Gastroschisis Complicated by Colonic Atresia

2021 ◽  
pp. 000313482110488
Author(s):  
Hayley M. Everett ◽  
S. Dave Bhattacharya
Keyword(s):  
Operating Room ◽  
Abdominal Wall Defect ◽  
Intestinal Atresia ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Tube Placement ◽  
Ileocecal Region ◽  
Colonic Atresia ◽  
Intestinal Dysmotility ◽  
Significant Length

Introduction: Gastroschisis with colonic atresia is a rare association. Due to its rarity and variation in presentation, no standardized surgical treatment option exists. Complicated gastroschisis is associated with a higher morbidity and mortality than intestinal atresia or gastroschisis alone. Methods: This is a case report of a neonate with congenital gastroschisis. On day of life 1, a silo was placed. On day of life 4, the upper portion of silo contents appeared more congested with dusky discoloration and the patient was oliguric. She was taken to the operating room for exploration. Results: The patient required resection of the terminal ileum and an atretic portion of the cecum due to necrosis. Four days later, primary closure of the gastroschisis defect was performed with creation of an end ileostomy. Elective ileostomy takedown was performed 5 months later. She returned to the operating room for anastomotic revision and gastrostomy tube placement for intestinal dysmotility and prolonged ileus. Tube feedings were discontinued 3 months post-operatively. Conclusions: Gastroschisis with intestinal atresia is associated with increased hospital length of stay, longer duration of parenteral nutrition, more severe intestinal dysfunction, increased surgical complications, and higher mortality than gastroschisis or intestinal atresia alone. With associated colonic atresia, loss of a significant length of bowel due to necrosis, including the ileocecal region, is almost unavoidable. An already compromised blood supply to the atretic bowel is further impaired by a tight abdominal wall defect and postnatal increases in gravitational force. Complicated gastroschisis remains a complex surgical challenge requiring further discussion.

Opioid Abuse or Dependence Increases 30-day Readmission Rates after Major Operating Room Procedures

2018 ◽  
Vol 128 (5) ◽  
pp. 880-890 ◽  
Author(s):  
Atul Gupta ◽  
Junaid Nizamuddin ◽  
Dalia Elmofty ◽  
Sarah L. Nizamuddin ◽  
Avery Tung ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Operating Room ◽  
Healthcare Utilization ◽  
Cohort Analysis ◽  
Hospital Costs ◽  
Hospital Length ◽  
Opioid Abuse ◽  
Hospital Length Of Stay ◽  
Opioid Overdose ◽  
Readmission Rates

Abstract Background Although opioids remain the standard therapy for the treatment of postoperative pain, the prevalence of opioid misuse is rising. The extent to which opioid abuse or dependence affects readmission rates and healthcare utilization is not fully understood. It was hypothesized that surgical patients with a history of opioid abuse or dependence would have higher readmission rates and healthcare utilization. Methods A retrospective cohort analysis was performed of patients undergoing major operating room procedures in 2013 and 2014 using the National Readmission Database. Patients with opioid abuse or dependence were identified using International Classification of Diseases codes. The primary outcome was 30-day hospital readmission rate. Secondary outcomes included hospital length of stay and estimated hospital costs. Results Among the 16,016,842 patients who had a major operating room procedure whose death status was known, 94,903 (0.6%) had diagnoses of opioid abuse or dependence. After adjustment for potential confounders, patients with opioid abuse or dependence had higher 30-day readmission rates (11.1% vs. 9.1%; odds ratio 1.26; 95% CI, 1.22 to 1.30), longer mean hospital length of stay at initial admission (6 vs. 4 days; P < 0.0001), and higher estimated hospital costs during initial admission ($18,528 vs. $16,617; P < 0.0001). Length of stay was also higher at readmission (6 days vs. 5 days; P < 0.0001). Readmissions for infection (27.0% vs. 18.9%; P < 0.0001), opioid overdose (1.0% vs. 0.1%; P < 0.0001), and acute pain (1.0% vs. 0.5%; P < 0.0001) were more common in patients with opioid abuse or dependence. Conclusions Opioid abuse and dependence are associated with increased readmission rates and healthcare utilization after surgery.

