scholarly journals DEMOGRAPHIC ANALYSIS OF ACETABULAR FRACTURES TREATED IN A QUATERNARY CARE HOSPITAL FROM 2005 TO 2016

2019 ◽  
Vol 27 (6) ◽  
pp. 317-320 ◽  
Author(s):  
Marcelo Cortês Cavalcante ◽  
Frederico Augusto Alves de Arruda ◽  
Guilherme Boni ◽  
Gustavo Tadeu Sanchez ◽  
Daniel Balbachevsky ◽  
...  
Keyword(s):  
Length Of Stay ◽  
White Male ◽  
Age Distribution ◽  
Posterior Wall ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Acetabular Fractures ◽  
Care Hospital ◽  
Level Of Evidence ◽  
Average Hospital

ABSTRACT Objective: Analyze the clinical and sociodemographic data on acetabular fractures in a Brazilian quaternary care hospital and compare with data reported in the literature. Methods: A descriptive, analytical cross-sectional epidemiological study analyzing 87 patients with acetabular fractures at Hospital São Paulo (UNIFESP/EPM) between 2005 and 2016. Demographic variables such as age, sex, occupation, educational level and color were investigated. Acetabular fractures were classified according to the AO/OTA group and Judet and Letournel classification. Therapeutic approach, hospital length of stay and waiting time for surgery as well as complications were analyzed. Associations were established among the various variables obtained. Results: The mean age of patients with acetabulum fractures was 39.8 years (SD 13.1 years). There was a predominance of posterior wall (34.5%) and dual-column (14.9%) fractures. The average hospital length of stay was 14.4 days. More than 90% of patients underwent a surgical procedure. One-fourth of patients had complications, the main one being infection (12.6%). Conclusions: Unimodal age distribution was obtained with a predominance of white male economically active patients. There was a predominance of posterior wall fractures. More than 90% of patients underwent surgery before they had been in hospital for 14 days. A statistically significant association was found between complications and exceeded length of hospital stay. Level of evidence II, Retrospective study.

30-Day Outcomes for Total Ankle Arthroplasty in Patients With Anemia

2021 ◽  
pp. 107110072110175
Author(s):  
Jordan R. Pollock ◽  
Matt K. Doan ◽  
M. Lane Moore ◽  
Jeffrey D. Hassebrock ◽  
Justin L. Makovicka ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Univariate Analysis ◽  
Hospital Length ◽  
Total Ankle Arthroplasty ◽  
Hospital Length Of Stay ◽  
Preoperative Anemia ◽  
Improvement Project ◽  
Average Hospital ◽  
Ankle Arthroplasty ◽  
Reoperation Rates

Background: While anemia has been associated with poor surgical outcomes in total knee arthroplasty and total hip arthroplasty, the effects of anemia on total ankle arthroplasty remain unknown. This study examines how preoperative anemia affects postoperative outcomes in total ankle arthroplasty. Methods: A retrospective analysis was performed using the American College of Surgeons National Surgery Quality Improvement Project database from 2011 to 2018 for total ankle arthroplasty procedures. Hematocrit (HCT) levels were used to determine preoperative anemia. Results: Of the 1028 patients included in this study, 114 patients were found to be anemic. Univariate analysis demonstrated anemia was significantly associated with an increased average hospital length of stay (2.2 vs 1.8 days, P < .008), increased rate of 30-day readmission (3.5% vs 1.1%, P = .036), increased 30-day reoperation (2.6% vs 0.4%, P = .007), extended length of stay (64% vs 49.9%, P = .004), wound complication (1.75% vs 0.11%, P = .002), and surgical site infection (2.6% vs 0.6%, P = .017). Multivariate logistic regression analysis found anemia to be significantly associated with extended hospital length of stay (odds ratio [OR], 1.62; 95% CI, 1.07-2.45; P = .023) and increased reoperation rates (OR, 5.47; 95% CI, 1.15-26.00; P = .033). Anemia was not found to be a predictor of increased readmission rates (OR, 3.13; 95% CI, 0.93-10.56; P = .066) or postoperative complications (OR, 1.27; 95% CI, 0.35-4.56; P = .71). Conclusion: This study found increasing severity of anemia to be associated with extended hospital length of stay and increased reoperation rates. Providers and patients should be aware of the increased risks of total ankle arthroplasty with preoperative anemia. Level of Evidence: Level III, retrospective comparative study.

