scholarly journals Factors Affecting Length of Stay Following 3-Column Spinal Osteotomies in Pediatric Patients

2019 ◽  
pp. 219256821989522
Author(s):  
So Kato ◽  
Taylor Dear ◽  
Stephen J. Lewis
Keyword(s):  
Body Weight ◽  
Postoperative Complications ◽  
Length Of Stay ◽  
Pediatric Patients ◽  
Perioperative Complications ◽  
Intraoperative Complications ◽  
Operation Time ◽  
Fluid Administration ◽  
Prolonged Stay ◽  
Factors Affecting

Study Design: A retrospective analysis. Objectives: Length of stay (LOS) is one of the important indicators for the quality of patient care. Although perioperative complications are known to be associated with longer LOS in general, little has been understood regarding LOS after 3-column spinal osteotomy for the rigid spinal deformity in pediatric population. The main objective of the article is to identify factors affecting the LOS in pediatric patients undergoing 3-column posterior spinal osteotomies. Methods: Following research ethics approval, a retrospective review was performed of 35 consecutive posterior 3-column spinal osteotomies performed on pediatric patients in a single academic institution. Patients’ demographic data, preoperative comorbidities, details of operative procedures, intraoperative complications, and postoperative complications were investigated, and LOS was compared among the groups. Results: The mean LOS was 9.0 days, and the median LOS was 7 days (range = 4-23 days). Low body weight and syndromic deformity were associated with longer LOS. Operation time ≥6 hours and total perioperative fluid administration greater than or equal to twice the estimated blood volume were associated with longer LOS. Among postoperative complications, those with respiratory complication had prolonged stay. Conclusions: Preoperative low body weight and syndromic scoliosis had longer LOS after 3-column osteotomies. Excessive fluid administration and respiratory complications were associated with longer LOS.

Morbidity Associated with Diverting Loop Ileostomies: Weighing Diversion in Rectosigmoid Resection

2017 ◽  
Vol 83 (7) ◽  
pp. 786-792
Author(s):  
Nathan Belkin ◽  
Liliana G. Bordeianou ◽  
Paul C. Shellito ◽  
Alexander T. Hawkins
Keyword(s):  
Adjuvant Chemotherapy ◽  
Postoperative Complications ◽  
Anterior Resection ◽  
Massachusetts General Hospital ◽  
Perioperative Complications ◽  
Primary Anastomosis ◽  
Operation Time ◽  
Emergency Department Visits ◽  
Rectosigmoid Resection ◽  
Estimated Blood Loss

Anterior resection with primary anastomosis is the procedure of choice for patients with rectosigmoid cancers with good sphincter function. Surgeons may perform an associated diverting loop ileostomy (DLI) to minimize the likelihood and/or the severity of an anastomotic leak. To examine the morbidity of DLIs, we performed a review of a prospectively maintained database. Participants included all patients at the Massachusetts General Hospital who underwent anterior resection from January 2013 to July 2015 for rectosigmoid cancers and who subsequently underwent adjuvant chemotherapy. The primary outcome was time to start of adjuvant chemotherapy. Secondary outcomes included length of hospitalization, perioperative complications, and 60-day postoperative complications. Inclusion criteria were met in 57 patients and DLI was performed in 21 (37%). The DLI group had higher estimated blood loss (431.7 vs 192.1 mL, P = 0.03) and a longer operation time (3.7 vs 2.3 hours, P = 0.0007). The DLI group took over a week longer to start adjuvant chemotherapy than the non-DLI group (median time to chemo: 43 vs 34 days, P = 0.002). Postoperatively, DLI was associated with a longer hospitalization (6.7 vs 3.1 days, P = 0.0003), more perioperative complications (57.1% vs 13.9%, P = 0.0006), and more 60-day read-missions or emergency department visits (38.1% vs 5.6%, P = 0.002). Ostomies are associated with appreciable morbidity. In turn, they do not eliminate postoperative complications. Surgeons should closely consider ostomy morbidity in rectosigmoid resection and institute a proactive approach toward identification and prevention of complications.

scholarly journals Predictors of Prolonged Hospital Stay in Cardiac Surgery

2018 ◽  
Vol 3 (6) ◽  
pp. 157
Author(s):  
Zuraida Khairudin
Keyword(s):  
Risk Factors ◽  
Cardiac Surgery ◽  
Length Of Stay ◽  
Publishing House ◽  
Prolonged Stay ◽  
Factors Affecting ◽  
Kaplan Meier ◽  
Patients With Diabetes ◽  
Prolonged Hospital ◽  
Cabg Patients

