Perioperative dialogue on postoperative recovery measured by the use of pain medication, psychopharmaceutical agents and length of hospital stay

2018 ◽  
Vol 38 (4) ◽  
pp. 212-219
Author(s):  
Christine Leo Swenne ◽  
Louise Hjelte ◽  
Emma Härdne ◽  
Carin Friberg ◽  
Erebouni Arakelian
Keyword(s):  
Hospital Stay ◽  
Hyperthermic Intraperitoneal Chemotherapy ◽  
Length Of Hospital Stay ◽  
Pain Medication ◽  
Postoperative Recovery ◽  
Major Surgery ◽  
Control Group ◽  
Medication Consumption ◽  
Experienced Pain ◽  
Before And After

The effects of perioperative dialogue have been studied using qualitative methods, describing patient satisfaction with their care. However, they have not been studied in patients with peritoneal carcinomatosis who undergo major surgery, nor with quantitative variables. The aim was to study the use of pain medication and length of hospital stay following cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in patients who received, versus those who did not receive, perioperative dialogue. The study had a quantitative, retrospective and comparative design including 89 audits. Of these, 37 patients received perioperative dialogues, and 52 patients did not (the control group). The result showed that by postoperative day six, patients who received a perioperative dialogue experienced pain less frequently than patients in the control group. However, no differences between the groups were noted with regard to pain medication consumption and length of hospital stay. To ease their worries, all patients in both groups used benzodiazepines. The perioperative dialogue may be studied quantitatively, but it must involve the patient, who is an equal partner in the dialogue. Structured validated self-reporting measures may be used systematically before and after surgery in order to evaluate the perioperative dialogue using quantitative measures.

Goal-directed Intraoperative Fluid Administration Reduces Length of Hospital Stay after Major Surgery

2002 ◽  
Vol 97 (4) ◽  
pp. 820-826 ◽  
Author(s):  
Tong J. Gan ◽  
Andrew Soppitt ◽  
Mohamed Maroof ◽  
Habib El-Moalem ◽  
Kerri M. Robertson ◽  
...  
Keyword(s):  
Stroke Volume ◽  
Hospital Stay ◽  
Elective Surgery ◽  
Length Of Hospital Stay ◽  
Postoperative Hospital Stay ◽  
Fluid Administration ◽  
Major Surgery ◽  
Control Group ◽  
Surgical Morbidity ◽  
Protocol Group

Background Intraoperative hypovolemia is common and is a potential cause of organ dysfunction, increased postoperative morbidity, length of hospital stay, and death. The objective of this prospective, randomized study was to assess the effect of goal-directed intraoperative fluid administration on length of postoperative hospital stay. Methods One hundred patients who were to undergo major elective surgery with an anticipated blood loss greater than 500 ml were randomly assigned to a control group (n = 50) that received standard intraoperative care or to a protocol group (n = 50) that, in addition, received intraoperative plasma volume expansion guided by the esophageal Doppler monitor to maintain maximal stroke volume. Length of postoperative hospital stay and postoperative surgical morbidity were assessed. Results Groups were similar with respect to demographics, surgical procedures, and baseline hemodynamic variables. The protocol group had a significantly higher stroke volume and cardiac output at the end of surgery compared with the control group. Patients in the protocol group had a shorter duration of hospital stay compared with the control group: 5 +/- 3 versus 7 +/- 3 days (mean +/- SD), with a median of 6 versus 7 days, respectively ( = 0.03). These patients also tolerated oral intake of solid food earlier than the control group: 3 +/- 0.5 versus 4.7 +/- 0.5 days (mean +/- SD), with a median of 3 versus 5 days, respectively ( = 0.01). Conclusions Goal-directed intraoperative fluid administration results in earlier return to bowel function, lower incidence of postoperative nausea and vomiting, and decrease in length of postoperative hospital stay.

scholarly journals Does Goal-directed Fluid Therapy Affect Postoperative Orthostatic Intolerance?

