Choice of Classification for Determining the Tactics of Surgical Treatment of Pancreatic Injuries

The purpose of this study was the choice of classification for objective assessment of the severity of traumatic injuries of the pancreas on the basis of a comparative analysis of the immediate results of surgical treatment. A new variant of the classification of severity traumatic injuries of the pancreas was proposed. Comparative analysis of classifications D. Smego et al. (1985) and A.K. Eramishanсev et al. (1994) with the proposed option stratification affected by severity of damage was carried out. The study is based as a retrospective analysis of 202 patients with the treatment of traumatic injuries of the pancreas, made during the period from 1990 to 2006. For each of the classifications of all the patients were divided into 4 groups depending on the severity of the damage and determined the number and severity of specific postoperative complications, mortality, and length of hospital stay of discharged patients. Directly propor-tional to a statistically significant dependence of the increase in the number of unfavorable outcomes of treatment and duration of hospital stay with increased severity of damage to the pancreas when using the proposed classification author’s scheme was revealed. Other classifications were not statistically significant differences in complications and mortality in groups of patients with different degrees of severity of injury to the pancreas.

Download Full-text

Postoperative condition of patients as a result of treatment of inguinal hernias by laparoscopic and open methods

Paediatric Surgery Ukraine ◽

10.15574/ps.2021.72.30 ◽

2021 ◽

pp. 30-35

Author(s):

V.V. Skyba ◽

◽

A.V. Ivanko ◽

N.V. Voytyuk ◽

V.V. Lysytsia ◽

...

Keyword(s):

Inguinal Hernia ◽

Surgical Treatment ◽

Open Access ◽

Hospital Stay ◽

Laparoscopic Approach ◽

Length Of Hospital Stay ◽

Lower Percentage ◽

Hernia Surgery ◽

Inguinal Hernias ◽

Inguinal Hernia Surgery

Purpose – to analyze condition of patients after surgical treatment of inguinal hernias by laparoscopic and open methods. Materials and methods. A retrospective review of medical histories and outpatient charts of all patients who underwent inguinal hernia surgery at the Kyiv City Clinical Hospital No. 1 from January 2018 to July 2020 was conducted. Results. During the above period of time in our hospital open hernioplasty was performed in 86 patients, laparoscopic hernioplasty – 138 patients. With open hernioplasty, the average duration of surgical treatment was 40±12 minutes. The laparoscopic technique was 35±12 minutes. The length of hospital stay was significantly longer in the group of patients with the open method (48±12 hours) than in the group of laparoscopic plastic surgery (12±3 hours). From the group of patients who underwent open hernioplasty, 62 patients complained of long-term pain syndrome, from the group of laparoscopy – 12 patients. The cosmetic appearance was dissatisfied with 34 patients in the open access group and only 2 patients in the laparoscopic plastic group. Postoperative complications were observed in 34 patients who underwent surgical treatment through open access, and in 15 patients – by laparoscopy. Conclusions. The laparoscopic approach of inguinal hernia surgery is superior to open access, as it reduces the length of hospital stay, postoperative recovery, improves the aesthetic effect of the operation, reduces the frequency of infection of incisions. According to the results of the study, this technique gives a better result in the early postoperative period, a lower percentage of chronic pain and a higher degree of patient satisfaction compared to open access with the same low recurrence rate. Therefore, in our opinion, laparoscopic access to hernioplasty is the optimal method of treatment and can be recommended as a method of choosing inguinal hernia surgery. Postoperative assessment of the quality of life of patients after treatment of inguinal hernia by laparoscopic and open methods. The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local ethics committee of all participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: inguinal hernia, laparoscopy, open access surgery, analysis of methods, operation.

Download Full-text

Treatment of the pilonidal sinus in children using laser radiation

Laser Medicine ◽

10.37895/2071-8004-2020-24-4-32-36 ◽

2021 ◽

Vol 24 (4) ◽

pp. 32-36

Author(s):

D. S. Zolotukhin ◽

I. V. Krochek ◽

S. V. Sergiyko

Keyword(s):

