Enhanced recovery after laryngectomy: A feasibility study in 25 patients

2021 ◽  
pp. 175045892110156
Author(s):  
Tiarnan Magos ◽  
Gabriella Massa ◽  
Edward Burdett ◽  
Abdulla Al Khalfan ◽  
Jabin Thaj ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Head And Neck ◽  
Feasibility Study ◽  
Total Laryngectomy ◽  
Enhanced Recovery ◽  
Complication Rates ◽  
Enhanced Recovery Programme ◽  
Significant Difference ◽  
Stay Time ◽  
Local Expert

Purpose To describe the development and implementation of an enhanced recovery programme for patients undergoing total laryngectomy. Methods A feasibility study set in a tertiary head and neck unit in London, United Kingdom. The programme was developed based on Enhanced Recovery After Surgery (ERAS) Society guidelines for head and neck cancer surgery and local expert group consensus. An ERAS ‘booklet’ was devised which accompanied all laryngectomy patients during their inpatient stay. Contributors included otolaryngologists, anaesthetists, dieticians, physiotherapists, speech and language therapists and nurses. A 12-month pilot study was undertaken. The main outcome measures were feasibility and adherence. Results An enhanced recovery programme for 25 people undergoing total laryngectomy was successfully piloted in a tertiary referral head and neck unit. Median length of stay was reduced in the post-ERAS group by 1.5 days. No statistically significant difference in length of stay, time to first gastrografin swallow, rate of fistula nor postoperative normalcy of eating between the pre and post-ERAS patients who underwent laryngectomy was observed. Clavien-Dindo-grouped complication rates were significantly higher in the post-ERAS group. Conclusion This enhanced recovery programme for patients undergoing laryngectomy is the first of its kind in the literature. Implementation has been demonstrated feasible. Further longitudinal studies are required to reliably inform us on ERAS programmes’ effects on laryngectomy outcomes.

scholarly journals 931 Deep Inferior Epigastric Perforator (DIEP) Flap: Impact of Early Drain Removal on Seroma Formation Rate and Duration of Inpatient Stay

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
K Grigg ◽  
R Clancy ◽  
C Lewis ◽  
P Jackson
Keyword(s):  
Length Of Stay ◽  
Enhanced Recovery ◽  
Formation Rate ◽  
Seroma Formation ◽  
Diep Flap ◽  
Complication Rates ◽  
Post Surgery ◽  
Drain Removal ◽  
Significant Difference ◽  
The Mean

Abstract Aim Donor site seroma can follow deep inferior epigastric flap (DIEP) harvest. Post-surgery gradient technology (GTC) garments are worn by DIEP patients postoperatively following drain removal to reduce seroma formation. Early drain removal was considered a contributing factor to increased seroma formation rate. From June 2018 drain removal regardless of output was instigated at day two post-surgery. Prior to this, drains were removed when less than 30mls over 24 hours. We aim to assess the seroma rate post DIEP harvest with early drain removal. Method Retrospective review of prospectively managed database between June 2018 to May 2020. Surgical complications and length of stay in hospital were recorded. Results 200 patients underwent DIEP flap breast reconstruction. The mean age of patients was 52 years (range 28-73). There was no significant difference in seroma complication rate between those who had drains removed on day 3 compared with day 2 ((1.02% (1/98) vs. (0.98% (1/102); p = 1). The mean length of stay in hospital for the 1st cohort was 3.86 days and for the 2nd cohort was 3.23 days. There were no complications related to drain removal. Conclusions Our data suggests that drain removal after 2 days postoperatively with DIEP reconstruction does not affect seroma complication rates. Moreover, it leads to a shorter hospital stay. These conclusions are in keeping with enhanced recovery protocols and an early drain removal surgical process could be advised.

Reduction in opioid use and postoperative pain scores after elective laparotomy with implementation of enhanced recovery after surgery protocol on a gynecologic oncology service

2019 ◽  
Vol 29 (5) ◽  
pp. 935-943 ◽  
Author(s):  
Amanda Rae Schwartz ◽  
Stephanie Lim ◽  
Gloria Broadwater ◽  
Lauren Cobb ◽  
Fidel Valea ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Oral Morphine ◽  
Gynecologic Surgery ◽  
Complication Rates ◽  
Opioid Use ◽  
Pain Scores ◽  
Significant Difference ◽  
Eras Protocol

