Study comparing the stroke unit outcome and conventional ward treatment: a randomized study in Joinville, Brazil

BACKGROUND AND PURPOSE: To assess the impact of a stroke unit (SU) on acute phase treatment when compared to a conventional general ward treatment (GW). METHOD: Seventy-four patients with acute stroke were randomized between a SU and conventional general ward (GW). We compared both groups regarding the length of hospital stay, lethality and functional and clinical status within 6 months, using the Scandinavian scale and Barthel index. RESULTS: Thirty-five and thirty-nine patients were allocated at SU and GW, respectively. Lethality on the 10th day at SU and GW achieved 8.5% and 12.8% respectively (p= 0.41), whereas 30-days mortality rates achieved 14.2% and 28.2% (p= 0.24), 17.4% and 28.7% on the 3rd month (p= 0.39), and 25.7% and 30.7% on the 6th month (p= 0.41). Thirty-day survival curve achieved 1.8 log rank (p= 0.17), with a trend for lower lethality in the SU. In order to save one death in 6 months in SU, NNT (the number need to treat) was 20; to get one more home independent patient NNT was 15. No significant difference was found between the length of hospital stay and morbidity. CONCLUSION: No significant benefit was found in SU patients compared to GW group. However,an evident benefit in absolute numbers was observed in lethality, survival curve and NNT in thirty days period after stroke. Further collaborative studies or incresead number of patients are required to define the role of SU.

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Is Obesity a Risk Factor for Spinal Surgeries? A Retrospective Study in a Specialized Orthopedic Spine Center

Journal of Research in Orthopedic Science ◽

10.32598/jrosj.8.1.759.1 ◽

2021 ◽

Vol 8 (1) ◽

pp. 37-42

Author(s):

Hasan Ghandhari ◽

◽

Ebrahim Ameri ◽

Mohsen Motalebi ◽

Mohamad-Mahdi Azizi ◽

...

Keyword(s):

Retrospective Study ◽

Postoperative Complications ◽

Blood Loss ◽

Hospital Stay ◽

Length Of Hospital Stay ◽

Obese Group ◽

Obese Patients ◽

Number Of Patients ◽

Significant Difference ◽

Duration Of Surgery

Background: Various studies have shown the effects of morbid obesity on the adverse consequences of various surgeries, especially postoperative infections. However, some studies have shown that the complications of spinal surgery in obese and non-obese patients are not significantly different. Objectives: This study investigated and compared the duration of surgery, length of hospital stay, and complications after common spinal surgeries by orthopedic spine fellowship in obese and non-obese patients in a specialized spine center in Iran. Methods: All patients who underwent decompression with or without lumbar fusion were included in this retrospective study. These patients were classified into two groups: non-obese (BMI <30 kg/m2) and obese (BMI ≥30 kg/m2). The data related to type and levels of surgery, 30-day hospital complications, length of hospital stay, rate of postoperative wound infection, blood loss, and need for transfusion were all extracted and compared between the two groups. Results: A total of 148 patients (74%) were in the non-obese group and 52 patients (26%) in the obese group. The number of patients that need packed cells was significantly higher in the obese group (51.8% vs 32.6%) (P=0.01). Otherwise, there were not a significant difference between type of treatment (fusion or only decompression) (P=0.78), interbody fusion (P=0.26), osteotomy (P=0.56), duration of surgery (P=0.25), length of hospital stay (P=0.72), mean amount of blood loss (P=0.09), and postoperative complications (P=0.68) between the two groups. Conclusion: Our results suggest that duration of surgery, length of hospital stay, and postoperative complications are not associated with the BMI of the patients.

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The Effect of Omentoplasty on the Rate of Anastomotic Leakage after Intestinal Resection: A Randomized Controlled Trial

The American Surgeon ◽

10.1177/000313481708300215 ◽

2017 ◽

Vol 83 (2) ◽

pp. 157-160 ◽

Cited By ~ 1

Author(s):

Shirzad Nasiri ◽

Babak Mirminachi ◽

Reyhaneh Taherimehr ◽

Roya Shadbakhsh ◽

Mohsen Hojat

Keyword(s):

