scholarly journals Hartmann’s procedure, reversal and rate of stoma-free survival

2018 ◽  
Vol 100 (4) ◽  
pp. 301-307 ◽  
Author(s):  
S Hallam ◽  
BS Mothe ◽  
RMR Tirumulaju
Keyword(s):  
Length Of Stay ◽  
Complication Rate ◽  
Major Complication ◽  
Wound Dehiscence ◽  
Hartmann’S Procedure ◽  
Hartmann's Procedure ◽  
Retrospective Audit ◽  
Audit Period ◽  
American Society ◽  
American Society Of Anesthesiologists

Background Hartmann’s procedure is a commonly performed operation for complicated left colon diverticulitis or malignancy. The timing for reversal of Hartmann’s is not well defined as it is technically challenging and carries a high complication rate. Methods This study is a retrospective audit of all patients who underwent Hartmann’s procedure between 2008 and 2014. Reversal of Hartmann’s rate, timing, American Society of Anesthesiologists grade, length of stay and complications (Clavien–Dindo) including 30-day mortality were recorded. Results Hartmann’s procedure (n = 228) indications were complicated diverticular disease 44% (n = 100), malignancy 32% (n = 74) and other causes 24%, (n = 56). Reversal of Hartmann’s rate was 47% (n = 108). Median age of patients was 58 years (range 21–84 years), American Society of Anesthesiologists grade 2 (range 1–4), length of stay was eight days (range 2–42 days). Median time to reversal of Hartmann’s was 11 months (range 4–96 months). The overall complication rate from reversal of Hartmann’s was 21%; 3.7% had a major complication of IIIa or above including three anastomotic leaks and one deep wound dehiscence. Failure of reversal and permanent stoma was less than 1% (n = 2). Thirty-day mortality following Hartmann’s procedure was 7% (n = 15). Where Hartmann’s procedure wass not reversed, for 30% (n = 31) this was the patient’s choice and 70% (n = 74) were either high risk or unfit. Conclusions Hartmann’s procedure is reversed less frequently than thought and consented for. Only 46% of Hartmann’s procedures were stoma free at the end of the audit period. The anastomotic complication rate of 1% is also low for reversal of Hartmann’s procedure in this study.

scholarly journals Analysis of factors affecting reversal of Hartmann’s procedure and post-reversal complications

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Jae Hyun Kang ◽  
Byung Mo Kang ◽  
Sang Nam Yoon ◽  
Jeong Yeon Kim ◽  
Jun Ho Park ◽  
...  
Keyword(s):  
Medical Records ◽  
Elective Surgery ◽  
Multivariable Analysis ◽  
Colorectal Disease ◽  
Hartmann’S Procedure ◽  
Class Iii ◽  
Factors Affecting ◽  
Hartmann's Procedure ◽  
American Society ◽  
American Society Of Anesthesiologists

Abstract Although Hartmann’s procedure (HP) is commonly used as emergency treatment for colorectal disease, the reversal of HP (HR) is infrequently performed. The aims were to evaluate the rate of HR and determine the factors predictive of achieving HR. We retrospectively reviewed the medical records of patients who underwent HP between January 2007 and June 2019 at six Hallym University-affiliated hospitals. Multivariable analysis was performed to identify which factors were independently associated with HR. In the study period, 437 patients underwent HP, and 127 (29.0%) subsequently underwent HR. Of these, 46 (35.9%) patients experienced post-HR complications. In multivariable analysis, an interval between HP and HR of > 6 months was associated with the only lower rate of post-HR complications. Multivariate analysis showed that HR was less likely in patients aged > 70 years, those with American Society of Anesthesiologists (ASA) class III or IV, elective surgery, those experiencing more than two HP-related complications, and those with a malignancy (an indication for HP). One-third of the patients underwent HR. Age > 70 years, ASA class III or IV, elective surgery, more than two HP-related complications, and malignancy were associated with a non-HR rate.

