scholarly journals Influence of the Covid-19 pandemic on hospital stay after knee and hip arthroplasty

2021 ◽  
Vol 27 (5) ◽  
pp. 570-577
Author(s):  
A.G. Aliev ◽  
◽  
A. Riakhi ◽  
A.P. Sereda ◽  
E.V. Veber ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Hip Arthroplasty ◽  
Total Duration ◽  
Length Of Hospital Stay ◽  
Significant Difference ◽  
Revision Tha ◽  
Duration Of Hospitalization ◽  
Bed Days ◽  
Knee And Hip Arthroplasty ◽  
The Impact

Abstract. Introduction The Covid-19 pandemic has led to quite significant changes in the length of hospital stay of orthopedic patients. Meanwhile, there has been a tendency for early discharge after arthroplasty for quite some time due to the increasing burden on health care systems that became possible due to the implementation of accelerated rehabilitation protocols. This study is dedicated to the effect of discharge terms on the incidence of postoperative complications. Material and methods A retrospective study of 1,837 patients who underwent primary/revision THA and TKA at our center in 2020 was carried out. The impact of the pandemic was assessed by comparing the duration of hospitalization, the incidence of complications and functional status in patients operated on before and after the introduction of epidemiological restrictions. Purpose of the study To assess the impact of the Covid-19 pandemic on the length of patients’ hospital stay after knee and hip arthroplasty. Results The total duration of hospitalization after primary THA was reduced by 35 % (from 11.8 ± 3.3 to 7.7 ± 2.6 bed-days), and by 38 % (from 19.9 ± 7.5 to 12.8 ± 6.3 bed-days) after revision THA. The overall readmission rate (for surgical and nonsurgical complications) after primary THA was 4.1 % before the pandemic and 4.3 % during the pandemic; for primary TKA it was 2.1 % and 5.1 %, respectively; for revision THA – 13.9 % and 4.5 %, revision TKA – 4.4 % and 9.8 %, respectively. Comparative assessment for each diagnosis separately did not show significant difference. Evaluation of the questionnaire survey using the Oxford hip/knee score also showed the absence of a statistically significant relationship between the time of discharge and the functional state of the operated joint. The interviewing of patients regarding the infection with coronavirus yielded positive answers in 22 % (n = 419). The onset of symptoms during hospitalization or within 14 days after discharge was noted by 4 % of respondents (n = 75). Conclusion The incidence of complications and unfavorable outcomes did not depend on the length of hospital stay after THA and TKA.

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

2020 ◽  
Vol 102 (2) ◽  
pp. 98-103 ◽  
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.

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

2003 ◽  
Vol 61 (2A) ◽  
pp. 188-193 ◽  
Author(s):  
Norberto L. Cabral ◽  
Carla Moro ◽  
Giana R. Silva ◽  
Rosana Herminia Scola ◽  
Lineu César Werneck
Keyword(s):  
Hospital Stay ◽  
Stroke Unit ◽  
Survival Curve ◽  
Clinical Status ◽  
Randomized Study ◽  
Length Of Hospital Stay ◽  
General Ward ◽  
Number Of Patients ◽  
Significant Difference ◽  
The Impact

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.

scholarly journals EFFECT OF TRAHEOSTOMY ON THE INPATIENT TREATMENT OF PATIENTS WITH CONTACT MEDIASTINITES

2019 ◽  
Vol 26 (1) ◽  
pp. 94-100
Author(s):  
Alexander L. Gromov ◽  
Mikhail A. Gubin ◽  
Sergei V. Ivanov ◽  
Denis S. Tishkov
Keyword(s):  
Conflict Of Interest ◽  
Inpatient Treatment ◽  
Surgical Intervention ◽  
Maxillofacial Surgery ◽  
Total Duration ◽  
Treatment Results ◽  
Microbiological Characteristics ◽  
Duration Of Hospitalization ◽  
Bed Days ◽  
The Impact

