Association Between Perioperative Fluid Balance and 30-Day Unplanned Readmission After Major Abdominal Surgery

2019 ◽  
Vol 26 (4) ◽  
pp. 401-407
Author(s):  
Tak Kyu Oh ◽  
Ah-Young Oh ◽  
Jung-Won Hwang
Keyword(s):  
Confidence Interval ◽  
Abdominal Surgery ◽  
Fluid Balance ◽  
Odds Ratio ◽  
Readmission Rate ◽  
Major Abdominal Surgery ◽  
Unplanned Readmission ◽  
Academic Hospital ◽  
Relative Value ◽  
Duration Of Surgery

Perioperative positive fluid balance (FB) increases postoperative complication and length of hospital stay. We aimed to investigate 30-day unplanned readmission after major abdominal surgery based on perioperative FB (%) on postoperative days (POD) 0 to 3. This retrospective cohort study analyzed medical records of patients who underwent elective major abdominal surgery (surgery time >2 hours, estimated blood loss >500 mL) at a single tertiary academic hospital from January 2010 to December 2017. Cumulative FB was calculated by total input fluid − output fluid in liters × weight (kg)−1 on admission × 100 during POD 0 (24 hours), 0 to 1 (48 hours), 0 to 2 (72 hours), and 0 to 3 (96 hours). Of the 3650 patients in the final analysis, 503 (13.8%) had unplanned readmission within 30 days. In the multivariable logistic regression analysis, FB on POD 0 (24 hours), 0 to 1 (48 hours), 0 to 2 (72 hours), and 0 to 3 (96 hours) showed no significant association with 30-day unplanned readmission (all P > .05). However, an increase of 10 000 points in the total relative value unit scores was associated with 5% increase in 30-day unplanned readmission (odds ratio = 1.05, 95% confidence interval = 1.02-1.07; P = .001), and 1-hour increase in surgery time was associated with 10% increase in 30-day unplanned readmission (odds ratio = 1.10, 95% confidence interval = 1.05-1.15; P < .001). This study showed that perioperative FB is not associated with 30-day unplanned readmission rate after a major abdominal surgery. Total relative value unit scores and duration of surgery were significantly associated with 30-day unplanned readmission rate after major abdominal surgery in a single tertiary academic hospital.

scholarly journals GAVCA Study: Randomized, Multicenter Trial to Evaluate the Quality of Ventricular Catheter Placement with a Mobile Health Assisted Guidance Technique

Neurosurgery ◽  
2017 ◽  
Vol 83 (2) ◽  
pp. 252-262 ◽  
Author(s):  
Ulrich-Wilhelm Thomale ◽  
Andreas Schaumann ◽  
Florian Stockhammer ◽  
Henrik Giese ◽  
Dhani Schuster ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Mobile Health ◽  
Primary Endpoint ◽  
Odds Ratio ◽  
Catheter Placement ◽  
Ventricular Catheter ◽  
Catheter Position ◽  
Simple Method ◽  
Duration Of Surgery ◽  
Catheter Failure

Abstract BACKGROUND Freehand ventricular catheter placement may represent limited accuracy for the surgeon's intent to achieve primary optimal catheter position. OBJECTIVE To investigate the accuracy of a ventricular catheter guide assisted by a simple mobile health application (mhealth app) in a multicenter, randomized, controlled, simple blinded study (GAVCA study). METHODS In total, 139 eligible patients were enrolled in 9 centers. Catheter placement was evaluated by 3 different components: number of ventricular cannulation attempts, a grading scale, and the anatomical position of the catheter tip. The primary endpoint was the rate of primary cannulation of grade I catheter position in the ipsilateral ventricle. The secondary endpoints were rate of intraventricular position of the catheter's perforations, early ventricular catheter failure, and complications. RESULTS The primary endpoint was reached in 70% of the guided group vs 56.5% (freehand group; odds ratio 1.79, 95% confidence interval 0.89-3.61). The primary successful puncture rate was 100% vs 91.3% (P = .012). Catheter perforations were located completely inside the ventricle in 81.4% (guided group) and 65.2% (freehand group; odds ratio 2.34, 95% confidence interval 1.07-5.1). No differences occurred in early ventricular catheter failure, complication rate, duration of surgery, or hospital stay. CONCLUSION The guided ventricular catheter application proved to be a safe and simple method. The primary endpoint revealed a nonsignificant improvement of optimal catheter placement among the groups. Long-term follow-up is necessary in order to evaluate differences in catheter survival among shunted patients.