ObjectiveEnhanced Recovery After Surgery (ERAS) protocols are designed to mitigate the physiologic stress response created by surgery, to decrease the time to resumption of daily activities, and to improve overall recovery. This study aims to investigate postoperative recovery outcomes following gynecologic surgery before and after implementation of an ERAS protocol.MethodsA retrospective chart review was performed of patients undergoing elective laparotomy at a major academic center following implementation of an ERAS protocol (11/4/2014–7/27/2016) with comparison to a historical cohort (6/23/2013–9/30/2014). The primary outcome was length of hospital stay. Secondary outcomes included surgical variables, time to recovery of baseline function, opioid usage, pain scores, and complication rates. Statistical analyses were performed using Wilcoxon rank sum, Fisher’s exact, and chi squared tests.ResultsOne hundred and thirty-three women on the ERAS protocol who underwent elective laparotomy were compared with 121 historical controls. There was no difference in length of stay between cohorts (median 4 days; P = 0.71). ERAS participants had lower intraoperative (45 vs 75 oral morphine equivalents; P < 0.0001) and postoperative (45 vs 154 oral morphine equivalents; P < 0.0001) opioid use. ERAS patients reported lower maximum pain scores in the post-anesthesia care unit (three vs six; P < 0.0001) and on postoperative day 1 (four vs six; P = 0.002). There was no statistically significant difference in complication or readmission rates.ConclusionsERAS protocol implementation was associated with decreased intraoperative and postoperative opioid use and improved pain scores without significant changes in length of stay or complication rates.

scholarly journals Many small steps to reducing length of stay: A visit to the DH pilot enhanced recovery scheme

2010 ◽  
Vol 92 (8) ◽  
pp. 266-268
Author(s):  
Matthew Worrall
Keyword(s):  
Length Of Stay ◽  
Health Service ◽  
Patient Experience ◽  
Enhanced Recovery ◽  
Enhanced Recovery Programme ◽  
Department Of Health ◽  
Recovery Scheme ◽  
Hospital Stays ◽  
Improve Patient

Enhanced recovery (ER) is one of the current buzz terms in the health service but it seems to mean a different thing depending on to whom you speak. The Department of Health (DH) invited applications from acute trusts across England to become 'innovation sites' for the enhanced recovery programme. These sites are supported by DH as they implement a defined programme that aims to improve patient experience through shorter hospital stays. The Bulletin spent a day at one of them, West Hertfordshire Hospitals NHS Trust, to witness the changes made.

An enhanced recovery programme reduces length of stay after rectal surgery

2010 ◽  
Vol 25 (11) ◽  
pp. 1359-1362 ◽  
Author(s):  
Graham Branagan ◽  
Lynn Richardson ◽  
Archana Shetty ◽  
Helen S. Chave
Keyword(s):  
Length Of Stay ◽  
Enhanced Recovery ◽  
Rectal Surgery ◽  
Enhanced Recovery Programme

Discrepancy in Postoperative Outcomes between Auditing Databases: A NSQIP Comparison

2018 ◽  
Vol 84 (8) ◽  
pp. 1294-1298 ◽  
Author(s):  
William B. Lyman ◽  
Michael Passeri ◽  
Allyson Cochran ◽  
David A. Iannitti ◽  
John B. Martinie ◽  
...  
Keyword(s):  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Statistical Significance ◽  
Postoperative Pancreatic Fistula ◽  
Complication Rates ◽  
Audit System ◽  
Acs Nsqip ◽  
Outcome Reporting ◽  
Significant Difference ◽  
Chi Squared

In 2014, ACS-NSQIP® targeted pancreatectomies to improve outcome reporting and risk calculation related to pancreatectomy. At the same time, our department began prospectively collecting data for pancreatectomy in the Enhanced Recovery After Surgery® Interactive Audit System (EIAS). The purpose of this study is to compare reported outcomes between two major auditing databases for the same patients undergoing pancreatectomy. The same 171 patients were identified in both databases. Clinical outcomes were then obtained from each database and compared to determine whether reported complication rates were statistically different between auditing databases. A combination of Wilcoxon rank sum and Pearson's chi-squared tests were used to calculate statistical significance. No significant difference was appreciated in captured demographics between EIAS and NSQIP. Significant differences in reported rates for renal dysfunction, postoperative pancreatic fistula, return to the operative room, and urinary tract infection were noted between EIAS and NSQIP. Although significant differences in reported complication rates were demonstrated between EIAS and NSQIP for pancreatectomy, much of the discrepancy is attributable to subtle differences in definitions for postoperative occurrences between the two auditing databases. It is vital for surgeons to understand the exact definition that determines the complication rate for a given database.

