Preoperative nutritional status impacts clinical outcome and hospital length of stay in pelvic exenteration patients – a retrospective study

Background: Preoperative malnutrition is common in surgical oncology patients and can have negative effects on postoperative outcomes. Pelvic exenteration is major surgery associated with high morbidity rates. Associations between preoperative malnutrition, determined using the patient-generated subjective global assessment, and postoperative outcomes in this patient cohort has not yet been investigated. Aim: To determine if preoperative nutritional status is associated with postoperative surgical and quality of life (QoL) outcomes after pelvic exenteration surgery. Methods: A retrospective cohort study was conducted at a quaternary hospital investigating 123 patients who had pelvic exenteration surgery from January 2017 to August 2019. Preoperative nutritional status and postoperative surgical and QoL outcomes were collected and analysed to determine any associations. Results: Overall, 49.6% of patients were female with a median age of 59 years. Forty patients (32.5%) were malnourished and 83 (67.5%) were well nourished before surgery. Well-nourished patients had a shorter length of hospital stay ( p = 0.034) and at 6 months post-surgery, presented with a significantly better physical and mental QoL score ( p = 0.038 and p = 0.001 respectively). The regression analyses showed that intensive care unit (ICU) readmission rates were 7.19 times more likely to occur in malnourished patients ( p = 0.022). Conclusions: Preoperative malnutrition is associated with increased length of stay, ICU readmissions and poorer QoL following pelvic exenteration. Nutrition screening, assessment and optimisation of management are essential in this patient cohort to improve patient outcomes. Future studies are needed to measure the effect of interventions and identify the most beneficial model of care for this complex patient group.

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Comparison of open and robotic-assisted prostatectomy: The University of British Columbia experience

Canadian Urological Association Journal ◽

10.5489/cuaj.1707 ◽

2014 ◽

Vol 8 (3-4) ◽

pp. 92 ◽

Cited By ~ 9

Author(s):

Louis-Olivier Gagnon ◽

Larry Goldenberg ◽

Kenny Lynch ◽

Antonio Hurtado ◽

Martin Gleave

Keyword(s):

Urinary Incontinence ◽

Length Of Stay ◽

Learning Curve ◽

Tertiary Care ◽

Surgical Margin ◽

Hospital Length Of Stay ◽

Positive Surgical Margin ◽

Robotic Assisted ◽

Post Surgery ◽

The Impact

Introduction: We assessed outcomes and costs of open prostatectomy (OP) versus robotic-assisted prostatectomy (RAP) at a single tertiary care university hospital.Methods: We retrospectively analyzed 200 consecutive OP by 1 experienced open surgeon (MG) and 200 consecutive RAP by an experienced open surgeon (SLG), after allowing for a short learning curve of 70 cases.Results: The 2 groups had similar demographics, including mean age (64.7 vs. 64.2) and mean body mass index (27.2 vs. 27.2). The OP group had a higher proportion of higher risk cancers compared to the RAP group (32.5% vs. 8.5%). Mean skin-to-skin operative room time was less for the OP (114.2 vs. 234.1 minutes). Transfusion rates were similar at 1.5% with OP compared to 3.5% with RAP. The mean length of stay was 1.78 days for OP compared to 1.76 days for RAP, for the last 100 patients in each group. The OP group had more high-grade disease in the prostatectomy specimen, with Gleason ≥8 in 23.5% compared to 3.5% in the RAP group. Positive surgical margin rates were comparable at 31% for OP and 24.6% for RAP, and remained similar after stratification for pT2 and pT3 disease. The grade I and II perioperative complication rate (Clavien-Dindo classification) was lower in the OP group (8.5% vs. 20%). Postoperative stress urinary incontinence rates (4.8% for OP and 4.6% for RAP) and biochemical-free status (91.8% for OP and 96% for RAP) did not differ at 12 months post-surgery. The additional cost of RAP was calculated as $5629 per case. The main limitations of this study are its retrospective nature and lack of validated questionnaires for evaluation of postoperative functional outcomes.Conclusion: While hospital length of stay, transfusion rates, positive surgical margin rates and postoperative urinary incontinence were similar, OP had a shorter operative time and a lower cost compared to the very early experience of RAP. Future parallel prospective analysis will address the impact of the learning curve on these outcomes.

