9 vs. Group II 52.7%) and BMI (Group I 32.1 vs. Group II 30.8) were similar (p = 0.25). Conclusion Our study found significantly shorter hospital stay after DIEP flap for patients who expected an earlier discharge date despite similar patient characteristics and uniform ERAS protocol. Patient expectations should be considered during patient counseling and as a confounding variable when analyzing ERAS protocols.

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