Intraoperative Tidal Volume as a Risk Factor for Respiratory Failure after Pneumonectomy

2006 ◽  
Vol 105 (1) ◽  
pp. 14-18 ◽  
Author(s):  
Evans R. Fernández-Pérez ◽  
Mark T. Keegan ◽  
Daniel R. Brown ◽  
Rolf D. Hubmayr ◽  
Ognjen Gajic
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Pulmonary Function Tests ◽  
Bronchopleural Fistula ◽  
Fluid Administration ◽  
Postoperative Respiratory Failure ◽  
Increased Risk ◽  
Duration Of Surgery

Background Respiratory failure is a leading cause of postoperative morbidity and mortality in patients undergoing pneumonectomy. The authors hypothesized that intraoperative mechanical ventilation with large tidal volumes (VTs) would be associated with increased risk of postpneumonectomy respiratory failure. Methods Patients undergoing elective pneumonectomy at the authors' institution from January 1999 to January 2003 were studied. The authors collected data on demographics, relevant comorbidities, neoadjuvant therapy, pulmonary function tests, site and type of operation, duration of surgery, intraoperative ventilator settings, and intraoperative fluid administration. The primary outcome measure was postoperative respiratory failure, defined as the need for continuation of mechanical ventilation for greater than 48 h postoperatively or the need for reinstitution of mechanical ventilation after extubation. Results Of 170 pneumonectomy patients who met inclusion criteria, 30 (18%) developed postoperative respiratory failure. Causes of postoperative respiratory failure were acute lung injury in 50% (n = 15), cardiogenic pulmonary edema in 17% (n = 5), pneumonia in 23% (n = 7), bronchopleural fistula in 7% (n = 2), and pulmonary thromboembolism in 3% (n = 1). Patients who developed respiratory failure were ventilated with larger intraoperative VT than those who did not (median, 8.3 vs. 6.7 ml/kg predicted body weight; P &lt; 0.001). In a multivariate regression analysis, larger intraoperative VT (odds ratio, 1.56 for each ml/kg increase; 95% confidence interval, 1.12-2.23) was associated with development of postoperative respiratory failure. The interaction between larger VT and fluid administration was also statistically significant (odds ratio, 1.36; 95% confidence interval, 1.05-1.97). Conclusion Mechanical ventilation with large intraoperative VT is associated with increased risk of postpneumonectomy respiratory failure.

scholarly journals Thirty-Day Readmission Rates After Takotsubo Syndrome With or Without Malignancy: A Nationwide Readmissions Database Analysis

2020 ◽  
Author(s):  
Sun-Joo Jang ◽  
Ilhwan Yeo ◽  
Chanel Jonas ◽  
Parag Goyal ◽  
Jim W. Cheung ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Odds Ratio ◽  
Readmission Rate ◽  
Takotsubo Syndrome ◽  
Database Analysis ◽  
Readmission Rates ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Baseline Characteristics

Abstract Background: Association of malignancy with readmission after TTS hospitalization has not been fully described. We sought to examine the rates, cause and cost of 30-day readmissions and 30-day all-cause mortality of Takotsubo syndrome (TTS) patients with or without malignancy. Methods: The Nationwide Readmissions Databases from 2010 to 2014 were queried to identify and compare baseline characteristics and outcomes of patients hospitalized for TTS with and without malignancy. Results: We identified 61,588 index hospitalizations for TTS. TTS patients with malignancy were older (70.6 ± 0.2 vs. 66.1 ± 0.1, p < 0.001), and the overall burden of comorbidities was higher than in those without malignancy. TTS patients with malignancy had significantly higher 30-day readmission rates than those without malignancy (15.9% vs. 11.0%; odds ratio [OR], 1.35; 95% confidence interval [CI], 1.18 - 1.56). Majority (75.5%) of the etiologies for readmissions were non-cardiac, with infection being most common (20.1%). The 30-day readmission rate due to the recurrent TTS was similar in both groups (0.4% and 0.5%, respectively; p = 0.47). Importantly, 30-day all-cause mortality was higher in TTS with vs. without malignancy (4.8% vs 2.5%; OR, 1.62; 95% CI, 1.25 - 2.10). The total costs (index admission + readmission) were higher by 25% (p < 0.001) in TTS patients with malignancy vs. without malignancy. Conclusions: In patients hospitalized with TTS, the presence of malignancy was associated with increased risk of 30-day readmission, mostly attributable to non-cardiac etiologies. Importantly, the 30-day all-cause mortality and cost were also significantly higher. These findings highlight the importance of optimization of treatment and follow up in patients with malignancy after hospitalizations for TTS.

