scholarly journals Enhanced recovery care versus traditional non- ERAS  care following osteotomies in developmental dysplasia of the hip in children : a retrospective case-cohort study

2020 ◽  
Author(s):  
Jin Li ◽  
Saroj Rai ◽  
Renhao Ze ◽  
Xin Tang ◽  
Ruikang Liu ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Enhanced Recovery ◽  
Perioperative Complications ◽  
Length Of Hospital Stay ◽  
Developmental Dysplasia ◽  
Control Group ◽  
Postoperative Fever ◽  
Vas Score ◽  
Significant Difference ◽  
Dysplasia Of The Hip

Abstract Background: Enhanced recovery after surgery (ERAS) has been shown to shorten the length of hospital stay and reduce the incidence of perioperative complications in many surgical fields. However, there has been a paucity of research examining the application of ERAS in major pediatric orthopedic surgeries. This study aims to compare the perioperative complications and length of hospital stay after osteotomies in children with developmental dysplasia of the hip (DDH) between ERAS and traditional non-ERAS group. Methods: The ERAS group consisted of 86 patients included in the ERAS program from January 2016 to December 2017. The Control group consisted of 82 DDH patients who received osteotomies from January 2014 to December 2015. Length of hospital stay, physiological function, postoperative visual analogue scale (VAS) score, and postoperative complications were compared between the two groups. Results: The mean duration of hospital stay was significantly reduced from 10.0±3.1 in the traditional care group to 6.0±0.8 days in the ERAS(P<0.001). The VAS score in 3-day was significantly lower in ERAS group (2.9±0.8) than traditional non-ERAS group (4.0±0.8) (P<0.001). However, there was no significant difference in the frequency of breakout pain (VAS >4) between two groups (29.5±6.3 vs.30.6±6.5, P=0.276). The frequency of postoperative fever was lower in the ERAS group. The frequency of urinary tract infection in both groups were not noticeable because the catheter was removed promptly after the surgery. Conclusion: The ERAS protocol is both safe and feasible for pediatric DDH patients undergoing osteotomies, and it can shorten the length of hospital stay without increasing the risk of perioperative complications.

scholarly journals Enhanced recovery care versus traditional care following osteotomies in developmental dysplasia of the hip in children: a retrospective case-cohort study

2020 ◽  
Author(s):  
Jin Li ◽  
Saroj Rai ◽  
Renhao Ze ◽  
Xin Tang ◽  
Ruikang Liu ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Enhanced Recovery ◽  
Perioperative Complications ◽  
Length Of Hospital Stay ◽  
Developmental Dysplasia ◽  
Care Group ◽  
Vas Score ◽  
Significant Difference ◽  
Traditional Care ◽  
Dysplasia Of The Hip

Abstract Background: Enhanced recovery after surgery (ERAS) has been shown to shorten the length of hospital stay and reduce the incidence of perioperative complications in many surgical fields. However, there has been a paucity of research examining the application of ERAS in major pediatric orthopedic surgeries. This study aims to compare the perioperative complications and length of hospital stay after osteotomies in children of developmental dysplasia of the hip (DDH) between ERAS and traditional care group.Methods: The ERAS group consisted of 86 patients included in the ERAS program from January 2016 to December 2017. The Control group consisted of 82 DDH patients who received osteotomies from January 2014 to December 2015. Length of hospital stay, physiological function, postoperative visual analogue scale (VAS) score, and postoperative complications were compared between the two groups.Results: The mean duration of hospital stay was significantly reduced from 10.0±3.1 in the traditional care group to 6.0±0.8 days in the ERAS(P<0.001). Pain response was better in the ERAS group than traditional care group in terms of mean 3-day VAS score (2.9±0.8 vs. 4.0±0.8, P<0.001) and maximum VAS score (4.1±0.8 vs. 4.9±0.8, P<0.001). However, there was no significant difference in the frequency of break-out pain (VAS >4) between two groups (29.5±6.3 vs.30.6±6.5, P=0.276 ). The frequency of fever is lower in the ERAS group, possibly due to better temperature monitoring and management in the operating room. The frequency of urinary infection in both groups were not noticeable because the catheter was removed promptly after the surgery. Conclusion: The ERAS protocol is both safe and feasible for pediatric DDH patients undergoing osteotomies, and it can shorten the length of hospital stay without increasing the risk of perioperative complications.