2013 ◽  
Vol 119 (4) ◽  
pp. 813-823 ◽  
Author(s):  
Morten Bundgaard-Nielsen ◽  
Øivind Jans ◽  
Rasmus G. Müller ◽  
André Korshin ◽  
Birgitte Ruhnau ◽  
...  
Keyword(s):  
Stroke Volume ◽  
Fluid Therapy ◽  
Orthostatic Intolerance ◽  
Length Of Hospital Stay ◽  
Early Mobilization ◽  
Postoperative Recovery ◽  
Major Surgery ◽  
Control Group ◽  
Open Radical Prostatectomy ◽  
Double Blinded

Abstract Background: Early mobilization is important for postoperative recovery but is limited by orthostatic intolerance (OI) with a prevalence of 50% 6 h after major surgery. The pathophysiology of postoperative OI is assumed to include hypovolemia besides dysregulation of vasomotor tone. Stroke volume–guided fluid therapy, so-called goal-directed therapy (GDT), corrects functional hypovolemia, and the authors hypothesized that GDT reduces the prevalence of OI after major surgery and assessed this in a prospective, double-blinded trial. Methods: Forty-two patients scheduled for open radical prostatectomy were randomized into standard fluid therapy (control group) or GDT groups. Both groups received a fixed-volume crystalloid regimen supplemented with 1:1 replacement of blood loss with colloid, and in addition, the GDT group received colloid to obtain a maximal stroke volume (esophageal Doppler). The primary outcome was the prevalence of OI assessed with a standardized mobilization protocol before and 6 h after surgery. Hemodynamic and hormonal orthostatic responses were evaluated. Results: Twelve (57%) versus 15 (71%) patients in the control and GDT groups (P = 0.33), respectively, demonstrated OI after surgery, group difference 14% (CI, −18 to 45%). Patients in the GDT group received more colloid during surgery (1,758 vs. 1,057 ml; P = 0.001) and reached a higher stroke volume (102 vs. 89 ml; P = 0.04). OI patients had an increased length of hospital stay (3 vs. 2 days; P = 0.02) and impaired hemodynamic and norepinephrine responses on mobilization. Conclusion: GDT did not reduce the prevalence of OI, and patients with OI demonstrated impaired cardiovascular and hormonal responses to mobilization.

scholarly journals Observation of the Efficacy of Laparoscopic Resection of Anterior Rectal Cancer in Treating Rectal Cancer

2019 ◽  
Vol 3 (4) ◽  
Author(s):  
Hao Zhang
Keyword(s):  
Rectal Cancer ◽  
Hospital Stay ◽  
Laparoscopic Resection ◽  
Length Of Hospital Stay ◽  
Operation Time ◽  
Treatment Method ◽  
Postoperative Recovery ◽  
Control Group ◽  
Observation Group ◽  
Significant Difference

Objective: To analyze the efficacy of laparoscopic resection of anterior rectal cancer in treating rectal cancer. Methods: Fifty patients with rectal cancer who were treated in Gucheng County Hospital of Hebei Province from September 2017 to September 2019 were selected and recruited in the present study. These patients were divided into two groups, namely the control group and observation groups, by random number table method. Each group consisted of 25 patients. The control group underwent laparoscopic assisted transanorectal mesorectal excision, whereas the observation group underwent laparoscopic resection of anterior rectal cancer. The two groups were compared for related indicators, indicators pertaining to postoperative recovery, and complications. Results: There was no significant difference in the number of lymph node dissections between the two groups (P>0.05). The amount of intraoperative blood loss, surgical operation time, and incision length in the observation group were lower than those in the control group, and the differences were statistically significant (P<0.05). The time of getting out of bed, anal exhaust, and duration of hospital stay were shorter in the observation group than those of the control group, and the differences were statistically significant (P<0.05). In addition, the incidence of postoperative complications in the observation group was lower than that in the control group, and the differences were statistically significant (P<0.05). Conclusions: Laparoscopic resection of anterior rectal cancer is effective for rectal cancer patients. This treatment method can effectively reduce the amount of intraoperative bleeding, shorten the operation time, the time of anal exhaust, get out of bed, and the length of hospital stay, as well as improve condition of the patients.

