Surgical Intervention for Laryngomalacia: Age-Related Differences in Postoperative Sequelae

2020 ◽  
Vol 129 (9) ◽  
pp. 901-909
Author(s):  
Vijay A. Patel ◽  
David Adkins ◽  
Jad Ramadan ◽  
Adrian Williamson ◽  
Michele M. Carr
Keyword(s):  
Length Of Stay ◽  
Surgical Intervention ◽  
Hospital Setting ◽  
Inpatient Setting ◽  
Improvement Program ◽  
Perioperative Morbidity ◽  
Prolonged Length ◽  
Laryngeal Surgery ◽  
Age Related ◽  
Significant Difference

Objective: Identify risk factors and determine perioperative morbidity of children undergoing surgery for laryngomalacia (LM). Methods: A retrospective analysis of the multi-institutional American College of Surgeons National Surgical Quality Improvement Program-Pediatric Database (ACS-NSQIP-P) was performed to abstract patients aged <18 years with LM (ICD-10 code Q31.5) who underwent laryngeal surgery (CPT code 31541) from 2015 to 2017. Analyzed clinical variables include patient demographics, hospital setting, length of stay, medical comorbidities, postoperative complications, readmission, and reoperation. Results: A total of 491 patients were identified, 283 were male (57.6%) and 208 were female (42.4%). The mean age at time of surgery was 1.07 years (range .01-17 years). Younger patients were more likely to undergo surgery in the inpatient setting compared to their counterparts ( P < .001). Infants were more likely to have prolonged duration of days from admission to surgery ( P < .001), days from surgery to discharge ( P < .001), and total length of stay ( P<.0010). Finally, there was no significant difference between age groups with respect to 30-day general surgical complications ( P = .189), with an overall low incidence of reintubation (1.2%), readmission (3.1%), and reoperation (1.6%). Conclusion: This analysis supports laryngeal surgery as a safe surgical procedure for LM. However, younger children are more likely to undergo operative intervention in the inpatient setting, endure delays from hospital admission to surgical intervention, and experience a prolonged length of stay due to their overall medical complexity. Recognition of key factors may assist in optimizing perioperative risk assessment and promote timely procedural planning in this unique pediatric patient subpopulation.

Fast Track Minimally Invasive Transmyocardial Revascularization

2009 ◽  
Vol 4 (4) ◽  
pp. 217-220
Author(s):  
Kurt E. Wehberg ◽  
Debra Jackson ◽  
Joseph Walters ◽  
Brandon Redmond ◽  
James C. Todd ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Ejection Fraction ◽  
Minimally Invasive ◽  
Fast Track ◽  
Lower Lobe ◽  
Hospital Length Of Stay ◽  
Perioperative Morbidity ◽  
Prolonged Length ◽  
Transmyocardial Revascularization ◽  
Management Protocol

Objective We evaluated the initial results of a fast-track discharge protocol for patients undergoing minimally invasive transmyocardial revascularization (MiTMR). Methods Fifteen male patients, aged 64.5 ± 9.2 years, with an ejection fraction of 46.8% ± 9.9%, underwent MiTMR through a mini-left anterior thoracotomy aided by robotic-controlled thoracoscopic assistance. A postoperative management protocol included immediate extubation, early chest tube and pulmonary artery catheter removal, and mobilization within 12 hours. Results There were no operative arrhythmias or in-hospital mortalities. Three of 15 patients developed left lower lobe atelectasis, delaying discharge between 2 and 5 days. Overall hospital length of stay was 1.4 ± 1.2 days, although 12 of 15 patients (80%) were discharged to home in 23 hours. Mild-moderate cardiomyopathy (ejection fraction 30%–50%) was not associated with prolonged length of stay. Mean hospital profit margin was $1882.50. One 30-day readmission occurred on day 23 for rapid atrial fibrillation, and one death occurred on day 11. Conclusions Despite these high-risk patients having end-staged, ischemic coronary artery disease, most MiTMR patients can be discharged to home in less than 24 hours. Perioperative morbidity and mortality rates are relatively low, and hospital profit margins are modest.