Hospital Stay ◽

Anastomotic Leakage ◽

Controlled Trial ◽

Randomized Study ◽

Intestinal Resection ◽

Length Of Hospital Stay ◽

Fistula Formation ◽

Intestinal Surgery ◽

Increased Risk ◽

Significant Difference

Anastomotic leakage is a major postoperative complication after intestinal surgery leading to increased risk of morbidity and mortality. Omentoplasty has been evaluated to prevent anastomotic leakage in several studies. However, there is no consensus regarding whether or not omentoplasty should be used to decrease the rate of anastomotic leakage after intestinal resection. A prospective, randomized study was conducted to evaluate the influence of omentoplasty on anastomotic leakage after intestinal resection. A total of 124 patients who underwent intestinal resection were enrolled in this prospective study. Patients were randomly assigned to receive either the omentoplasty or nonomentoplasty. In the omentoplasty group, the omentum was wrapped around the anastomotic region. Age, gender, site and type of anastomosis, duration of hospital stay, and performance of omentoplasty were recorded. This study was registered in Iranian Registry of clinical trial (number: IRCT201412316925N3). The rate of anastomotic leakage was significantly lower in the omentoplasty group (P = 0.04). Patients in the omentoplasty group developed a significantly lower rate of postoperative infection and peritonitis (P < 0.05). There was no significant difference of abscess and fistula formation between the two groups (P > 0.05). The length of hospital stay was longer in the nonomentoplasty group, compared with that for omentoplasty patients (P < 0.05). No death occurred in the omentoplasty subjects, while six nonomentoplasty patients died (P < 0.05). Our data demonstrated that omentoplasty is useful to lower the rate of postoperative complications in patients underwent intestinal surgery.

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The Impact of COVID-19 on Hospitalised COPD Exacerbations in Malta

Pulmonary Medicine ◽

10.1155/2021/5533123 ◽

2021 ◽

Vol 2021 ◽

pp. 1-7

Author(s):

Yvette Farrugia ◽

Bernard Paul Spiteri Meilak ◽

Neil Grech ◽

Rachelle Asciak ◽

Liberato Camilleri ◽

...

Keyword(s):

Length Of Hospital Stay ◽

Chronic Obstructive ◽

Inpatient Mortality ◽

Obstructive Pulmonary Disease ◽

Predictors Of Mortality ◽

Copd Exacerbations ◽

Number Of Patients ◽

Significant Difference ◽

The Difference ◽

The Impact

Introduction and Aims. The first COVID-19 case in Malta was confirmed on the 7th of March 2020. This study is aimed at investigating a significant difference between the number of acute exacerbations of chronic obstructive pulmonary disease (AECOPD) admissions and their inpatient outcome at Mater Dei Hospital during the COVID-19 pandemic when compared to the same period in 2019. Furthermore, we aim to determine predictors of mortality in AECOPD inpatients. Method. Data was collected retrospectively from electronic hospital records during the periods 1st March until 10th May in 2019 and 2020. Results. There was a marked decrease in AECOPD admissions in 2020, with a 54.2% drop in admissions ( n = 119 in 2020 vs. n = 259 in 2019). There was no significant difference in patient demographics or medical comorbidities. In 2020, there was a significantly lower number of patients with AECOPD who received nebulised medications during admission (60.4% in 2020 vs. 84.9% in 2019; p ≤ 0.001 ). There were also significantly lower numbers of AECOPD patients admitted in 2020 who received controlled oxygen via venturi masks (69.0% in 2020 vs. 84.5% in 2019; p = 0.006 ). There was a significant increase in inpatient mortality in 2020 (19.3% [ n = 23 ] and 8.4% [ n = 22 ] for 2020 and 2019, respectively, p = 0.003 ). Year was found to be the best predictor of mortality outcome ( p = 0.001 ). The lack of use of SABA pre-admission treatment ( p = 0.002 ), active malignancy ( p = 0.003 ), and increased length of hospital stay ( p = 0.046 ) were also found to be predictors of mortality for AECOPD patients; however, these parameters were unchanged between 2019 and 2020 and therefore could not account for the increase in mortality. Conclusions. There was a decrease in the number of admissions with AECOPD in 2020 during the COVID-19 pandemic, when compared to 2019. The year 2020 proved to be a significant predictor for inpatient mortality, with a significant increase in mortality in 2020. The decrease in nebuliser and controlled oxygen treatment noted in the study period did not prove to be a significant predictor of mortality when corrected for other variables. Therefore, the difference in mortality cannot be explained with certainty in this retrospective cohort study.

