Evolution of incidence, mortality and cost of nontraumatic abdominal emergencies treated in Brasil in a period of nine years

SUMMARY OBJECTIVE: To evaluate the incidence, mortality and cost of non-traumatic abdominal emergencies treated in Brazilian emergency departments. METHODS: This paper used DataSus information from 2008 to 2016 (http://www.tabnet.datasus.gov.br). The number of hospitalizations, costs - AIH length of stay and mortality rates were described in acute appendicitis, acute cholecystitis, acute pancreatitis, acute diverticulitis, gastric and duodenal ulcer, and inflammatory intestinal disease. RESULTS: The disease that had the highest growth in hospitalization was diverticular bowel disease with an increase of 68.2%. For the period of nine years, there were no significant changes in the average length of hospital stay, with the highest increase in gastric and duodenal ulcer with a growth of 15.9%. The mortality rate of gastric and duodenal ulcer disease increased by 95.63%, which is significantly high when compared to the other diseases. All had their costs increased but the one that proportionally had the highest increase in the last nine years was the duodenal and gastric ulcer, with an increase of 85.4%. CONCLUSION: Non-traumatic abdominal emergencies are extremely prevalent. Hence, the importance of having updated and comparative data on the mortality rate, number of hospitalization and cost generated by these diseases to provide better healthcare services in public hospitals.

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Endoscopic transpedicular thoracic discectomy

Neurosurgical FOCUS ◽

10.3171/foc.1999.6.5.4 ◽

1999 ◽

Vol 6 (5) ◽

pp. E3

Author(s):

Hae-Dong Jho

Keyword(s):

Motor Vehicle ◽

Motor Vehicle Accident ◽

Average Length ◽

Length Of Hospital Stay ◽

Skin Incision ◽

Magnetic Resonance Images ◽

Transpedicular Approach ◽

Transverse Skin Incision ◽

The One ◽

Thoracic Discectomy

Object To minimize the invasiveness and maximize the adequacy of the decompressive proceedure in thoracic discectomy, a 70° endoscope was adopted to perform transpedicular thoracic discectomy. Methods A posterior transpedicular approach was performed via a 2-cm transverse skin incision, using the operating microscope or a 0°-lens endoscope. Using a 70°-lens endoscope, discectomy was performed after obtaining direct visualization of the ventral aspect of the spinal cord dura mater. This surgical technique has been used in 25 patients. There were 12 men and 13 women whose age ranged from 29 to 70 years (median 46 years). Thirteen patients experienced myelopathy, with or without radiculopathy, 10 presented with radiculopathy, and two patients suffered from segmental pain. The follow-up period ranged from 4 to 60 months (median 27 months). In 12 of the 13 patients with myelopathy, excellent improvement was shown postoperatively. In the remaining patient, symptoms recurred when she was injured in a motor vehicle accident 3 months postsurgery. In nine of 10 patients with radiculopathy pain resolved completely. In the one patient with right-sided hypochondral pain and in the two patients with segmental pain no relief was obtained despite excellent discectomy results that were demonstrated on postoperative magnetic resonance images. The average length of hospital stay was overnight. Conclusions The use of a 70°-lens endoscope via a transpedicular route has made thoracic discectomy comparable with cervical or lumbar discectomy in its surgical invasiveness, in the patient's recovery time, and in complexity of surgical procedure.

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Inequality in Health: The Correlation between Poverty and Injury—A Comprehensive Analysis Based on Income Level in Taiwan: A Cross-Sectional Study

Healthcare ◽

10.3390/healthcare9030349 ◽

2021 ◽

Vol 9 (3) ◽

pp. 349

Author(s):

Shi-Hao Huang ◽

Shih-Chun Hsing ◽

Chien-An Sun ◽

Chi-Hsiang Chung ◽

Chang-Huei Tsao ◽

...

