A single-center experience of steroid therapy for COVID-19 management

Aim: There is an emerging role of steroids in the management of COVID-19. We aimed to compare the outcome of COVID-19 patients (recovery versus mortality) who were treated with steroids with those who were not treated with steroids during their course of hospital stay. Methods: A retrospective analysis of all moderately to severely ill COVID-19 patients, meeting the inclusion and exclusion criteria, admitted to our center during the study period of four months, was performed. The patients were categorized into two groups: Group I included 25 patients who were given steroids, and Group II also included 25 patients who were not given any steroids during their hospital stay. The primary outcome (recovery versus mortality), length of hospital stay as well as other features were compared between the two groups. Results: The mean length of hospital stay was 9.3 days in the steroids group and 10.9 days in the non-steroids group with a p value of 0.249. None of the patients was shifted to a ventilator in either group. One patient in the steroids group (4%) and two patients in the non-steroids group (8%) needed to be put on high flow nasal cannula. One patient died in the steroids group with a recovery rate of 96%, while two patients died in the non-steroids group with a recovery rate of 92% (p value 0.552). Conclusion: Treatment with steroids in moderately to severely ill COVID-19 patients did not decrease the length of hospital stay or mortality in our study.

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The efficacy of corticosteroids therapy in patients with moderate to severe SARS-CoV-2 infection: a multicenter, randomized, open-label trial

Respiratory Research ◽

10.1186/s12931-021-01833-6 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Mostafa Ghanei ◽

Masoud Solaymani-Dodaran ◽

Ali Qazvini ◽

Amir Hosein Ghazale ◽

Seyed Amin Setarehdan ◽

...

Keyword(s):

Hospital Stay ◽

Length Of Hospital Stay ◽

Diabetic Patients ◽

Open Label ◽

Mitt Population ◽

Treatment Regimens ◽

Clinical Recovery ◽

Group I ◽

The Mean ◽

Open Label Trial

Abstract Background We performed a multicenter, randomized open-label trial in patients with moderate to severe Covid-19 treated with a range of possible treatment regimens. Methods: Patients were randomly assigned to one of three regimen groups at a ratio of 1:1:1. The primary outcome of this study was admission to the intensive care unit. Secondary outcomes were intubation, in-hospital mortality, time to clinical recovery, and length of hospital stay (LOS). Between April 13 and August 9, 2020, a total of 336 patients were randomly assigned to receive one of the 3 treatment regimens including group I (hydroxychloroquine stat, prednisolone, azithromycin and naproxen; 120 patients), group II (hydroxychloroquine stat, azithromycin and naproxen; 116 patients), and group III (hydroxychloroquine and lopinavir/ritonavir (116 patients). The mean LOS in patients receiving prednisolone was 5.5 in the modified intention-to-treat (mITT) population and 4.4 days in the per-protocol (PP) population compared with 6.4 days (mITT population) and 5.8 days (PP population) in patients treated with Lopinavir/Ritonavir. Results The mean LOS was significantly lower in the mITT and PP populations who received prednisolone compared with populations treated with Lopinavir/Ritonavir (p = 0.028; p = 0.0007). We observed no significant differences in the number of deaths, ICU admission, and need for mechanical ventilation between the Modified ITT and per-protocol populations treated with prednisolone and Lopinavir/Ritonavir, although these outcomes were better in the arm treated with prednisolone. The time to clinical recovery was similar in the modified ITT and per-protocol populations treated with prednisolone, lopinavir/ritonavir, and azithromycin (P = 0.335; P = 0.055; p = 0.291; p = 0.098). Conclusion The results of the present study show that therapeutic regimen (regimen I) with low dose prednisolone was superior to other regimens in shortening the length of hospital stay in patients with moderate to severe COVID-19. The steroid sparing effect may be utilized to increase the effectiveness of corticosteroids in the management of diabetic patients by decreasing the dosage.

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Impact of Spleen Size on Outcomes in Laparoscopic Splenectomy in Children

Gastroenterology Research and Practice ◽

10.1155/2015/603915 ◽

2015 ◽

Vol 2015 ◽

pp. 1-4 ◽

Cited By ~ 3

Author(s):

Cetin Ali Karadag ◽

Basak Erginel ◽

Ozgur Kuzdan ◽

Nihat Sever ◽

Melih Akın ◽

...