Are Orthopedic Hand Surgeons Undercompensated for Time Spent in the Operating Room? A Study of Relative Value Units

Hand ◽  
2022 ◽  
pp. 155894472110643
Author(s):  
Trevor Simcox ◽  
Sakib Safi ◽  
Jacob Becker ◽  
Jason Kreinces ◽  
Adam Wilson
Keyword(s):  
Complication Rate ◽  
Operative Time ◽  
Major Complication ◽  
Hand Surgery ◽  
Reoperation Rate ◽  
Orthopedic Procedures ◽  
Improvement Program ◽  
Relative Value ◽  
American Society ◽  
American Society Of Anesthesiologists

Background: This study aims to investigate whether compensation is equitable among the most commonly performed orthopedic hand surgeries and when compared with general orthopedic procedures. Methods: The National Surgical Quality Improvement Program database was queried for all orthopedic procedures, from 2016 to 2018, performed more than 150 times using Current Procedural Terminology (CPT) codes. Physician work relative value unit (wRVU) data were obtained from the 2020 US Centers for Medicare and Medicaid Services fee schedule. Linear regressions were used to determine whether there was an association among wRVU, operative time, and wRVU per hour (wRVU/h). Reimbursement for hand surgery CPT codes was compared with that of nonhand orthopedic CPT codes. The CPT codes were stratified into quartile cohorts based on mean operative time, major complication rate, mortality rate, American Society of Anesthesiologists class, reoperation rate, and readmission rate. Student t tests were used to compare wRVU/h between cohorts. Results: Forty-two hand CPT codes were identified from 214 orthopedic CPT codes, accounting for 32 333 hand procedures. The median wRVU/h was significantly lower for procedures in the longest operative time quartile compared with the shortest operative time quartile ( P < .001). Compared with hand procedures, nonhand procedures were found to have significantly higher mean operative time ( P < .001), mean complication rate ( P < .001), mean wRVU ( P = .001), and mean wRVU/h ( P = .007). Conclusions: The 2020 Physician wRVU scale does not allocate proportional wRVUs to orthopedic hand procedures with longer mean operative times. There is a decrease in mean reimbursement rate for hand procedures with longer mean operative time. When compared with general orthopedic procedures, hand procedures have a lower mean wRVU/h and complication rate.

Reasons for 30-day Postoperative Readmissions for Medicare Patients at a Community-based Teaching Hospital

2015 ◽  
Vol 81 (4) ◽  
pp. 381-386
Author(s):  
Jennifer L. Kirsch ◽  
Shanu N. Kothari ◽  
Janelle M. Ausloos ◽  
Jacob D. Gundrum ◽  
Kara J. Kallies
Keyword(s):  
Length Of Stay ◽  
Operative Time ◽  
Reform Initiatives ◽  
Readmission Rates ◽  
Community Based ◽  
Related Factors ◽  
Medicare Patients ◽  
Patient Noncompliance ◽  
American Society ◽  
American Society Of Anesthesiologists

Healthcare reform initiatives have proposed reducing reimbursement for certain 30-day readmissions among Medicare patients. Our objective was to evaluate the incidence and reasons for 30-day postoperative readmissions at our institution. The medical records of Medicare patients who underwent surgery from January 1, 2010, through May 16, 2011, were reviewed. Statistical analysis included χ2, Wilcoxon rank sum, and t tests. Two thousand eight hundred sixty-five patients were included; 199 (7%) had a 30-day readmission. The readmission group included a higher proportion of men (53.8 vs 43.6%, P = 0.005), and patients with an American Society of Anesthesiologists (ASA) Class 3 or greater (84 vs 66%, P < 0.001) versus the nonreadmission group. Mean index length of stay and operative time were longer in the readmitted versus nonreadmitted group (4.8 vs 2.8 days, P < 0.001; 122.8 vs 98.2 minutes, P < 0.001). Readmission reasons were surgically related (53%), surgically unrelated (35%), planned (7%), and patient-related (5%). Higher 30-day postoperative readmission rates were associated with male sex, higher ASA class, and longer index length of stay and operative time. Reasons for readmission included surgical- and patient-related factors. Decreased reimbursement should be discouraged for readmissions directly related to patient noncompliance.

scholarly journals Multi- and univariate analyses of the weekend effect for elective lower-limb joint replacements

2018 ◽  
Vol 100 (1) ◽  
pp. 42-46 ◽  
Author(s):  
WTE Briggs ◽  
BLT Guevel ◽  
AW McCaskie ◽  
SM McDonnell
Keyword(s):  
Length Of Stay ◽  
Joint Replacement ◽  
Lower Limb ◽  
Weekend Effect ◽  
Joint Replacements ◽  
Risk Patients ◽  
Postoperative Length ◽  
Day Of The Week ◽  
American Society ◽  
American Society Of Anesthesiologists