scholarly journals Implementation and Effectiveness of Early Chest Tube Removal during an Enhanced Recovery Programme after Oesophago-gastrectomy

2015 ◽  
Vol 53 (197) ◽  
pp. 24-27 ◽  
Author(s):  
Rajeev Bhandari ◽  
You Yong-hao
Keyword(s):  
Pleural Effusion ◽  
Hospital Stay ◽  
Chest Tube ◽  
Enhanced Recovery ◽  
Task Force ◽  
Length Of Hospital Stay ◽  
Control Group ◽  
Tube Removal ◽  
Significant Difference ◽  
Chest Tube Removal

Introduction: Oesophageal resection were notoriously complicated and produces a cohort of patients prone to postoperative complications and here we would like to focus on the implementation and effectiveness of early chest tube removal in ERAS after oesophago-gastrectomy considering the various aspect like pleural effusion and reducing the length of hospital stay which ultimately lead to reducing the economic burden on patient.Methods: An ERAS programme was devised and implemented with the support of a dedicated in-hospital task-force. The patients underwent esophago-gastrectomy were randomly divided into two groups: the ERAS group and the control group (non-ERAS). The ERAS group was treated with early removal of the chest tube after surgery, and the control group was treated with traditional way and outcomes were compared between them.Results: The length of hospital stay and the cost of hospitalization in the ERAS group were significantly lower than those in the control group（p<0.05. However, there was no statistical significant difference in the incidences of pleural effusion between the two groups（p＞0.05).Conclusions: The introduction of early chest tube removal as an ERAS programme after oesophago-gastrectomy would not increase the risk of pleural effusion and would not increase the total length of stay and cost of hospitalisation without jeopardising patient safety or clinical outcomes.

Effect of Chewing Gum on Bowel Motility in Women Undergoing Post-Operative Cesarean Section

2018 ◽  
Vol 3 (06) ◽  
Author(s):  
Dr.Randa Mohammed AboBaker
Keyword(s):  
Cesarean Section ◽  
Hospital Stay ◽  
Demographic Data ◽  
Length Of Hospital Stay ◽  
Chewing Gum ◽  
Control Group ◽  
Controlled Clinical Trial ◽  
Bowel Motility ◽  
Gum Chewing ◽  
Significant Difference

Postoperative Ileus (POI) is one of the most common problems after obstetrics, gynecologic and abdominal surgeries. Sham feeding, such as gum chewing, accelerates the return of bowel function and the length of hospital stay. The present study aims to evaluate the effect of chewing gum on bowel motility in women undergoing post-operative cesarean section. Intervention study was used at the Postpartum Department of Maternity and Children Hospital, KSA. A randomized controlled clinical trial research design. Through a convenience technique, 80 post Caesarian Section (CS) women were included in the study. Data were collected through three tools: Tool (I): Socio-demographic data and reproductive history interview schedule. Tool (II): Postoperative Assessment Sheet. Tool (III): Outcomes of gum chewing and the length of hospital stay.  Method: subjects were assigned randomly into two groups of (40) the experimental and (40) the control. Subjects in the study group were asked to chew two pieces of sugarless gum for 30 min/three times daily in the morning, noon, and evening immediately after recovery from anesthesia and in Postpartum Department; while subjects in the control group followed the hospital routine care. Each woman in both groups was tested abdominally using a stethoscope to auscultate the bowel sounds and asked to report immediately the time of either passing flatus or stool. Results: illustrated that a highly statistically significant difference was observed between the two groups concerning their gum chewing outcomes. Where, P = 0.000. The study concluded that gum chewing is safe, well tolerated and appears to be effective in reducing the incidence and consequences of POI following CS.