Comparative Analysis ◽

Surgical Treatment ◽

Hospital Stay ◽

Pain Syndrome ◽

Surgical Excision ◽

Duration Of Surgery ◽

Invasive Method ◽

Open Excision ◽

Interstitial Thermotherapy ◽

Late Postoperative Period

The work carried out a comparative analysis of the results of surgical treatment of the epithelial-coccygeal course of ECC in 133 children aged 3 to 17 years, using laser-induced interstitial thermotherapy (LIT) and open excision. Comparative analysis was carried out according to the following criteria: duration of surgery, average time of hospital stay, duration of pain syndrome on a 10-point scale (VAS), the presence of complications in the early and late postoperative period. In the main group, the average time of hospital stay was 4.9 ± 0.3; the duration of surgical treatment was 17.2 ± 2.8 minutes. The duration of the pain syndrome was 5.3 ± 2.1 hours, and its severity was 2.7 ± 0.8 points. Average terms of epithelialization of fistulas are 3.1 ± 2.8 days. Recurrence of ECC was observed in 7 patients (11.7%), which required re-intervention. In 3 (5.0%) patients, LIT was used, and in 4 (6.7%), excision using plastics according to the Bascom method. In the comparison group, the duration of surgical treatment was 32.6 ± 5.4 minutes. The duration of inpatient treatment is 16.7 ± 1.4 days. Pain syndrome averaged 71.8 ± 11.9 hours, severity 6.5 ± 2.3 points. The number of relapses was 9 (12.3%), of which 5 (6.8%) children underwent laser treatment, and 4 (5.5%) repeated surgical excision with Bascom with recovery. This technique is an effective and minimally invasive method for treating ECC, which makes it possible to recommend this method for use in pediatric surgical practice.

Download Full-text

Surgical treatment of colonic Crohn’s disease: a national snapshot study

Langenbeck s Archives of Surgery ◽

10.1007/s00423-020-02038-z ◽

2020 ◽

Author(s):

Keyword(s):

Crohn’S Disease ◽

Surgical Treatment ◽

Crohn's Disease ◽

Hospital Stay ◽

Subtotal Colectomy ◽

Postoperative Morbidity ◽

Elective Surgery ◽

Length Of Hospital Stay ◽

High Rate ◽

Segmental Colectomy

Abstract Aim The different surgical options for patients with colonic Crohn’s disease (CD) include segmental colectomy, subtotal colectomy or proctocolectomy with end ileostomy. We present a national, multicentre study, promoted by the Italian Society of Colorectal Surgery with the aim to collect benchmark data and national variations on multidisciplinary management and postoperative outcomes of patients undergoing surgery for colonic CD. Methods All adult patients having elective surgery for colonic CD from June 2018 to May 2019 were eligible for participation in this retrospective study. The primary outcome measure was postoperative morbidity within 30 days of surgery. Results One hundred twenty-two patients were included: 55 subtotal colectomy, 30 segmental colectomy, 25 proctectomy and 12 proctocolectomy. Eighty-six patients (70.4%) were discussed at the inflammatory bowel disease (IBD) multidisciplinary team meeting (MDT) prior to surgery. This ranged from 76.6% for segmental colectomy to 60% for subtotal colectomy, 66.6% for proctocolectomy and 48% for proctectomy. The proportion of patients counselled by a stoma nurse preoperatively was 50%. Laparoscopy was associated with reduced postoperative morbidity (p = 0.017) and shorter length of hospital stay (p < 0.001), whilst pre-operative anti-TNF was associated with Dindo-Clavien ≥ 3 complications (p = 0.023) and longer in-hospital stay (p = 0.007). The main procedure performed (segmental colectomy, subtotal colectomy, proctocolectomy or proctectomy) was not associated with postoperative morbidity (p = 0.626). Conclusions Surgery for colonic CD has a high rate of postoperative complications. Almost a third of the patients were not preoperatively discussed at the IBD MDT, whilst the use of minimally invasive surgery for surgical treatment of colonic CD ranges from 40 to 66%.

Download Full-text

Analysis of the influence of risk factors on the development of complications after heart surgery

Medical Science And Education Of Ural ◽

10.36361/1814-8999-2021-22-2-111-114 ◽

2021 ◽

Vol 22 (2) ◽

pp. 111-114

Author(s):

V. V. Sokolova ◽

◽

V. E. Shneider ◽

T. E. Burova ◽

A. V. Dorovikova ◽

...