Abstract 101: Gender Differences in the Timing of Access to the Prehospital Phase of STEMI Care

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Robert O’Connor ◽  
Ross Megargel ◽  
Angela DiSabatino ◽  
William Weintrub ◽  
Charles Reese
Keyword(s):  
Gender Differences ◽  
Length Of Stay ◽  
Tertiary Care ◽  
Female Gender ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Symptom Duration ◽  
Care Hospital ◽  
Private Vehicle ◽  
Prehospital Management

Introduction : The purpose of this study is to determine the degree of gender differences in lay person recognition, emergency medical services (EMS) activation, and the prehospital management of STEMI. Methods : Data were gathered prospectively from May 1999 to January 2007 on consecutive patients with STEMI who presented to a tertiary care hospital emergency department. Patients arriving by ambulance and private vehicle were included. Data collection included determining symptom duration, whether a prehospital ECG was obtained, whether the cardiac interventional lab was activated prior to patient arrival at the hospital, patient age, and hospital length of stay. Prehospital activation of the cath lab was done by emergency medicine based on paramedic ECG interpretation in consultation with cardiology. Statistical analysis was performed using the Mann-Whitney U test, the Yates-corrected chi-square test, and linear regression. Results : A total of 3260 cases were studied, of which, 3097 had complete data for analysis. Only EMS cases were included in the ECG analysis, and only patients having a prehospital ECG were included in the prehospital activation of cath lab analysis. Regression analysis showed that older age and female gender were significant predictors of access and arrival by EMS. The mean age in years was higher for EMS arrival (69 women; 59 men) than for private vehicle (62 women; 56 men). Conclusion : Women with STEMI tend to use EMS more frequently then men, but are older and wait longer before seeking treatment. Whether these factors contribute to the longer length of stay remains to be determined.

scholarly journals 2286. Evaluating the Impact of Ceftolozane/Tazobactam on Clinical Outcomes in Patients with Multi-Drug-resistant Pseudomonas aeruginosa Pneumonia

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S783-S784
Author(s):  
Matthew Mills ◽  
Ashley MacWhinnie ◽  
Timmy Do
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Length Of Stay ◽  
Clinical Cure ◽  
Standard Of Care ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Multi Drug Resistance ◽  
Average Hospital ◽  
Definitive Therapy ◽  
The Impact

Abstract Background Ceftolozane/tazobactam is a novel cephalosporin and β-lactamase inhibitor antibiotic that has shown to have potent activity against Pseudomonas aeruginosa including strains exhibiting multi-drug resistance (MDR). The purpose of this study was to evaluate ceftolozane/tazobactam efficacy in MDR P. aeruginosa pneumonia compared with historical standard of care. Methods This was a retrospective cohort study of patients hospitalized across AdventHealth Central Florida campuses with MDR P. aeruginosa pneumonia from January 1, 2017 through December 31, 2018. This study included patients ≥ 18 years of age with a diagnosis of pneumonia and a positive respiratory culture with MDR P. aeruginosa. The primary outcome of this study was the rate of clinical cure by day 14 of definitive therapy. Secondary outcomes included 30-day readmission rate, average hospital length of stay (LOS), cost of admission, average ICU LOS after initiation of definitive antibiotic, and total days of antibiotic exposure for pneumonia. Data were analyzed with statistical computer software utilizing independent samples t-test and chi square tests of independence as appropriate. Results A total of 115 patients were included in the final analysis, 62 patients treated with ceftolozane/tazobactam and 53 patients treated with historical standard of care. Rate of clinical cure was similar between patients treated with ceftolozane/tazobactam, 72.6% (n = 45), and those treated with historical standard of care, 67.9% (n = 36), {X2 (1) = 0.297, p = 0.683}. Other outcomes assessed were also similar between groups except for average hospital length of stay (42.7 days vs. 30.3 days t(113) = 2.054, p = 0.042), and cost of admission ($78,550 vs. $47,681, t(113) = 2.458, p = 0.016), which were significantly greater in the ceftolozane/tazobactam treatment group. Conclusion In patients diagnosed with MDR P. aeruginosa pneumonia, clinical cure rates were not significantly different between those treated with ceftolozane/tazobactam compared with historical standard of care. Significantly greater hospital length of stay and cost of admission was associated with use of ceftolozane/tazobactam, although many patient factors may have influenced these results. Disclosures All authors: No reported disclosures.

scholarly journals Reversal of warfarin anticoagulation in geriatric traumatic brain injury due to ground-level falls