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10th paediatric nutrition week (2019) – influence of the previous nutritional status on hospital length of stay in children

Clinical Nutrition ESPEN ◽

10.1016/j.clnesp.2020.09.511 ◽

2020 ◽

Vol 40 ◽

pp. 577

Author(s):

V. Raoult ◽

D. Guimber ◽

N. Peretti ◽

H. Piloquet ◽

R. Hankard ◽

...

Keyword(s):

Length Of Stay ◽

Nutritional Status ◽

Hospital Length ◽

Hospital Length Of Stay

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Validation of population-specific Mini-Nutritional Assessment with its long-term mortality-predicting ability: results of a population-based longitudinal 4-year study in Taiwan

British Journal Of Nutrition ◽

10.1017/s0007114510000188 ◽

2010 ◽

Vol 104 (1) ◽

pp. 93-99 ◽

Cited By ~ 20

Author(s):

Alan C. Tsai ◽

Shu-Fang Yang ◽

Jiun-Yi Wang

Keyword(s):

Life Satisfaction ◽

Length Of Stay ◽

Nutritional Status ◽

Mortality Risk ◽

Nutritional Assessment ◽

Mini Nutritional Assessment ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Nutritional Screening ◽

Screening Assessment

Nutrition is a key element in geriatric health, and nutritional screening/assessment is a key component of comprehensive geriatric evaluation. The study aimed to validate the Mini Nutritional Assessment Taiwan version-1 (MNA-T1) which adopted population-specific anthropometric cut-points, and version-2 (MNA-T2) which replaced BMI with mid-arm and calf circumferences in the scale for predicting the nutritional status of elderly Taiwanese. Using data of a population-representative longitudinal study of 2802 Taiwanese aged 65 years or older, the study graded the nutritional status of each subject with the original and both modified versions at baseline, analysed their hospital length of stay, the Activities of Daily Living (ADL), the Center for Epidemiologic Studies Depression Scale (CES-D) and life-satisfaction scores at baseline and end of 4 years, and tracked their survival during the period. Results showed that both modified versions had superior predictive abilities compared with the original MNA, and their graded scores correlated better with hospital length of stay, and ADL, CES-D and life-satisfaction scores. Both modified versions were effective in predicting follow-up mortality risk. The relative mortality risk was about 7 times for those rated malnourished and 2·5 times for those rated at risk of malnutrition compared with those who were rated normal at baseline by the two modified versions. These results suggest that both of the modified versions are effective in predicting the nutrition and health statuses of Taiwanese elderly and would serve to validate the predictive ability of the two modified versions. The MNA-T2, which requires no BMI, can make routine nutritional screening/assessment an easier task.

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Childhood Nephrotic Syndrome Management and Outcome: A Single Center Retrospective Analysis

International Journal of Nephrology ◽

10.1155/2017/2029583 ◽

2017 ◽

Vol 2017 ◽

pp. 1-7 ◽

Cited By ~ 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.

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Affects on timeliness of dietitian assessment in acute care: Nutrition screening in acute care related to hospital length of stay and timing of dietitian assessment

The FASEB Journal ◽

10.1096/fasebj.25.1_supplement.989.3 ◽

2011 ◽

Vol 25 (S1) ◽

Author(s):

Danielle DeGarie ◽

Dana Gonzales ◽

Nicholas Hays ◽

Reza Hakkak

Keyword(s):

Length Of Stay ◽

Acute Care ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Nutrition Screening

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Surgical Scheduling Impacts Hospital Length of Stay and Associated Healthcare Costs for Patients Undergoing Total Hip and Knee Arthroplasty

HSS Journal ® ◽

10.1177/15563316211040055 ◽

2021 ◽

pp. 155633162110400

Author(s):

Sofia Ahsanuddin ◽

Daniel J. Snyder ◽

Hsin-Hui Huang ◽

Aakash Keswani ◽

Jashvant Poeran ◽

...