Introduction The weekend effect is a perceived difference in outcome between medical care provided at the weekend when compared to that of a weekday. Clearly multifactorial, this effect remains incompletely understood and variable in different clinical contexts. In this study we analyse factors relevant to the weekend effect in elective lower-limb joint replacement at a large NHS multispecialty academic healthcare centre. Materials and Methods We reviewed the electronic medical records of 352 consecutive patients who received an elective primary hip or knee arthroplasty. Patient, clinical and time-related variables were extracted from the records. The data were anonymised, then processed using a combination of uni- and multivariate statistics. Results There is a significant association between the selected weekend effect outcome measure (postoperative length of stay) and patient age, American Society of Anesthesiologists classification, time to first postoperative physiotherapy and time to postoperative radiography but not day of the week of operation. Discussion We were not able to demonstrate a weekend effect in elective lower-limb joint replacement at our institution nor identify a factor that would require additional weekend clinical medical staffing. Rather, resource priorities would seem to include measures to optimise at-risk patients preoperatively and measures to reduce time to physiotherapy and radiography postoperatively. Conclusions Our findings imply that postoperative length of stay could be minimised by strategies relating to patient selection and access to postoperative services. We have also identified a powerful statistical methodology that could be applied to other service evaluations in different clinical contexts.

scholarly journals Early postoperative complications and 90-day mortality in patients undergoing radical cystectomy

2020 ◽  
Vol 74 ◽  
pp. 354-361
Author(s):  
Paweł Hackemer ◽  
Bartosz Małkiewicz ◽  
Fryderyk Menzel ◽  
Krzysztof Tupikowski ◽  
Aleksandra Drabik ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mortality Rate ◽  
Radical Cystectomy ◽  
Complication Rate ◽  
Wound Dehiscence ◽  
Treatment Method ◽  
Regional Lymph Nodes ◽  
Factors Associated ◽  
American Society ◽  
Muscle Invasive

Introduction: The standard treatment method of muscle-invasive bladder cancer is radical cystectomy. This complex procedure consists of removing the urinary bladder with distal ureters and regional lymph nodes. Additionally, the prostate with seminal vesicles in men and uterus with ovaries in women should be excised. Therefore, this demanding oncological surgery is associated with a high occurrence of complications. The aim of this study was to assess the complications after radical cystectomy and identify the factors associated with severe complications and high mortality rate. Materials/Methods: We retrospectively analyzed medical data of 213 patients who underwent a radical cystectomy. Preoperative risk factors were assessed based on American Society of Anesthesiologists classification (ASA) and the Charlson Comorbidity Index (CCI). Clavien-Dindo classification was also included in our analysis. We investigated various factors associated with 30-day and 90-day mortality. Results: Complications after surgery were reported in 38% (n = 81) of patients in the studied group. Excluding perioperative high fever, the complication rate was 18%. The following complications were observed in 30-day postoperative period: wound infection (n = 6), wound dehiscence (n = 4), mechanical bowel obstruction (n = 3), hemorrhage (n = 2), cardiological (n = 8), stroke (n = 3). Observed 30-day mortality was 2.3% (n = 5), while 90-day mortality was 8.9% (n = 19). The mortality rate was associated with the stage of cancer and the type of urinary diversion. Conclusions: Radical cystectomy is a complex and traumatic urological surgery. It is associated with a significant complication rate and mortality, and it negatively affects quality of life. Therefore, all known risk factors should be thoroughly assessed preoperatively to select optimal treatment. Furthermore, the patient should be carefully informed about the risks associated with the surgery.

The Relationship Between Preoperative Physical Activity With American Society of Anesthesiologists Score and Postoperative Length of Stay in Patients Undergoing Radical Prostatectomy

2021 ◽  
pp. 1-8
Author(s):  
Efthymios Papadopoulos ◽  
Priya Brahmbhatt ◽  
Shabbir M.H. Alibhai ◽  
George A. Tomlinson ◽  
Andrew G. Matthew ◽  
...  
Keyword(s):  
Physical Activity ◽  
Logistic Regression ◽  
Radical Prostatectomy ◽  
Length Of Stay ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Physical Status ◽  
American Society ◽  
American Society Of Anesthesiologists ◽  
The Relationship

Background: The relationship between preoperative physical activity (PA) and hospital length of stay (LOS) following radical prostatectomy (RP) is poorly understood. In addition, the relationship between PA and the American Society of Anesthesiologists Physical Status score (ASA PS), an established prognosticator of surgical risk, has not been studied. The authors assessed the relationship between leisure-time PA (LTPA), ASA PS, and LOS in individuals undergoing RP. Methods: This retrospective cohort study was conducted using data from an institutional database. Ordinal logistic regression was used to assess the relationship between preoperative LTPA and physical status as indicated by the ASA PS. Binary logistic regression was used to assess the relationship between preoperative LTPA and LOS. Results: A sample of 1064 participants were included in the analyses. The participants in the highest preoperative LTPA quartile had 45% reduced odds (P = .015) of a worse ASA PS classification compared with participants in the lowest quartile. The participants engaging in vigorous LTPA preoperatively had 35% lower odds (P = .014) of a >2-day LOS following RP compared with participants who were not engaging in preoperative vigorous LTPA. Conclusions: Our findings suggest that total and vigorous preoperative LTPA is associated with improved preoperative American Society of Anesthesiologists scores and LOS following RP, respectively.