2019 ◽  
Vol 4 (1) ◽  
pp. e000352
Author(s):  
Michael John Paisley ◽  
Arianne Johnson ◽  
Spencer Price ◽  
Bernard Chow ◽  
Liliana Limon ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Vitamin K ◽  
Geriatric Patients ◽  
Oral Anticoagulants ◽  
Ground Level ◽  
International Normalized Ratio ◽  
Fresh Frozen Plasma ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Level Of Evidence

BackgroundThe efficacy of prothrombin complex concentrate (PCC) compared with fresh frozen plasma (FFP) for reversal of oral anticoagulants has not been investigated in geriatric patients suffering intracranial hemorrhage (ICH) due to a ground-level fall (GLF).MethodsPatients 65 years and older who were treated at Santa Barbara Cottage Hospital between January 2011 and March 2018 with ICH after a GLF while taking warfarin were reviewed. Patients were reversed with either FFP (n=25) or PCC (n=27) and patient outcomes were compared. Separate analyses were conducted for patients who received adjuvant vitamin K administration and those who did not.ResultsMortality rates, hospital length of stay, intensive care unit admission and length of stay were similar for both FFP and PCC intervention. There was no difference in radiological progression of hemorrhage within the first 24 hours of admission (FFP: 36%, PCC: 43%, p=0.365). In patients who had international normalized ratio (INR) values measured prior to intervention, 81% (17 out of 21) of the PCC group reached an INR value below 1.5 within an 8-hour period, whereas only 29% (4 out of 14) of the FFP group did (p=0.002). Vitamin K was concomitantly given to 28% of the patients receiving FFP, and 81% of those patients receiving PCC. No significant differences in outcomes were found whether adjunctive vitamin K was administered or not, in either FFP or PCC group. However, when vitamin K was not administered, the PCC group had a higher rate of INR reversal (80% vs. 10% for FFP, p=0.006).ConclusionAdministration of PCC is as effective in short-term outcomes as FFP in treating geriatric patients on warfarin sustaining an ICH after a GLF. INR reversal was more successful, significantly faster, and required lower infusion volumes in patients receiving PCC.Level of evidenceLevel III.

Endoscopic transnasal/transoral odontoid resection in children: results of a combined neurosurgical and otolaryngological protocolized, institutional approach

2021 ◽  
pp. 1-8
Author(s):  
Rajiv R. Iyer ◽  
J. Fredrik Grimmer ◽  
Douglas L. Brockmeyer
Keyword(s):  
Length Of Stay ◽  
Blood Loss ◽  
Pediatric Population ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Endoscopic Endonasal ◽  
Sleep Study ◽  
Average Hospital ◽  
Institutional Approach ◽  
Estimated Blood Loss

OBJECTIVE Odontogenic ventral brainstem compression can be a source of significant morbidity in patients with craniocervical disease. The most common methods for odontoidectomy are the transoral and endoscopic endonasal routes. In this study, the authors investigated the use of an institutional protocol for endoscopic transnasal/transoral odontoidectomy in the pediatric population. METHODS From 2007 to 2017, a multidisciplinary institutional protocol was developed and refined for the evaluation and treatment of pediatric patients requiring odontoidectomy. Preoperative assessment included airway evaluation, a sleep study (if indicated), discussion of possible tonsillectomy/adenoidectomy, and thorough imaging review by the neurosurgery and otolaryngology teams. Further preoperative anesthesia consultation was obtained for difficult airways. Intraoperatively, adenoidectomy was performed at the discretion of otolaryngology. The odontoidectomy was performed as a combined procedure. Primary posterior pharyngeal closure was performed by the otolaryngologist. The postoperative protocol called for immediate extubation, advancement to a soft diet at 24 hours, and no postoperative antibiotics. Outcome variables included time to extubation, operative time, estimated blood loss, hospital length of stay, and postoperative complications. RESULTS A total of 13 patients underwent combined endoscopic transoral/transnasal odontoid resection with at least 3 years of follow-up. All patients had stable to improved neurological function in the postoperative setting. All patients were extubated immediately after the procedure. The average operative length was 201 ± 46 minutes, and the average estimated blood loss was 44.6 ± 40.0 ml. Nine of 13 patients underwent simultaneous tonsillectomy and adenoidectomy. The average hospital length of stay was 6.6 ± 5 days. The first patient in the series required revision surgery for removal of a small residual odontoid. One patient experienced pharyngeal flap dehiscence requiring revision. CONCLUSIONS A protocolized, institutional approach for endoscopic transoral/transnasal odontoidectomy is described. The use of a combined, multidisciplinary approach leads to streamlined patient management and favorable outcomes in this complex patient population.