Abstract 246: Length of Stay and Its Association With Get With the Guidelines-stroke Award Recognition

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Theresa Hamm ◽  
Angela Overton ◽  
Kathie Thomas ◽  
Renee Sednew
Keyword(s):  
Ischemic Stroke ◽  
Length Of Stay ◽  
Average Length ◽  
Hospital Costs ◽  
Stroke Patients ◽  
Improvement Program ◽  
Recommended Care ◽  
Award Winning ◽  
Significant Difference ◽  
Get With The Guidelines

Background and Objectives: The average length of stay (ALOS) provides important information regarding care efficiency and the financing of hospitals. A shorter ALOS helps to reduce hospital costs, increase capacity optimization, and improve hospital efficiency. A longer ALOS can be associated with reduced readmission rates and mortality rates. The objective of this study was to analyze the ALOS for stroke patients based on etiology subtype and Get With The Guidelines (GWTG)-Stroke award recognition. Methods: A retrospective review of the ALOS for hemorrhagic and ischemic stroke patients was conducted for the states of Illinois, Iowa, and Michigan from 99 hospitals using GWTG-Stroke from July 2014 through December 2015. Stroke subsets, GWTG award status, and ALOS were examined. Results: The national ALOS is 5.22 days for ischemic stroke, 12.75 days for subarachnoid hemorrhage (SAH), and 8.5 days for intracerebral hemorrhage (ICH). The ALOS for ischemic stroke was 4.36 days for non-award winning hospitals and 4.52 days for award winning hospitals. The ALOS for SAH was 7.51 days for non-award winning hospitals and 10.77 days for award winning hospitals. The ALOS for ICH was 18.63 days for non-award winning hospitals and 6.80 days for award winning hospitals. Further broken down, hospitals with a higher award (gold vs silver), had longer ALOS for both SAH and ICH (11.11 vs 8.72 and 7.07 vs 5.84 respectively), while there was no significant difference in ALOS for ischemic stroke. Conclusions: This study demonstrated that GWTG-Stroke award winning hospitals have a shorter ALOS for ICH and a higher ALOS for SAH than non-award winning hospitals. Those hospitals that have attained gold award status more closely align with national ALOS. Thus, hospitals that are more adherent to guideline recommended care via a quality improvement program may be more efficient when providing care, which impacts hospitals costs.

scholarly journals Surgery Delay Increases Length of Stay in Thoracolumbar Trauma

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Lawrence Zeldin ◽  
Sean N Neifert ◽  
Robert J Rothrock ◽  
Ian T McNeill ◽  
Jonathan S Gal ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Spinal Injury ◽  
Specific Effect ◽  
Spinal Trauma ◽  
Spine Injury ◽  
Complication Rates ◽  
Improvement Program ◽  
Delayed Surgery ◽  
Significant Difference ◽  
Surgery Timing

Abstract INTRODUCTION The ideal timing from admission of a thoracolumbar spinal trauma patient to the start of surgery at US trauma centers remains a hotly contested area of debate. The effect of surgical latency on patient outcomes in thoracolumbar trauma remains unclear. METHODS All 2013 to 2015 thoracolumbar spinal trauma cases from the American College of Surgeons Trauma Quality Improvement Program (TQIP) were analyzed. Patients with unsurvivable spine injury, polytraumas (serious injuries in more than one bodily region), and those discharged within 24 h were excluded. Patients were classified into 3 groups by surgery timing: less than 8 h (early, N = 1699), between 8 and 24 h (normal, N = 946), and over 24 h (delayed, N = 1601). Mortality, length of stay (LOS), and complication rates were compared between groups. Demographic variables and complication rates were compared. Multivariate logistic regression was utilized to determine the specific effect of surgery timing on outcomes. RESULTS Patients with earlier surgery presented with more severe spinal trauma (P < .0001). Patients in the normal surgical timing cohort were most likely to have altered mental status (4.97% vs 3.24%, P = .05), and less likely to suffer from UTI (4.97% vs 3.24%, P = .03). Patients in the delayed cohort were older (46.2 vs 43.7 yr, P = .0003), more likely to have a longer LOS (11.3 vs 10.6 d, P = .02), return to the ICU (2.94% vs 1.29%, P = .001), experience unplanned intubation (2.06% vs 1%, P = .01) and suffer from cardiac arrest (0.53% vs 1.19%, P = .04). Upon multivariate analysis, delayed surgery was an independent risk factor for prolonged LOS (OR: 1.21, 95% CI: 0.56-1.87, P = .0003). CONCLUSION Patients with earlier surgery possessed more severe spinal injury. When adjusting for demographics and severity, no significant difference is seen in mortality between the different surgery times; however, LOS is prolonged in patients with delayed surgery.

scholarly journals Morbidity and mortality after liver surgery for colorectal liver metastases: a cohort study in a high-volume fast-track programme