Keyword(s):

Length Of Stay ◽

Skilled Nursing Facility ◽

Hospital Length ◽

Postoperative Outcomes ◽

Hospital Length Of Stay ◽

Skilled Nursing ◽

Total Hip ◽

Surgical Scheduling ◽

Modifiable Factor ◽

Day Of The Week

Background: Surgical scheduling, specifically the day of the week on which surgery is performed, has been associated with various postoperative outcomes in patients undergoing lower extremity joint arthroplasty. Purpose: We sought to investigate surgical scheduling as a potential modifiable factor for patient quality metrics and related costs. Methods: In a retrospective prognostic study, all total knee and total hip arthroplasty (TKA/THA) cases that took place in 2017 to 2018 at a multihospital academic health system were queried. Patients were separated by the day of the week the surgery was performed, with Monday/Tuesday compared to Thursday/Friday. Outcomes included length of stay (LOS) (extended LOS defined as 3 days or longer), cost, and complications. Multivariable regression models measured associations between scheduling of surgery and outcomes; odds ratios (OR) and 95% confidence intervals (CIs) are reported. Results: Overall, 1,571 TKA and 992 THA patients were included (65% and 35%, respectively, performed on Monday/Tuesday and 70% and 30%, respectively, performed on Thursday/Friday). Patients undergoing TKA on Monday/Tuesday versus Thursday/Friday had higher American Society of Anesthesiologists scores (42% vs 33% with score of 3 or higher) but less often an extended LOS (31% vs 54%; adjusted OR: 2.76, 95% CI: 2.22-3.46), lower skilled nursing facility costs (unadjusted mean, $12,515 vs $14,154) and lower home health aide costs (unadjusted mean, $3,793 vs $4,192). Similar patterns were observed in THA patients. Conclusion: These results from institutional data suggest that surgical scheduling is a modifiable factor possibly associated with postoperative outcomes. Furthermore, more rigorous study is warranted.

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Abstract P400: Racial Disparities in Subarachnoid Hemorrhage Outcomes-A Single Center Experience

Stroke ◽

10.1161/str.52.suppl_1.p400 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Jerome Deas ◽

Eyad Almallouhi ◽

Chirantan Banerjee

Keyword(s):

Subarachnoid Hemorrhage ◽

Length Of Stay ◽

Hospital Length ◽

University Hospital ◽

Hospital Length Of Stay ◽

P Value ◽

High Morbidity ◽

Chi Square ◽

Single Center Experience ◽

Discharge Outcomes

Introduction: Subarachnoid hemorrhage (SAH) has high morbidity and mortality, and prior studies have reported outcome disparities between African American (AA) and Caucasian patients. We compared demographics, risk factors, and discharge outcomes among different ethnicities treated at our comprehensive stroke center. Methods: We used data on all SAH patients admitted between July 2014 and March 2020 to our university hospital in the Southeast United States. Race was categorized into AA, Caucasian, and “other.” Pearson chi-square test and analysis of variance were used to compare these variables between the different groups. Results: A total of 578 SAH patients were identified (39% AA patients, 54% Caucasian, and 7% other). Admission Glascow Coma Score (GCS) and Hunt & Hess scores were comparable between the 3 groups. AA patients were significantly younger (51 vs 59 in Caucasian group vs 56 years in Other, p-value <0.001) and had higher BP at admission (systolic BP 152 vs 144 vs 145, p=0.002, diastolic BP 86 vs 80 vs 81, p<0.001). AA patients were more likely to have a history of hypertension (p<0.001) and had higher BMI (30 vs 28.1 vs 26, p=0.003) and Hemoglobin A1c (5.8 vs 5.6 vs 6.1, p=0.013). Modified Rankin scale (mRS) at discharge, in-hospital mortality, and discharge destination were similar between the groups, but AA patients had a longer mean hospital length of stay (19 vs 14 vs 17 days, p=0.035). Conclusion: In our cohort, AA SAH patients were significantly younger and had more comorbidities at admission. Although they had a higher length of stay, discharge outcomes were comparable to other races.