Advancing the Use of Laparoscopy in Trauma: Repair of Intraperitoneal Bladder Injuries

2019 ◽  
Vol 85 (12) ◽  
pp. 1402-1404 ◽  
Author(s):  
Michael R. Arnold ◽  
Caroline D. Lu ◽  
Bradley W. Thomas ◽  
Gaurav Sachdev ◽  
Kyle W. Cunningham ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Injury Severity ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Bladder Rupture ◽  
Trauma Patients ◽  
Average Hospital ◽  
Early Return ◽  
Significant Difference ◽  
Intraperitoneal Bladder Rupture

Traumatic intraperitoneal bladder rupture (IBR) requires surgical repair. Traditionally performed via laparotomy, experience with laparoscopic bladder repair (LBR) after blunt trauma is limited. Benefits of laparoscopy include decreased length of stay (LOS), less pain, early return to work, fewer adhesions, and lower risk of incisional hernia. The aim of this series is to demonstrate the potential superiority of LBR in select trauma patients. This is a retrospective review performed of all IBR patients from 2008 to 2016. Demographics, clinical management, outcomes, and follow-up were compared between LBR and open bladder repair (OBR) patients. Twenty patients underwent OBR, and seven underwent LBR. There was no significant difference in gender, age, or Injury Severity Score. There were no deaths or reoperations in either group. Average hospital length of stay and ICU days were similar between groups. There was one patient with UTI and one with readmission in each group. There were two incisional hernias and two bowel obstructions in the OBR group, with one patient requiring operative intervention. No such complications occurred in the LBR group. LBR for traumatic IBR can be safely performed in select patients, even in those with multiple extra-abdominal injuries.

Average Hospital Length of Stay, Nurses’ Work Demands, and Their Health and Job Outcomes

2014 ◽  
Vol 46 (3) ◽  
pp. 199-206 ◽  
Author(s):  
Sung-Hyun Cho ◽  
Mihyun Park ◽  
Sang Hee Jeon ◽  
Hyoung Eun Chang ◽  
Hyun-Ja Hong
Keyword(s):  
Length Of Stay ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Work Demands ◽  
Job Outcomes ◽  
Average Hospital

scholarly journals Analysis of Postoperative Complications in Spinal Surgery, Hospital Length of Stay, and Unplanned Readmission: Application of Dindo-Clavien Classification to Spine Surgery

2018 ◽  
Vol 9 (3) ◽  
pp. 279-286 ◽  
Author(s):  
Gaston Camino Willhuber ◽  
Cristina Elizondo ◽  
Pablo Slullitel
Keyword(s):  
Risk Factors ◽  
Postoperative Complications ◽  
Length Of Stay ◽  
Spine Surgery ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Unplanned Readmission ◽  
Level Of Evidence ◽  
Clavien Classification ◽  
Surgical Complexity

Study Design: Retrospective study. Level of evidence III. Objective: Postoperative complications in spine surgery are associated with increased morbidity, hospital length of stay, and health care costs. Registry of complications in orthopedics and the spine surgery is heterogeneous. Methods: Between July 2016 and June 2017, 274 spinal surgeries were performed, the presence of postoperative complications was analyzed at 90 days (according to the classification of Dindo-Clavien, grades I-V), hospital length of stay, surgical complexity (low, medium, and high), unplanned readmission, and risk factors were evaluated. Results: A total of 79 patients suffered a complication (28.8%), of them 21 (26.7%) were grade I, 24 (30.3%) were grade II, 4 (5.7%) were grade IIIA, and 29 (37.3%) were grade IIIB. There were no IV and V grade cases. The most frequent complication was excessive pain followed by deep wound infection and anemia. Surgical complexity and surgical time were significantly associated with the risk of developing a complication. The average number of hospital length of stay in patients without and with complications were 2.7 and 10.6, respectively, and the unplanned readmission rate was 11%. Conclusions: Registry of postoperative complications allows the correct standardization and risk factors required to establish measures to decrease them, the application of Dindo-Clavien classification was useful for the purpose of our study.