Immunology, Treatment and Public Health Aspects of Subarachnoid Hemorrhage

2020 ◽  
Author(s):  
Junjing ZHAO ◽  
Jianping ZHANG ◽  
Yongxia BU ◽  
Wei LU ◽  
Gejin ZHAO
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Effective Rate ◽  
Control Group ◽  
Observation Group ◽  
Before And After ◽  
Immune Globulins ◽  
The Impact ◽  
Ig G

Background: We aimed to explore the treatment and safety of subarachnoid hemorrhage. Methods: A retrospective analysis was applied on 137 patients with subarachnoid hemorrhage treated in Binzhou Central Hospital, Bingzhou, China from March 2015 to October 2018. Seventy cases with interventional embolization of intracranial aneurysms were divided as the observation group, and 67 cases with craniotomy for aneurysm clipping were divided as the control group. The changes of immune globulins before and after surgery, CD4+, CD8+, NIHSS scores, BI scores, the total effective rate of subarachnoid hemorrhage, the total length of postoperative hospital stay and conditions of postoperative complications as well as 30-day survival were compared between the two groups. Results: The levels of Ig G, Ig M, Ig A, and CD4+ after surgery in the observation group were significantly lower than those before surgery (P<0.05), but significantly higher than those in the control group (P<0.05); the total time of postoperative hospitalization in the observation group was shorter than that in the control group (P<0.05). The incidence of intracranial infection and cerebral vasospasm in the observation group was significantly lower than that in the control group (P<0.05). The NIHSS score of the observation group was significantly lower than that of the control group (P<0.05), and the BI score was significantly higher than that of the control group (P<0.05). Conclusion: Patients with subarachnoid hemorrhage undergoing interventional embolization of aneurysms can reduce the impact on immune function, decrease the adverse reactions caused by treatments, shorten the length of hospital stay and fully improve the efficacy.

Effect of Chewing Gum on Bowel Motility in Women Undergoing Post-Operative Cesarean Section

2018 ◽  
Vol 3 (06) ◽  
Author(s):  
Dr.Randa Mohammed AboBaker
Keyword(s):  
Cesarean Section ◽  
Hospital Stay ◽  
Demographic Data ◽  
Length Of Hospital Stay ◽  
Chewing Gum ◽  
Control Group ◽  
Controlled Clinical Trial ◽  
Bowel Motility ◽  
Gum Chewing ◽  
Significant Difference

Postoperative Ileus (POI) is one of the most common problems after obstetrics, gynecologic and abdominal surgeries. Sham feeding, such as gum chewing, accelerates the return of bowel function and the length of hospital stay. The present study aims to evaluate the effect of chewing gum on bowel motility in women undergoing post-operative cesarean section. Intervention study was used at the Postpartum Department of Maternity and Children Hospital, KSA. A randomized controlled clinical trial research design. Through a convenience technique, 80 post Caesarian Section (CS) women were included in the study. Data were collected through three tools: Tool (I): Socio-demographic data and reproductive history interview schedule. Tool (II): Postoperative Assessment Sheet. Tool (III): Outcomes of gum chewing and the length of hospital stay.  Method: subjects were assigned randomly into two groups of (40) the experimental and (40) the control. Subjects in the study group were asked to chew two pieces of sugarless gum for 30 min/three times daily in the morning, noon, and evening immediately after recovery from anesthesia and in Postpartum Department; while subjects in the control group followed the hospital routine care. Each woman in both groups was tested abdominally using a stethoscope to auscultate the bowel sounds and asked to report immediately the time of either passing flatus or stool. Results: illustrated that a highly statistically significant difference was observed between the two groups concerning their gum chewing outcomes. Where, P = 0.000. The study concluded that gum chewing is safe, well tolerated and appears to be effective in reducing the incidence and consequences of POI following CS.