Efficacy of Negative Pressure Wound Treatment in Preventing Surgical Site Infections after Whipple Procedures

2017 ◽  
Vol 83 (10) ◽  
pp. 1166-1169 ◽  
Author(s):  
Ryan Gupta ◽  
Geoffrey C. Darby ◽  
David K. Imagawa
Keyword(s):  
Negative Pressure ◽  
Average Rate ◽  
Surgical Site Infections ◽  
Whipple Procedure ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Tube Placement ◽  
Wound Treatment ◽  
Improvement Program ◽  
Significant Difference

Surgical site infections (SSIs) occur at an average rate of 21.1 per cent after Whipple procedures per NSQIP data. In the setting of adherence to standard National Surgery Quality Improvement Program (NSQIP) Hepatopancreatobiliary recommendations including wound protector use and glove change before closing, this study seeks to evaluate the efficacy of using negative pressure wound treatment (NPWT) over closed incision sites after a Whipple procedure to prevent SSI formation. We retrospectively examined consecutive patients from January 2014 to July 2016 who met criteria of completing Whipple procedures with full primary incision closure performed by a single surgeon at a single institution. Sixty-one patients were included in the study between two cohorts: traditional dressing (TD) (n = 36) and NPWT dressing (n = 25). There was a statistically significant difference (P = 0.01) in SSI formation between the TD cohort (n = 15, SSI rate = 0.41) and the NPWT cohort (n = 3, SSI rate = 0.12). The adjusted odds ratio (OR) of SSI formation was significant for NPWT use [OR = 0.15, P = 0.036] and for hospital length of stay [OR = 1.21, P = 0.024]. Operative length, operative blood loss, units of perioperative blood transfusion, intraoperative gastrojejunal tube placement, preoperative stent placement, and postoperative antibiotic duration did not significantly impact SSI formation (P > 0.05).

Percutaneous Cholecystostomy Tubes versus Medical Management for Acute Cholecystitis

2021 ◽  
pp. 000313482110545
Author(s):  
Madeline D. Cook ◽  
Saleema A. Karim ◽  
Hanna K. Jensen ◽  
Judy L. Bennett ◽  
Lyle J. Burdine ◽  
...  
Keyword(s):  
Medical Management ◽  
Study Groups ◽  
The United States ◽  
Hospital Length ◽  
Cost Of Care ◽  
Hospital Length Of Stay ◽  
Tube Placement ◽  
Percutaneous Cholecystostomy ◽  
Cholecystostomy Tube ◽  
Percutaneous Cholecystostomy Tube

Background Cholecystitis is one of the most common infections treated surgically in the United States. Surgical risk is prohibitive in some patients, leading to alternative therapeutic strategies, including medical management (antibiotics) with or without percutaneous cholecystostomy tube (PCT) drainage. Materials and methods Using the Healthcare Cost and Utilization Project (HCUP) National Readmission Database (NRD), we performed a retrospective review to compare medically managed patients with or without PCT placement by evaluating 60-day readmissions rates, health care costs, and hospital length of stay (LOS). Both study groups were matched using the Elixhauser comorbidity index, age, and sex. Univariate and multivariate statistical analyses were performed using STATA. Results 776,766 patients were included in the analysis. The population receiving PCT placement was on average 16 years older (69.9 vs 53.6 years; P < .01), less likely to be female (40.7% vs 59.3%; P < .01), and had almost twice as many comorbidities (3.36 vs 1.81; P < .01) compared to the population receiving medical management. After matching our data to account for these incongruities, PCT patients were still 10.4 times more likely to be readmitted, had a 11.6% increase in the cost of care, and a 37.6% increase in LOS compared to those managed medically. Discussion Percutaneous cholecystostomy tube placement for cholecystitis is associated with a higher readmission rate, increased charges, and increased LOS compared to antibiotic therapy alone, even after correcting for age, sex, and comorbidities.