The aimwas to assess the impact of emergency and planned tracheostomy on the main indicators of inpatient treatment in patients with contact mediastinitis.Materials and methods.This work was performed on the basis of the Department of Maxillofacial Surgery of the Kursk Regional Clinical Hospital. In order to conduct a comparative assessment of the treatment results, the patients with contact mediastinitis (46 people, surveyed period 2008–2017) were divided into 2 subgroups: control (25 people, 7 women, 18 men), who were treated without a tracheostomy; and the main group (21 people: 9 women, 12 men), with tracheostomy performed. The etiological and microbiological characteristics of the disease, the total duration of inpatient treatment, the length of stay in the resuscitation and intensive care units (bed-days), the dependence of the disease outcome (death, recovery) on the form of surgical intervention (tracheostomy) were evaluated.Results.A statistically significant effect of tracheostomy on the total duration of hospitalization and mortality rate was established (p0.05). Consequently, at present this issue cannot be resolved unambiguously and requires further research and mathematical analysis.Conclusion.The implementation of tracheostomy significantly increases the duration of inpatient treatment of patients with contact odontogenic mediastinites (p0.05).Conflict of interest: the authors declare no conflict of interest.

scholarly journals Prolonged postoperative ileus after elective colorectal cancer surgery

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.

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

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.

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

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.

scholarly journals 1079. Impact of Antimicrobial Stewardship Program (ASP) on Patients with Neurological Conditions

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S383-S383
Author(s):  
Lay Hoon Andrea Kwa ◽  
Li Wen Loo ◽  
Yixin Liew ◽  
Maciej Piotr Chlebicki
Keyword(s):  
Hospital Stay ◽  
Antimicrobial Stewardship ◽  
Length Of Hospital Stay ◽  
Duration Of Therapy ◽  
Stewardship Program ◽  
Morbidity Score ◽  
Co Morbidity ◽  
Significant Difference ◽  
Neurological Conditions ◽  
The Impact

Abstract Background Rising rates of antimicrobial resistance worldwide has dire consequences on patient care, as infections with resistant organisms impair patients’ recovery, resulting in protracted illness and hence prolonged hospital stay. Antimicrobial Stewardship Programs (ASPs) have shown to effectively reduce antibiotic resistance. Locally, we observed that patients with neurological conditions were often initiated on antibiotics for change in mental state or isolated fevers. Little is known whether these patients truly require antibiotics and hence, we aim to study the impact of ASP in these patients. Methods Retrospective review of ASP database between January 2014 and December 2017 was conducted, among all patients admitted to the neurology department in SGH and in whom the ASP team recommended discontinuation of empiric use of antibiotics. Demographics were collected. Clinical outcomes, duration of antibiotics therapy, length of hospital stay (LOS), infection-related readmissions and mortality, were compared between interventions accepted and rejected groups. Results The ASP team recommended 184 interventions [overall acceptance rate of 82.6% (152/184)]. There was no significant difference in underlying demographics, and Charlson Co-morbidity score between the 2 groups. However, the interventions-acceptance group had shorter duration of therapy by 1.67 days (4.99 ± 2.50 days vs. 6.66 ± 2.34 days; P < 0.01) and LOS by 2 days (22.5 ± 51.4 days vs. 24.5 ± 3.04 days; P = 0.83). There were no significant differences in 14-day mortality and readmission rates between the 2 groups. Conclusion In patients with neurological conditions, ASP interventions were safe, and associated with a significant reduction in the duration of therapy and LOS. Disclosures All authors: No reported disclosures.

Challenges to the Orthopaedic Arthroplasty Enhanced Recovery Programme

2017 ◽  
Vol 27 (1-2) ◽  
pp. 15-20 ◽  
Author(s):  
HL Kerr ◽  
LA Armstrong ◽  
L Beard ◽  
D Teichmann ◽  
J Mutimer
Keyword(s):  
Retrospective Study ◽  
Hospital Stay ◽  
Hip Arthroplasty ◽  
Enhanced Recovery ◽  
Length Of Hospital Stay ◽  
Medical Problems ◽  
Enhanced Recovery Programme ◽  
Total Knee ◽  
Knee And Hip Arthroplasty

We performed a retrospective study of patients undergoing total knee and hip arthroplasty on an enhanced recovery programme, to identify pre- and postoperative factors contributing to an increased length of hospital stay. Of 109 patients, only 61 (56%) were ready for discharge on the fifth postoperative day. The three most common reasons for delays were oozing wounds, postoperative medical problems and failure to reach physiotherapy goals.

scholarly journals The Impact of Cytochrome P450 3A5 Genotype on Early Tacrolimus Metabolism and Clinical Outcomes in Lung Transplant Recipients