The prolonged stay after cardiac surgery can significantly decrease the quality of life. Many studies have assessed the risk factors associated with length of stay but only a few have discussed the risk factors of prolonged stay after surgery. Therefore, this study is aimed to determine the risk factors affecting long term stay in hospital after CABG and to make comparison between group for each risk factors. All the risk factors were determined by Kaplan-Meier analysis. Overall, 3096 of CABG patients were discharged within less than 14 days, whereas 332 patients required prolonged (>14days) stays. The findings from the suruiual analysis indicated that patients with diabetes and wound infection stayed longer in the hospital. Keywords: CABG, length of stay, prolonged stay, Kaplan-Meier analysis eISSN 2514-7528 © 2018. The Authors. Published for AMER ABRA cE-Bs by e-International Publishing House, Ltd., UK. This is an open-access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Peer–review under responsibility of AMER (Association of Malaysian Environment-Behaviour Researchers), ABRA (Association of Behavioural Researchers on Asians) and cE-Bs (Centre for Environment-Behaviour Studies), Faculty of Architecture, Planning & Surveying, Universiti Teknologi MARA, Malaysia.

Factors affecting hospital admission and length of stay of poisoned patients in the North East of England

1996 ◽  
Vol 15 (11) ◽  
pp. 915-919 ◽  
Author(s):  
Shl Thomas ◽  
S. Lewis ◽  
L. Bevan ◽  
S. Bhattacharyya ◽  
MG Bramble ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Hospital Admission ◽  
Hospital Stay ◽  
Patient Characteristics ◽  
Case Mix ◽  
Prolonged Stay ◽  
Factors Affecting ◽  
North East ◽  
The North ◽  
The Impact

1 Poisoning is a common reason for presentation to hospital and hospital admission but there is no agreed policy for managing these patients. This study exam ined the management of patients presenting with poisoning and the factors affecting the probability of hospital admission and prolonged stay. 2 Data on all cases of poisoning presenting to six Accident and Emergency departments in the North East of England over 12 weeks in 1994 was collected prospectively from A&E notes. Length of stay and outcome were recorded from hospital computer records. 3 Overall, 73% of patients were admitted to a medical ward. Probability of admission was not independently affected by age or gender but was increased in those with intentional poisoning (Odds Ratio (OR) 3.3 [95% CI 1.8, 6.1]), a history of self harm (OR 1.7, [1.0, 2.9]) or potentially hazardous poisoning (OR 3.7 [2.1, 6.6]). There were significant variations between hospitals (50 - 80%) which could not be attributed to case mix. 4 Prolonged stay ( > 2 nights) was more common in patients over 65 years (OR 6.8 [2.9, 16.1]), those with intentional poisoning (OR 2.7 [1.1, 6.6]) and those with potentially hazardous poisoning (OR 2.6 [1.4, 4.9]). Mean hospital stay was 1.5 days and varied signifi cantly between hospitals from 0.8 to 2.1 days and this was independent of case mix. 5 There are appreciable variations in the management of poisoning between hospitals which are not explained by patient characteristics. Savings would occur if rates of admission and duration of stay were reduced by those hospitals where admission is more frequent or hospital stay is longer. However, the impact of this on long term morbidity is unknown.

scholarly journals Robot-assisted vs. laparoscopic repair of complete upside-down stomach hiatal hernia (the RATHER-study): A prospective comparative single center study

2021 ◽  
Vol 108 (Supplement_4) ◽  
Author(s):  
F Nocera ◽  
A Wilhelm ◽  
R Schneider ◽  
L Koechlin ◽  
D Daume ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Laparoscopic Surgery ◽  
Postoperative Complications ◽  
Hiatal Hernia ◽  
Laparoscopic Repair ◽  
Intraoperative Complications ◽  
Operation Time ◽  
Hiatal Hernia Repair ◽  
Robot Assisted

