scholarly journals The impact of complications on prolonged length of hospital stay after resection in colorectal cancer: A retrospective study of Taiwanese patients

2017 ◽  
Vol 45 (2) ◽  
pp. 691-705 ◽  
Author(s):  
Herng-Chia Chiu ◽  
Yi-Chieh Lin ◽  
Hui-Min Hsieh ◽  
Hsin-Pao Chen ◽  
Hui-Li Wang ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Length Of Stay ◽  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Prolonged Hospital Stay ◽  
Prolonged Length ◽  
Regression Methods ◽  
Major Complications ◽  
Prolonged Hospital ◽  
The Impact

Objectives To assess the impact of minor, major and individual complications on prolonged length of hospital stay in patients with colorectal cancer (CRC) after surgery using multivariate models. Methods This was a retrospective review of data from patients who underwent surgery for stage I–III CRC at two medical centres in southern Taiwan between 2005–2010. Information was derived from four databases. Multivariate logistic regression methods were used to assess the impact of complications on prolonged length of stay (PLOS) and prolonged postoperative length of stay (PPOLOS). Results Of 1658 study patients, 251 (15.1%) experienced minor or major postsurgical complications during hospitalizations. Minor and major complications were significantly associated with PLOS (minor, odds ratio [OR] 3.59; major, OR 8.82) and with PPOLOS (minor, OR 5.55; major, OR 10.00). Intestinal obstruction, anastomosis leakage, abdominal abscess and bleeding produced the greatest impact. Conclusions Minor and major complications were stronger predictors of prolonged hospital stay than preoperative demographic and disease parameters. Compared with the PLOS model, the PPOLOS model better predicted risk of prolonged hospital stay. Optimal surgical and medical care have major roles in surgical CRC patients.

Prolonged Length of Stay After Liver Transplantation

ICU Director ◽  
2012 ◽  
Vol 3 (2) ◽  
pp. 75-79
Author(s):  
Andrew T. Young ◽  
Gebhard Wagener
Keyword(s):  
Liver Transplantation ◽  
Length Of Stay ◽  
Hospital Stay ◽  
Kidney Injury ◽  
Hospital Length ◽  
Meld Score ◽  
Hospital Length Of Stay ◽  
Prolonged Hospital Stay ◽  
Prolonged Length ◽  
Prolonged Hospital

Prolonged hospital length of stay after liver transplantation uses a large amount of hospital resources. The authors evaluated factors associated with prolonged hospital stay in a large single center series. Prolonged hospital stay was defined as more than 30 days. A total of 578 adult cadaveric liver transplants were included, and of these, 160 (27.7%) had a prolonged hospital stay. These patients had shorter waitlist time, higher preoperative MELD (model for end-stage liver disease) scores and received organs from donors with lower donor risk indices. In multivariate analysis, only preoperative MELD score remained significant. Postoperatively, there was no difference in the incidence of acute kidney injury; however, patients with prolonged hospital stay were more likely to have early allograft dysfunction and a higher 90-day mortality.

scholarly journals P.3.20 Hospitalization outcomes of road traffic injury patients in the largest hospital in the philippines

2019 ◽  
Vol 76 (Suppl 1) ◽  
pp. A101.3-A102
Author(s):  
Sophia Francesca Lu
Keyword(s):  
Length Of Stay ◽  
Hospital Stay ◽  
Strong Evidence ◽  
Glasgow Coma Score ◽  
Road Traffic ◽  
Road Traffic Injury ◽  
Prolonged Hospital Stay ◽  
Prolonged Length ◽  
Traffic Injury ◽  
Prolonged Hospital