Etomidate Use for Rapid Sequence Intubation Is Not Associated With Nosocomial Infection

2020 ◽  
pp. 089719002097961
Author(s):  
Daniel Colon Hidalgo ◽  
Vishali Amin ◽  
Arushi Hukku ◽  
Kathryn Kutlu ◽  
Megan A. Rech
Keyword(s):  
Hospital Stay ◽  
Secondary Infection ◽  
Length Of Hospital Stay ◽  
Adrenal Suppression ◽  
Rapid Sequence Intubation ◽  
Control Group ◽  
Secondary Infections ◽  
Rapid Sequence ◽  
Significant Difference ◽  
Secondary Outcomes

Introduction: Etomidate is commonly used for induction of anesthesia for rapid sequence intubation (RSI). It has little impact on hemodynamic status, making it a widely used agent. Due to the inhibition of cortisol production, etomidate causes adrenal suppression. The purpose of this study is to determine whether there is a correlation with etomidate use and the incidence of secondary infections. Methods: This was a retrospective cohort of hospitalized patients who received either etomidate or control (ketamine, propofol, or no agent) for RSI. The primary endpoint was the incidence of secondary infections. Secondary outcomes included number of mechanical ventilator-free days within 28 days, 30-day mortality, length of hospital stay, and length of intensive care unit stay. Results: A total of 434 patients were reviewed, of which 129 (29.7%) met the study criteria (n = 94 etomidate; n = 35 control). The incidence of secondary infection was numerically higher in the etomidate group compared with the control group, though this was not statistically significant (38.7% vs. 28.6%, p = 0.447). Also, though the secondary outcomes showed no statistically significant difference between the groups, the patients in the control group had a longer hospital stay (14.0 vs. 18.1, p = 0.20) and a longer ICU stay (11.0 vs. 14.1, p = 030). Furthermore, the etomidate group had a non-statistically significant higher incidence of bacteremia (8 vs. 0, p = 0.17) Conclusion: The use of etomidate was not associated with increased incidence of secondary infection. To fully understand the effects of etomidate use and its subsequent adrenal suppression, larger studies are needed.

scholarly journals The severity of developmental dysplasia of the hip does not correlate with the abnormality in pelvic incidence

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Rongshan Cheng ◽  
Muyin Huang ◽  
Willem Alexander Kernkamp ◽  
Huiwu Li ◽  
Zhenan Zhu ◽  
...  
Keyword(s):  
Pelvic Incidence ◽  
Sagittal Plane ◽  
Three Dimensional ◽  
Developmental Dysplasia ◽  
Control Group ◽  
Type I ◽  
Type Ii ◽  
Computed Tomography Images ◽  
Significant Difference ◽  
Dysplasia Of The Hip

Abstract Background The purpose of this study was to investigate the association between the severity of Developmental dysplasia of the hip (DDH) and the abnormality in pelvic incidence (PI). Methods This was a retrospective study analyzing 53 DDH patients and 53 non-DDH age-matched controls. Computed tomography images were used to construct three-dimensional pelvic model. The Crowe classification was used to classify the severity of DDH. The midpoint of the femoral head centers and sacral endplates were projected to the sagittal plane of the pelvis. The PI was defined as the angle between a line perpendicular to the sacral plate at its midpoint and a line connecting this point to the axis of the femoral heads. Independent sample t-tests were used to compare the differences between the PI of DDH group and the non-DDH controls group. Kendall’s coefficient of concordance was used to determine the correlation between the severity of DDH and PI. Results Patients with DDH had a significantly (p = 0.041) higher PI than the non-DDH controls (DDH 47.6 ± 8.2°, normal 44.2 ± 8.8°). Crowe type I patients had a significantly (p = 0.038) higher PI (48.2 ± 7.6°) than the non-DDH controls. No significant difference between the PI in Crowe type II or III patients and the PI in non-DDH controls were found (Crowe type II, 50.2 ± 9.6°, p = 0.073; Crowe type III, 43.8 ± 7.2°, p = 0.930). No correlation was found between the severity of DDH and the PI (r = 0.091, p = 0.222). Conclusions No correlation was found between the severity of DDH and the PI. The study confirmed that the PI in DDH (Crowe type I) group was higher than that of the non-DDH control group, while the PI does not correlate with the severity of DDH.