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Day of surgery: the impact on patient length of stay in a tertiary vascular unit

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2019.0075 ◽

2020 ◽

Vol 102 (2) ◽

pp. 98-103 ◽

Cited By ~ 1

Author(s):

NC Holford ◽

C Ní Ghuidhir ◽

L Hands

Keyword(s):

Length Of Stay ◽

Hospital Stay ◽

Support Services ◽

Length Of Hospital Stay ◽

Abdominal Aortic Aneurysm Repair ◽

Significant Difference ◽

Postoperative Length ◽

The Difference ◽

Aneurysm Repair ◽

The Impact

Background Our hypothesis was that patients undergoing surgery earlier in the week would have better access to physiotherapy and other discharge services after surgery and, as a result, would have a shorter length of hospital stay compared with patients undergoing surgery later in the week. This study aimed to assess whether there is a significant difference in postoperative length of hospital stay between the groups with secondary assessment by operation subtype. Methods We identified all patients admitted for vascular surgery in 2015 from a prospectively collected database and divided the week into Monday to Wednesday and Thursday to Friday. Endovascular cases were included but day cases were excluded. Further analysis was performed with a breakdown in both groups by operation type. Statistical analysis was performed using SPSS version 16.0. Results We identified 652 patients who met our criteria. Within the elective patient group, there was a significantly longer length of stay of three days for the late-week group compared with two days for the early-week group (P = 0.016). Femoral artery procedures had a median length of stay of two days for those operated on early in the week compared with four days later in the week (P < 0.005). Open abdominal aortic aneurysm repair showed a trend to longer length of stay in the late-week group (P = 0.06). Conclusion Day of surgery appears to impact on patients’ length of stay following vascular procedures, with the greatest impact on medium-sized procedures. This difference could be explained by the difference in weekend support services, but further evaluation is required following introduction of weekend support services to assess this.

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Laparoscopic Assisted Vaginal Hysterectomy: A Case Control Comparative Study with Total Abdominal Hysterectomy

Faridpur Medical College Journal ◽

10.3329/fmcj.v8i2.20370 ◽

2014 ◽

Vol 8 (2) ◽

pp. 59-62

Author(s):

Fahmida Zesmin ◽

Begum Hosne Ara ◽

Fatema Begum ◽

Nusrat Fatima

Keyword(s):

Hospital Stay ◽

Vaginal Hysterectomy ◽

Length Of Hospital Stay ◽

Total Abdominal Hysterectomy ◽

Abdominal Hysterectomy ◽

Case Control ◽

Eligibility Criteria ◽

Laparoscopic Assisted Vaginal Hysterectomy ◽

Number Of Patients ◽

Significant Difference

This case control study was conducted in the department of Gynae & Obstetrics, Sir Salimullah Medical College & Mitford Hospital (SSMC & MH), Dhaka, during the period of January 2008 to December 2008 to compare the length of operation, blood loss, length of hospital stay, drug requirements for pain and post-operative pain and activity levels between Laparoscopically Assisted Vaginal Hysterectomy (LAVH) & Total Abdominal Hysterectomy (TAH). A total of 50 patients who met some eligibility criteria were consecutively included in the study and matched in a case control manner for age, weight, diagnosis & uterine size. The procedures were performed by the same surgeon. On average, LAVH operations took significantly longer than TAH operations (P<0.001). Equal number of patients of both groups (40%) needed blood transfusion. No significant difference about haemoglobin level compared to TAH group on 3rd POD (P=0.246). However total amount of analgesics needed was much higher in the TAH group than that of the LAVH group (243.7 ± 40.3VS 182.1 ± 69.6 mg; P= 0.005) and the total cost of operation was significantly less in the TAH group (4500 ± 500 takas) than in the LAVH group (6500 ± 500 taka) (P<0.001). It was observed that LAVH group produced earlier relief from pain in terms of pain VAS on 3rd POD, (P<0.001). LAVH is less painful, has a shorter length of hospital stay and quicker return to work than TAH. Moreover LAVH does not increase intra or postoperative complications. DOI: http://dx.doi.org/10.3329/fmcj.v8i2.20370 Faridpur Med. Coll. J. 2013;8(2): 59-62

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Prospective Randomized Blinded Study to Compare Laparoscopic and Open Inguinal Hernioplasty

Academia Journal of Surgery ◽

10.47008/ajs/2020.3.1.32 ◽

2020 ◽

Vol 3 (1) ◽

pp. 149-154

Author(s):

Mohd. Ilyas ◽

Venkat Vaijnath Cholleti

Keyword(s):