BackgroundRoad traffic injuries claim are among the leading causes of preventable death, claiming around 7000 lives every year. Accordingly, injuries to the head and neck are the main causes of death and disability.ObjectiveThis aimed to identify the determinants of prolonged length of stay in the hospital among victims of road traffic injury.MethodsA retrospective cohort study was conducted. Socio-demographics, accident details (e.g. time of injury, type of victim, other party to the accident, time to admission, intoxication, and helmet use), the Glasgow Coma Score upon admission, head injuries, torso injuries, injuries to the limbs, and length of stay) were abstracted from the patient charts and cleaned accordingly. The predictor model for the determinants of prolonged length of stay in the hospital was built.ResultsThere were 427 road traffic injury victims that were admitted during the time period considered. The distribution of the time to admission differed between those who have a short length of stay and long stay differed significantly (p<0.01). Glasgow coma score, type of victim, mortality, age, and sex were found to be important determinants of prolonged hospital stay. Those who have a low Glasgow Coma Score (i.e. more severe cases) were found to be 2.77 (95% CI: 1.13–6.91) times more likely to stay longer in the hospital as compared to those who have high Score. There is strong evidence for this association. Passengers are 78% (95% CI: 0.06–0.84) less likely to stay longer in the Hospital as compared to drivers. There is also strong evidence for this association.ConclusionBased on the predictive model from 427 traffic injury patients, determinants of prolonged hospital stay were identified. Consequent policies and programs should address this.

565 POST-OPERATIVE WEIGHT LOSS AND OUTCOMES FOLLOWING ESOPHAGECTOMY

2020 ◽  
Vol 33 (Supplement_1) ◽  
Author(s):  
R Khaw ◽  
S Munro ◽  
J Sturrock ◽  
H Jaretzke ◽  
S Kamarajah ◽  
...  
Keyword(s):  
Weight Loss ◽  
Length Of Stay ◽  
Hospital Stay ◽  
Enhanced Recovery ◽  
Length Of Hospital Stay ◽  
Failure To Thrive ◽  
Post Discharge ◽  
Postoperative Weight Loss ◽  
Poor Outcomes ◽  
The Impact

Abstract   Oesophageal cancer is the 11th most common cancer worldwide, with oesophagectomy remaining the mainstay curative treatment, despite significant associated morbidity and mortality. Postoperative weight loss remains a significant problem and is directly correlated to poor prognosis. Measures such as the Enhanced Recovery After Surgery (ERAS) programme and intraoperative jejunostomy feed have looked to tackle this. This study investigates the impact of these on mortality, length of hospital stay and postoperative weight loss. Methods Patients undergoing oesophagectomy between January 1st 2012—December 2014 and 28th October 2015–December 31st 2019 in a national tertiary oesophagogastric unit were included retrospectively. Variables measured included comorbidities, operation, histopathology, weights (pre- and post-operatively), length of hospital stay, postoperative complications and mortality. Pre-operative body weight was measured at elective admission, and further weights were identified from a prospectively maintained database, during further clinic appointments. Other data was collected through patient notes. Results 594 patients were included. Mean age at diagnosis was 65.9 years (13–65). Majority of cases were adenocarcinoma (63.3%), with varying stages of disease (TX-4, NX-3). Benign pathology accounted for 8.75% of cases. Mean weight loss post-oesophagectomy exceeded 10% at 6 months (SD 14.49). Majority (60.1%) of patients were discharged with feeding jejunostomy, and 5.22% of these required this feed to be restarted post-discharge. Length of stay was mean 16.5 days (SD 22.3). Complications occurred in 68.9% of patients, of which 13.8% were infection driven. Mortality occurred in 26.6% of patients, with 1.83% during hospital admission. 30-day mortality rate was 1.39%. Conclusion Failure to thrive and prolonged weight-loss following oesophagectomy can contribute to poor recovery, with associated complications and poor outcomes, including increased length of stay and mortality. Further analysis of data to investigate association between weight loss and poor outcomes for oesophagectomy patients will allow for personalised treatment of high-risk patients, in conjunction with members of the multidisciplinary team, including dieticians.

scholarly journals Influence of Weekday of Admission and Level of Distress on Length of Hospital Stay in Patients With Low Back Pain: A Retrospective Cohort Study