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Charlotte Egeland ◽  
Andreas Arendtsen Rostved ◽  
Nicolai Aagaard Schultz ◽  
Hans-Christian Pommergaard ◽  
Thomas Røjkjær Daugaard ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Liver Metastases ◽  
Liver Surgery ◽  
Colorectal Liver Metastases ◽  
Fast Track ◽  
High Volume ◽  
Infectious Complications ◽  
Morbidity And Mortality ◽  
Perioperative Morbidity ◽  
Prolonged Length

Abstract Background For colorectal liver metastases, surgery is a high-risk procedure due to perioperative morbidity. The objective was to assess severity of complications after fast-track liver surgery for colorectal liver metastases and their impact on morbidity and mortality. Methods All patients were treated according to the same fast-track programme. Complications were graded according to the Clavien–Dindo classification for patients undergoing surgery from 2013 to 2015. Correlation between complications and length of stay was analysed by multivariate linear regression. Results 564 patient cases were included of which three patients died within 3 months (0.53%, 95% CI: 0.17–1.64%). Complications were common with Grade ≤ 2 in 167 patients (30%) and ≥ Grade 3a in 93 (16%). Patients without complications had a mean length of stay of 4.1 days, which increased with complications: 1.4 days (95% CI: 1.3–1.5) for Grade 2, 1.7 days (1.5–2.0) for Grade 3a, 2.3 days (1.7–3.0) for Grade 3b, 2.6 days (1.6–4.2) for Grade 4a, and 2.9 days (2.8–3.1) for Grade 4b. Following were associated with increased length of stay: complication severity grade, liver insufficiency, ascites, biliary, cardiopulmonary, and infectious complications. Conclusions Complications after liver surgery for colorectal liver metastases, in a fast track setting, were associated with low mortality, and even severe complications only prolonged length of stay to a minor degree.

scholarly journals 1381. Do Gut Microbiome Profiles Correlate with Hospital Length of Stay During Hematopoietic Stem Cell Transplantation?

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S776-S777
Author(s):  
Angelico Mendy ◽  
Kitty Tierney ◽  
Tara Mink ◽  
Walaa Hussein ◽  
Peter Monaco ◽  
...  
Keyword(s):  
Stem Cell ◽  
Length Of Stay ◽  
Microbial Diversity ◽  
Hematopoietic Stem Cell ◽  
Gut Microbiome ◽  
P Value ◽  
Inpatient Setting ◽  
Hematopoietic Stem ◽  
Microbiome Diversity ◽  
Significant Difference

Abstract Background Length of stay is not only an indicator of how successful a hospitalized patient’s treatment and recovery is, but is also an indicator of fiscal costs to the hospital. Hematopoietic stem cell transplants (HSCT) patients typically experience extended hospital admissions that can vary significantly patient to patient with hospital discharge dependent upon a recovered white blood cell count. Recent literature suggests a gut microbial influence on hematopoiesis. We sought to explore potential associations between gut microbiome diversity and the length of stay in patients undergoing HSCT in the inpatient setting. Methods Within two healthcare systems, we identified patients who would receive conditioning chemotherapy and subsequent HSCT in the inpatient setting. Pre-chemotherapy stool was collected, sequenced with shotgun metagenomics, and analyzed for gut microbial diversity using Inverse-Simpson index. The length of admission or length of stay during their transplant process was recorded. We assessed whether there was an association with gut microbial diversity and length of stay. Results 24 patients we evaluated for diversity and length of stay. There was no significant correlation between age or gender and length of stay. Significant difference in length of stay was seen between allogenic vs autogenic transplants (p value ≤0.01). Within the 24 patients, lengths of stay ranged from 8 to 36 days with a mean average of 20.9 days. Gut diversity ranged from 1.8 to 23.9. An overall negative association between length of stay and diversity was seen, though this was determined not statistically significant (p value 0.09). Length of Stay correlation with pre-chemotherapy Gut Microbiome diversity Conclusion Our study showed no significant association between gut microbial diversity and inpatient length of stay during HSCT. Overall, a trend towards increased length of stay in patients with decreased diversity was noted. Additional studies of greater participant size are necessary to confirm or further study these findings. Disclosures All Authors: No reported disclosures

scholarly journals Hospital-acquired conditions: predictors and implications for outcomes following spine tumor resection

