scholarly journals Reevaluating the weekend effect on patients with hydrocephalus undergoing operative shunt intervention

2016 ◽  
Vol 17 (2) ◽  
pp. 156-162 ◽  
Author(s):  
Frank J. Attenello ◽  
Eisha Christian ◽  
Timothy Wen ◽  
Steven Cen ◽  
Gabriel Zada ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
High Volume ◽  
Adverse Outcomes ◽  
Weekend Effect ◽  
Shunt Revision ◽  
Published Data ◽  
Inpatient Mortality ◽  
Shunt Insertion ◽  
Related Quality ◽  
The Impact

OBJECT Recently published data have suggested an increase in adverse outcomes in pediatric patients after insertion or revision of a ventricular CSF diversion shunt after a same-day weekend procedure. The authors undertook an evaluation of the impact of weekend admission and time to shunting on surgery-related quality outcomes in pediatric patients who underwent ventricular shunt insertion or revision. METHODS Pediatric patients with hydrocephalus who underwent ventriculoperitoneal, ventriculoatrial, or ventriculopleural shunt placement were selected from the 2000–2010 Nationwide Inpatient Sample and Kids’ Inpatient Database. Multivariate regression analyses (adjusted for patient, hospital, case severity, and time to shunting) were used to determine the differences in inpatient mortality and routine discharge rates among patients admitted on a weekday versus those among patients admitted on a weekend. RESULTS There were 99,472 pediatric patients with shunted hydrocephalus, 16% of whom were admitted on a weekend. After adjustment for disease severity, time to procedure, and admission acuity, weekend admission was not associated with an increase in the inpatient mortality rate (p = 0.46) or a change in the percentage of routine discharges (p = 0.98) after ventricular shunt procedures. In addition, associations were unchanged after an evaluation of patients who underwent shunt revision surgery. High-volume centers were incidentally noted in multivariate analysis to have increased rates of routine discharge (OR 1.04 [95% CI 1.01–1.07]; p = 0.02). CONCLUSIONS Contrary to those of previous studies, the authors’ data suggest that weekend admission is not associated with poorer outcomes for ventricular shunt insertion or revision. Increased rates of routine discharge were noted at high-volume centers.

The impact of beta-lactam allergy labels on hospitalized children

2020 ◽  
pp. 1-7
Author(s):  
Trahern W. Jones ◽  
Nora Fino ◽  
Jared Olson ◽  
Adam L. Hersh
Keyword(s):  
Length Of Stay ◽  
Pediatric Patients ◽  
The United States ◽  
Adverse Outcomes ◽  
Hospitalized Children ◽  
Beta Lactam ◽  
Healthcare Facilities ◽  
Antibiotic Allergy ◽  
Hospitalization Costs ◽  
The Impact

Abstract Background and objectives: Antibiotic allergy labels are common and are frequently inaccurate. Previous studies among adults demonstrate that β-lactam allergy labels may lead to adverse outcomes, including prescription of broader-spectrum antibiotics, increased costs, and increased lengths of stay, among others. However, data among pediatric patients are lacking, especially in the United States. In this study, we sought to determine the impact of β-lactam allergy labels in hospitalized children with regards to clinical and economic outcomes. Method: This retrospective cohort study included pediatric patients 30 days to 17 years old, hospitalized at Intermountain Healthcare facilities from 2007 to 2017, who received ≥1 dose of an antibiotic during their admission. Patients with β-lactam allergies were matched to nonallergic patients based on age, sex, clinical service line, admission date, academic children’s hospital or other hospital admission, and the presence of chronic, comorbid conditions. Outcomes included receipt of broader-spectrum antibiotics, clinical outcomes including length of stay and readmission, and antibiotic and hospitalization costs. Results: In total, 38,906 patients were identified. The prevalence of antibiotic allergy increased from 0.9% among those < 1 year peaked at 10.6% by age 17. Patients with β-lactam allergy received broader-spectrum antibiotics and experienced higher antibiotic costs than nonallergic controls. However, there were no differences in the length of stay, readmission rates, or total number of days of antibiotics between allergic and nonallergic patients. Conclusions: Hospitalized pediatric patients with β-lactam allergy labels receive broader-spectrum antibiotics and experience increased antibiotic costs. This represents an important opportunity for allergy delabeling and antibiotic stewardship.

Impact of trainee involvement in esophagectomy on clinical outcomes: a narrative systematic review of the literature

2019 ◽  
Vol 32 (10) ◽  
pp. 1-8
Author(s):  
P Prasad ◽  
M Navidi ◽  
A Immanuel ◽  
S M Griffin OBE ◽  
A W Phillips
Keyword(s):  
Systematic Review ◽  
Clinical Outcomes ◽  
Meta Analysis ◽  
Neoadjuvant Treatment ◽  
Length Of Hospital Stay ◽  
High Volume ◽  
Cochrane Library ◽  
Published Data ◽  
Meta Analyses ◽  
The Impact