The neuropathogenesis of delirium

2002 ◽  
Vol 12 (1) ◽  
pp. 62-67 ◽  
Author(s):  
Susan White
Keyword(s):  
Hospital Stay ◽  
Older Patients ◽  
Independent Predictor ◽  
Length Of Hospital Stay ◽  
Predisposing Factors ◽  
Advanced Age ◽  
Major Surgery ◽  
Common Disorder ◽  
Disturbance Of Consciousness ◽  
Short Period

Delirium is a common disorder in ill older patients, characterized by a fluctuating disturbance of consciousness and changes in cognition that develop over a short period of time. Studies have shown that delirium is an independent predictor of increased length of hospital stay, and is associated with increased dependency and mortality, as well as being distressing for patients and families. Much is known about the epidemiology of delirium, including predisposing factors such as pre-existing dementia and advanced age, and common precipitants such as infection, drugs and major surgery. In comparison, very little is known about the neuropathological mechanisms that lead to the development of delirium.

ERAS Improves Postoperative Recovery in Children

2021 ◽  
Author(s):  
Tingmei Wu ◽  
Haiwen Li ◽  
Huixia Zhou ◽  
Xuemei Hao ◽  
Xiaojun Wang ◽  
...  
Keyword(s):  
Inflammatory Cytokine ◽  
Enhanced Recovery ◽  
Length Of Hospital Stay ◽  
Final Analysis ◽  
Postoperative Recovery ◽  
Controlled Study ◽  
Control Group ◽  
Robot Assisted ◽  
Cytokine Levels ◽  
Eras Protocol

Abstract Objective: Enhanced recovery after surgery (ERAS) protocols are established in adults but not fully evaluated in children. This study investigated whether an ERAS protocol improved recovery and influenced postoperative inflammatory cytokine levels in children undergoing surgery for hydronephrosis. Methods: This randomized controlled study included patients who underwent robot-assisted laparoscopic surgery for hydronephrosis at Bayi Children's Hospital (Beijing, China) between October 2018 and September 2019. Patients were randomized to an ERAS group (perioperative ERAS protocol) or control group (standard perioperative management). Outcomes related to postoperative recovery and inflammatory cytokine levels were evaluated. Results: The final analysis included 18 patients in each group. Five patients (27.78%) in each group experienced postoperative complications (abdominal pain, nausea and vomiting, subcutaneous emphysema or fever). The ERAS group had a shorter time to first postoperative flatus than the control group (25 vs. 49 hours; P =0.009), although the time for abdominal drainage flow to reach ≤20 mL/day, time to urinary catheter removal and length of hospital stay did not differ significantly between groups. Preoperative plasma cytokine levels were comparable between groups. Compared with the control group, the ERAS group had a higher IL-6 level on postoperative day 2 ( P <0.05) and a lower concentration of IL-1β on postoperative days 1 and 2 ( P <0.05). Postoperative levels of CRP, TNFα and IL-10 did not differ significantly between groups. Conclusions: ERAS may accelerate postoperative recovery and modulate the postoperative inflammatory response in pediatric patients undergoing robot-assisted laparoscopic pyeloplasty for hydronephrosis.

The Association between Prolonged Antibiotic Use in Culture Negative Infants and Length of Hospital Stay and Total Hospital Costs

2021 ◽  
Author(s):  
Wesam Sourour ◽  
Valeria Sanchez ◽  
Michel Sourour ◽  
Jordan Burdine ◽  
Elizabeth Rodriguez Lien ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Blood Culture ◽  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Antibiotic Use ◽  
Hospital Length Of Stay ◽  
Control Group ◽  
Multivariate Linear Regression Analysis ◽  
Negative Blood Culture ◽  
Total Cost

Objective This study aimed to determine if prolonged antibiotic use at birth in neonates with a negative blood culture increases the total cost of hospital stay. Study design This was a retrospective study performed at a 60-bed level IV neonatal intensive care unit. Neonates born <30 weeks of gestation or <1,500 g between 2016 and 2018 who received antibiotics were included. A multivariate linear regression analysis was conducted to determine if clinical factors contributed to increased hospital cost or length of stay. Results In total, 190 patients met inclusion criteria with 94 infants in the prolonged antibiotic group and 96 in the control group. Prolonged antibiotic use was associated with an increase length of hospital stay of approximately 31.87 days, resulting in a $69,946 increase in total cost of hospitalization. Conclusion Prolonged antibiotics in neonates with negative blood culture were associated with significantly longer hospital length of stay and increased total cost of hospitalization. Key Points

scholarly journals Perbandingan Tindakan Massage Counterpressure dan Pemberian Dark Chocolate terhadap Penurunan Nyeri Haid (Dismenorea)