Inguinal Hernia ◽

Hernia Repair ◽

Hospital Stay ◽

Inguinal Hernia Repair ◽

Randomized Study ◽

Early Assessment ◽

Post Operative Pain ◽

Number Of Patients ◽

Study Results ◽

Significant Difference

Background: Hernia is one of the common surgical problems. Repair of inguinal hernia is one of the commonest surgical procedures worldwide, irrespective of country, race or socio-economic status and constitutes a major health-care in every country. Subjects and Methods: This is a randomised prospective study done over 50 patients in the department of general surgery of Kamineni hospitals, LB Nagar, Hyderabad during the period of October 2010 to August 2012 with the aim to compare laproscopic inguinal hernia repair and open inguinal hernia repair with regards to post-operative pain, surgical site infections, hospital stay and time taken to return to work, by a randomized study. Results: Compare laparoscopic and mesh inguinal hernia repairs, there is no significant difference in early assessment with regards to duration of operation, post-operative pain, analgesic requirements on the day of surgery and first post-operative day, hospital stay, return to daily and normal activities and post-operative complications. Conclusion: Laparoscopic mesh hernioplasty still remains to be validated with larger number of patients and longer duration of follow up.

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Prolonged postoperative ileus after elective colorectal cancer surgery

Vojnosanitetski pregled ◽

10.2298/vsp160527387n ◽

2018 ◽

Vol 75 (8) ◽

pp. 780-786

Author(s):

Milica Nestorovic ◽

Goran Stanojevic ◽

Branko Brankovic ◽

Vanja Pecic ◽

Ljiljana Jeremic

Keyword(s):

Prospective Study ◽

Surgical Site Infection ◽

Hospital Stay ◽

Anastomotic Leakage ◽

Postoperative Ileus ◽

Length Of Hospital Stay ◽

Site Infection ◽

Significant Difference ◽

Prolonged Postoperative Ileus ◽

The Impact

Background/Aim. Postoperative ileus is a frequent and frustrating occurence for both, patients and surgeons after abdominal surgery. Besides clinical importance of postoperative ileus, its economic aspect is also important. The aim of this prospective study was to analyze development of prolonged postoperative ileus after elective colorectal surgery for cancer and its impact on early postoperative outcome. Methods. This prospective study included all eligible patients, 18 years or older, scheduled for open colorectal resection for cancer from June, 2015 to February, 2016. Patients with metastatic disease, prior hemoirradiation or any resection other then curative were excluded. The study duration was up to 30 days postoperatively. Primary outcome measure was development of prolonged postoperative ileus according to strict definition. The impact of prolonged postoperative ileus on other outcome measures such as postoperative complications, surgical site infections, anastomotic leakage, reoperations, mortality and length of hospital stay were of great interest, too. Results. This prospective study included 103 patients, 64 (37.9%) men and 39 (62.1%) women, mean age 66 years. Prolonged postoperative ileus developed in 12 (11.3%) patients. One third of the patients had some type of surgical site infection, while 47.6% had complications. Ten (9.7%) patients required reoperation. Comparing the group of patients with prolonged postoperative ileus with those without, there were no statistically significant differences in rates of surgical site infection and anastomotic leakage. There was statistically significant difference in terms of complications (_2 = 34.966; p < 0.001), complications grade III (_2 = 23.43; p < 0.001) and reoperations (_2 = 15.724; p <0.001). Patients who developed prolonged postoperative ileus had statistically significant longer postoperative hospital stay (Z = 2.291, p = 0.022) and longer total length of hospital stay (Z = 2.377, p = 0.015). According to regression analyzes prolonged postoperative ileus represents a risk factor for reoperations [odds ratio (OR) = 12.286; p = 0.001]. Conclusion. Prolonged postoperative ileus, although not life-threatening complication effects recovery, increases length of hospital stay and contributes to poor surgical outcome.

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Earlier Initiation of Postoperative Physical Therapy Decreases Opioid Use after Total Knee Arthroplasty

The Journal of Knee Surgery ◽

10.1055/s-0040-1721034 ◽

2020 ◽

Author(s):

Tal Frenkel Rutenberg ◽

Haim Izchak ◽

Yoav Rosenthal ◽

Uri Barak ◽

Shai Shemesh ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Physical Therapy ◽