2020 ◽  
Author(s):  
Emanuel Brunner ◽  
André Meichtry ◽  
Davy Vancampfort ◽  
Reinhard Imoberdorf ◽  
David Gisi ◽  
...  
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
Back Pain ◽  
Hospital Stay ◽  
Linear Model ◽  
Length Of Hospital Stay ◽  
Complex Problem ◽  
Interdisciplinary Management ◽  
Prolonged Length ◽  
The Impact

Abstract BackgroundLow back pain (LBP) is often a complex problem requiring interdisciplinary management to address patients’ multidimensional needs. The inpatient care for patients with LBP in primary care hospitals is a challenge. In this setting, interdisciplinary LBP management is often unavailable during the weekend. Delays in therapeutic procedures may result in prolonged length of hospital stay (LoS). The impact of delays on LoS might be strongest in patients reporting high levels of psychological distress. Therefore, this study investigates which influence the weekday of admission and distress have on LoS of inpatients with LBP.MethodsRetrospective cohort study conducted between 1 February 2019 and 31 January 2020. ANOVA was used to test the hypothesized difference in mean effects of the weekday of admission on LoS. Further, a linear model was fitted for LoS with distress, categorical weekday of admission (Friday/Saturday vs. Sunday-Thursday), and their interactions.ResultsWe identified 173 patients with LBP. Mean LoS was 7.8 days (SD=5.59). Patients admitted on Friday (mean LoS=10.3) and Saturday (LoS=10.6) had longer stays but not those admitted on Sunday (LoS=7.1). Analysis of the weekday effect (Friday/Saturday vs. Sunday-Thursday) showed that admission on Friday or Saturday was associated with significant increase in LoS compared to admission on other weekdays (t=3.43, p=<0.001). 101 patients (58%) returned questionnaires, and complete data on distress was available from 86 patients (49%). According to a linear model for LoS, the effect of distress on LoS was significantly modified (t=2.51, p=0.014) by dichotomic weekdays of admission (Friday/Saturday vs. Sunday-Thursday).ConclusionsPatients with LBP are hospitalized significantly longer if they have to wait more than two days for interdisciplinary LBP management. This particularly affects patients reporting high distress. Our study provides a platform to further explore whether interdisciplinary LBP management addressing patients’ multidimensional needs reduces LoS in primary care hospitals.

Impact of postoperative haemoglobin on length of stay post fractured hip repair in patients with standardised perioperative management

2018 ◽  
Vol 29 (2) ◽  
pp. 172-176
Author(s):  
Siu-Wai Choi ◽  
Frankie K L Leung ◽  
Tak-Wing Lau ◽  
Gordon T C Wong
Keyword(s):  
Length Of Stay ◽  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Postoperative Recovery ◽  
Medical Complications ◽  
Fractured Neck Of Femur ◽  
Neck Of Femur ◽  
Total Length ◽  
The Impact ◽  
Postoperative Haemoglobin

Introduction: Perioperative blood transfusion is not without risk and effort should be made to limit patients’ exposure to allogeneic blood. However, there is conflicting data regarding the impact of anaemia on postoperative recovery in patients with repaired hip fractures. It is hypothesised that for a given baseline functional status and fracture type, lower postoperative haemoglobin will increase rehabilitation time and prolong total length of hospital stay. Methods: This is a retrospective study on data collected prospectively on patients entered into the Clinical Pathway aged >65 years admitted to Queen Mary Hospital (QMH) with a fractured neck of femur during 2011–2013. Potential predictor variables were analysed with linear regression with respect to total length of stay and those that reached a significance level of 0.05 were included in further analysis. Results: 1092 patients were admitted to QMH with a suspected fractured neck of femur; data from 747 patients were analysed. The fracture sites were neck of femur (50%), intertrochanteric (48%) and subtrochanteric fracture (2%). Approximately 30% of patients received blood transfusions. Of these only the development of postoperative medical complications statistically prolonged hospital stay. No relationship was seen with haemoglobin levels cut-off above and below 10 g/dl with the result remaining non-significant down to a cut-off of above and below 8 g/dl. Discussion: This study revealed that post-surgical haemoglobin level of between 8 g/dl and 10 g/dL did not have an impact on the total length of hospital stay. The development of postoperative medical complications was the only factor that prolonged the total length of stay.