Keyword(s):

Hospital Stay ◽

Laparoscopic Splenectomy ◽

Operative Time ◽

Length Of Hospital Stay ◽

Time Rate ◽

Open Procedure ◽

Group I ◽

Longitudinal Length ◽

The Mean ◽

Group Ii

Background. The aim of our study is to compare the efficacy of laparoscopic splenectomy (LS) between enlarged spleens and normal sized spleens.Methods. From June 2006 to September 2012, 50 patients underwent LS. The patients consisted of 24 girls and 26 boys with the mean age of 8.64 years (1–18). The patients are divided into two groups according to spleen’s longitudinal length on the ultrasonography. Group I consisted of the normal sized spleens; Group II consisted of spleens that are exceeding the upper limit. Groups are compared in terms of number of ports, operative time, rate of conversion to open procedure, and length of hospital stay.Results. The mean number of ports was 3.27 and 3.46, the mean length of the operation was 116.36 min and 132.17 min, rate of conversion to open procedure was 9.09% and 10.25%, and the mean length of hospital stay was 3.36 days and 3.23 days, respectively, in Group I and Group II. Although there is an increase in the number of the ports, the operative time, rate of conversion to open procedure, and the length of hospital stay, the difference was not significant between groups (P>0.05).Conclusion. LS is safe and effective in enlarged spleens as well as normal sized spleens.

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Ep.Th.654Home Based Pre-Rehabilitation in Hepatic & Pancreatic Oncological Surgery- A Way Forward for Improved Patient Outcome

British Journal of Surgery ◽

10.1093/bjs/znab309.070 ◽

2021 ◽

Vol 108 (Supplement_7) ◽

Author(s):

Nauman Ahmed ◽

Rami Obeidallah ◽

Daren Subar

Keyword(s):

Hospital Stay ◽

Length Of Hospital Stay ◽

Cost Effective ◽

P Value ◽

Oncological Surgery ◽

Operative Outcomes ◽

Home Based ◽

Group I ◽

Operative Complications ◽

Group Ii

Abstract Aims To ascertain the impact of ‘’Cost effective home-based pre-rehabilitation’’ on post-operative outcomes in patients undergoing major hepatic and pancreatic oncological surgery. Methods In this non-randomized comparative study (2019-2021), we included 36 patients having pancreatic or hepatic malignancy. In group I, patients were signed up for home-based pre-rehabilitation program and dietary modification. Group II; included patients who did not have rehabilitation. The two groups were compared for post-operative outcomes (post-operative complications, length of ITU and hospital stay) Results Mean age was 69.05±9.68 years in group I and 67.50±8.75 years in group II (p-value 0.61). Open approach was used in 02 (11.0%) patients in group I and in 09 (50%) patients in group II (p-value 0.01). More patients in group II needed admission in intensive care unit (ICU); 18 (100%) versus 11 (61.1%) in group II (p-value 0.0003). The group I had shorter length of hospital stay as compared to Group II (p-value 0.0001). There was no significant difference in post-operative complications between the groups. Conclusion Home based pre-rehabilitation, has shown beneficial outcomes in terms of less requirement for ITU admission post operatively, shorter length of hospital stay and cost effective method of pre rehabilitation.

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Outcomes of Percutaneous Nephrolithotripsy With or Without Nephrostomy Tube: A Comparative Study

Journal of Nepalgunj Medical College ◽

10.3126/jngmc.v18i1.35213 ◽

2020 ◽

Vol 18 (1) ◽

pp. 96-99

Author(s):

Naresh Man Shrestha

Keyword(s):