2021 ◽  
Author(s):  
Wenwen Du ◽  
Xiaoxing Wang ◽  
Dan Zhang ◽  
Wenqian Chen ◽  
Xianglin Zhang ◽  
...  
Keyword(s):  
Cytochrome P450 ◽  
Hospital Stay ◽  
Clinical Outcomes ◽  
Kidney Injury ◽  
Length Of Hospital Stay ◽  
Blood Concentrations ◽  
Azole Antifungals ◽  
Significant Difference ◽  
Cytochrome P450 3A5 ◽  
The Impact

Abstract Background Tacrolimus (Tac) is the cornerstone of immunosuppressant therapy after lung transplantation (LTx). It shows great inter-individual variability in pharmacokinetics, which could partly be explained by pharmacogenetic factors. Objective We aim to investigate the effect of cytochrome P450 3A5 (CYP3A5) (rs776746) genotypes on early post-operative Tac metabolism and clinical outcomes in LTx recipients. Methods 90 recipients who underwent LTx from 2017 to 2019 at our institution were enrolled in the study. The effect of CYP3A5 genotype on Tac concentration, dose, dose adjusted concentration (C/D) and interaction with azole antifungals were assessed during week 1–4 after transplantation. Associations between CYP3A5 genotype and the incidence of acute kidney injury (AKI), length of hospital stay and mortality were analyzed. Results CYP3A5*1 carriers had lower C/D than CYP3A5*3/*3 group at all time points (p < 0.05). To reach comparable blood concentrations, CYP3A5*1 carriers required higher doses compared with CYP3A5*3/*3 group (p < 0.05). Use of azole antifungals did not blunt the effect of CYP3A5 genotypes on Tac metabolism. Logistic regression showed Tac concentration at week 1, not CYP3A5 genotype, was associated with the incidence of AKI. No statistically significant difference was found between CYP3A5 genotypes and the length of hospital stay (48 (37–68) vs 46(32–57) days, p = 0.264). Kaplan–Meier analysis showed no statistically significant difference between 30-day or 1-year mortality and CYP3A5 genotype. Conclusion CYP3A5 genotype could affect Tac metabolism early after LTx. However, it has no influence on the incidence of AKI, length of hospital stay and mortality.

scholarly journals Clinical rationale for the treatment tactics of term patients diagnosed with transient neonatal tachypnoea without parenteral nutrition

2021 ◽  
Vol 20 (5) ◽  
pp. 29-34
Author(s):  
N. V. Kalyakova ◽  
E. V. Shestak ◽  
D. S. Dodrov
Keyword(s):  
Parenteral Nutrition ◽  
Hospital Stay ◽  
Average Length ◽  
Total Duration ◽  
Length Of Hospital Stay ◽  
Venous Access ◽  
Rapid Expansion ◽  
Control Group ◽  
Vacuum Extraction ◽  
Significant Difference

Introduction. To analyze the efficacy and safety of treatment tactics for term patients diagnosed with TTN in an ICU without venous access and parenteral nutrition.Materials and methods. The study gives a retrospective analysis of the medical records of 241 ICU patients from January 2020 to March 2021. 83 children meet general criteria for inclusion in the study.Results and Discussion. While comparing the study group and the control group, no significant difference was detected in the incidence of risk factors during pregnancy and childbirth, such as gestational diabetes, ARVI during pregnancy, chorioamnionitis, preeclampsia, and the frequency of a prolonged anhydrous period, the frequency of induced labor, delivery by caesarean section, fetal distress and the use of vacuum extraction. Despite the same initial level of severity of respiratory disorders, when the child was admitted to the ICU, the duration of CPAP therapy was significantly higher in the control group: 7.5 (5.5-12) versus 5 (4-6) hours p = 5×10-5. The average length of hospital stay in the ICU and the total length of hospital stay was significantly higher in the control group (p = 4×10-11 and p = 0.006, respectively), as well as the need for treatment in the Neonatal Pathology unit conditions (p = 0.001).Conclusion. Analyzing the tactics of treating term patients diagnosed with TTN, the study proved that children without venous access require less time for respiratory therapy with CPAP in the NICU, the total duration of hospitalization in the NICU is significantly lower, as well as the need for additional treatment in the Neonatal Pathology unit. The study revealed that the early onset of enteral nutrition and the rapid expansion of the feeding portion, provided with child’s stable health condition, enable to avoid the installation of venous access and the prescription of parenteral nutrition at the ICU stage.

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