Keyword(s):

Risk Factors ◽

Cardiac Surgery ◽

Comparative Analysis ◽

Postoperative Complications ◽

Hospital Stay ◽

Heart Surgery ◽

Length Of Hospital Stay ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Surgery Department

Aim. To study the influence of risk factors on the development of complications in patients after heart surgery. Materials and methods. The study was carried out on the basis of the cardiac surgery department of the «OKB № 1», Tyumen. In the course of the work, a retrospective analysis of the results of cardiac surgery with sternotomy access was carried out on the basis of 469 case histories of patients in the period 2014-2020. Results. During the study, all patients were divided into 2 groups: patients with complications associated with access and without complications. As a result, a database of patients was created, on the basis of which a comparative analysis of 45 risk factors was carried out. Based on a comparative analysis, it was proved that in the development of postoperative complications, the leading risk factors among preoperative ones are diabetes mellitus, chronic obstructive pulmonary disease, obesity; among intraoperative risk factors, hemorrhage during surgery of more than 1000 ml is statistically significant. The number of resternotomies in history and the presence of risk factors affect the length of hospital stay and mortality after cardiac surgery. Conclusion. Timely diagnosis of concomitant diseases, their compensation and correction in the postoperative period affects and prevents the development of early postoperative complications. Careful hemostasis, a differentiated approach to osteosynthesis of the sternum after sternotomy reduce the risk of postoperative complications and the number of hospital stay days, which significantly reduces the economic costs of the hospital.

Download Full-text

Usefulness of Six Diagnostic and Screening Measures for Undernutrition in Predicting Length of Hospital Stay: A Comparative Analysis

Journal of the Academy of Nutrition and Dietetics ◽

10.1016/j.jand.2014.11.015 ◽

2015 ◽

Vol 115 (6) ◽

pp. 927-938 ◽

Cited By ~ 23

Author(s):

Rita S. Guerra ◽

Isabel Fonseca ◽

Fernando Pichel ◽

Maria T. Restivo ◽

Teresa F. Amaral

Keyword(s):

Comparative Analysis ◽

Hospital Stay ◽

Length Of Hospital Stay ◽

Screening Measures

Download Full-text

A Decade of Variation in the Surgical Treatment of Cervical Degenerative Disease: An Analysis of 20288 Inpatient Surgery Records from the Period of 2000-2016 (Preprint)

10.2196/preprints.12703 ◽

2018 ◽

Author(s):

Si Zheng ◽

Yan Li ◽

Yun Xia Wu ◽

Jiao Li ◽

Jia Yang Wang ◽

...

Keyword(s):

Surgical Treatment ◽

Hospital Stay ◽

Average Length ◽

Length Of Hospital Stay ◽

Demographic Characteristics ◽

Female Ratio ◽

Age At Surgery ◽

Cervical Degenerative Disease ◽

Male To Female ◽

Surgical Operations

BACKGROUND Cervical degenerative disease (CDD) refers to disease involving degenerative processes that occur in the cervical spine. In recent decades, with the development of more accurate diagnosis and better treatment options, inpatient surgery for CDD has become the mainstay when conservative treatment fails, yet little is known about variations in patient demographic characteristics associated with surgical treatment. OBJECTIVE This study assessed the number of surgical operations, variation in mean age at surgery, the male to female ratio and the average length of hospital stay for CDD patients. METHODS We conducted a real-world study using inpatient surgery data from the department of orthopedics in a hospital in northern China (2000-2016). Regression modeling and time series analysis were used. The length of hospital stay was used to measure improvement associated with treatment. RESULTS This study analyzed 20,288 inpatient surgery records. Over the last 17 years, the number of surgical operations increased (average annual increase of 11.13%), with some fluctuations. In total, 76.38% of surgeries occurred in patients aged 41 - 65 years (15,496), and there was no significant change in mean age at surgery for CDD patients during the study period. The male to female ratio of the patients was 1.83:1 (13,126 vs 7,162). Interestingly, the proportion of surgeries performed on female patients showed an increasing trend from 2000 to 2016 (P < .001). The average length of hospital stay for surgical treatment decreased from 23.21 days to 6.53 days, and showing a steady decline from 2012 onward. CONCLUSIONS This study investigated the demographic characteristics and trends over time among CDD patients who underwent surgical treatment. The mean age at surgery was stable during the 17-year study period, with an increased proportion of female patients and a decreased average length of hospital stay with time. These data may be valuable to guide resource allocation for early prevention, diagnosis and surgical treatment for CDD.