Hospital Stay ◽

Renal Stone ◽

Standard Procedure ◽

Operation Time ◽

P Value ◽

Nephrostomy Tube ◽

Group I ◽

The Mean ◽

Tubeless Pcnl ◽

Percutaneous Nephrolithotripsy

Introduction: Percutaneous Nephrolithotripsy (PCNL) is one of the most accepted surgical modality for removal of renal stone. Placement of a nephrostomy tube at the end of PCNL is a standard procedure for PCNL, however many reports have showed the safety and efficacy of tubeless PCNL for the removal of renal stone. Aims: The present study aimed to report the outcomes of PCNL with or without nephrostomy tube. Methods: It is Prospective Hospital Study conducted from June 2017 to April 2020 in the Department of Urology Nepalgunj Medical College. Total 153 patients under inclusion criteria were divided into two groups. Group 1 (75 patients) was allocated to patients who were being treated under standard PCNL procedure while Group 2 (78 patients) was allocated for patients who were being treated under Tubeless PCNL procedure. The two groups were compared for operation time (minutes), hospital stay (days), post operative dose of analgesic (mg), post operative complications such as, leakage (%), bleeding (%) and infection (%). Data were analyzed from SPSS and p-value less than 0.5 was considered as significant. Results: In Group II the mean hospital stay, analgesic dose and rate of leakage was significantly lesser than Group I (p<0.05) whereas, the mean operation time, rate of infection and bleeding were not significantly different between two groups (p>0.05). Conclusion: Tubeless PCNL procedure causes more rapid recovery and earlier discharge from the hospital, reduction in postoperative pain and no leakage when compared to standard tubless PCNL.

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Laparoscopic donor nephrectomy: technique and outcome, a single-center experience

African Journal of Urology ◽

10.1186/s12301-021-00254-7 ◽

2021 ◽

Vol 27 (1) ◽

Author(s):

Osama Zaytoun ◽

Moustafa Elsawy ◽

Kareem Ateba ◽

Ayman Khalifa ◽

Ahmed Hamdy ◽

...

Keyword(s):

Hospital Stay ◽

Graft Function ◽

Length Of Hospital Stay ◽

Donor Nephrectomy ◽

Laparoscopic Donor Nephrectomy ◽

Single Center Experience ◽

Clavien Grade ◽

Grade Ii ◽

The Mean ◽

Operative Notes

Abstract Background Laparoscopic donor nephrectomy (LDN) has been established as a surgical standard for living kidney donation. The aim of this work is to report our own experience with LDN regarding outcome and technique. Methods We prospectively identified 110 LDN cases between May 2017 and April 2020. Donor case files and operative notes were analyzed for age, sex, laterality, body mass index, warm ischemia time (WIT), intraoperative and postoperative complications, operative time, and length of hospital stay (LOS). Data were analyzed using SPSS version 10 (SPSS: An IBM Company, IBM Corporation, Armonk, NY, the USA). Results The mean age was 38 years, and 77% were males. Three cases (2.72%) required conversion to conventional open donor nephrectomy (ODN). Nevertheless, none of cases required intraoperative blood transfusion. The mean WIT was 2.6 min. Two cases (1.8%) developed major vascular injury (Clavien grade IIIb) and required conversion to ODN. Postoperatively, one patient (0.9%) needed transfusion of one unit of packed RBCs (Clavien grade II). The mean LOS was 2 days. Most common early postoperative complication was ileus (Clavien grade II) that developed in 4 (3.6%) cases. Incisional hernia (Clavien grade IIIb) was encountered in two (1.8%) cases. Two (1.8%) cases developed wound infection at the incision site and treated conservatively (Clavien grade I). Conclusions LDN is a safe technique with accepted intraoperative and postoperative morbidity. It offers short hospital stay, better cosmesis and early convalescence. In experienced hands, it can effectively deal with various vascular and ureteral anomalies without compromising early graft function.

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Laparoscopy for blunt abdominal trauma: a challenging endeavor

Scandinavian Journal of Surgery ◽

10.1177/1457496918816927 ◽

2018 ◽

Vol 108 (4) ◽

pp. 273-279 ◽

Cited By ~ 2

Author(s):

M. Z. Koto ◽

O. Y. Matsevych ◽

F. Mosai ◽

S. Patel ◽

C. Aldous ◽

...

Keyword(s):