The effects of major depression disorder on neurogenic thoracic outlet syndrome surgery outcomes

Vascular ◽  
2021 ◽  
pp. 170853812110627
Author(s):  
Khaled I Alnahhal ◽  
Suhas Penukonda ◽  
Ranjana Lingutla ◽  
Ali Irshad ◽  
Genève M Allison ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Hospital Stay ◽  
Thoracic Outlet Syndrome ◽  
Surgical Intervention ◽  
Hospital Charges ◽  
Prolonged Hospital Stay ◽  
Total Hospital ◽  
Multivariable Logistic Regression ◽  
Prolonged Hospital ◽  
The Impact

Objectives Thoracic outlet syndrome (TOS) is a group of disorders caused by impingement of the neurovascular structures at the thoracic outlet. Neurogenic TOS (nTOS), which is thought to be caused by a compression of the brachial plexus, accounts for more than 90% of the cases. Although treatment for nTOS is successful through physiotherapy and/or surgical decompression, little is known about the impact of psychosocial factors, namely, major depressive disorder (MDD), on postoperative outcomes such as non-routine discharge (NRD). Here, we assess whether MDD predicts the type of discharge following nTOS surgical intervention. Methods A retrospective analysis of the National Inpatient Sample database from the years 2005–2018 was performed. Using the International Classification of Diseases Clinical Modification, Ninth and Tenth revisions, patients who underwent a surgical intervention for nTOS were identified. Our primary outcome was to investigate the effects of MDD on nTOS patient disposition status after surgical management; secondary outcomes included analysis of total hospital charges and length of stay. NRD was defined as anything beyond discharge home without healthcare services. Univariate and multivariable logistic regression analyses were conducted to assess MDD and other potential independent predictors of NRD and prolonged hospital stay (> 2 days) following surgical intervention. Results A total of 6099 patients were identified: 596 (9.77%) patients with MDD and 5503 (90.23%) without MDD. On average, patients with MDD were older (39.6 ± 12.0 years vs. 36.0 ± 13.0 years; p < 0.001), female (80.7% vs. 63.5%; p < 0.001), white (89.6% vs. 85.6%; p = 0.030), and on Medicare (9.6% vs 5.2%; p < 0.001). Univariate and multivariable logistic regression models identified MDD as an independent risk factor associated with a higher risk of NRD (adjusted odds ratio [aOR], 1.50; 95% confidence interval [CI], 1.0–2.2). Additionally, chronic kidney disease (aOR, 2.60; 95% CI, 1.2–5.4), postoperative complications (aOR, 1.87; 95% CI, 1.2–2.9), and Medicare (aOR, 2.95; 95% CI, 1.9–4.7) were statistically significant predictors for higher risk of NRD. However, MDD was not associated with prolonged hospital stay (aOR, 1.00; 95% CI, 0.8–1.2) or higher median of total charges (MDD group: $27,867 vs. non-MDD group: $28,123; p = 0.799). Conclusion Comorbid MDD was strongly associated with higher NRD rates following nTOS surgical intervention. MDD had no significant impact on length of hospital stay or total hospital charges. Additional prospective research is necessary in order to better evaluate the impact of MDD in patients with nTOS.

