scholarly journals TOTAL COST OF HOSPITALIZATION OF PATIENTS UNDERGOING ELECTIVE LAPAROSCOPIC CHOLECYSTECTOMY RELATED TO NUTRITIONAL STATUS

2016 ◽  
Vol 29 (2) ◽  
pp. 81-85 ◽  
Author(s):  
Francisco Julimar Correia de MENEZES ◽  
Lara Gadelha Luna de MENEZES ◽  
Guilherme Pinheiro Ferreira da SILVA ◽  
Antônio Aldo MELO-FILHO ◽  
Daniel Hardy MELO ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Length Of Stay ◽  
Nutritional Status ◽  
Medical Records ◽  
Public Hospital ◽  
Nutritional Risk ◽  
Western World ◽  
Morbidly Obese ◽  
Elective Laparoscopic Cholecystectomy ◽  
The Cost

ABSTRACT Background: In the Western world, the population developed an overweight profile. The morbidly obese generate higher cost to the health system. However, there is a gap in this approach with regard to individuals above the eutrofic pattern, who are not considered as morbidly obese. Aim: To correlate nutritional status according to BMI with the costs of laparoscopic cholecystectomy in a public hospital. Method: Data were collected from medical records about: nutritional risk assessment, nutricional state and hospital cost in patients undergoing elective laparoscopic cholecystectomy. Results: Were enrolled 814 procedures. Average age was 39.15 (±12.16) years; 47 subjects (78.3%) were women. The cost was on average R$ 6,167.32 (±1830.85) to 4.06 (±2.76) days of hospitalization; 41 (68.4%) presented some degree of overweight; mean BMI was 28.07 (±5.41) kg/m²; six (10%) individuals presented nutritional risk ≥3. There was a weak correlation (r=0.2) and not significant (p <0.08) between the cost of hospitalization of the sample and length of stay; however, in individuals with normal BMI, the correlation was strong (r=0,57) and significant (p<0.01). Conclusion: Overweight showed no correlation between cost and length of stay. However, overweight individuals had higher cost of hospitalization than those who had no complications, but with no correlation with nutritional status. Compared to those with normal BMI, there was a strong and statistically significant correlation with the cost of hospital stay, stressing that there is normal distribution involving adequate nutritional status and success of the surgical procedure with the consequent impact on the cost of hospitalization.

scholarly journals P17 An audit of Trakcare discharge times for Laparoscopic Cholecystectomy

BJS Open ◽  
2021 ◽  
Vol 5 (Supplement_1) ◽  
Author(s):  
Jacob Rapier ◽  
Steven Hornby ◽  
Jacob Rapier
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Length Of Stay ◽  
Initial Data ◽  
Best Practice ◽  
Average Length ◽  
Accurate Data ◽  
Day Case ◽  
Average Length Of Stay ◽  
Number Of Patients ◽  
Elective Laparoscopic Cholecystectomy

Abstract Introduction Nationally 61,220 Laparoscopic Cholecystectomies are carried out annually. Those carried out as day-cases reduce providers’ costs and increase income through the best practice tariff. The system in our trust to record discharges is ‘Trakcare’. The aim of this audit was to accurately measure the discharge times of patients undergoing elective Laparoscopic Cholecystectomies, to try and reduce the number of patients recorded as having an overnight stay by accurate data collection. Methods Initial data was collected for all elective Laparoscopic Cholecystectomy discharge times on Trakcare, over a 1 month period. This data was then re-audited prospectively both from Trakcare and discharges reported by nurses/patients. A comparison was then made of Trakcare against reported discharge times. Results Initially 54 operations were recorded, with 30 completed as day cases (55.6%). The re-audited data (on Trakcare) recorded 47 operations, with 15 completed as day cases (37.91%). Of these discharges we were able to capture 26 (55.32%) manually, and 11 were completed as day cases (42.31%). Measuring these 26 with the same operations on Trakcare we were unable to show a difference in the number of cases completed as a day case (11 vs 11), with only a 33 minute decrease in the average length of stay. Conclusion Trakcare is a reliable tool for measuring the date of discharge for patients. The recommendations in are: scheduling surgery for a time pre-13:00 shows a higher proportion of patients discharged the same day, and continue to use Trakcare to record discharge times.

scholarly journals Cost-Effectiveness Analysis Kloramfenikol Dan Seftriakson Untuk Pengobatan Demam Tifoid Pada Pasien Dewasa Di Rumah Sakit Sanglah Denpasar

2019 ◽  
Vol 2 (2) ◽  
pp. 105-112
Author(s):  
Amelia Lorensia ◽  
Doddy De Queljoe ◽  
Made Dwike Swari Santi
Keyword(s):  
Cost Effectiveness ◽  
Length Of Stay ◽  
Typhoid Fever ◽  
Medical Records ◽  
Cost Effective ◽  
Cost Effectiveness Ratio ◽  
Hospital Perspective ◽  
Effectiveness Analysis ◽  
The Cost ◽  
Two Alternatives