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Hubungan IMT dan Kadar Albumin berhubungan dengan Penyembuhan Luka

Jurnal Keperawatan Padjadjaran ◽

10.24198/jkp.v4i1.137 ◽

1970 ◽

Vol 4 (1) ◽

Author(s):

Syahrul Said ◽

Nurpudji A. Taslim ◽

Burhanuddin Bahar

Keyword(s):

Body Mass Index ◽

Wound Healing ◽

Food Intake ◽

Length Of Stay ◽

Nutritional Status ◽

Body Mass ◽

Gastrointestinal Surgery ◽

Albumin Level ◽

Cross Sectional ◽

Post Surgery

Pasien perioperatif gastrointestinal berisiko tinggi mengalami malnutrisi. Malnutrisi dapat menyebabkan hasil yang tidak diharapkan pada asuhan keperawatan perioperatif. Penelitian ini bertujuan untuk mengidentifikasi hubungan status gizi pasien bedah gastrointestinal berdasarkan parameter antropometri (Indeks Massa Tubuh, Tebal Lipatan Kulit, dan Lingkar Lengan Atas) dan klinis (albumin dan tingkat hemoglobin) dengan penyembuhan luka dan lama rawat inap, serta mengidentifikasi asupan makanan pasien pra dan pasca operasi. Penelitian cross-sectional ini mengukur 38 pasien yang menjalani pembedahan gastrointestinal di sebuah rumah sakit umum daerah di Indonesia. IMT, TLK, LLA, albumin dan kadar hemoglobin diukur sebelum dan sesudah operasi. asupan makanan diukur dengan 24 jam makanan Recall. Sementara penyembuhan luka pasien diukur pada hari ke-3 dan ke-7 hari pasca pembedahan. Terjadi peningkatan prevalensi malnutrisi pada pasien sebesar 60% selama tinggal di rumah sakit. IMT dan kadar albumin secara bermakna berhubungan dengan penyembuhan luka (p <0,05). Rerata lama rawat inap pasien dengan IMT normal (13,8 ± 5,6 hari) lebih pendek dari pasien gizi kurang (27,8 ± 17,7 hari) dan pasien gizi lebih (22,4 ± 11,6 hari). Asupan pasien umumnya di bawah kebutuhan mereka. IMT, tingkat albumin, dan asupan makanan memiliki peran penting untuk penyembuhan luka dan lama rawat inap pasien pembedahan gastrointestinal di rumah sakit. Rumah sakit harus melakukan penilaian awal status gizi pasien (setidaknya IMT dan kadar albumin) untuk mengidentifikasi kebutuhan pasien, dan memberikan intervensi yang tepat sebelum dan setelah operasi.Kata kunci: Kadar albumin, lama rawat inap, penyembuhan luka, status gizi. Body Mass Index and Albumin Level related to Wound HealingAbstractPatients with gastrointestinal perioperative are at high risk of being malnutrition. Malnutrition could cause an adverse outcome of perioperative nursing care. This study aimed to identify the relationship of nutritional status of gastrointestinal surgical patients based on anthropometrical (Body Mass Index, Tricep Skin Fold, Mid Arm Circumference) and clinical laboratory (albumin and haemoglobin level) parameters to wound healing and length of stay (LOS), and identify food intake of patients pre and post surgery. This cross-sectional study included 38 patients who were undergoing gastrointestinal surgery at a regional hospital in Indonesia. BMI, TSF, MAC, albumin and hemoglobin level were measured pre and post surgery. Food intake was measured by 24 hours Food Recall. While patients wound healing was measured on the 3rd and 7thday of surgery. Malnutrition among patients increases 60% during the stay in the hospital. BMI and albumin level were significantly related to wound healing (p<0,05). The average LOS of patients with normal BMI (13.8 ± 5.6 days) was shorter than the underweight patient (27.8 ± 17.7 days) and overweight patients (22.4 ± 11.6 days). Intake of patients was generally under the need of their body. BMI status, albumin level, and food intake play a significant role to wound healing and length of stay patient gastrointestinal surgery at the hospital. The hospital should perform an initial assessment (at least BMI and albumin level) of nutritional status of patients to identify the need for patients, and provide appropriate intervention before and after surgery.Keywords: Albumin level, length of stay, nutritional status, wound healing.

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