2017 ◽  
Vol 27 (6) ◽  
pp. 717-722 ◽  
Author(s):  
Nikita Lakomkin ◽  
Constantinos G. Hadjipanayis
Keyword(s):  
Risk Factors ◽  
Length Of Stay ◽  
Adverse Events ◽  
Multivariable Analysis ◽  
Tumor Resection ◽  
Improvement Program ◽  
Spine Tumor ◽  
Prolonged Length ◽  
Hospital Acquired Conditions ◽  
Hospital Acquired

OBJECTIVEHospital-acquired conditions (HACs) significantly compromise patient safety, and have been identified by the Centers for Medicare and Medicaid Services as events that will be associated with penalties for surgeons. The mitigation of HACs must be an important consideration during the postoperative management of patients undergoing spine tumor resection. The purpose of this study was to identify the risk factors for HACs and to characterize the relationship between HACs and other postoperative adverse events following spine tumor resection.METHODSThe 2008–2014 American College of Surgeons’ National Surgical Quality Improvement Program database was used to identify adult patients undergoing the resection of intramedullary, intradural extramedullary, and extradural spine lesions via current procedural terminology and ICD-9 codes. Demographic, comorbidity, and operative variables were evaluated via bivariate statistics before being incorporated into a multivariable logistic regression model to identify the independent risk factors for HACs. Associations between HACs and other postoperative events, including death, readmission, prolonged length of stay, and various complications were determined through multivariable analysis while controlling for other significant variables. The c-statistic was computed to evaluate the predictive capacity of the regression models.RESULTSOf the 2170 patients included in the study, 195 (9.0%) developed an HAC. Only 2 perioperative variables, functional dependency and high body mass index, were risk factors for developing HACs (area under the curve = 0.654). Hospital-acquired conditions were independent predictors of all examined outcomes and complications, including death (OR 2.26, 95% CI 1.24–4.11, p = 0.007), prolonged length of stay (OR 2.74, 95% CI 1.98–3.80, p < 0.001), and readmission (OR 9.16, 95% CI 6.27–13.37, p < 0.001). The areas under the curve for these models ranged from 0.750 to 0.917.CONCLUSIONSThe comorbidities assessed in this study were not strongly predictive of HACs. Other variables, including hospital-associated factors, may play a role in the development of these conditions. The presence of an HAC was found to be an independent risk factor for a variety of adverse events. These findings highlight the need for continued development of evidence-based protocols designed to reduce the incidence and severity of HACs.

Patient and Aneurysm Characteristics Predicting Prolonged Length of Stay After Elective Open AAA Repair in the Endovascular Era

2017 ◽  
Vol 52 (1) ◽  
pp. 5-10 ◽  
Author(s):  
Sergio Casillas-Berumen ◽  
Florencia A. Rojas-Miguez ◽  
Alik Farber ◽  
Sevan Komshian ◽  
Jeffrey A. Kalish ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Chronic Obstructive ◽  
Improvement Program ◽  
Obstructive Pulmonary Disease ◽  
Prolonged Length ◽  
Type Iv ◽  
Caucasian Race ◽  
Risk Patients ◽  
Aneurysm Repair ◽  
Aortic Aneurysm Repair

Introduction: Open aortic aneurysm repair (AAA) repair can be resource intensive and associated with a prolonged length of stay (LOS). We sought to examine patient and aneurysm predictors of prolonged LOS to better identify those at risk in the preoperative setting. Methods: Patient data were obtained from the targeted AAA American College of Surgery National Surgical Quality Improvement Program database from 2012 to 2014 of patients undergoing open AAA repair. Multivariable logistic regression was used to determine predictors of prolonged postoperative LOS defined as greater than 10 days (75th percentile). Results: There were 1172 open AAA repairs identified. The majority (54%) of patients were older than 70 years and male (74%). Surgical approach was transperitoneal (70.9%) and retroperitoneal (29.1%). Aneurysms were 51.4% infrarenal, 33% juxtarenal, 5.7% pararenal, 7.4% suprarenal, and 2.5% type IV thoracoabdominal. Mean and median LOS were 9.1 ± 7.4 and 7 (0-72) days, respectively. Independently associated with extended LOS factors were visceral revascularization (odds ratio [OR]: 5.32, 95% confidence interval [CI]: 2.77-10.22, P < .001), type IV thoracoabdominal extent (OR: 3.09, 95% CI: 1.01-9.46, P = .048), suprarenal extent (OR: 1.89, 95% CI: 1.07-3.34, P = .029) and juxtarenal (OR: 1.43, 95% CI: 1.01-2.02, P = .004), non-Caucasian race (OR: 2.80, 95% CI: 1.77-4.41, P < .001), chronic obstructive pulmonary disease (OR: 1.76, 95% CI: 1.20-2.59, P = .004), not-from-home admission (OR: 1.91, 95% CI: 1.13-3.24), and age greater than 70 (OR: 1.49, 95% CI: 1.08-2.05, P = .014). Conclusion: We identified patient and aneurysm characteristics independently associated with protracted LOS following open AAA repair. Prospective identification of high-risk patients may allow physicians and hospitals to engage in multidisciplinary collaborations preoperatively to try to improve LOS in this resource-intensive population.