Keyword(s):

Health Insurance ◽

Mortality Rate ◽

Nonprofit Organizations ◽

Low Income ◽

Average Length ◽

Length Of Hospital Stay ◽

Income Group ◽

National Health Insurance System ◽

Cross Sectional ◽

The Government

Is income still an obstacle that influences health in Taiwan, the National Health Insurance system was instituted in 1995? After collecting injured inpatient data from the health insurance information of nearly the whole population, we categorized the cases as either low-income or nonlow-income and tried to determine the correlation between poverty and injury. Chi-square tests, Fisher’s exact tests, an independent-samples t-test, and percentages were used to identify differences in demographics, causes for hospitalization, and other hospital care variables. Between 1998 and 2015, there were 74,337 inpatients with low-income injuries, which represented 1.6% of all inpatients with injury events. The hospitalization mortality rate for the low-income group was 1.9 times higher than that of the nonlow-income group. Furthermore, the average length of hospital stay (9.9 days), average medical expenses (1681 USD), and mortality rate (3.6%) values for the low-income inpatients were higher than those of the nonlow-income group (7.6 days, 1573 USD, and 2.1%, respectively). Among the injury causes, the percentages of “fall,” “suicide,” and “homicide” incidences were higher for the low-income group than for the nonlow-income group. These findings support our hypothesis that there is a correlation between poverty and injury level, which results in health inequality. Achieving healthcare equality may require collaboration between the government and private and nonprofit organizations to increase the awareness of this phenomenon.

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Clinical Adverse Events in Elderly Hospitalized Patients in a Medical Ward-a prospective study

Elderly Health Journal ◽

10.18502/ehj.v6i1.3418 ◽

2020 ◽

Author(s):

Rita Vieira Alves ◽

Marilia Fernandes ◽

Inês Figueiredo ◽

Diogo Drummond Borges ◽

Margarida Antunes

Keyword(s):

Mortality Rate ◽

Length Of Stay ◽

Adverse Events ◽

Prospective Study ◽

Elderly Women ◽

Average Length ◽

Intervention Group ◽

Healthcare Services ◽

Medical Ward ◽

Controlled Clinical Trial

Introduction: Studies to date describe between 3% to 50% of patients experiencing one or more clinical adverse event (CAE) during their hospital admission and many preventable. The aim of this prospective study was to determine the frequency of medical CAEs in a medical ward. Also the study aimed to compare data between patient age groups and determine the effect on length of hospital stay and mortality. Methods: This experimental study was a randomized, controlled clinical trial that was conducted in 2018. Two elderly day care centers in Yazd city ,in central Iran were selected and randomly assigned to control and intervention groups. Then, according to the inclusion criteria, eligible people were selected from the centers and enrolled in the study. Participants were 58 elderly women who were assigned to control (n: 29) and intervention (n: 29) groups. Yoga exercises were held for 2 months (three 1-h sessions a week) for intervention group. The Wechsler Memory Scale was completed for both groups before and after the intervention. Data were analyzed by SPSS using descriptive and inferential statistics. Results: 62 episodes were studied, 14.8% of those admitted to hospital experienced a CAE. The most frequent adverse events included analytical alterations, anemia and blood loss, infection and altered state of consciousness. The most commonly implicated therapies were anticoagulants (23%) which lead to episodes of bleeding, anti-hypertensive and diuretics (17%) immunosuppressive therapy (16%) beta blockers (1%) & insulin (1%). Mean length of stay in hospital was 17 days in all groups, longer than the average length of stay of this medical ward which is 11 days. Mortality rate within one year of hospitalization was 30% in total, again significantly higher than the 10% mortality rate calculated for the same period on the ward. Conclusion: This study demonstrates that CAEs are still far too common, probably underestimated, cause serious harm to patients and strains healthcare services further.

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55 A Review of Stroke Demographics and Outcomes at a Regional Hospital without a Stroke Unit

Age and Ageing ◽

10.1093/ageing/afz103.31 ◽

2019 ◽

Vol 48 (Supplement_3) ◽

pp. iii17-iii65

Author(s):

Lushen Pillay ◽

Kushan Galav ◽

Deeptish Tulsi ◽

Joanna McGlynn ◽

John Doherty ◽

...