Abstract Objective Complete upside-down stomach (cUDS) hernias are a subgroup of large hiatal hernias characterized by high risk of life-threatening complications and technically challenging surgical repair including complex mediastinal dissection. In a prospective, comparative clinical study, we evaluated intra- and postoperative outcomes, quality of life and symptomatic recurrence rates in patients with cUDS undergoing robot-assisted, as compared to standard laparoscopic repair (the RATHER-study). Methods All patients with cUDS herniation requiring elective surgery in our institution between July 2015 and June 2019 were evaluated. Patients undergoing primary open surgery or additional associated procedures were not considered. Primary endpoints were intra- and postoperative complications, 30-day morbidity, and mortality. During the 8-53 months follow-up period, patients were contacted by telephone to assess symptoms associated to recurrence, whereas quality of life was evaluated utilizing the Gastroesophageal Reflux Disease–Health-Related Quality of Life (GERD-HRQL) questionnaire. Results A total of 55 patients were included. 36 operations were performed with robot-assisted (Rob-G), and 19 with standard laparoscopic (Lap-G) technique. Patients characteristics were similar in both groups. Median operation time was 232 min. (IQR: 145-420) in robot-assisted vs. 163 min. (IQR:112-280) in laparoscopic surgery (p < 0.001). Intraoperative complications occurred in 5/36 (12.5%) cases in the Rob-G group and in 5/19 (26%) cases in the Lap-G group (p = 0.28). No conversion was necessary in either group. Minor postoperative complications occurred in 13/36 (36%) Rob-G patients and 4/19 (21%) Lap-G patients (p = 0.36). Mortality or major complications did not occur in either group. Two asymptomatic recurrences were observed in the Rob-G group only. No patient required revision surgery. Finally, all patients expressed satisfaction for treatment outcome, as indicated by similar GERD-HRQL scores. Conclusion While robot-assisted surgery provides additional precision, enhanced visualization, and greater feasibility in cUDS hiatal hernia repair, its clinical outcome is at least equal to that obtained by standard laparoscopic surgery.

scholarly journals Laparoendoscopic single-site nephrectomy versus conventional laparoendoscopic nephrectomy for kidney tumor: a systematic review and meta-analysis

2019 ◽  
Vol 39 (8) ◽  
Author(s):  
Dengyuan Feng ◽  
Rong Cong ◽  
Hong Cheng ◽  
Yi Wang ◽  
Jiajun Zhou ◽  
...  
Keyword(s):  
Perioperative Complications ◽  
Meta Analysis ◽  
Intraoperative Complications ◽  
Operation Time ◽  
Single Site ◽  
Cochrane Library ◽  
Kidney Tumor ◽  
Analgesic Requirement ◽  
Laparoendoscopic Single Site ◽  
Estimated Blood Loss

Abstract With the increasing application of laparoendoscopic single-site nephrectomy (LESS-N) in kidney tumor, accumulating studies compared it with conventional laparoendoscopic nephrectomy (CL-N). However, controversial outcomes were reported. Hence, this meta-analysis was carried out to clarify these issues. Online databases PubMed, EMBASE and the Cochrane Library were searched comprehensively for eligible studies published before 24 July 2018. Odds ratios (ORs) or standardized mean differences (SMDs) with corresponding 95% confidence intervals (CIs) were collected for evaluating the pooled results of relevant outcomes. Ultimately, 13 eligible articles were enrolled. Meanwhile, compared with CL-N, LESS-N was related to a longer operation time (SMD: 0.40; 95% CI, 0.23–0.58; P=0.000), a shorter length of hospital stay (LOS) (SMD: −0.32; 95% CI, −0.62 to −0.02; P=0.034), a lower visual analog scale (VAS) score (SMD: −0.89; 95% CI, −1.22 to −0.56; P=0.000) and a lower analgesic requirement (SMD: −0.55; 95% CI, −0.87 to −0.23; P=0.001). There was no statistical difference in the postoperative day of oral intake, estimated blood loss (EBL), conversion rate, perioperative complications, intraoperative complications, postoperative complications, minor complications and major complications between LESS-N and CL-N. Patients with LESS-N for kidney tumor could have a longer operation time and shorter LOS, and meanwhile could need less analgesics and suffer less pain after LESS-N.

Perioperative Outcomes of Holmium Laser Enucleation of the Prostate: A Systematic Review

2021 ◽  
pp. 1-13
Author(s):  
Angelo Porreca ◽  
Michele Colicchia ◽  
Alessandro Tafuri ◽  
Daniele D’Agostino ◽  
Gian Maria Busetto ◽  
...  
Keyword(s):  
Systematic Review ◽  
Postoperative Complications ◽  
Surgical Complications ◽  
Perioperative Complications ◽  
Intraoperative Complications ◽  
Holmium Laser ◽  
Perioperative Outcomes ◽  
Safe Procedure ◽  
Laser Enucleation ◽  
Holmium Laser Enucleation