68 Application of the Modified Hospital Length of Stay Predictor

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S44-S45
Author(s):  
Sylvia Dao ◽  
Heather Lynch
Keyword(s):  
Length Of Stay ◽  
Multiple Regression ◽  
Acute Care Hospital ◽  
Multiple Regression Model ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Care Hospital ◽  
Inhalational Injury ◽  
The Difference ◽  
The Relationship

Abstract Introduction Developing formulas to predict accurate length of stay (LOS) is challenging in burn patients as many complex variables can effect LOS. A recently published article in 2016 provided new formulas (NFs) to predict hospital LOS. Our goal is to compare our patients actual LOS (ALOS) to the NFs published, the traditional 1day/%TBSA rule, and to the hospital expected LOS (ELOS) based on patients CMI/DRGs. Methods Data was collected from Jan ‘16 to Dec ‘18 on all patients &gt;18 years of age using NTRACS burn registry. We excluded deaths, non-burns, readmissions, any records with missing information, and any patients transferred to another acute care hospital. We performed multiple regression to examine the relationship between LOS with age, inhalational injury (INHINJ), and TBSA on all patients. We divided this population into three groups per the NFs recommendations: 1) INHINJ; 2) without INHINJ &lt; 40 years old; 3) without INHINJ &gt;40 years old. Using these three groups, we calculated the difference between ALOS to 1) the traditional LOS formula, 2) the NFs as established in the 2016 article, and to 3) the hospitals ELOS metrics. For acuity comparison, we also calculated average CMI in each study group. The NFs published are as follows: Results The multiple regression model with all three variables (Age, % TBSA, and INHINJ) produced R² = 0.321, F(3,883) = 139.23, p &lt; .05. INHINJ, age, and TBSA had significant positive regression, indicating an increase or presence of all three variables will lengthen LOS. The regression equation is: LOS = (-3.93) +1.71(AGE) +1.11(TBSA) +15.81 (Inhalation). Every year increase in age increased LOS by 1.71 days. Every 1% increase in TBSA increased LOS by 1.11 days. Presence of INHINJ (0= no INHINJ; 1= INHINJ) increased LOS by 15.81 days. Table 1 depicts the mean ± SD of the difference in LOS (predicted - actual) for the three predictive models of LOS. Negative values indicate underestimation of LOS and positive values indicate overestimate of LOS. Conclusions Application of the predictive LOS formulas has underestimated LOS in this population, with the exception of the NFs to predict LOS on patients &gt;40 years old without INHINJ. Furthermore, an R² value of 0.32 indicates that the variables utilized in this study do not account for 68% of the variation we see. This is further exemplified by the wide standard deviations, particularly in the INHINJ group. Applicability of Research to Practice Directly Applicable.

scholarly journals Percutaneous, PMMA-augmented, pedicle screw instrumentation of thoracolumbar ankylotic spine fractures

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Rina E. Buxbaum ◽  
Adi Shani ◽  
Hani Mulla ◽  
Alon Rod ◽  
Nimrod Rahamimov
Keyword(s):  
Length Of Stay ◽  
Blood Loss ◽  
Thoracolumbar Spine ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
High Morbidity ◽  
Spine Fractures ◽  
Average Hospital ◽  
Percutaneous Instrumentation ◽  
The Mean

Abstract Introduction Fractures in the ankylotic spine may have an insidious presentation but are prone to displace with devastating consequences. The long lever arm of ankylosed spine fragments may lead to pulmonary and great vessel injury and is difficult to adequately immobilize. Conservative treatment will produce in many cases poor outcomes with high morbidity and mortality. Open surgical treatment is also fraught with technical difficulties and can lead to major blood loss and prolonged operative times. In recent years, percutaneous instrumentation of non-ankylotic spine fractures has gained popularity, producing similar outcomes to open surgery with shorter operative times and reduced blood loss and hospital length of stay. We describe our experience implementing these techniques in ankylotic spine patients. Methods We retrospectively retrieved from our hospital’s electronic health records all patients treated for thoracolumbar spine fractures between 2008 and 2015 with a diagnosis of ankylosing spondylitis (AS) or diffuse idiopathic skeletal hyperostosis (DISH). Operative and postoperative data, results, and complications were tabulated, and radiographic parameters were evaluated. Results Twenty-four patients with ankylotic spine disease underwent percutaneous augmented instrumentation between 2008 and 2015. The mean age was 76. All patients had at least one comorbidity. The mean number of ankylosed levels was 14. Mean operative time was 131 min. The average postoperative hemoglobin decrease was 1.21 gr/%, with only 4 patients requiring blood transfusion. 45.8% of the patients had postoperative medical complications. One patient (4.2%) had a superficial postoperative infection, and one patient died in hospital. The average hospital length of stay was 14.55 days. All patients retained their preoperative ASIA grades, and 3 improved one grade. All patients united their fractures without losing reduction. Conclusions PMMA-augmented percutaneous instrumentation is an attractive surgical option for this difficult patient subset, especially when compared to other available current alternatives.

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