scholarly journals The Type of Gastrectomy and Modified Frailty Index as Useful Predictive Indicators for One-Year Readmission Due to Nutritional Difficulty in Patients Who Undergo Gastrectomy for Gastric Cancer.

2021 ◽  
Author(s):  
Tomohiro Osaki ◽  
Hiroaki Saito ◽  
Wataru Miyauchi ◽  
Yuji Shishido ◽  
Kozo Miyatani ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Total Gastrectomy ◽  
Readmission Rate ◽  
Frailty Index ◽  
Partial Gastrectomy ◽  
Readmission Rates ◽  
Modified Frailty Index ◽  
One Year ◽  
Distal Partial Gastrectomy ◽  
Predictive Indicators

Abstract Background Patients who undergo gastrectomy for gastric cancer are likely to have nutritional difficulty after surgery. Therefore, readmission due to nutritional difficulty is frequently observed in such patients. This study aimed to identify predictive indicators for readmission due to nutritional difficulty in patients who underwent gastrectomy for gastric cancer. Methods We retrospectively reviewed surgical outcomes in 516 consecutive patients who underwent gastrectomy for gastric cancer. Results The readmission rate within one year was 13.8%. Readmission due to nutritional difficulty was observed in 20 patients (3.9%), and nutritional difficulty was the second leading cause of readmission. Multivariate analysis revealed that the type of gastrectomy and the modified frailty index were independent predictive indicators of readmission due to nutritional difficulty. The readmission rates due to nutritional difficulty were 1.2%, 4.7%, and 11.5% in patients who underwent distal partial gastrectomy and had low modified frailty index, in those who underwent distal partial gastrectomy and had high modified frailty index or those who underwent either proximal partial or total gastrectomy and had low modified frailty index, and in those who underwent either proximal partial or total gastrectomy and had high modified frailty index, respectively (P = 0.0008). Conclusions Because the readmission rate due to nutritional difficulty is high in patients who underwent either total or proximal partial gastrectomy with high modified frailty index, intensive follow-up and nutritional support is needed to reduce readmission due to nutritional difficulty, which can help improve the patients’ quality of life and reduce additional medical costs.

scholarly journals The type of gastrectomy and modified frailty index as useful predictive indicators for 1-year readmission due to nutritional difficulty in patients who undergo gastrectomy for gastric cancer

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Tomohiro Osaki ◽  
Hiroaki Saito ◽  
Wataru Miyauchi ◽  
Yuji Shishido ◽  
Kozo Miyatani ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Readmission Rate ◽  
Frailty Index ◽  
Partial Gastrectomy ◽  
Readmission Rates ◽  
Modified Frailty Index ◽  
Improve Patient ◽  
Predictive Indicators

Abstract Background Patients who undergo gastrectomy for gastric cancer (GC) are likely to have nutritional difficulty after surgery. Readmission due to nutritional difficulty is common in such patients. Thus, in this study, we aim to identify the predictive indicators for readmission due to nutritional difficulty in patients who underwent gastrectomy for GC. Methods We retrospectively reviewed surgical outcomes in 516 consecutive patients who underwent gastrectomy for GC. Results The readmission rate within 1 year was 13.8%. Readmission due to nutritional difficulty was observed in 20 patients (3.9%); it was determined as the second leading cause of readmission. Multivariate analysis revealed that the type of gastrectomy and the modified frailty index (mFI) were independent predictive indicators of readmission due to nutritional difficulty. Patients were assigned 1 point for each predictive indicator, and the total points were calculated (point 0, point 1, or point 2). The readmission rates due to nutritional difficulty were 1.2%, 4.7%, and 11.5% in patients with 0, 1, and 2 points, respectively (P = 0.0008). Conclusions The readmission rate due to nutritional difficulty was noted to be high in patients who underwent total or proximal partial gastrectomy with high mFI. Intensive follow-up and nutritional support are needed to reduce readmissions due to nutritional difficulty. Reduced readmission rates can improve patient quality of life and reduce medical costs.

The usefulness of Roux-en-Y reconstruction with aboral pouch following total gastrectomy for gastric cancer.

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 209-209
Author(s):  
Shirou Iwagami ◽  
Sugihara Hidetaka ◽  
Takao Mizumoto ◽  
Tatsuo Kubota ◽  
Nobutomo Miyanari ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Total Gastrectomy ◽  
Prognostic Nutritional Index ◽  
Short Term ◽  
Common Procedure ◽  
Term Outcome ◽  
Nutritional Parameters ◽  
Nutritional Index ◽  
One Year ◽  
Outcome Of Surgery

209 Background: Patients with gastric cancer that involves the upper part of the stomach should undergo total gastrectomy for their curative resection. Roux-en-Y reconstruction is the most common procedure followingtotal gastrectomy. However, this reconstruction causes them various postgastrectomy symptoms and problems of their nutritional status and QOL. Although the development of the new reconstruction to prevent these symptoms have being carried out, we have not generally established procedures. Methods: To compare the feasibility and the nutritional parameters of the patients with Roux-en-Y reconstruction with aboral pouch following total gastrectomy to the simple Roux-en-Y. From February 2011 to June 2014, sixty three patients with gastric cancer underwent total gastrectomy. We analyzed the short-term outcome of surgery and the nutritional parameters in two groups. Results: The aboral pouch was created as a side to side anastomosis approximately 50 cms distal to the esophagojejunostomy, 12 cm in length. Most nutritional parameters after surgery were similar in two groups. However, lymphocyte, serum albumin and prognostic nutritional index in aboral pouch group one year later were good tendency compared with simple Roux-en-Y group. Conclusions: Roux-en-Y reconstruction with aboral pouch might become one of the standard methods after total gastrectomy for gastric cancer.