Download Full-text

Descending Necrotizing Mediastinitis: Analysis of 9 Cases in Our Hospital

Ear Nose & Throat Journal ◽

10.1177/0145561320933964 ◽

2020 ◽

pp. 014556132093396

Author(s):

Peng Wu ◽

Fan Ye ◽

Ziheng Zhang ◽

Linghao Zhang ◽

Hailiang Lin ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Surgical Treatment ◽

Hospital Stay ◽

Intensive Care Unit Stay ◽

Multidisciplinary Approach ◽

Average Length ◽

Length Of Hospital Stay ◽

Descending Necrotizing Mediastinitis ◽

Hospital Deaths

Objectives: Descending necrotizing mediastinitis (DNM) is a serious and progressive infection involving the neck and chest and with high mortality if not treated quickly and properly. The aim of this study is to share our practices for managing this condition. Methods: We retrospectively evaluated 9 patients diagnosed with DNM in our hospital between January 2006 and October 2019. Age, gender, origin of infection, length of hospital stay, microorganisms present, type of surgical treatment, and clinical outcomes were reviewed. Results: All patients underwent surgery to drain neck and mediastinal secretions and collections. Three (33.3%) patients were treated with transcervical drainage alone, and 6 (66.7%) patients were treated with combined transcervical and transthoracic drainage. Reoperations were reported in 3 (33.3%) cases. The average length of hospital stay was 22.78 ± 10.05 days (range: 9-40 days). The average length of intensive care unit stay was 6.44 ± 10.10 days (range: 0-25 days). There were no in-hospital deaths, and all patients were discharged home with good outcomes. Conclusions: To improve the prognosis of DNM, we suggest early and adequate debridement of all affected areas along with the proper use of antibiotics. A multidisciplinary approach involving both cardiothoracic and ENT surgeons is also required.

Download Full-text

Endoscopic Versus Surgical Treatment of Downstream Pancreatic Duct Stones in Chronic Pancreatitis

The American Surgeon ◽

10.1177/000313481107701146 ◽

2011 ◽

Vol 77 (11) ◽

pp. 1531-1538 ◽

Cited By ~ 2

Author(s):

Jianguo Hong ◽

Jian Wang ◽

Alex M. Keleman ◽

David K. Imagawa ◽

Kesen Xu ◽

...

Keyword(s):

Surgical Treatment ◽

Pain Relief ◽

Hospital Stay ◽

Success Rate ◽

Pancreatic Duct ◽

Length Of Hospital Stay ◽

Long Term Results ◽

Stone Removal ◽

Pancreatic Duct Stones

Pancreatic duct stone is thought not only to be the cause of abdominal pain but also to be a risk factor for pancreatic cancer. Several treatment options have been implemented in the treatment of pancreatic duct stones. Stone location is a critical factor in selecting treatment. We present the results of 27 endoscopic treatments and 35 surgical treatments performed in three hospitals at a single university between January 2000 and January 2005. The results were compared retrospectively in terms of success rate of stone removal, length of hospital stay, complications, pain relief, and changes of pancreatic functions. In our study, endoscopy resulted in a similar success rate of stone removal and short-term pain relief rate as the surgical approach and with a shorter length of hospital stay. However, the surgical group had a more favorable long-term clinical result, as well as a lower number of hospital readmissions at the 5-year follow-up point. Based on long-term results, surgical treatment is more effective than endoscopy.

Download Full-text

Perioperative Outcomes of Transurethral Resection, Open Prostatectomy, and Laser Therapy in the Surgical Treatment of Benign Prostatic Obstruction: A “Real-World” Data Analysis from the URO-Cert Prostate Centers

Urologia Internationalis ◽

10.1159/000517673 ◽

2021 ◽

pp. 1-6

Author(s):

Jan Herden ◽

Thomas Ebert ◽

Daniel Schlager ◽

Jana Pretzer ◽

Daniel Porres ◽

...

Keyword(s):