<b><i>Introduction:</i></b> The aim of the study was to systematically review the literature and describe perioperative complications of holmium laser enucleation of the prostate (HoLEP), including the Clavien-Dindo classification of surgical complications. <b><i>Methods:</i></b> All English language publications on HoLEP were evaluated. We followed the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses) guidelines to evaluate PubMed<sup>®</sup>, Scopus<sup>®</sup>, and Web of Science™ databases from January 1, 1998, to June 1, 2020. <b><i>Results:</i></b> Fifty-seven studies were included, for a total of 10,371 procedures. We distinguished between intra-, peri-, and postoperative complications. Overall, the rate of complications is 0–7%. Intraoperative complications include incomplete morcellation (2.3%), capsular perforation (2.2%), bladder (2.4%), and ureteric orifice (0.4%) injuries. Perioperative complications include postoperative urinary retention (0.2%), hematuria and clot retention (2.6%), and cystoscopy for clot evacuation (0.7%). Postoperative complications include dysuria (7.5%), stress (4.0%), urge (1.8%), transient (7%) and permanent (1.3%) urinary incontinence, urethral stricture (2%) and bladder neck contracture (1%). <b><i>Conclusions:</i></b> HoLEP is a safe procedure, with a satisfactory low complication rate. The most common reported perioperative complications are not severe (Clavien-Dindo classification grades 1–2). Further randomized studies are certainly warranted to fully determine the predictor of surgical complications in order to prevent them and improve this technique.

Analysis of clinical factors associated with intraoperative and postoperative complications of retrograde intrarenal surgery

2021 ◽  
pp. 1-12
Author(s):  
Cuneyt Ozden ◽  
Cetin Volkan Oztekin ◽  
Sahin Pasali ◽  
Samet Senel ◽  
Doruk Demirel ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Intraoperative Complications ◽  
Solitary Kidney ◽  
Classification Systems ◽  
Retrograde Intrarenal Surgery ◽  
Intraoperative Complication ◽  
Factors Affecting ◽  
Factors Associated ◽  
Independent Risk Factors ◽  
Residual Stones

Abstract The aim of this study was to evaluate the factors affecting intraoperative and postoperative complications in retrograde intrarenal surgery. In the retrospective cohort study, 706 retrograde intrarenal surgery procedures applied to 617 patients were reviewed. Intraoperative and postoperative complications were classified according to the modified Satava and modified Clavien classification systems. The stone-free rate was 57.6% and the success rate was 74.8%. Intraoperative complications were observed in 30.5% (n:215) patients. The most common intraoperative complication was mild bleeding (8.5%). The only independent risk factor associated with intraoperative complications was the presence of residual stones. Postoperative complications were observed in 26.9% (n:190) of the patients. The most common postoperative complications were fever requiring antipyretic (8.6%). Independent risk factors associated with postoperative complications were the presence of residual stones and the presence of solitary kidney. Continuous...

Effects of age on perioperative complications of extensive multilevel thoracolumbar spinal fusion surgery

2010 ◽  
Vol 12 (4) ◽  
pp. 402-408 ◽  
Author(s):  
Jordan M. Cloyd ◽  
Frank L. Acosta ◽  
Colleen Cloyd ◽  
Christopher P. Ames
Keyword(s):  
Postoperative Complications ◽  
Elderly Patients ◽  
Spinal Fusion ◽  
Perioperative Complications ◽  
Intraoperative Complications ◽  
The Elderly ◽  
Complication Rates ◽  
Fusion Surgery ◽  
Spinal Fusion Surgery

Object The elderly compose a substantial proportion of patients presenting with complex spinal pathology. Several recent studies have suggested that fusion of 4 or more levels increases the risk of perioperative complications in elderly patients. Therefore, the purpose of this study was to analyze the effects of age in persons undergoing multilevel (≥ 5 levels) thoracolumbar fusion surgery. Methods A retrospective review of all hospital records, operative reports, and clinic notes was conducted for 124 consecutive patients who underwent surgery between 2000 and 2007 with an average follow-up of 3.5 years and a minimum follow-up of 1.2 years. The most frequent preoperative diagnoses included scoliosis, tumor, osteomyelitis, vertebral fracture, and degenerative disc disease with stenosis. Complications were classified as intraoperative and major and minor postoperative as well as the need for revision surgery. Multivariate logistic regression analysis was used to determine the effects of age and other potentially prognostic factors. Results After controlling for other factors, increasing age was associated with an elevated risk for major postoperative complications (OR 1.04, 95% CI 1.00–1.10) as were increasing levels of fusion (OR 1.5, 95% CI 1.1–2.1) and male sex (OR 4.6, 95% CI 1.3–16.2). In patients 65 years of age or older, rates of intraoperative complications, major and minor postoperative complications, and reoperation were 14.1, 23.4, 29.7, and 26.6%, respectively. The number of comorbidities was associated with a greater risk for perioperative complications in elderly patients (OR 1.8, 95% CI 1.1–2.8). Conclusions Age is a positive risk factor for major postoperative complications in extensive thoracolumbar spinal fusion surgery. Complication rates in the elderly are high, and good clinical judgment and careful patient selection are needed before performing extensive thoracolumbar reconstruction in older persons.

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