Does Alcohol Intoxication Protect Patients from Severe Injury and Reduce Hospital Mortality? The Association of Alcohol Consumption with the Severity of Injury and Survival in Trauma Patients

2013 ◽  
Vol 79 (12) ◽  
pp. 1289-1294 ◽  
Author(s):  
Chi-Hsun Hsieh ◽  
Li-Ting Su ◽  
Yu-Chun Wang ◽  
Chih-Yuan Fu ◽  
Hung-Chieh Lo ◽  
...  
Keyword(s):  
Alcohol Consumption ◽  
Hospital Stay ◽  
Brain Injuries ◽  
Injury Severity ◽  
Motor Vehicle ◽  
Length Of Hospital Stay ◽  
Trauma Patients ◽  
Prolonged Hospital Stay ◽  
Severe Injuries ◽  
Prolonged Hospital

Alcohol-related motor vehicle collisions are a major cause of mortality in trauma patients. This prospective observational study investigated the influence of antecedent alcohol use on outcomes in trauma patients who survived to reach the hospital. From 2005 to 2011, all patients who were older than 18 years and were admitted as a result of motor vehicle crashes were included. Blood alcohol concentration (BAC) was routinely measured for each patient on admission. Patients were divided into four groups based on their BAC level, which included nondrinking, BAC less than 100, BAC 100 to 200, and BAC 200 mg/dL or greater. Patient demographics, physical status and injury severity on admission, length of hospital stay, and outcome were compared between the groups. Odds ratios of having a severe injury, prolonged hospital stay, and mortality were estimated. Patients with a positive BAC had an increased risk of sustaining craniofacial and thoracoabdominal injuries. Odds ratios of having severe injuries (Injury Severity Score [ISS] 16 or greater) and a prolonged hospital stay were also increased. However, for those patients whose ISS was 16 or greater and who also had a brain injury, risk of fatality was significantly reduced if they were intoxicated (BAC 200 mg/dL or greater) before injury. Alcohol consumption does not protect patients from sustaining severe injuries nor does it shorten the length of hospital stay. However, there were potential survival benefits related to alcohol consumption for patients with brain injuries but not for those without brain injuries. Additional research is required to investigate the mechanism of this association further.

Compliance with enhanced recovery after surgery program in gynecology: are all items of equal importance?

2019 ◽  
Vol 29 (4) ◽  
pp. 810-815 ◽  
Author(s):  
Basile Pache ◽  
Jonas Jurt ◽  
Fabian Grass ◽  
Martin Hübner ◽  
Nicolas Demartines ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Gynecologic Oncology ◽  
Length Of Hospital Stay ◽  
Gynecologic Surgery ◽  
Complication Rates ◽  
Prolonged Length ◽  
Academic Center ◽  
The Impact

IntroductionEnhanced recovery after surgery (ERAS) guidelines in gynecologic surgery are a set of multiple recommendations based on the best available evidence. However, according to previous studies, maintaining high compliance is challenging in daily clinical practice. The aim of this study was to assess the impact of compliance to individual ERAS items on clinical outcomes.MethodsRetrospective cohort study of a prospectively maintained database of 446 consecutive women undergoing gynecologic oncology surgery (both open and minimally invasive) within an ERAS program from 1 October 2013 until 31 January 2017 in a tertiary academic center in Switzerland. Demographics, adherence, and outcomes were retrieved from a prospectively maintained database. Uni- and multivariate logistic regression was performed, with adjustment for confounding factors. Main outcomes were overall compliance, compliance to each individual ERAS item, and impact on post-operative complications according to Clavien classification.ResultsA total of 446 patients were included, 26.2 % (n=117) had at least one complication (Clavien I–V), and 11.4 % (n=51) had a prolonged length of hospital stay. The single independent risk factor for overall complications was intra-operative blood loss > 200 mL (OR 3.32; 95% CI 1.6 to 6.89, p=0.001). Overall compliance >70% with ERAS items (OR 0.15; 95% CI 0.03 to 0.66, p=0.12) showed a protective effect on complications. Increased compliance was also associated with a shorter length of hospital stay (OR 0.2; 95% CI 0.435 to 0.93, p=0.001).ConclusionsCompliance >70% with modifiable ERAS items was significantly associated with reduced overall complications. Best possible compliance with all ERAS items is the goal to achieve lower complication rates after gynecologic oncology surgery.

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