Repetitive Imaging following Minimally Invasive Repair of Pectus Excavatum Is Unnecessary

2018 ◽  
Vol 29 (05) ◽  
pp. 408-411 ◽  
Author(s):  
Richard Sola ◽  
Yangyang R. Yu ◽  
Tyler C. Friske ◽  
Abdur R. Jamal ◽  
Eric H. Rosenfeld ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Clinical Outcomes ◽  
Pectus Excavatum ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Tube Placement ◽  
Haller Index ◽  
Significant Difference ◽  
Repeat Imaging

Introduction The objective of this study was to evaluate the necessity of repeat imaging after an initial chest radiograph (CXR) following minimally invasive repair of pectus excavatum (MIRPE). Materials and Methods A retrospective review was performed on patients who underwent MIRPE from January 2012 to July 2016 at two academic children's hospitals. Data collected included demographics, severity of pectus defect (Haller index [HI]), utilization of CXRs, outpatient follow-up, and clinical outcomes. Results A total of 360 patients (171 at Hospital 1 and 189 at Hospital 2) underwent MIRPE. Median age was 15.6 years and 84% were males. The median HI was 4.0. Median postoperative hospital length of stay was 4.2 days and median time to bar removal was 34 months. There was significant variation in postoperative imaging between the hospitals, including frequency of immediate postoperative CXR, total number of CXRs during hospitalization, and number of postoperative outpatient CXRs prior to bar removal. However, there was no significant difference in outcomes between the hospitals, including postoperative pneumothorax, postoperative chest tube placement, and complications. Conclusion These data suggest that increased repetitive imaging after an initial postoperative CXR does not affect clinical outcomes and may not be necessary after MIRPE.

Displacement Patterns of Blunt Rib Fractures and Their Relationship to Thoracic Coinjuries: Minimal Displacements Count

2016 ◽  
Vol 82 (3) ◽  
pp. 199-206 ◽  
Author(s):  
Nikolay Bugaev ◽  
Janis L. Breeze ◽  
Majid Alhazmi ◽  
Hassan S. Anbari ◽  
Sandra S. Arabian ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Length Of Stay ◽  
Chest Tube ◽  
Hospital Length ◽  
Rib Fractures ◽  
Axial Displacement ◽  
Hospital Length Of Stay ◽  
Tube Placement ◽  
Chest Tube Placement ◽  
Displacement Patterns

Displacement patterns of rib fractures (RF) and their association with thoracic coinjuries and outcomes are unknown. This is a retrospective review of adult patients with blunt closed RF who underwent chest CT at a Level I trauma center (2007–2012). Displacement patterns of RF were compared among the three-dimensional planes using CT images. An analysis of receiver operating characteristic (ROC) curves was performed to identify displacements in each plane most strongly associated with chest coinjuries. Univariate analysis was used to find association of displaced RF with hospital course and outcome. There were 1127 RF (245 patients, most in ribs 3–9, 45 per cent displaced). Axial displacement was the most common, with odds ratios 7.20 and 2.13 compared with cranio-caudal, and impaction-separation (along rib axis) movement, respectively. Axial displacement thresholds performed well with hemothorax (2.8 mm, ROC = 0.74), pneumothorax (2.6 mm, ROC = 0.70), hemopneumothorax (3.1 mm, ROC = 0.77), flail chest (3.4 mm, ROC = 0.80), and chest tube placement (2.8 mm, ROC = 0.75). RF displacement was associated with increased days on mechanical ventilation and hospital length of stay. In conclusion, even minimal RF displacement is associated with increased risk of chest coinjuries and chest tube placement, and displacements correlated with increased days on mechanical ventilation and hospital length of stay. Future studies are required to investigate these associations, especially in relationship to the indications for rib plating.