Keyword(s):

Mortality Rate ◽

Length Of Stay ◽

Stroke Unit ◽

Average Length ◽

Length Of Hospital Stay ◽

Local Analysis ◽

Stroke Patients ◽

Stroke Units ◽

Average Length Of Stay ◽

Stroke Register

Abstract Background According to the 2017 National Stroke Register Report; 75% of strokes occur in patients aged 65 years and older. Within the audit 19 stroke units reported that 70.6% of stroke patients were admitted to a stroke unit and their median length of stay of 9 days. Numerous studies have shown better outcomes in patients admitted to a stroke unit versus a medical unit leading to national stroke networks and bypass protocols for patients. However, stroke patients can still be found in non-stroke unit hospitals such as our own. Methods Demographics from HIPE data was collected on all stroke patients admitted to our hospital between January 1st and December 31st 2017. Basic statistical methods were used to analyse the data. Results We analyzed 103 patient records. The average age at presentation was 73 years (range: 35-97) and 60.1% were males. The average length of hospital stay was 16.1 days (range 1- 130 days). Ischemic (77%) events were more common than haemorrhagic events (23%). The three most common co-morbidities were hypertension (45%), hyperlipidemia (30%) and atrial fibrillation (19%). Discharge destination was home (66%), nursing home (14%), national rehabilitation (2%) and an 18% mortality rate within 3 months. The mortality rate was higher in the hemorrhagic (42%) compared to ischemic (11%). Conclusion The average length of stay was 16.1 days, considerably higher than the national stroke unit average of 9. The overall mortality rate was 5% higher than the national of 13%. Limited rehabilitation services and time awaiting national rehabilitation beds contributed to the long LOS. There is a definite need for a dedicated stroke service at our hospital, local analysis suggests that 6 beds would meet the needs of our catchment area; and this would lead to better outcomes for stroke patients. A further locally dedicated stroke audit is needed.

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The effectiveness of Dakin’s solution in wound care after debridement in Fournier’s gangrene

International Surgery Journal ◽

10.18203/2349-2902.isj20202812 ◽

2020 ◽

Vol 7 (7) ◽

pp. 2156

Author(s):

Onur Karsli ◽

Fatih Gokalp

Keyword(s):

Mortality Rate ◽

Average Length ◽

Wound Care ◽

Length Of Hospital Stay ◽

Fournier’S Gangrene ◽

Concomitant Disease ◽

Perianal Region ◽

Fournier's Gangrene ◽

War Wounds ◽

Fournier Gangrene

Background: Fournier's gangrene (FG) is a specific form of necrotizing fasciitis seen in the external genital organs and perianal region. The basic management of Fournier's gangrene is based on critical surgical debridement. Dakin's solution (sodium hypochlorite) was originally developed to treat war wounds. In this study, we aimed to show potentially efficient of Dakin’s solution on wound healing and reoperation rate.Methods: Thirty-three patients who were debrided due to Fournier Gangrene during 2012-2020 were included in the study. After debridement, wound care was done twice a day by dressing with a sponge moistened with Dakin's solution. Patients' age, concomitant disease, involvement site, re-debridement requirement, complications, and discharge times were recorded.Results: The mean age of 33 male patients who participated in the study was (51-74) 63.93±15.36. Although all patients had scrotal involvement, nine patients had perineal (27.2%), 12 patients had inguinal (36.3%), four patients had a penis and pubic spread (12.1%). The mortality rate was 6%. The average length of hospital stay was 13.1±4.2 days, and the average number of debridements was 1.Conclusions: Fournier gangrene is an important disease characterized by necrotizing infection of the genital, perineal, and perianal region and progresses with high mortality. Our mortality rate was lower than literature and we have linked our mortality rate to using Dakin's solution for wound care. Dressing with Dakin's solution is an effective and reliable method for wound care in FG patients.