scholarly journals Retrospective analysis of 30-day unplanned readmission after major abdominal surgery with reversal by sugammadex or neostigmine

2019 ◽  
Vol 122 (3) ◽  
pp. 370-378 ◽  
Author(s):  
Tak Kyu Oh ◽  
Ah-Young Oh ◽  
Jung-Hee Ryu ◽  
Bon-Wook Koo ◽  
In-Ae Song ◽  
...  
Keyword(s):  
Abdominal Surgery ◽  
Retrospective Analysis ◽  
Major Abdominal Surgery ◽  
Unplanned Readmission

Risk of Respiratory Complications and Wound Infection in Patients Undergoing Ambulatory Surgery

2002 ◽  
Vol 97 (4) ◽  
pp. 842-847 ◽  
Author(s):  
Paul S. Myles ◽  
George A. Iacono ◽  
Jennifer O. Hunt ◽  
Helen Fletcher ◽  
John Morris ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Wound Infection ◽  
Odds Ratio ◽  
Ambulatory Surgery ◽  
Smoking Status ◽  
Breath Holding ◽  
Respiratory Complications ◽  
Odds Ratios ◽  
Increased Risk ◽  
Duration Of Surgery

Background Smoking is considered to be a risk factor for patients undergoing surgery and anesthesia, but it is unclear whether this is applicable to patients undergoing ambulatory surgery. The aim of this study was to determine the risk of respiratory complications and wound infection among smokers. Methods The authors studied a random selection of 489 adult patients undergoing ambulatory surgery. Smoking status was determined by self-report and confirmed with end-expired carbon monoxide analysis. The risk of respiratory complications (i.e., desaturation, cough, laryngospasm, bronchospasm, breath-holding, or apnea) and wound infection (i.e., wound redness or discharge +/- positive microbial culture, requiring antibiotic therapy) in smokers nonsmokers was ascertained. Odds ratios were estimated from multivariable logistic regression and adjusted for age, gender, body mass index, partner's smoking status, domiciliary smoking exposure, and extent and duration of surgery. Results Most smokers continued to smoke up until the day of surgery. Smokers had a higher rate of respiratory complications (32.8% vs. 25.9%; adjusted odds ratio, 1.71; 95% confidence interval, 1.03-2.84; = 0.038) and wound infection (3.6% vs. 0.6%; odds ratio, 16.3; 95% confidence interval, 1.58-175; = 0.019). Odds ratios comparing current plus ex-smokers with nonsmokers were of similar magnitude for most of these complications. Conclusions Smoking was associated with an increased risk of respiratory complications and postoperative wound infection in ambulatory surgery patients. These findings warrant increased efforts at promoting smoking avoidance and cessation.

scholarly journals Thirty-Day Readmission Rates after Takotsubo Syndrome with or without Malignancy: A Nationwide Readmissions Database Analysis

2021 ◽  
Vol 10 (16) ◽  
pp. 3701
Author(s):  
Sun-Joo Jang ◽  
Ilhwan Yeo ◽  
Chanel Jonas ◽  
Parag Goyal ◽  
Jim W. Cheung ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Odds Ratio ◽  
Readmission Rate ◽  
Takotsubo Syndrome ◽  
Database Analysis ◽  
Readmission Rates ◽  
Increased Risk ◽  
Common Causes

The association between malignancy and readmission after Takotsubo syndrome (TTS) hospitalization has not been fully described. We sought to examine the rates, cause, and cost of 30-day readmissions of TTS, with or without malignancy, by utilizing Nationwide Readmissions Databases from 2010 to 2014. We identified 61,588 index hospitalizations for TTS. TTS patients with malignancy tended to be older (70.6 ± 0.2 vs. 66.1 ± 0.1, p < 0.001), and the overall burden of comorbidities was higher than in those without malignancy. TTS patients with malignancy had significantly higher 30-day readmission rates than those without malignancy (15.9% vs. 11.0%; odds ratio (OR), 1.35; 95% confidence interval (CI), 1.18–1.56). Non-cardiac causes were the most common causes of readmission for TTS patients with malignancy versus without malignancy (75.5% vs. 68.1%, p < 0.001). The 30-day readmission rate due to recurrent TTS was very low in both groups (0.4% and 0.5%; p = 0.47). The total costs were higher by 25% (p < 0.001) in TTS patients with vs. without malignancy. In summary, among patients hospitalized with TTS, the presence of malignancy was associated with increased risk of 30-day readmission and increased costs. These findings highlight the importance of optimized management for TTS patients with malignancy.

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