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 Evaluation of an enhanced recovery protocol on patients having radical cystectomy for bladder cancer

2018 ◽  
Vol 12 (12) ◽  
Author(s):  
Bonnie Liu ◽  
Trustin Domes ◽  
Kunal Jana
Keyword(s):  
Bladder Cancer ◽  
Radical Cystectomy ◽  
Enhanced Recovery ◽  
Effective Means ◽  
Control Group ◽  
Complication Rates ◽  
Readmission Rates ◽  
Significant Difference ◽  
And Gender ◽  
Eras Protocol

Introduction: Enhanced recovery after surgery (ERAS) protocols are multimodal perioperative care protocols that are designed to shorten recovery time and reduce complication rates.1,2 An ERAS protocol was implemented in the Saskatoon Health region for radical cystectomy patients in 2013. This study evaluates the safety and efficacy of the protocol for patients having radical cystectomy for bladder cancer. Methods: Length of stay (LOS), early in-hospital complication rates, 30-day readmission rates, age, and gender were collected for patients seen for bladder cancer requiring radical cystectomy in Saskatoon between January 2007 and December 2016. Of these patients, 176 were pre-ERAS implementation (control group) and 84 were post-ERAS implementation (experimental group). The data from each variable was compared between the groups using a Z-test. Results: There was no significant difference in age or gender of patients between the groups. Average LOS pre-ERAS was 14.25±14.57 days, which is significantly longer than the post-ERAS average of 10.91±8.56 days (p=0.043). There was no significant difference in 30-day readmission rate (19.87% pre-ERAS vs. 19.05% post-ERAS; p=0.873) or complication rate (51.7% pre-ERAS vs. 46.4% post-ERAS; p=0.425). Conclusions: The implementation of an ERAS protocol for radical cystectomy reduces LOS, with no effect on early complication rates or 30-day readmission rates. This indicates that the protocol is safe for patients when compared to previous practices and is an effective means of reducing LOS.

scholarly journals EMERGENCY LAPAROTOMIES UNDER SPINAL ANESTHESIA: A RETROSPECTIVE, FACILITY BASED OBSERVATIONAL STUDY, IN KABUL, AFGHANISTAN

2021 ◽  
Vol 9 (06) ◽  
pp. 751-756
Author(s):  
Wais Farda ◽  
◽  
Ahmad Bashir Nawazish ◽  
Keyword(s):  
Length Of Stay ◽  
Observational Study ◽  
General Anesthesia ◽  
Spinal Anesthesia ◽  
Average Length ◽  
Emergency Laparotomy ◽  
Complication Rates ◽  
Abdominal Incision ◽  
Significant Difference ◽  
The Mean

Background: Laparotomy is most commonly performed under general anesthesia, but spinal anesthesia (SA) is considered an alternative to in the context of limited resources. The safety and efficacy of using SA as substitute for general anesthesia(GA) has not been explored in Afghanistan. Methodology: We conductedan observational study in the general surgery department of Isteqlal hospital in Kabul, Afghanistan on 196 adult patients undergoing emergency laparotomy under spinal anesthesia betweenApril 2018-April 2020. Results: The mean age of patients was 41.5 years (SD=19.4), the ratio of males to females was 1.9:1 and almost half (44.4%) had comorbidities. 21% were classified as ASA grade III and IV with a similar pattern among males and females. A total of 11 (5.6%) cases were converted to GA. Conversion pattern to GA was similar amongmales and females(P=0.71), ASA grade (P=0.432) and age group (P=0.642). The mean length of stay after operation was 6.5 days (SD=4.1). 32 (16.3%) patients suffered SA complications with no significant difference in terms of sex (P=0.134). Hypotension and headache accounted for 97% of complications. Complication rates were similar in terms of intervertebral level (P=0.349), type of abdominal incision (P>0.1) and average length of stay (P=0.156). 18 patients (9.2%) died due to MOF, sepsis, respiratory failure, thromboembolism and cardiogenic shock. Conclusion: Spinal anesthesia is considered a safe and effective anesthesia for emergency laparotomies, even for those with comorbidities. Based on our findings we would recommend spinal anesthesia as an alternative to general anesthesiain emergency laparotomy in Afghanistan.

Perioperative complication rates following neoadjuvant therapy in pancreatic adenocarcinoma.