Initial Suction Evacuation of Traumatic Hemothoraces: A Novel Approach to Decreasing Chest Tube Duration and Complications

2012 ◽  
Vol 78 (8) ◽  
pp. 883-887 ◽  
Author(s):  
Rajesh Ramanathan ◽  
Luke G. Wolfe ◽  
Therese M. Duane
Keyword(s):  
Length Of Stay ◽  
Chest Tube ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Tube Placement ◽  
Suction Catheter ◽  
Trauma Patients ◽  
Surgical Drainage ◽  
High Resource ◽  
Number Of Patients

Between 2 and 4.4 per cent of all patients with trauma chest tubes develop retained hemothoraces. Retained hemothoraces prolong chest tube duration and hospital length of stay, and increase infectious complications like empyema. Early surgical drainage of retained hemothoraces has been shown to decrease complications and reduce hospital length of stay. However, the high resource and expertise requirement may limit the widespread applicability of surgical drainage. We present the results of a relatively simple and novel intervention for traumatic hemothoraces undertaken by our faculty to shorten chest tube duration and prevent empyema formation. At our Level I trauma center, 10 trauma patients underwent initial suction evacuation of their traumatic hemothoraces using a sterile suction catheter before chest tube placement. Compared with propensity matched controls, patients that underwent initial suction evacuation experienced significantly shorter chest tube duration (4.2 ± 1.9 vs 5.8 ± 2.3 days, P = 0.04). Also, in this population, there was an 8.2 per cent decrease in the number of patients that developed empyema or required additional drainage. Our study suggests that initial suction evacuation of traumatic hemothoraces is an effective and relatively easy intervention that reduces the duration of chest tube therapy, empyema formation, and the need for additional surgical intervention.

Carotid endarterectomy following thrombolysis for acute ischaemic stroke

VASA ◽  
2017 ◽  
Vol 46 (2) ◽  
pp. 116-120 ◽  
Author(s):  
Naz Ahmed ◽  
Damian Kelleher ◽  
Manmohan Madan ◽  
Sarita Sochart ◽  
George A. Antoniou
Keyword(s):  
Ischaemic Stroke ◽  
Carotid Endarterectomy ◽  
Acute Ischaemic Stroke ◽  
Intravenous Thrombolysis ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Wound Complications ◽  
Cardiac Complications ◽  
High Dependency ◽  
Low Incidence

Abstract. Background: Insufficient evidence exists to support the safety of carotid endarterectomy (CEA) following intravenous thrombolysis (IVT) for acute ischaemic stroke. Our study aimed to report a single-centre experience of patients treated over a five-year period. Patients and methods: Departmental computerised databases were interrogated to identify patients who suffered an ischaemic stroke and subsequently underwent thrombolysis followed by CEA. Mortality and stroke within 30 days of surgery were defined as the primary outcome end points. Results: Over a five-year period, 177 out of a total of 679 carotid endarterectomies (26 %) were performed in patients presenting with acute ischaemic stroke. Twenty-five patients (14 %) received IVT prior to CEA in the form of alteplase. Sixty percent of patients were male with a mean age of 68 years. Sixteen patients (64 %) underwent CEA within 14 days of IVT and the median interval between thrombolysis and CEA was 7.5 days (range, 3–50 days). One female patient died of a further intraoperative stroke within 30 days of surgery, yielding a mortality rate of 4 %. Two patients (8 %) suffered from cardiac complications postoperatively resulting in a short high dependency unit stay. Another two patients (8 %) developed local wound complications, which were managed conservatively without the need for re-operation. The median hospital length of stay was 4.5 days (range, 1–33 days). Conclusions: Our experience indicates that CEA post-thrombolysis has a low incidence of mortality. Further high quality evidence is required before CEA can be routinely recommended following IVT for acute ischaemic stroke.

Sign in / Sign up

Export Citation Format

Share Document