P1092Syncope in the emergency department: can 24-hour holter monitoring be of any help?

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
J Lopes ◽  
C Saleiro ◽  
D Campos ◽  
J Sousa ◽  
L Puga ◽  
...  
Keyword(s):  
Emergency Department ◽  
Readmission Rate ◽  
Holter Monitoring ◽  
Readmission Rates ◽  
Chi Square ◽  
Loop Recorder ◽  
Device Implantation ◽  
One Year ◽  
Group B ◽  
Syncope Episode

Abstract Background  Syncope is a very common reason for presenting to the emergency department (ED). The existence of a telemetry unit is crucial but it is not the reality in some hospitals. In order to avoid unnecessary ward admission, 24-hour Holter (24HH) monitoring could be useful to help with the diagnosis (when the arrhythmic etiology is suspected and the symptoms are frequent enough) and also be important to safely discharge a patient.  Purpose  The purpose of this study is to evaluate the diagnostic performance of 24HH monitoring, during a syncope episode in the ER, and to compare the readmission rates between patients with normal and abnormal not diagnostic 24HH monitoring.  Methods  A cohort study of consecutive patients (P) who were monitored with 24HH in one hospital in the ED, between January 2015 and December 2017, were included. All the 24HH results were seen by a senior cardiologist and divided in three groups: A - normal, B - abnormal Holter study unlikely to explain syncope and C- Holter study considered to be diagnostic.  Groups A and B were compared using chi-square independence test to evaluate association between the result of the 24HH and readmission rates at 30 days and 1 year, as well as mortality and device implantation at 1 year. Multivariate logistic regression was used to look for other confounders.  Results  A total of 111 P were included in this study. Mean age was 75 ± 14 years old, with 55.6% male patients.  A previous emergency episode with syncope was present in 56.9% of P. The mortality at one-year follow-up was 11.9%. The 24HH was considered diagnostic in 25.2% of P (28 P), with 18.9% of all the P with necessity of pacemaker (PM) implantation. In the patients with a non-diagnostic 24HH, 6,4% implanted a loop recorder before discharge.  Group B patients had a higher 30-day readmission rate to the ED when compared with group A (OR = 4.050 CI 95 [1.13 – 14.497], p = 0.033), but no difference in one-year readmission rate (p= 0.065). There was no difference in one-year mortality between the two groups (p= 0.731) or in one-year implantation of pacemaker (p= 0.431).  Conclusion  The use of 24HH in the ED could be a valuable tool in the diagnosis of rhythm disorders that cause syncope.  An abnormal non diagnostic result can still be a predictor of 30-day readmission to the ED with similar complaints.

Clinicopathologic Analysis of Remnant Gastric Cancer after Distal Partial Gastrectomy: Experience of Single Center during 15 Years

2010 ◽  
Vol 10 (2) ◽  
pp. 63 ◽  
Author(s):  
Seung Hui Choi ◽  
Tae Gyun Kim ◽  
June Young Kim ◽  
Hoon Hur ◽  
Sang-Uk Han ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Partial Gastrectomy ◽  
Remnant Gastric Cancer ◽  
Single Center ◽  
Distal Partial Gastrectomy

scholarly journals Missing the Mark: Inaccuracy of administrative data in identification of hospitalized patients with pneumonia and results of a systematic clinical reclassification process on readmission rates

2017 ◽  
Vol 6 (6) ◽  
pp. 35
Author(s):  
Marcus D. Ruopp ◽  
Joel C. Boggan ◽  
Thomas L. Holland ◽  
Mary Jane Stillwagon ◽  
Joseph A. Govert ◽  
...  
Keyword(s):  
Administrative Data ◽  
Readmission Rate ◽  
Medical Center ◽  
Academic Medical Center ◽  
Hospital Readmissions ◽  
Final Diagnosis ◽  
Healthcare Systems ◽  
Readmission Rates ◽  
Control And Prevention ◽  
One Year