Hospital Stay ◽

Abdominal Trauma ◽

Blunt Abdominal Trauma ◽

Injury Severity ◽

Length Of Hospital Stay ◽

Trauma Patients ◽

Therapeutic Laparoscopy ◽

The Mean ◽

Trauma Score

Background and Aims: Laparoscopy in blunt abdominal trauma is challenging because of multiple associated injuries, higher trauma score values and higher morbidity and mortality, as compared with patients with penetrating abdominal trauma. The aim of this study was to investigate the role of laparoscopy in the management of blunt abdominal trauma patients and to highlight related challenges. Material and Methods: Over a 4-year period, patients managed laparoscopically for blunt abdominal trauma were retrospectively analyzed. Perioperative details, indications for laparoscopy and conversion, complications, and length of hospital stay were discussed. Results: A total of 35 stable patients underwent laparoscopy. The mean Injury Severity Score was 12 (4–38). Therapeutic laparoscopy was performed in 15 (56%) and diagnostic in 12 (44%) patients. Eight (23%) patients were converted to therapeutic laparotomy. Intraoperative bleeding, complex injuries, visualization problem, and equipment failure necessitated conversion. Three (30%) patients with negative computed tomography scan had therapeutic laparoscopy for mesenteric injuries. There were no missed injuries. The mean length of hospital stay was 11 days in both groups. Conclusion: Laparoscopy for stable patients is feasible and safe. Multiple injuries make laparoscopy more difficult, and advanced laparoscopic skills are required. The conversion rate is high; however, the non-therapeutic laparotomies were completely eliminated in this study.

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Hem-o-lok clips are safe and efficacious for laparoscopic cholecystectomy: Preliminary results of a single center experience

10.52768/jjgastro/1020 ◽

2021 ◽

Vol 1 (4) ◽

Author(s):

Gaetano Poillucci ◽

◽

Francesca Frangella ◽

Piero Liberatore ◽

Renato De Angelis ◽

...

Keyword(s):

Laparoscopic Cholecystectomy ◽

Retrospective Study ◽

Hospital Stay ◽

Gallbladder Disease ◽

Length Of Hospital Stay ◽

Complication Rates ◽

Biliary Leakage ◽

Single Center Experience ◽

The Mean ◽

Titanium Clips

Introduction: The aim of this retrospective study was to compare the outcomes after laparoscopic cholecystectomy using titanium clips or Hem-o-lok polymeric clips to close cystic artery and cystic duct. Methods: A total of 154 patients who underwent laparoscopic cholecystectomy for gallbladder disease from January 2019 to December 2019 at the Department of Surgery of the San Giovanni Addolorata Hospital in Rome (Italy) were studied retrospectively. In 100 patients, titanium clips were used, while Hem-o-lok clips were used in 54 patients. In the two groups, patients' demographic characteristics, laboratory tests and postoperative complications were analyzed. Results: The mean length of hospital stay was shorter in the Hem-o-lok group compared to the titanium clips group (2.0 SD0.7 vs. 3.6 SD5.5, p < 0.05). The overall complication rates for the titanium clips and the Hem-o-lock clips groups were 9% and 0% 7 days after surgery (p < 0.05), 10% and 9.3% 30 days after surgery, 13% and 16.7% 180 days after surgery. There were no statistically significant differences between the two groups in the typology of complications. Conclusion: Based on our results, Hem-o-lock have better postoperative outcomes after laparoscopic cholecystectomy for gallbladder disease in terms of complication rate 7 days after surgery and in terms of mean length of hospital stay. Keywords: laparoscopic cholecystectomy; Hem-O-Lok polymeric clips; titanium clips; biliary leakage; retrospective study.

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Pilonidal Sinus: How to Choose Between Excision and Open Granulation Versus Excision and Primary Closure?

Swiss Surgery ◽

10.1024/1023-9332.8.6.255 ◽

2002 ◽

Vol 8 (6) ◽

pp. 255-258 ◽

Cited By ~ 28

Author(s):

Perruchoud ◽

Vuilleumier ◽

Givel

Keyword(s):

Hospital Stay ◽

Pilonidal Sinus ◽

Primary Closure ◽

Average Length ◽

Length Of Hospital Stay ◽

Healing Time ◽

Incision And Drainage ◽

The Mean ◽

Primary Healing

Aims: The purpose of this study was to evaluate excision and open granulation versus excision and primary closure as treatments for pilonidal sinus. Subjects and methods: We evaluated a group of 141 patients operated on for a pilonidal sinus between 1991 and 1995. Ninety patients were treated by excision and open granulation, 34 patients by excision and primary closure and 17 patients by incision and drainage, as a unique treatment of an infected pilonidal sinus. Results: The first group, receiving treatment of excision and open granulation, experienced the following outcomes: average length of hospital stay, four days; average healing time; 72 days; average number of post-operative ambulatory visits, 40; average off-work delay, 38 days; and average follow-up time, 43 months. There were five recurrences (6%) in this group during the follow-up period. For the second group treated by excision and primary closure, the corresponding outcome measurements were as follows: average length of hospital stay, four days; average healing time, 23 days; primary healing failure rate, 9%; average number of post-operative ambulatory visits, 6; average off-work delay, 21 days. The average follow-up time was 34 months, and two recurrences (6%) were observed during the follow-up period. In the third group, seventeen patients benefited from an incision and drainage as unique treatment. The mean follow-up was 37 months. Five recurrences (29%) were noticed, requiring a new operation in all the cases. Discussion and conclusion: This series of 141 patients is too limited to permit final conclusions to be drawn concerning significant advantages of one form of treatment compared to the other. Nevertheless, primary closure offers the advantages of quicker healing time, fewer post-operative visits and shorter time off work. When a primary closure can be carried out, it should be routinely considered for socio-economical and comfort reasons.