Hospital Stay ◽

Knee Arthroplasty ◽

Length Of Hospital Stay ◽

Osteoarthritis Of The Knee ◽

Opioid Use ◽

Significant Difference ◽

Total Knee ◽

The Impact

AbstractFor patients with advanced osteoarthritis of the knee, total knee arthroplasty (TKA) has been shown to provide significant pain relief and improved function with consistent, reproducible results. Post-operative physical therapy (PT) plays an important role is restoring muscle strength and range of motion (ROM). Yet, the impact of earlier physical therapy initiation after TKA has not been well defined. We assessed 205 patients that underwent primary TKA including 136 patients who started PT on the first post-operative day (POD1) and a second group that started PT 3 days after surgery (POD3), or later. Length of hospital stay (LOS), opioid use during hospital stay, complications, re-admissions, knee ROM and the need for subsequent hospitalized rehabilitation were recorded. LOS was not significantly shorter in the early PT group, compared with the delayed PT group (6.4 ± 2.2 days vs. 6.8 ± 2 days, respectively, P = .217). Patients in the delayed PT group consumed more opioids during their inpatient stay compared with the early PT group on both POD 3 (89% vs 82%, p = 0.013) and POD 4 (81% vs 66%, p = 0.005). There was no significant difference in the incidence of Immediate post-operative complications or final knee ROM between the two groups. While early postoperative PT did not impact hospital LOS or final knee ROM, it was associated with an earlier reduction in postoperative opioid consumption after primary TKA.

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Does Clarithromycin Use in Acute Viral Bronchiolitis Shorten Length of Hospital Stay?

10.38092/jpa-2020-856328 ◽

2020 ◽

pp. 62-65

Author(s):

Gülnur Esenülkü ◽

Fatma Hancı

Keyword(s):

Hospital Stay ◽

Clinical Status ◽

Length Of Hospital Stay ◽

High Rate ◽

Clinical Practices ◽

Pediatric Clinic ◽

Significant Difference ◽

Group A ◽

Group B ◽

Acute Viral Bronchiolitis

Introduction: Acute bronchiolitis is the most common cause of hospitalization among infants. Although antibiotics are not recommended in the absence of secondary bacterial infection, rates of antibiotic usage is high rate in clinical practices Objectives: To test the hypothesis that clarithromycin use in infants with acute viral bronchiolitis shortens length of hospital stay. Materials and Methods: One hundred sixty-seven patients aged 1-24 months hospitalized for treatment with a diagnosis of acute viral bronchiolitis at pediatric clinic between April 2017 and May 2018 were investigated retrospectively. The patients were divided into two separate groups, Group A (122 patients), using clarithromycin therapy during hospitalization, and Group B (45 patients), which did not receive clarithromycin (Group B). Demographic and clinical data, treatments received, and duration of hospital stay were obtained from patients’ records. Results: The rate of clarithromycin use in this study was 73%. No statistically significant difference in length of hospital stay was determined between patients receiving clarithromycin and those receiving no antibiotic therapy. However, length of hospital stay decreased with age. Clarithromycin use elicited no statistically significant decrease in hospital stay in patients with acute viral bronchiolitis. Conclusions: The routine use of clarithromycin is not recommended in acute viral bronchiolitis in the light of its cost and side-effects, and the fact is has no impact on clinical status and hospital stay

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Effect of renin-angiotensin system blocker on COVID-19 in young patients with hypertension

Journal of Investigative Medicine ◽

10.1136/jim-2021-002036 ◽

2022 ◽

pp. jim-2021-002036

Author(s):

Mustafa Kuzeytemiz ◽

Erhan Tenekecioglu

Keyword(s):

Hospital Stay ◽

Stress Test ◽

Length Of Hospital Stay ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Clinical Prognosis ◽

Significant Difference ◽

The Impact ◽

Treadmill Stress Test ◽

Treadmill Stress

Hypertension is found frequently in patients with COVID-19 and is often treated with ACE inhibitors (ACEIs) and angiotensin receptor blockers (ARBs). SARS-CoV-2, the pathogen of COVID-19, binds to the receptors of ACE2 to enter the alveolar cells, raising questions on whether these drugs are salutary or harmful with respect to any propensity for COVID-19 or to disease prognosis. We investigated the impact of ACEI/ARB and the clinical prognosis of patients with hypertension with COVID-19. In this study, 250 patients with hypertension (<45 years old) with COVID-19 were recruited. None of these patients had any chronic disease except for hypertension. The study population was grouped according to antihypertensive medication: ACEI/ARB user and non-ACEI/ARB user. Patients were followed for clinical prognosis and biochemical and radiological findings during their hospital stay. Adverse cardiovascular event (myocardial infarction, all-cause death, stroke), transfer to the intensive care unit, severity of symptoms during the treatment course, length of hospital stay and effort capacity in the treadmill stress test were recorded. During hospital stay, there was no significant difference in terms of length of hospital stay, medication for COVID-19, left ventricular ejection fraction on echocardiography and metabolic equivalents in the treadmill stress test between patients treated with and without ACEI/ARB. During treatment of COVID-19, there was no significant difference in clinical adverse event, effort capacity and clinical course between patients with and without ACEI/ARB. It appears that patients with COVID-19 may continue to use ACEI/ARB or that ACEI/ARB may be added safely to their antihypertensive treatment.

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