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The Problem of Capacity Management in Greek Public Hospitals

KnE Social Sciences ◽

10.18502/kss.v1i2.676 ◽

2017 ◽

Vol 1 (2) ◽

pp. 414

Author(s):

Christos Tsitsakis ◽

Persefoni Polychronidou ◽

Anastasios Karasavvoglou

Keyword(s):

Length Of Stay ◽

Average Length ◽

National Health System ◽

Healthcare Services ◽

Capacity Management ◽

Point Of View ◽

Public Hospitals ◽

Theory Of Constraints ◽

Healthcare Organizations ◽

Average Length Of Stay

One of the most important problems that the users of Greek National Health System face, is the long waiting lists. Αrather superficial explanationof this phenomenon is usually refer the increasing demand for healthcare services, ignoring that the problem is mainly a problem of capacity management, which is associated with the occupancy rate of specific wards of a hospital, and the average length of stay.The theory of constraints can apply successfully to healthcare organizations, to solve problems of capacity management, reducing the inpatient length of stay and increasing the satisfaction from the offering services as has been proved by international research.In this paper, we study the problem from this point of view. Our qualitative research revealed that there is a bottle-neck in the normal flow of patients, because of the delays in the imaging departments of the hospitals.The increase of the capacity of the imaging departments would offer a feasible solution to the problem.

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Impact of orthogeriatric management on the average length of stay of patients aged over seventy five years admitted to hospital after hip fractures

International Orthopaedics ◽

10.1007/s00264-020-04908-z ◽

2021 ◽

Author(s):

Pierre-Sylvain Marcheix ◽

Camille Collin ◽

Jérémy Hardy ◽

Christian Mabit ◽

Achille Tchalla ◽

...

Keyword(s):

Surgical Treatment ◽

Hip Fracture ◽

Mortality Rate ◽

Length Of Stay ◽

Average Length ◽

Discharge Rate ◽

Length Of Hospital Stay ◽

Median Length ◽

Average Length Of Stay ◽

Significant Difference

Abstract Introduction Hip fracture is a frequent and serious condition in the elderly. We conducted a retrospective cohort study to answer the following questions: (1) Could treatment in an orthogeriatric unit help to reduce the average length of stay for patients aged over 75 years admitted to hospital for the treatment of a hip fracture?; and (2) Could such treatment influence the post-operative outcomes of patients with hip fracture? Methods and materials Our study included 534 patients admitted to hospital between January 2017 and December 2018 for surgical treatment of a hip fracture. We compared 246 patients who received traditional orthopaedic care with 288 patients treated in an orthogeriatric unit. Results Our cohort included 410 women (77%). The average age was 87.5 ± six years, and 366 patients (68%) were living at home prior to the fracture. A statistically significant difference in median length of stay (from 10 to 9 days) was observed between patients who did and did not receive orthogeriatric unit treatment (groups 1 and 2; 95% CI: 0.64; 2.59; p = 0.001). There was no difference in pre-operative delay, intra-hospital mortality rate, place of recovery, rate of institutionalisation after six months, or the number of new fractures at 6 months between the groups. The mortality rate after six months was 23.6% and 21.3% in groups 1 and 2, respectively; the difference was not significant. Discussion Orthogeriatric unit treatment reduced the median length of stay by one day, in line with most previous studies. According to Pablos-Hernandez et al., multifaceted orthogeriatric treatment is most effective. In our study, only 38% of the patients received surgical treatment within 48 hours, where early surgery is key for reducing the length of hospital stay. The intrahospital mortality rate was 2.6%, which is comparable to literature data. The discharge rate did not differ by orthogeriatric treatment status, which is also consistent with previous findings (e.g. Gregersen et al.). Lastly, the mortality rate after six months was slightly reduced by orthogeriatric care. In line with this, Boddaert et al. reported a difference in mortality rate after six months between groups who did and did not receive orthogeriatric treatment (15% vs. 24%).

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DUODENAL ULCER PERFPRATION - A CLINICAL STUDY IN A TERTIARY HEALTH CARE SET UP.

10.36106/ijar/2111446 ◽

2020 ◽

pp. 44-45

Author(s):

Abinasha Mohapatra ◽

Himansu Shekhar Mishra

Keyword(s):

Duodenal Ulcer ◽

Medical Science ◽

Duodenal Perforation ◽

Ulcer Disease ◽

Ulcer Perforation ◽

Lower Socioeconomic ◽

Abdominal Emergencies ◽

Set Up ◽

Duodenal Perforations ◽

Duodenal Ulcer Perforation

BACKGROUND - Peptic ulcer disease though having multifactorial etiologies, out of which H.pyroli infection and NSAIDs use are leading causes of duodenal perforation. Gastro-duodenal perforations are common in surgical practice. Acute perforations of duodenum are estimated to occur in 2-10% of patients with ulcers. MATERIALS AND METHODS - This a retrospective study ( done between August 2019 to August 2020), where 100 patients with duodenal ulcer perforation were enrolled, analyzed and compared in Department of General Surgery, Veer Surendra Sai Institute of Medical Science And Research (VIMSAR) , Burla, Sambalpur. RESULTS – More common in 40-59 years age group, male and lower socioeconomic status. CONCLUSION-Duodenal ulcer perforation is one of the most common acute abdominal emergencies.