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Propensity-adjusted cost analysis of radial versus femoral access for neuroendovascular procedures

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2020-016728 ◽

2020 ◽

pp. neurintsurg-2020-016728

Author(s):

Joshua S Catapano ◽

Andrew F Ducruet ◽

Stefan W Koester ◽

Tyler S Cole ◽

Jacob F Baranoski ◽

...

Keyword(s):

Hospital Stay ◽

Hospital Costs ◽

Length Of Hospital Stay ◽

Diagnostic Procedures ◽

Femoral Access ◽

Catheter Size ◽

The Mean ◽

The Difference ◽

Procedure Type ◽

Angiographic Findings

BackgroundTransradial artery (TRA) access for neuroendovascular procedures is associated with fewer complications than transfemoral artery (TFA) access. This study compares hospital costs associated with TRA access to those associated with TFA access for neurointerventions.MethodsElective neuroendovascular procedures at a single center were retrospectively analyzed from October 1, 2018 to May 31, 2019. Hospital costs for each procedure were obtained from the hospital financial department. The primary outcome was the difference in the mean hospital costs after propensity adjustment between patients who underwent TRA compared with TFA access.ResultsOf the 338 elective procedures included, 63 (19%) were performed through TRA versus 275 (81%) through TFA access. Diagnostic procedures were more common in the TRA cohort (51 of 63, 81%) compared with the TFA cohort (197 of 275, 72%), but the difference was not significant (p=0.48). The TRA cohort had a shorter length of hospital stay (mean (SD) 0.3 (0.5) days) compared with the TFA cohort (mean 0.7 (1.3) days; p=0.02) and lower hospital costs (mean $12 968 ($6518) compared with the TFA cohort (mean $17 150 ($10 946); p=0.004). After propensity adjustment for age, sex, symptoms, angiographic findings, procedure type, sheath size, and catheter size, TRA access was associated with a mean hospital cost of $2514 less than that for TFA access (95% CI −$4931 to −$97; p=0.04).ConclusionNeuroendovascular procedures performed through TRA access are associated with lower hospital costs than TFA procedures. The lower cost is likely due to a decreased length of hospital stay for TRA.

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The Role of Nutritional Access in Malnourished Elderly Undergoing Major Surgery for Acute Abdomen: A Propensity Score-Matched Analysis

The American Surgeon ◽

10.1177/0003134820973719 ◽

2020 ◽

pp. 000313482097371

Author(s):

Shekhar Gogna ◽

David Samson ◽

James Choi ◽

Jorge Con ◽

Kartik Prabhakaran ◽

...

Keyword(s):

Propensity Score ◽

Abdominal Surgery ◽

Acute Abdomen ◽

Anastomotic Dehiscence ◽

The Elderly ◽

Major Surgery ◽

P Value ◽

Gastrointestinal Complications ◽

Group I

Background About 50% of the elderly undergoing emergency abdominal surgery are malnourished. The role of timely surgical nutritional access in this group of patients is unknown. Methods We analyzed the National Inpatient Sample database from 2009 through the first three-quarters of 2015 of patients aged ≥65 years who were malnourished and underwent major abdominal surgery for the acute abdomen within the first 2 days of hospital admission. Results Of 3 246 721 patients analyzed, 4311 patients met inclusion criteria. Of these, only 507 (11.8%) patients had surgical nutritional access (gastrostomy or jejunostomy) (group I), while 3804 patients (88.2%) did not (group II). In the propensity score-matched population, there were 482 patients in each group. The patients in group I had lower odds of mortality and postoperative gastrointestinal complications (paralytic ileus, anastomotic dehiscence, and intestinal fistulae) ( P-value <.01, respectively). Discussion Elderly who receive surgical nutritional access have lower rates of gastrointestinal complications and mortality.

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