Surgical Treatment ◽

Hospital Stay ◽

Laser Therapy ◽

Transurethral Resection ◽

Length Of Hospital Stay ◽

Treatment Quality ◽

Quality Data ◽

Perioperative Outcomes ◽

Open Prostatectomy ◽

Benign Prostatic Obstruction

Introduction: The aim of the study is to compare length of hospital stay, transfusion rates, and re-intervention rates during hospitalization for transurethral resection of the prostate (TUR-P), open prostatectomy (OP), and laser therapy (LT) for surgical treatment of benign prostatic obstruction (BPO). Methods: URO-Cert is an organization, in which clinical data of prostatic diseases from 2 university, 19 public, and 3 private hospitals and 270 office-based urologists are collected in order to document treatment quality. Data on diagnostics, therapy, and course of disease are recorded web based. The analysis includes datasets from 2005 to 2017. Results: Of 10,420 patients, 8,389 were treated with TUR-P, 1,334 with OP, and 697 with LT. Median length of hospital stay was 6 days (IQR: 4–7) for TUR-P, 9 days (IQR: 7–11) for OP, and 5 days (IQR: 4–6) for LT (p < 0.001). Risk for a hospital stay ≥7 days was higher for OP versus TUR-P (OR: 7.25; 95% CI = 6.27–8.36; p < 0.001) and LT (OR: 17.89; 95% CI = 14.12–22.65; p < 0.001) and higher for TUR-P versus LT (OR: 2.47; 95% CI = 2.03–3.01; p < 0.001). OP had a significantly higher risk for transfusions than TUR-P (OR: 2.44; 95% CI = 1.74–3.41; p < 0.001) and LT (OR: 3.32; 95% CI = 1.56–7.01; p < 0.001). Transfusion rates were not significantly different between TUR-P and LT (OR: 1.36; 95% CI = 0.66–2.79; p = 0.51). Risk of re-intervention was not different between all 3 approaches. Conclusion: OP was associated with higher transfusion rates and longer hospital stay than TUR-P and LT. Risk of transfusion was not different between TUR-P and LT, but TUR-P was inferior to LT concerning length of hospital stay. Re-intervention rates during hospitalization did not differ between the groups.

Download Full-text

Trends in isolated lumbar spinal stenosis surgery among working US adults aged 40–64 years, 2010–2014

Journal of Neurosurgery Spine ◽

10.3171/2018.1.spine17964 ◽

2018 ◽

Vol 29 (2) ◽

pp. 169-175 ◽

Cited By ~ 11

Author(s):

Micheal Raad ◽

Callum J. Donaldson ◽

Mostafa H. El Dafrawy ◽

Daniel M. Sciubba ◽

Lee H. Riley ◽

...

Keyword(s):

Surgical Treatment ◽

Hospital Stay ◽

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Skilled Nursing Facility ◽

Length Of Hospital Stay ◽

Nursing Facility ◽

Skilled Nursing ◽

The Us ◽

Lumbar Spinal

OBJECTIVERecommendations for the surgical treatment of isolated lumbar spinal stenosis (LSS) (i.e., in the absence of concomitant scoliosis or spondylolisthesis) are unclear. The aims of this study were to investigate trends in the surgical treatment of isolated LSS in US adults and determine implications for outcomes.METHODSThe authors analyzed inpatient and outpatient claims from the Truven Health Analytics MarketScan Commercial Claims and Encounters Database for 20,279 patients aged 40–64 years who underwent surgery for LSS between 2010 and 2014. Only patients with continuous 12-month insurance coverage after surgery were included. The rates of decompression with arthrodesis versus decompression only and of simple (1- or 2-level, single-approach) versus complex (> 2-level or combined-approach) arthrodesis were analyzed by year and geographic region. These trends were further analyzed with respect to complications, length of hospital stay, payments made to the hospital, and patient discharge status. Statistical significance was set at p < 0.05.RESULTSThe proportion of patients who underwent decompression with arthrodesis compared with decompression only increased significantly and linearly from 2010 to 2014 (OR 1.08; 95% CI 1.06–1.10). Arthrodesis was more likely to be complex rather than simple with each subsequent year (OR 1.4; 95% CI 1.33–1.49). This trend was accompanied by an increased likelihood of postoperative complications (OR 1.11; 95% CI 1.02–1.21), higher costs (payments increased by a mean of US$1633 per year; 95% CI 1327–1939), and greater likelihood of being discharged to a skilled nursing facility as opposed to home (OR 1.11; 95% CI 1.03–1.20). The South and Midwest regions of the US had the highest proportions of patients undergoing arthrodesis (48% and 42%, respectively). The mean length of hospital stay did not change significantly (p = 0.324).CONCLUSIONSFrom 2010 to 2014, the proportion of adults undergoing decompression with arthrodesis versus decompression only for the treatment of LSS increased, especially in the South and Midwest regions of the US. A greater proportion of these fusions were complex and were associated with more complications, higher costs, and a greater likelihood of being discharged to a skilled nursing facility.

Download Full-text