2019 ◽  
Vol 3 (1) ◽  
pp. 281-291
Author(s):  
Rindang Fitriana Ulfa ◽  
Agus Suwandono ◽  
Kamilah Budhi
Keyword(s):  
Pain Medication ◽  
Dark Chocolate ◽  
Control Group ◽  
Menstrual Pain ◽  
Control Group Design ◽  
Group Design ◽  
A Value ◽  
Before And After ◽  
Massage Group ◽  
Quasi Experimental

The purpose of this study was to see the comparison between the administration of Massage Counterpressure and the provision of dark chocolate to reduce menstrual pain (dysmenorrhoea). The design uses a quasi-experimental design with two groups of pretest and posttest with control group design. The results showed that in the dark chocolate and anti-pain medication group, massage counterressure and anti-pain medicine obtained ρ value of 0,000. there are significant differences before and after the administration of action. The results of the man whitney test found that there were differences between the 2 groups with a value of ρ value of 0,000. Conclusion, there is a difference of influence between the dark chocolate group and the counterpressure massage group on the intensity of menstrual pain. Giving 100 grams of dark chocolate for 2 days and anti-pain medication is more effective than a 20-minute counterpressure massage for 2 days and anti-pain medication for menstrual pain intensity.   Keywords: Dark Chocolate, Massage counterprssure, Menstrual pain

scholarly journals Consent for the discontinuation of life-prolonging treatment in cancer patients: a retrospective comparative analysis before and after the enforcement of the Life Extension Medical Decision law

2020 ◽  
Author(s):  
YuJin Chung ◽  
JinHo Beom ◽  
JiEun Lee ◽  
Incheol Park ◽  
Junho Cho
Keyword(s):  
Emergency Room ◽  
Hospital Stay ◽  
Cancer Patients ◽  
Average Length ◽  
Length Of Hospital Stay ◽  
Life Extension ◽  
Medical Decision ◽  
Patient Consent ◽  
Before And After ◽  
The Law

Abstract Background The Life Extension Medical Decision law enacted on February 4, 2018 in South Korea was the first to consider the suspension of nonsensical life-prolonging treatment, and its enactment raised big controversy in Korean society. However, there is no study on whether the actual life-prolonging treatment for patients has decreased after enforcing the law. This study aimed to compare the provision of patient consent before and after the enforcement of the law among cancer patients who visited a tertiary university hospital's emergency room to understand the effects of the law on cancer patients' clinical care. Methods This retrospective single cohort study included advanced cancer patients over 19 years of age who visited the emergency room at a tertiary university hospital. The two study periods were as follows: from February 2017 to January 2018 (before) and from May 2018 to April 2019 (after). The primary outcome was the average length of hospital stay. The consent rate for cardiopulmonary resuscitation (CPR), intubation, continuous renal replacement therapy (CRRT), and intensive care unit (ICU) admission were the secondary outcomes. Results The average length of hospital stay decreased after the law was enforced, from 4 days to 2 days (p= 0.001). The rates of direct transfers to secondary and nursing hospitals increased from 8.2% to 21.2% (p=0.001) and from 1.0% to 9.7%, respectively (p<0.001). The rate of provision of consent for admission to the ICU decreased from 6.7% to 2.3% (p=0.032). For CPR and CRRT, the rate of provision of consent decreased from 1.0% to 0.0% and from 13.9% to 8.8%, respectively, but the differences were not significant (p=0.226 and p=0.109, respectively). Conclusion According to previous research, for patients wishing only conservative treatment, the reduction in hospital stays at tertiary hospitals ultimately reduces the physical, emotional, financial burdens and also improves the quality of end-of-life at home or in a hospice facility. In this context, this research ultimately show that the purpose of the LEMD law has been achieved. Further research in several hospitals including those patients who completed the consent after hospitalization is needed to generalize the clinical implication of the LEMD law.

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