scholarly journals Development and Feasibility of the Early Rehabilitation Program on Postoperative Enhanced Recovery Following Minimally Invasive Esophagectomy: A Prospective Randomized Controlled Trial

2020 ◽  
Author(s):  
Funa Yang ◽  
Lijuan Li ◽  
Yanzhi Mi ◽  
Limin Zou ◽  
Xiaofei Chu ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Physical Function ◽  
Enhanced Recovery ◽  
Rehabilitation Program ◽  
Postoperative Hospital Stay ◽  
Early Rehabilitation ◽  
Control Group ◽  
Function Recovery ◽  
Significant Difference ◽  
Physical Function Recovery

Abstract Background: Perioperative rehabilitation management is essential to enhanced recovery after surgery. Few reports, however, focused on quantitative, detailed early activity plans for patients after esophagectomy. Aim: The purpose of this research was to estimate the effect of the Early Rehabilitation Program (ERP) on the recovery of bowel function and physical function for patients undergoing esophagectomy. Method: In this single-blind, 2-arm, parallel-group, randomized pilot clinical trial, patients were selected from June 2019 to February 2020 and assigned to the intervention group (IG) or the control group(CG) randomly. The participants in IG received an ERP strategy during the perioperative period, and the CG received routine care. The recovery of bowel and physical function, readiness for hospital discharge (RHD) and postoperative hospital stay were evaluated on the day of discharge. Results: 215 cases were enrolled and randomized to the CG (n=108) or IG (n=107). There was no significant difference between the two groups in terms of demographic and clinical characteristics and baseline physical function. After the ERP intervention, the IG group presented a significantly shorter time to first flatus (P<0.001) and to first bowel movement postoperative (P=0.024), and a better physical function recovery (P＜0.001), compared with the CG group. The analysis also showed that participants in the IG have higher scores of RHD and shorter length of postoperative stay than the CG (P＜0.05). Conclusion: The findings suggest that the ERP can improve bowel and physical function recovery, ameliorate patients' RHD, and shorten postoperative hospital stay for patients undergoing MIE.Trial registration：ClinicalTrials.gov Identifier: NCT01998230

Anatomical parameters of and differences in the proximal femoral cavity in adult patients with developmental hip dysplasia

2021 ◽  
pp. 1-12
Author(s):  
Ran Zhao ◽  
Hong Cai ◽  
Hua Tian ◽  
Ke Zhang ◽  
Admin
Keyword(s):  
Femoral Head ◽  
Developmental Dysplasia ◽  
Adult Patients ◽  
Control Group ◽  
Marrow Cavity ◽  
Significant Difference ◽  
Group A ◽  
Group B ◽  
Dysplasia Of The Hip ◽  
Anatomical Parameters

Objective: To explore the anatomical parameters proximal femoral cavity and developmental dysplasia of the hip. Methods: The retrospective study was conducted at Peking University Third Hospital, Beijing, China, and comprised data of adult patients of either gender who underwent total hip arthroplasty from January 2009 to August 2015. Paients with a diagnosis of primary osteoarthrosis or aseptic necrosis of the femoral head were taken as the control group A, while patients with developmental dysplasia of the hip in group B were graded into subgroups I-IV using the Crowe classification. For each patient, the inner diameter of the proximal femoral medullary cavity was measured on preoperative radiographs using Noble’s technique. Data was analysed using SPSS 20. Results: Of the 835 hips, 571(68.4%) were in group A and 264(31.6%) in group B. The mean age of the patients at the time of surgery was 58.3 ± 12.3 years. Overall, there were 404(48.4%) hips of male patients; 59(22.3%) in group B. There were 431(51.6%) hips of female patients; 205(77.7%) in group B. In group B, 186(70.5%) hips were graded I, 38(14.4%)grade II, 22(8.3%)grade III, and 18(6.8%) hips were graded IV. There were significant differences in femoral offset, height of the femoral head, and canal flare index of the metaphysis between groups A and B (p<0.05). There was no significant difference in the morphology of the marrow cavity between subgroups II and III.

