Impact of a Goal Directed Fluid Therapy on Length of Hospital Stay and Costs of Hepatobiliary Pancreatic Surgery. A Prospective Observational Study

Introduction: Peptic ulcer perforation carries high mortality and morbidity. Boey’s score is shown to be a simple scoring system to help predict morbidity and mortality. This is a prospective observational study to evaluate the applicability of Boey’s score in predicting mortality and morbidity in Nepalese patients. Methods: This study was conducted in the Dept. of Surgery, Nepal Medical College and Teaching Hospital (NMCTH), Attarkhel, Jorpati between 1st of July 2012 to 30th June 2019 over a period of 7 years. This was a prospective observational study. All patients who underwent laparotomy for suspected peptic ulcer perforation peritonitis were included in the study. Results: Fourty-seven patients were included in the study. Male patients outnumbered females by a ratio of almost 4:1. Eighteen (38%) patients had Boey’s score of 1, and 7 (15 %) patients had a Boey’s score of 3. Overall postoperative mortality was 7 (15%). Boey’s score predicted morbidity and mortality with a p-value of <0.01. The length of hospital stay was also more in patients with a higher score and it was statistically significant. Conclusions: Boey’s score is both easy and effective in predicting postoperative morbidity, mortality and length of hospital stay.

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Enhanced Drainage Protocol in Large Amoebic Liver Abscess

The Surgery Journal ◽

10.1055/s-0041-1740625 ◽

2021 ◽

Vol 07 (04) ◽

pp. e351-e356

Author(s):

Jignesh A. Gandhi ◽

Pravin H. Shinde ◽

Sadashiv N. Chaudhari ◽

Amay M. Banker

Keyword(s):

Observational Study ◽

Hospital Stay ◽

Liver Abscess ◽

Prospective Observational Study ◽

Clinical Symptoms ◽

Length Of Hospital Stay ◽

Amoebic Liver Abscess ◽

Secondary Outcome ◽

P Value ◽

Pigtail Catheter

Abstract Background Amebic liver abscess (ALA) contributes significantly to morbidity and mortality in patients of the developing world. Even though medical management is the primary modality of treatment, 15% of the cases are refractory and require intervention for drainage. Pigtail catheterization is inefficient and results in a long duration of hospital stay. So, we conducted a prospective observational study to determine the efficacy and safety of drainage of large ALA using a wide bore 24 French (Fr) drain compared with a conventionally used 10 Fr pigtail catheter. Materials and Methods A single center prospective observational study was conducted over a period of 5 years and data of 122 patients was collected. After starting empirical medical therapy, patients underwent drainage of ALA with either a 10 French pigtail or a 24 Fr drain. The primary outcome variables were resolution of clinical symptoms such as fever and pain in abdomen, length of hospital stay, and resolution of abscess on imaging at day 3. Secondary outcome was complications related to the procedures. Results Data of 122 patients was collected. Males constituted a vast majority (96%) of the study population and the fifth decade was the most common age group involved. Alcoholics had a higher chance of developing a large ALA. Sixty-eight patients underwent drainage of the ALA using a 24 Fr drain which resulted in faster resolution of symptoms (2.4 vs. 5.1 days, p-value 0.033), a shorter duration of catheter in situ (6.4 vs. 13.2, p-value 0.011), and a faster drainage of ALA (residual volume at day 3; 177 vs. 212 mL, p-value 0.021). Twenty-eight patients had a biliary communication of which 26 required therapeutic endoscopic retrograde cholangiopancreatography. Conclusion In patients with a large ALA, placement of a wide bore 24 Fr catheter hastens recovery of the patients when compared with drainage with a standard 10 Fr pigtail catheter. Placement of a biliary stent serves as a useful adjunct for their management and it may obliviate the need for a major biliary diversion surgery.