scholarly journals Age-Related Changes of the Ocular Surface: A Hospital Setting-Based Retrospective Study

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Laura Ottobelli ◽  
Paolo Fogagnolo ◽  
Marta Guerini ◽  
Luca Rossetti
Keyword(s):  
Ocular Surface ◽  
Real Life ◽  
Hospital Setting ◽  
Adherence To Treatment ◽  
Recovery Rates ◽  
Age Related ◽  
Ocular Surface Diseases ◽  
Significant Difference ◽  
Prevalent Disease ◽  
Clinical Records

Purpose. To investigate the effects of age on the prevalence of ocular surface diseases (OSD), adherence to treatment, and recovery rates.Patients and Methods. Retrospective analysis of 3000 clinical records from a first-level general ophthalmology clinic. Patients with OSD were prospectively submitted a questionnaire to assess compliance and recovery rates.Results. OSD prevalence was 10.3%. Patients with OSD were significantly older than patients without it:67.5±20.3versus57.0±22.0years(P=0.036). No significant difference in season distribution was shown. Dry eye disease (DED) represented 58% of OSD; its prevalence increased with age until 80 years old and suddenly decreased thereafter. Asymptomatic DED was 37%. Adherence to treatment in OSD was very high (94%); recovery rates were lower in patients aged 21–40 and 61–80 (resp., 65.5% and 77.8%) and this was associated with higher OSDI scores. Tear substitutes represented 50% of all prescribed medications; their use increased with age.Discussion. In a “real-life” low-tech setting, OSD showed a prevalence of 10.3%. DED was the most prevalent disease, and it was asymptomatic in more than 1/3 of cases.

scholarly journals Effect of Myelopathy on Outcomes After Cervical Disc Replacement: A Study of a Local Patient Cohort and a Large National Cohort

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Sheeraz Qureshi ◽  
Andre Samuel ◽  
Steven Mcanany ◽  
Sravisht Iyer ◽  
Todd Albert ◽  
...  
Keyword(s):  
Neck Disability Index ◽  
Perioperative Outcomes ◽  
Cervical Disc ◽  
Improvement Program ◽  
Perioperative Morbidity ◽  
Cervical Disc Replacement ◽  
Arm Pain ◽  
Significant Difference ◽  
Patient Reported ◽  
National Cohort

Abstract INTRODUCTION Previous research has shown increased perioperative morbidity after anterior cervical discectomy and fusion (ACDF) for patients with myelopathy. However, the association of myelopathy with outcomes after CDR has not yet been shown. METHODS Consecutive patients undergoing CDR by a single surgeon were identified and patients undergoing CDR in the 2015 and 2016 National Surgical Quality Improvement Program (NSQIP) database were identified. Patients with a preoperative diagnosis of cervical myelopathy were identified in both cohort, and perioperative outcomes and short-term postoperative outcomes were compared between patients with and without myelopathy. Comparisons were also controlled based on the number of levels treated. RESULTS A total of 27 patients were identified in the institutional cohort, 12 patients (44.4%) with myelopathy. A total of 3023 patients were identified in the national cohort, 411 (13%) with myelopathy. In the institutional cohort, the nonmyelopathy group saw significant improvements in neck disability index (NDI), and visual analog scale (VAS) neck and arm pain at both 2 and 6 wk postoperatively. The myelopathy group only saw a significant improvement in NDI at 6 wk (−13.1± 4.1, P < .05) but not at 2 wk (P > .05). In the national cohort, myelopathy was associated with longer operative time and length of stay, even after controlling for the number of levels treated (P < .05). However, there was no significant difference in perioperative complications (P > .05). CONCLUSION Myelopathy is not associated with increased perioperative morbidity and complications after CDR. Significant improvement in patient reported outcomes is seen at 6 wk in myelopathy patients, although more rapid improvement is seen in patients without myelopathy.

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