scholarly journals Evaluation of Sacrum Morphology in Patient with Developmental Dysplasia of the Hip for Iliosacral Screw Fixation

2021 ◽  
Author(s):  
Nazım Karahan ◽  
Ahmet Oztermeli ◽  
Ahmet Aktan
Keyword(s):  
Contralateral Side ◽  
Developmental Dysplasia ◽  
Cross Sectional Area ◽  
Control Group ◽  
Iliosacral Screw ◽  
Sectional Area ◽  
Cross Sectional ◽  
Screw Length ◽  
Significant Difference ◽  
Dysplasia Of The Hip

Abstract Background: The purpose of this study was to evaluate the patients with developmental dysplasia of the hip (DDH) in terms of sacroiliac anatomy to proper placement of iliosacral screws. Methods: We retrospectively reviewed computed tomography (CT) records of 96 patients who were referred to our clinic. We mainly divided the patients into 2 groups; the iliosacral joint on the same side with DDH evaluated in the DDH group and on the contralateral side with DDH evaluated in the control group. The presence of the five qualitative characteristics of sacral dysplasia evaluated according to Route in both groups. The DDH group divided into three subgroups according to Hartofilakidis and Rout classifications. The cross-sectional area, length of the osseous corridor, coronal and vertical angulation evaluated in both groups. Results: Sacral dysplasia observed %87.5 in the DDH group,%83.3 in the control groups. The DDH group also exhibited a significantly lower S1 cross-sectional area and S1 iliosacral screw length than the control group (p:0.018,p:0,027; respectively). No statistically significant difference was observed according to Hartofilakidis(p>0.05). According to Rout, the S1 iliosacral screw length of the normal and transient groups were found to be significantly higher than those of the dysplastic groups (p: 0.004, p:0.0001; respectively). The transient group also exhibited a significantly lower S1 iliosacral screw length than the normal group (p:0.001). There were no significant differences in S1 and S2 axial and coronal angulation, S2 cross-sectional area, S2 iliosacral screw length in the DDH groups (p>0.05) Conclusion: When iliosacral screw is planned for patients with unilateral DDH, surgeons should consider that there are high rates of dysplastic sacral changes, differences in S1 cross sectional area and iliosacral screw length compared to the opposite side, and asymmetric sacral dysplastic changes in the upper sacrum.

scholarly journals Drainage or nondrainage for single-level anterior cervical discectomy with fusion and plating

2019 ◽  
Author(s):  
Pengfei Li ◽  
Dean Chou ◽  
Yuqiang Wang ◽  
Limin Wang ◽  
Ganggang Zhang ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Epidural Hematoma ◽  
Japanese Orthopaedic Association ◽  
Length Of Hospital Stay ◽  
Anterior Cervical Discectomy ◽  
Control Group ◽  
Study Group ◽  
Postoperative Fever ◽  
Cervical Discectomy ◽  
Single Level