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DRUG-RELATED PROBLEMS AND ITS PRESCRIBING INDICATORS IN STROKE PATIENTS: A PROSPECTIVE OBSERVATIONAL STUDY

Asian Journal of Pharmaceutical and Clinical Research ◽

10.22159/ajpcr.2021.v14i3.40529 ◽

2021 ◽

pp. 141-144

Author(s):

DURGA PRASAD THAMMISETTY ◽

DIVITI RANGANAYAKULU ◽

DEVANNA NAYAKANTI

Keyword(s):

Observational Study ◽

Drug Interactions ◽

Hospital Stay ◽

Prospective Observational Study ◽

Tertiary Care ◽

World Health ◽

Care Hospital ◽

Drug Related Problems ◽

Stroke Patients ◽

Prescribing Indicators

Objective: The objective of the study was to assess the drug-related problems (DRPs) and the World Health Organization (WHO) core prescribing indicators among stroke patients. Methods: A prospective observational study was conducted among stroke inpatients of Acute Medical Care and General Medicine Department of a tertiary care hospital located in Tirupati, Andhra Pradesh, India. A suitable data collection form was used to collect the data about demographics, clinical characteristics, WHO prescribing indicators, and DRPs. Descriptive statistics were used to represent the demographics, distribution of DRPs, and prescribing indicators in the study. Chi-square test was employed to test the significant association between the demographics and the occurrence of DRPs. Results: Among 174 patients included in the study, 89 had one or more DRPs. A total of 122 DRPs were identified in the study population. Drug interactions (48.4%) and adverse drug reactions (ADRs) (17.2%) were commonly observed DRPs. A significant direct association was observed between the occurrence of DRPs and number of comorbidities (p<0.001), polypharmacy (p<0.001), and hospital stay (p<0.05). The average number of drugs per prescription was 7.2. Of drugs prescribed, 67.6% were in their generic names. The percentage of encounters in which an antibiotic, injection was prescribed was 65.5% and 89.6% respectively. The percentage of drugs prescribed from an essential drug list was 91.2%. Conclusion: The rate of drug interactions and ADRs was high in treatment of stroke patients. Patients suffering from comorbidities, polypharmacy, and long hospital stay were positively associated with occurrence of DRPs in stroke. Regular monitoring and screening for drug interactions and ADRs were advised to reduce the burden DRPs in stroke patients admitted in a critical care unit.

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Adverse Drug Reaction (ADR) as a Cause of Hospitalization at a Government Hospital in Saudi Arabia: A Prospective Observational Study

Current Drug Safety ◽

10.2174/1574886314666190520105330 ◽

2019 ◽

Vol 14 (3) ◽

pp. 192-198 ◽

Cited By ~ 1

Author(s):

Nouf Alayed ◽

Bushra Alkhalifah ◽

Munirah Alharbi ◽

Naief Alwohaibi ◽

Maryam Farooqui

Keyword(s):

Saudi Arabia ◽

Observational Study ◽

Prospective Observational Study ◽

Hospital Admissions ◽

Financial Burden ◽

Length Of Hospital Stay ◽

Morbidity And Mortality ◽

Severity Assessment ◽

Hospitalization Rates ◽

Naranjo Algorithm

Background: ADRs represent a substantial burden on health care resources worldwide and are considered as one of the leading causes of morbidity and mortality which significantly affects hospitalization rates. However, ADR related hospital admissions are not well explored in Saudi Arabia. Objectives: The current study aims to evaluate ADR-related admissions at King Saud Hospital, Unaizah, Qassim, Saudi Arabia. Method: A prospective, observational study was conducted at King Saud Hospital Unaizah. Over a period of 6 months, patients above 12 years of age who visited the Emergency Department (ED) with an ADR were included in this study. The investigators collected patient data by reviewing the patient's medical records and the ED records for admission. The Naranjo algorithm was used to assess the causality of the suspected ADR, and Hartwig’s Severity Assessment Scale was used to assess the severity of the ADR. Results: Out of 4739 admissions to the wards, 38 (0.801%) were related to an ADR. The majority of patients were male (52.6%), with a mean age of ± 49.08 years. The total length of hospital stay was 565 days with a mean of ± 14.87 days. The causality assessment shows that 35 (92.1%) cases were probable ADRs, whereas 3 (7.9%) cases were possible ADRs. Moreover, the severity assessment showed that 6 (15.1%) cases were mild, and 27 (71.1%) and 5 (13.2%) cases were moderate and severe, respectively. In regard to the outcome of patients, most patients recovered after the ADR, and 2 ADRs resulted in the death of the patient. Conclusion: Our study shows that ADRs as a cause of hospitalization in Qassim population is considerably low. However, ADRs may contribute to morbidity and mortality and result in a considerable financial burden.

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