2020 ◽  
Vol 38 (4_suppl) ◽  
pp. 688-688
Author(s):  
Christopher R. Deig ◽  
Blake Beneville ◽  
Amy Liu ◽  
Aasheesh Kanwar ◽  
Alison Grossblatt-Wait ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Neoadjuvant Therapy ◽  
Pancreatic Adenocarcinoma ◽  
Locally Advanced ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Complication Rates ◽  
Significant Difference ◽  
Perioperative Complication ◽  
The Impact

688 Background: Whether upfront resection or total neoadjuvant therapy is superior for the treatment of potentially resectable pancreatic adenocarcinoma (PDAC) remains controversial. The impact of neoadjuvant treatment on major perioperative complication rates for patients (pts) undergoing resection for PDAC is commonly debated. We hypothesized that rates would be comparable among patients receiving neoadjuvant chemoradiation (neo-CRT), neoadjuvant chemotherapy alone (neo-CHT), or upfront surgery. Methods: This is a retrospective study of 208 pts with PDAC who underwent resection within a multidisciplinary pancreatico-biliary program at an academic tertiary referral center between 2011-2018. Data were abstracted from the medical record, an institutional cancer registry and NSQIP databases. Outcomes were assessed using χ2, Fisher’s exact test and two-tailed Student’s t-tests. Results: 208 pts were identified: 33 locally advanced, borderline or upfront resectable pts underwent neo-CRT, 35 borderline or resectable pts underwent neoadjuvant-CHT, and 140 resectable pts did not undergo neoadjuvant therapy. There were no statistically significant differences in major perioperative complication rates between groups. Overall rates were 36.4%, 34.3%, and 26.4% for pts who underwent neo-CRT, neo-CHT alone, or upfront resection, respectively (p = 0.38). No significant difference were observed in complication rates (35.3% v. 26.4%; p = 0.19) or median hospital length of stay (10 days v. 10 days; p = 0.87) in pts who received any neoadjuvant therapy versus upfront resection. There were two perioperative deaths in the neo-CRT group (6.1%), zero in the neo-CHT group, and four in the upfront resection group (2.9%); p = 0.22. Conclusions: There were no significant differences in major perioperative complication rates, hospital length of stay, or post-operative mortality in pts who underwent neoadjuvant therapy (neo-CRT or neo-CHT alone) versus upfront surgery. Notably, neo-CRT had comparable perioperative complication rates to neo-CHT alone, which suggests neoadjuvant radiation therapy may not pose additional surgical risk.

Abstract 249: The Costs and Acute Outcomes Following Pulmonary Vein Isolation for Atrial Fibrillation in Elderly Patients a Comparison Between Cryoballoon and Radiofrequency Ablation

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Chao-Feng Chen
Keyword(s):  
Atrial Fibrillation ◽  
Length Of Stay ◽  
Elderly Patients ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Left Atrial ◽  
Dwell Time ◽  
Complication Rates ◽  
Rf Ablation ◽  
Significant Difference

Backgroup: Limited comparative data exist regarding catheter ablation (CA) of atrial fibrillation (AF) using second-generation cryoballoon (CB-2) ablation versus radiofrequency (RF) ablation in elderly patients (>75 years ). This study aims to compare the costs and periprocedural outcomes in elderly patients using these two strategies. Methods: Elderly patients (>75years) with symptomatic drug-refractory AF were included in the study. Pulmonary vein isolation (PVI) was performed in all patients by CB or RF. The costs and periprocedural outcomes of the two strategies are compared using SPSS 22. Results: 324 elderly patients with symptomatic drug-refractory paroxysmal/short-lasting persistent AF received PVI using RF (n=176) and CB-2 (n=148) from September 2016 to April 2019. The CB-2 was associated with shorter procedure duration and left atrial dwell time (128.9±18.3 vs. 152.8±18.9 minutes, P<0.001; 89.4±18.4 vs. 101.9± 22.2minutes, P <0.001), but greater fluoroscopy utilization (24.3±10.9 vs. 19.2±7.5 minutes, P <0.001). Periprocedural complications occurred in 3.4% (CB-2) and 9.1% (RF) of patients (P=0.037). There was no significant difference between 2 groups for AF/atrial tachycardia (AT) recurrence until discharge (16.2 vs. 18.7%, P = 0.552). The length of stay after ablation was shorter, but the costs were greater in the CB-2 group ( P <0.001). Conclusions: Both CB-2 and RF ablation appear to be safe and effective for AF in elderly patients (>75 years). In addition, CB-2 is associated with shorter procedure time, left atrial dwell time, and length of stay after ablation, as well as lower complication rates, but its costs and fluoroscopy time are greater than those of the RF group.

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