Abstract Background Currently, conventional placement of natural pressure drainage after single-level anterior cervical discectomy with fusion and plating (ACDF) is used clinically to prevent complications such as symptomatic epidural hematoma and incision infection. Nevertheless, a literature review reported that there is no uniform standard for whether to place drainage after single-level ACDF surgery, and comparative studies on this subject are rare.Methods A prospective study of 100 patients who underwent single-level ACDF from January 2017 to June 2018 and met the selection criteria were randomly divided into the control group (45 patients with drainage after surgery) and the study group (48 patients without drainage after surgery). The same types of preoperative preparation, surgical technique and postoperative management were used in the two groups. The perioperative indicators, postoperative clinical efficacy and complications were compared between the two groups.Results The preoperative and postoperative Japanese Orthopaedic Association (JOA) scores, Visual Analogue Scale (VAS) scores and Neck Dysfunction Index (NDI) scores in the two groups were significantly different (P < 0.05). The length of hospital stay in the study group was significantly shorter than that in the control group (P < 0.05). There were no significant differences in postoperative fever, surgical site infection, symptomatic epidural hematoma, rate of incision healing, or complications between the two groups (P>0.05).Conclusions The safety and clinical outcome of patients with drainage after single-level ACDF were consistent with those of nondrainage patients. Additionally, nondrainage after single-level ACDF resulted in a decreased length of hospital stay and lessened the associated expenses.

scholarly journals Effect of Goal-directed Haemodynamic Therapy Guided by Non-invasive Monitoring on Perioperative Complications in Elderly Hip Fracture Patients Within an Enhanced Recovery Pathway.

2021 ◽  
Author(s):  
Juan Victor Lorente ◽  
Francesca Reguant ◽  
Anna Arnau ◽  
Marcelo Borderas ◽  
Juan Carlos Prieto ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Hospital Stay ◽  
Enhanced Recovery ◽  
Perioperative Complications ◽  
Intervention Group ◽  
Control Group ◽  
Haemodynamic Instability ◽  
Hip Fracture Surgery ◽  
One Year ◽  
Fracture Surgery

Abstract Background: Goal-Directed Hemodynamic Therapy (GDHT) has been shown to reduce morbidity and mortality in high-risk surgical patients. However, there is little evidence of its efficacy in patients undergoing hip fracture surgery. This study aims to evaluate the effect of GDHT guided by non-invasive haemodynamic monitoring on perioperative complications in patients undergoing hip fracture surgery.Methods: Patients > 64 years undergoing hip fracture surgery within an Enhanced Recovery Pathway were enrolled in this single-center, non-randomized, intervention study with a historical control group and 12-months follow-up. Exclusion criteria were patients with pathological fractures, traffic-related fractures and refractures. Control group patients received the standard care given at our hospital. Intervention group patients received an individualized management strategy aimed at achieving an optimal stroke volume by fluid administration, in addition to a systolic blood pressure > 90 mmHg and an optimal cardiac index according to the patient's age and baseline metabolic equivalents. No changes were made between groups in the enhanced recovery protocols, nor in the composition of the multidisciplinary team during the study period. Primary combined outcome was perioperative complications. Intraoperatively: haemodynamic instability, sustained cardiac arrhythmias. Postoperative complications: cardiovascular, respiratory, infectious and renal complications. Secondary outcomes were administered fluids, vasopressor requirements, perioperative transfusion, length of hospital stay, readmission and one-year survival.Results: 551 patients (Control group=272; Intervention group=279). Intraoperative haemodynamic instability was lower in the intervention group (37.5% vs 28.0%; p=0.017). GDHT patients had fewer postoperative cardiovascular (18.8% vs 7.2%; p < 0.001), respiratory (15.1% vs 3.6%; p<0.001) and infectious complications (21% vs 3.9%; p<0.001) but not renal (12.1% vs 33.7%; p<0.001). Intervention group patients had less vasopressors requirements (p<0.001) and received less fluids (p=0.001) than control group. Fewer patients required transfusion in GDHT group (p<0.001). For intervention group patients, median length of hospital stay was shorter (p < 0.001) and one-year survival higher (p<0.003).Conclusions: The use of GDHT decreases intraoperative complications and postoperative cardiovascular, respiratory and infectious but not postoperative renal complications. This strategy was associated with a shorter hospital stay and increased one-year survival.Trial registration: Clinicaltrials.gov: NCT02479321

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