Validation of a Risk Stratification Index and Risk Quantification Index for Predicting Patient Outcomes

2013 ◽  
Vol 119 (3) ◽  
pp. 525-540 ◽  
Author(s):  
Matthew J. G. Sigakis ◽  
Edward A. Bittner ◽  
Jonathan P. Wanderer
Keyword(s):  
Length Of Stay ◽  
Risk Stratification ◽  
Hospital Mortality ◽  
Severity Score ◽  
Physical Status ◽  
Risk Quantification ◽  
American Society ◽  
American Society Of Anesthesiologists ◽  
Procedure Codes ◽  
Receiver Operating

Abstract Background: External validation of published risk stratification models is essential to determine their generalizability. This study evaluates the performance of the Risk Stratification Indices (RSIs) and 30-day mortality Risk Quantification Index (RQI). Methods: 108,423 adult hospital admissions with anesthetics were identified (2006–2011). RSIs for mortality and length-of-stay endpoints were calculated using published methodology. 91,128 adult, noncardiac inpatient surgeries were identified with administrative data required for RQI calculation. Results: RSI in-hospital mortality and RQI 30-day mortality Brier scores were 0.308 and 0.017, respectively. RSI discrimination, by area under the receiver operating curves, was excellent at 0.966 (95% CI, 0.963–0.970) for in-hospital mortality, 0.903 (0.896–0.909) for 30-day mortality, 0.866 (0.861–0.870) for 1-yr mortality, and 0.884 (0.882–0.886) for length-of-stay. RSI calibration, however, was poor overall (17% predicted in-hospital mortality vs. 1.5% observed after inclusion of the regression constant) as demonstrated by calibration plots. Removal of self-fulfilling diagnosis and procedure codes (20,001 of 108,423; 20%) yielded similar results. RQIs were calculated for only 62,640 of 91,128 patients (68.7%) due to unmatched procedure codes. Patients with unmatched codes were younger, had higher American Society of Anesthesiologists physical status and 30-day mortality. The area under the receiver operating curve for 30-day mortality RQI was 0.888 (0.879–0.897). The model also demonstrated good calibration. Performance of a restricted index, Procedure Severity Score + American Society of Anesthesiologists physical status, performed as well as the original RQI model (age + American Society of Anesthesiologists + Procedure Severity Score). Conclusion: Although the RSIs demonstrated excellent discrimination, poor calibration limits their generalizability. The 30-day mortality RQI performed well with age providing a limited contribution.

Robotic Minor hepatectomy offers a Favorable Learning Curve and May Result in Superior Perioperative Outcomes Compared with Laparoscopic Approach

2017 ◽  
Vol 83 (10) ◽  
pp. 1085-1088 ◽  
Author(s):  
Victoriav O'Connor ◽  
Brooke Vuong ◽  
Su-Tau Yang ◽  
Andrew Difronzo
Keyword(s):  
Complication Rate ◽  
Laparoscopic Approach ◽  
Length Of Hospital Stay ◽  
Perioperative Outcomes ◽  
Robotic Assisted ◽  
Estimated Blood Loss ◽  
Specimen Volume ◽  
Grade 3 ◽  
American Society ◽  
American Society Of Anesthesiologists

Minorhepatectomy (MH) is a common type of robotic-assisted liver resection, but few studies compared it with laparoscopic. We compared the perioperative outcomes of patients who underwent robotic (RH) or laparoscopic (LH) minor hepatectomy and evaluated the effect of surgeon's experience on outcomes. A prospective database was used to identify patients from 2009 through 2016 who underwent RH or LH. Two surgeons performed RH starting in 2014, whereas LH had been established before that. Of the 93 patients, 42 were in RH and 51 in LH group. The mean patient age, gender, race, American Society of Anesthesiologists score, proportion of patients with cirrhosis and hepatocellular carcinoma were similar. Operative time, estimated blood loss (EBL), conversion to open, 30-day complication rate, Clavien–Dindo grade ≥ 3 complications, and length of hospital stay (LOS) were similar. There was no difference in average tumor size, specimen volume, or achievement of R0 margin. In RH group, after completing 15 cases, there were no conversions to open. After 25 cases, EBL, LOS, and 30-day complication rate were improved as compared with LH. Perioperative outcomes of robotic MH are equivalent to laparoscopic. After approximately 25 cases, robotic-assisted MH may result in superior outcomes compared with laparoscopic.