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Epidemiological comparison of stroke patients before and after Cincinatti Scale implementation

10.5327/1516-3180.589 ◽

2021 ◽

Author(s):

Brenda Luiza de Sousa Sanches ◽

Gabriela Malaquias Barreto Gomes ◽

Larissa Melo Targino ◽

Julia do Vale Moura Costa ◽

Thaís Lima Barreto ◽

...

Keyword(s):

Mortality Rate ◽

Average Length ◽

Cerebral Arteries ◽

Cross Sectional Study ◽

Cross Sectional ◽

Average Length Of Stay ◽

Premature Deaths ◽

Before And After ◽

The One ◽

Early Stroke

Introduction: Stroke is an obstruction or rupture of cerebral arteries that leads to brain damage. The Cincinnati Prehospital Stroke Scale (CPSS) aims to identify early stroke signs. Objectives: To epidemiologically compare stroke victims in Brazil before and after CPSS implementation. Design and setting: A cross-sectional study in Brazil. Methods: Data collected was published by the Health Ministry through DATASUS. A ten-year period was selected before and after the Cincinnati Scale (2010) implementation in Brazil. The data collected were mortality rate, lethality and average length of stay. Results: The average stroke mortality rate from 2000 to 2009 was 16.99, while from 2011 to 2020 it was 15.10, representing a 12,5% reduction. However, comparing these same periods, the average lethality rate increased by 4.92%. The median of stay averages before the implementation of the CPSS is 7.15 days, whereas the one afterwards is 7.45. Conclusions: The CPSS aims to identify stroke by evaluating weakness, speech and facial drop. A significant reduction in mortality has been noted since the implementation of the protocol, which may suggest its effectiveness in early stroke detection. Before the scale, the treatment was possibly late, leading to worse prognosis. Thus, the average stay increase between the evaluated periods could be explained by premature deaths.

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Analysis of stroke treatment outcomes in hospital setting in Brazil, between the years 2010 and 2019.

10.5327/1516-3180.447 ◽

2021 ◽

Author(s):

Giovanna Carvalho Sousa ◽

Gustavo Bomfim Barreto ◽

Lanna Victória Loula ◽

Louise Seixas Lordêllo ◽

Gustavo Sampaio Vilas-Boas ◽

...

Keyword(s):

Information System ◽

Mortality Rate ◽

Hospital Stay ◽

Average Length ◽

Hospital Setting ◽

Length Of Hospital Stay ◽

Secondary Data ◽

Stroke Treatment ◽

The World ◽

Treatment Mortality

Background: Stroke is an important cause of death and is a major cause of serious disability in Brazil and in the world. Therefore, it is fundamental to analyze its treatment in the hospital setting in Brazil. Objectives: To describe the progression of the stroke treatment in the hospital setting in Brazil between the years 2010 and 2019 and the outcomes associated to the disease. Design and Setting: Transversal, retrospective and quantitative study, with secondary data collected in the Hospital Information System of SUS (SIH / SUS) between 2010 and 2019, in Brazil. Methods: Data from number of hospitalizations for stroke treatment, mortality rate and average length of hospital stay were collected and analyzed. A comparison has been made between these data over the selected years. Results: The number of hospitalizations for stroke treatment had a 16,83% growth between 2010 and 2019. In comparison, the average length of hospital stay was 7,7 days in 2010 and 7,6 days in 2019. The mortality rate had a reduction of 10,52% between these years. Conclusions: Despite the growth of hospitalization to stroke treatment, there was a reduction in the average length of hospital stay and in the mortality rate associated to the procedure. It is possible to infer an optimization in the stroke lead in intensive care units in Brazil.

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