Objective: Pneumonia readmissions carry financial ramifications under the Hospital Readmissions Reduction Program (HRRP). As readmission determination utilizes administrative data, healthcare systems should evaluate accuracy of pneumonia diagnoses. We sought to develop a systemic process for pneumonia classification review and determine potential effects on pneumonia readmissions in a tertiary academic medical center in the United States.Methods: We performed independent reviews of all pneumonia discharges within 48 hours of discharge over a one-year period. We reclassified all pneumonia discharges into four categories based on the Centers for Disease Control and Prevention reference standard. Secondary review of discordant classifications was performed by discharging providers to determine final diagnosis. The primary outcome was readmission rate within 30 days by pneumonia clinical classification category.Results: Two hundred seventy-eight discharges were reviewed, with overall readmission rate of 18.0%. Independent review confirmed 191 cases (68.7%) as definite or probable pneumonia, while 87 cases (31.3%) were classified as either probably not or not pneumonia. Readmission rates differed significantly between cases reviewed as pneumonia vs. those reviewed as unlikely to be pneumonia (14.1% vs. 26.4%, p < .02). Discharging attending physicians agreed with independent reviewers in 58/87 cases (66.6%), attenuating readmission differences (rate 16.8% for those finalized as pneumonia vs. 22.4% for another diagnosis, p = .32). Pneumonia readmissions were reduced by 1.2% using the classification standard.Conclusions: Complex conditions such as pneumonia may be inaccurately diagnosed in many patients, potentially affecting penalties associated with readmission rates. Therefore, it is imperative that healthcare systems adopt systematic review processes to standardize diagnoses and improve comparative administrative data.

scholarly journals Time Interval After Various Types of Gastrectomy Until Metachronous Multiple Gastric Cancer: Analysis of Data From A Nationwide Japanese Survey

2021 ◽  
Author(s):  
Koshi Kumagai ◽  
Sang-Woong Lee ◽  
Masaichi Ohira ◽  
Masaki Aizawa ◽  
Satoshi Kamiya ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Total Gastrectomy ◽  
Proximal Gastrectomy ◽  
Partial Gastrectomy ◽  
Remnant Stomach ◽  
Time Interval ◽  
Reconstruction Procedure ◽  
Initial Surgery ◽  
Number Of Patients ◽  
Multiple Gastric Cancer

Abstract Background The time interval between initial partial gastrectomy and diagnosis of cancer in the remnant stomach reportedly differs according to the reconstruction procedure used in the initial gastrectomy. However, factors correlated with the time interval from the initial surgery for gastric cancer to the detection of metachronous multiple gastric cancer (MMGC) remain unclear. This study was performed to evaluate the association between the type of initial gastrectomy or reconstruction procedure and the time interval from initial gastrectomy to detection of MMGC as well as the association between the type of initial gastrectomy and the procedure performed for MMGC. Methods A questionnaire survey on remnant stomach cancer was conducted by the Japanese Society for Gastro-Surgical Pathophysiology in 2018. Participating facilities were asked to indicate the number of patients who underwent surgery for MMGC between 2003 and 2017, in accordance with the time interval from the initial gastrectomy until treatment for MMGC by type of initial gastrectomy or reconstruction procedure. The number of patients who underwent each treatment procedure (completion total gastrectomy or partial gastrectomy) was also collected. Results Analyses were performed using data from 45 facilities. Gastrectomy for MMGC was performed in 1,234 patients during the period. Billroth-II and Roux-en Y accounted for 22.3% (103/462) and 1.3% (6/462), respectively, of patients who underwent surgery for MMGC ≥ 10 years from initial DG, while these patients accounted for 8.0% (23/286) and 21.7% (65/286), respectively, of patients who underwent surgery for MMGC within 5 years after initial DG. Likewise, the proportion of each reconstruction procedure differed by the time interval from initial proximal gastrectomy to treatment for MMGC. In terms of the treatments performed for MMGC, the proportion of patients who underwent partial gastrectomy increased in accordance with the size of the remnant stomach after the initial gastrectomy. Conclusions The types of gastrectomy or reconstruction procedures for initial gastrectomy differed significantly by time interval between the initial gastrectomy and treatment for MMGC, and their time trends were assumed to be a major cause of the differences. The proportion of patients who underwent completion total gastrectomy deceased as the size of the remnant stomach increased.

scholarly journals Duodenal bypass does not decrease glucose levels of lean individuals with gastric cancer submitted to partial or total gastrectomy

2009 ◽  
Vol 46 (3) ◽  
pp. 230-232 ◽  
Author(s):  
Fernando A. Herbella ◽  
Ana C. Tineli ◽  
Jorge L. Wilson Jr ◽  
Jose C. Del Grande
Keyword(s):  
Gastric Cancer ◽  
Glucose Metabolism ◽  
Total Gastrectomy ◽  
Partial Gastrectomy ◽  
Diabetes Control ◽  
Oral Medication ◽  
Diabetic Patients ◽  
Glucose Levels

Change in glucose metabolism after bariatric operations may be credited to duodenal bypass. This study aims to evaluate the effect of duodenal bypass on glucose levels in lean individuals submitted to gastrectomy for gastric cancer. We reviewed 56 non-diabetic and 6 diabetic patients submitted to gastrectomy and Roux-en-Y for gastric cancer (partial gastrectomy in 66%/total gastrectomy in 34%). Glucose levels were not significantly altered after operation (P = 0.5). Diabetes control was improved in one patient with oral medication. In conclusion, duodenal bypass do not decrease glucose levels in lean individuals treated for gastric cancer.

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