scholarly journals Can visual aides influence rehabilitation and length of stay following knee replacement? A randomized controlled study

2015 ◽  
Vol 7 (1) ◽  
Author(s):  
Simon Abson ◽  
Benjamin Kenny ◽  
Reza Rahim ◽  
Daniel Benz ◽  
Jorgen Hellman
Keyword(s):  
Length Of Stay ◽  
Range Of Motion ◽  
Goal Attainment ◽  
Controlled Study ◽  
Visual Aids ◽  
Visual Aid ◽  
Patient Stay ◽  
American Society ◽  
Cohort Groups ◽  
American Society Of Anesthesiologists

Arthroplasty is increasingly performed within Australia, with a 2.7% rate increase of total knee arthroplasty (TKR) over the last year. With an increasing burden on the public health system and increasing waiting lists, all efforts are being made to decrease length of stay and improve the post operative rehabilitation process. There is currently insufficient evidence to make a conclusive statement about visual aids and improved goal attainment post TKR. The purpose of this study is to evaluate one such visual aid clinical photographs of patients knee range of motion (ROM) pre- and post-operatively and their effect on length of stay. Photographs of knee range of motion were obtained pre and post-operatively while the patient was anesthetized. In this study, a randomized, single blinded design allocated patients to either be shown or not shown their photographs on day 1 post operatively. Primary outcome measures were the number of days the patient remained in hospital. Secondary measures were Western Ontario and McMaster Universities Arthritis Index scores, Oxford Knee Scores, American Society of Anesthesiologists Score and knee ROM. Thirty-two patients (3 exclusions) were randomized to the photo group and 27 patients (4 exclusions) were randomized to the no photo group. The median length of stay between groups was not significantly different. Currently there is not enough evidence to conclude that visual aids effect length of stay or rehabilitation pathways. Further assessment with larger cohort groups is needed. Preoperative targeting and rehabilitation for patients with lower functional status may shorten post operative length of patient stay in our institution.

Acute sedation-associated complications in GI endoscopy (ProSed 2 Study): results from the prospective multicentre electronic registry of sedation-associated complications

Gut ◽  
2018 ◽  
Vol 68 (3) ◽  
pp. 445-452 ◽  
Author(s):  
Angelika Behrens ◽  
Anton Kreuzmayr ◽  
Hendrik Manner ◽  
Herbert Koop ◽  
Albrecht Lorenz ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Major Complication ◽  
Complication Rates ◽  
Gi Endoscopy ◽  
Study Results ◽  
Study Centre ◽  
Registration Number ◽  
Independent Risk Factors ◽  
American Society ◽  
American Society Of Anesthesiologists

ObjectivesSedation has been established for GI endoscopic procedures in most countries, but it is also associated with an added risk of complications. Reported complication rates are variable due to different study methodologies and often limited sample size.DesignsAcute sedation-associated complications were prospectively recorded in an electronic endoscopy documentation in 39 study centres between December 2011 and August 2014 (median inclusion period 24 months). The sedation regimen was decided by each study centre.ResultsA total of 368 206 endoscopies was recorded; 11% without sedation. Propofol was the dominant drug used (62% only, 22.5% in combination with midazolam). Of the sedated patients, 38 (0.01%) suffered a major complication, and overall mortality was 0.005% (n=15); minor complications occurred in 0.3%. Multivariate analysis showed the following independent risk factors for all complications: American Society of Anesthesiologists class >2 (OR 2.29) and type and duration of endoscopy. Of the sedation regimens, propofol monosedation had the lowest rate (OR 0.75) compared with midazolam (reference) and combinations (OR 1.0–1.5). Compared with primary care hospitals, tertiary referral centres had higher complication rates (OR 1.61). Notably, compared with sedation by a two-person endoscopy team (endoscopist/assistant; 53.5% of all procedures), adding another person for sedation (nurse, physician) was associated with higher complication rates (ORs 1.40–4.46), probably due to higher complexity of procedures not evident in the multivariate analysis.ConclusionsThis large multicentre registry study confirmed that severe acute sedation-related complications are rare during GI endoscopy with a very low mortality. The data are useful for planning risk factor-adapted sedation management to further prevent sedation-associated complications in selected patients.Trial registration numberDRKS00007768; Pre-results.

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