The number of typhoid fever patient in Indonesia is still high. Typhoid fever can be treated by antibiotic therapy such as chloramphenicol and ceftriaxone. The purpose of this study was to compare the cost-effectiveness of chloramphenicol and ceftriaxone which was given to adult patients who were diagnosed with typhoid fever in Sanglah Denpasar Hospital. A comparative study between two alternatives was conducted using the hospital perspective. Retrospective method was used to collect data from patient medical records, who was diagnosed and hospitalized in Sanglah Denpasar Hospital during January 2017 until July 2018. The cost analysis was perform using cost-effectiveness grid and cost-effectiveness ratio (ACER) methods. Cost-effectiveness grid showed that dominant of ceftriaxone for patient with typhoid fever. ACER analysis for ceftriaxone was IDR 2,097,170.88 with effectivenes (length of stay) 4.27 days, and was IDR 2,097,170.88 with effectiveness (the time of reaching normal temperature) 2.42 days. ACER analysis for chloramphenicol was IDR 2,555,464.22        with effectivenes (length of stay) 10.22 days, and was IDR 2,555,464.22 with effectiveness (the time of reaching normal temperature) 3.44 days. ACER analysis showed lower degree of ceftriaxone and higher effectiveness based on length of stay and the time of reaching normal temperature. The conclusion of this study is that ceftriaxone is more cost-effective than chloramphenicol.

Prospective, Double-Blinded, Randomized, Placebo-Controlled Comparison of Local Anesthetic and Nonsteroidal Anti-Inflammatory Drugs for Postoperative Pain Management after Laparoscopic Surgery

2007 ◽  
Vol 73 (6) ◽  
pp. 618-624 ◽  
Author(s):  
William Newcomb ◽  
Amy Lincourt ◽  
William Hope ◽  
Thomas Schmelzer ◽  
Ronald Sing ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Postoperative Pain ◽  
Length Of Stay ◽  
Oral Administration ◽  
Local Anesthetic ◽  
Local Infiltration ◽  
Elective Laparoscopic Cholecystectomy ◽  
Inflammatory Drugs ◽  
Anti Inflammatory ◽  
Double Blinded

Compared with the open approach, laparoscopy has been shown to significantly reduce postoperative pain. Improving postoperative analgesia in laparoscopic surgery is an area of continued interest. The goal of this study was to compare the efficacy of local anesthetic infiltration with or without preoperative nonsteroidal anti-inflammatory drugs. Patients undergoing elective laparoscopic cholecystectomy were enrolled in an Institutional Review Board-approved, prospective, double-blinded, randomized, placebo-controlled comparison study. Patients were randomized into four groups: Group I, preoperative oral administration of a placebo medication and prein cision local infiltration of 40 mL of 0.5 per cent bupivicaine at trocar sites; Group II, preoperative oral administration of 50 mg of rofecoxib; Group III, preoperative oral administration of 50 mg of rofecoxib and preincision local infiltration of 40 mL of 0.5 per cent bupivicaine into skin, muscle, and peritoneum; and Group IV, preoperative oral administration of a placebo medication. Postoperative pain scores were assessed at 4 hours, 8 hours, 12 hours, and 24 hours using a visual analog scale. Postoperative analgesic use, complications, and length of stay were recorded. Statistical significance was defined as P < 0.05. Fifty-five patients (46 women and 9 men) were enrolled in this study and underwent a standardized, elective, laparoscopic cholecystectomy for mild, symptomatic cholelithiasis (96.4%) and gallbladder polyps (3.6%). No patient had pain immediately before surgery. Postoperative analgesic requests, visual analog scale results, incidence of postoperative vomiting at 4 hours, 8 hours, 12 hours, and 24 hours, in addition to length of stay, were not statistically different between the four groups. No complications occurred. The use of preoperative rofecoxib, 0.5 per cent bupivicaine infiltration, or both for postoperative analgesia did not decrease postoperative pain or decrease length of stay after laparoscopic cholecystectomy compared with placebo. Preoperative administration of an oral anti-inflammatory pain medication, infiltration of a local anesthetic, or both had no greater effect than placebo in controlling discomfort after a laparoscopic cholecystectomy. The challenge of preempting postoperative pain continues and will require further investigation.

scholarly journals The cost of excessive postoperative use of antimicrobials: the context of a public hospital

2014 ◽  
Vol 41 (3) ◽  
pp. 149-154 ◽  
Author(s):  
Rafael Santos Santana ◽  
Ariane de Carvalho Viana ◽  
Jozimário da Silva Santiago ◽  
Michelle Santos Menezes ◽  
Iza Maria Fraga Lobo ◽  
...  
Keyword(s):  
Postoperative Period ◽  
Medical Records ◽  
Public Hospital ◽  
Antimicrobial Prophylaxis ◽  
Therapy Cost ◽  
Improper Use ◽  
Compromise Patient Safety ◽  
Total Therapy ◽  
The Cost ◽  
The Impact

OBJECTIVE: To evaluate the improper use of antimicrobials during the postoperative period and its economic impact. METHODS: We conducted a prospective cohort study by collecting data from medical records of 237 patients operated on between 01/11/08 and 31/12/08. RESULTS: from the 237 patients with the information collected, 217 (91.56%) received antimicrobials. During the postoperative period, 125 (57.7%) patients received more than two antimicrobials. On average, 1.7 ± 0.6 antimicrobials were prescribed to patients, the most commonly prescribed antibiotic being cephalothin, in 41.5% (154) of cases. The direct cost of antimicrobial therapy accounted for 63.78% of all drug therapy, this large percentage being attributed in part to the extended antimicrobial prophylaxis. In the case of clean operations, where there was a mean duration of 5.2 days of antibiotics, antimicrobials represented 44.3% of the total therapy cost. CONCLUSION: The data illustrate the impact of overuse of antimicrobials, with questionable indications, creating situations that compromise patient safety and increasing costs in the assessed hospital.

scholarly journals Length of stay in surgical patients: nutritional predictive parameters revisited

2012 ◽  
Vol 109 (2) ◽  
pp. 322-328 ◽  
Author(s):  
Ana Isabel Almeida ◽  
Marta Correia ◽  
Maria Camilo ◽  
Paula Ravasco
Keyword(s):  
Weight Loss ◽  
Length Of Stay ◽  
Nutritional Status ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Nutritional Risk ◽  
Surgical Patients ◽  
Anthropometric Parameters ◽  
Predictive Parameters ◽  
Nrs 2002

Nutritional evaluation may predict clinical outcomes, such as hospital length of stay (LOS). We aimed to assess the value of nutritional risk and status methods, and to test standard anthropometry percentilesv.the 50th percentile threshold in predicting LOS, and to determine nutritional status changes during hospitalisation and their relation with LOS. In this longitudinal prospective study, 298 surgical patients were evaluated at admission and discharge. At admission, nutritional risk was assessed by Nutritional Risk Screening-2002 (NRS-2002), Malnutrition Universal Screening Tool (MUST) and nutritional status by Subjective Global Assessment (SGA), involuntary % weight loss in the previous 6 months and anthropometric parameters; % weight loss and anthropometry were reassessed at discharge. At admission, risk/undernutrition results by NRS-2002 (P< 0·001), MUST (P< 0·001), % weight loss (P< 0·001) and SGA (P< 0·001) were predictive of longer LOS. A mid-arm circumference (MAC) or a mid-arm muscle circumference (MAMA) under the 15th and the 50th percentile, which was considered indicative of undernutrition, did predict longer LOS (P< 0·001); conversely, there was no association between depleted triceps skinfold (TSF) and longer LOS. In-hospital, there was a high prevalence of weight, muscle and fat losses, associated with longer LOS. At discharge, patients with a simultaneous negative variation in TSF+MAC+MAMA (n158, 53 %) had longer LOS than patients with a TSF+MAC+MAMA positive variation (11 (8–15)v.8 (7–12) d,P< 0·001). We concluded that at risk or undernutrition evaluated by all methods, except TSF and BMI, predicted a longer LOS. Moreover, MAC and MAMA measurements and their classification according to the 50th percentile threshold seem reliable undernutrition indicators.

EP.WE.739Antibiotics Prescriptions in Elective Laparoscopic Cholecystectomy

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Mohamed Abouelazayem ◽  
Sophie Coles ◽  
Dimitrios Tsironis
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Laparoscopic Cholecystectomy ◽  
Medical Records ◽  
Antibiotic Prescription ◽  
National Guidelines ◽  
Concomitant Procedure ◽  
Elective Laparoscopic Cholecystectomy ◽  
Current Guidelines ◽  
Bile Spillage

Abstract Aim To assess our compliance to the trust and national guidelines for antibiotic usage and prescription in elective laparoscopic cholecystectomy and to assess whether prophylactic antibiotics are prescribed appropriately and identify areas of improvement. Method Medical records for patients who underwent laparoscopic cholecystectomy over 3 months were collected (May – July 2019). Urgent laparoscopic cholecystectomies were excluded, and medical records were reviewed retrospectively for operative note details, patient risk factors, antibiotic prescribed, concomitant procedure, and complications. Results Appropriate antibiotic prescription represented 50% (Patient had at least one risk factor and prescribed antibiotic or no risk factors and wasn't prescribed antibiotics) and inappropriate prescription 50% (Patient had no risk factors and prescribed antibiotic or had risk factors and wasn't prescribed antibiotics). In the group with risk factors and wasn't prescribed antibiotics, Age was a risk factor in 17 patients, BMI in 25, Bile spillage in 10, and Diabetes in 3. Conclusion We are not compliant with the current guidelines for antibiotic prophylaxis in elective laparoscopic cholecystectomy, some patient with no risk factors received antibiotics while other with risk factors did not. We plan to disseminate this information in the governance meeting and print guidelines posters in theatres and then re-audit in 3 months’ time to assess progress.

Sign in / Sign up

Export Citation Format

Share Document