SUMMARY Changes in the structure of surgical training have affected trainees’ operative experience. Performing an esophagectomy is being increasingly viewed as a complex technical skill attained after completion of the routine training pathway. This systematic review aimed to identify all studies analyzing the impact of trainee involvement in esophagectomy on clinical outcomes. A search of the major reference databases (Cochrane Library, MEDLINE, EMBASE) was performed with no time limits up to the date of the search (November 2017). Results were screened in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and study quality assessed using the MINORS (Methodological Index for Non-Randomized Studies) criteria. Four studies that included a total of 42 trainees and 16 consultants were identified, which assessed trainee involvement in open esophagogastric resectional surgery. A total of 1109 patients underwent upper gastrointestinal procedures, of whom 904 patients underwent an esophagectomy. Preoperative characteristics, histology, neoadjuvant treatment, and overall length of hospital stay were comparable between groups. One study found higher rates of anastomotic leaks in procedures primarily performed by trainees as compared to consultants (P &lt; 0.01)—this did not affect overall morbidity or survival; however, overall anastomotic leak rates from the published data were 10.4% (trainee) versus 6.3% (trainer) (P = 0.10). A meta-analysis could not be performed due to the heterogeneity of data. The median MINORS score for the included studies was 13 (range 11–15). This study demonstrates that training can be achieved with excellent results in high-volume centers. This has important implications on the consent process and training delivered, as patients wish to be aware of the risks involved with surgery and can be reassured that appropriately supervised trainee involvement will not adversely affect outcomes.

scholarly journals Late pediatric ventriculoperitoneal shunt failures: a Singapore tertiary institution's experience

2016 ◽  
Vol 41 (5) ◽  
pp. E7 ◽  
Author(s):  
Lester Lee ◽  
Sharon Low ◽  
David Low ◽  
Lee Ping Ng ◽  
Colum Nolan ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Pediatric Patients ◽  
Shunt Revision ◽  
Shunt Failure ◽  
Shunt Insertion ◽  
Ventriculoperitoneal Shunts ◽  
Effects Of Aging ◽  
Age And Sex

OBJECTIVE The introduction of ventriculoperitoneal shunts changed the way hydrocephalus was treated. Whereas much is known about the causes of shunt failure in the first few years, there is a paucity of data in the literature regarding the cause of late shunt failures. The authors conducted a study to find out the different causes of late shunt failures in their institution. METHODS A 10-year retrospective study of all the patients who were treated in the authors' hospital between 2006 and 2015 was conducted. Late shunt failures included those in patients who had to undergo shunt revision more than 5 years after their initial shunt insertion. The patient's notes and scans were reviewed to obtain the age and sex of the patient, the time it took for the shunt to fail, the reason for failure, and the patient's follow-up. RESULTS Forty-six patients in the authors' institution experienced 48 late shunt failures in the last 10 years. Their ages ranged from 7 to 26 years (12.23 ± 4.459 years [mean ± SD]). The time it took for the shunts to fail was between 6 and 24 years (mean 10.25 ± 3.77 years). Reasons for failure resulting in shunt revision include shunt fracture in 24 patients (50%), shunt blockage in 14 patients (29.2%), tract fibrosis in 6 patients (12.5%), shunt dislodgement in 2 patients (4.2%), and shunt erosion in 2 patients (4.2%). Postoperative follow-up for the patients ranged from 6 to 138 months (mean 45.15 ± 33.26 months). CONCLUSIONS Late shunt failure is caused by the effects of aging on the shunt, and the complications are different from early shunt failure. A large proportion are complications associated with shunt calcification. The authors advocate a long follow-up for pediatric patients with shunts in situ to monitor them for various causes of late shunt failure.

scholarly journals Analysis on Health-related Quality of Life of 180 Chinese Patients with Sporadic Creutzfeldt-Jakob Disease

2020 ◽  
Author(s):  
Lina Zhang ◽  
Chen Gao ◽  
Yuan Wang ◽  
Wei Zhou ◽  
Kang Xiao ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Chinese Patients ◽  
Published Data ◽  
Health Related Quality ◽  
Cross Sectional ◽  
Related Quality ◽  
Health Related ◽  
Jakob Disease ◽  
The Impact

Abstract Aims Sporadic Creutzfeldt-Jakob disease (sCJD) heavily affects the patient’s motor, cognitive, and psychological functions with 100% fatality rate. Yet, there are few studies focusing on the impact of sCJD on the health-related quality of life (HRQoL) of the patients with validated instrument. We examined physical and mental conditions of those sCJD patients in China for the first time. Methods With EQ-5D-3L instrument, a telephone-based cross-sectional study was conducted in order to obtain health statuses of 180 probable Chinese sCJD cases diagnosed in the National Center for CJD surveillance from January 2017 to July 2018. Besides, a visual analogue score (VAS) was performed to evaluate the health status of the sCJD patients from the family members and relatives who nursing the patients. Results Nearly all of 180 sCJD patients showed the apparent problems in the demission of mobility, usual activities and self-care. More than 1/3 of patients (38.33%) recalled the moderate and severe problems in the demission of pain/uncomfortable. 47.78% of them had the problems in the demission of anxiety/depression. The health utility of sCJD patients was low, with the median of 0.206. Meanwhile, the EQ-VAS score of those sCJD patients was also extremely low, with the median of 0. Conclusion Compared with the published data of several other diseases, the quality of life of Chinese sCJD patients was extremely poor as demonstrated by the results of the generic EQ-5D-3L. More social attentions need to be paid to reduce the healthy and economic burdens for sCJD patients and their families.

scholarly journals Surgery-Related Quality of Life of Pediatric Patients With Crohn's Disease

2020 ◽  
Vol 8 ◽  
Author(s):  
Valeria Dipasquale ◽  
Enrica Antonelli ◽  
Laura Cannavò ◽  
Giorgio Cavatoi ◽  
Carmelo Romeo ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Pediatric Patients ◽  
University Hospital ◽  
Ileocecal Resection ◽  
Severe Problem ◽  
Related Quality ◽  
The Impact

Objective: Up to 30% of pediatric patients with Crohn's disease (CD) require surgery. The aim of the study was to evaluate long-term health-related quality of life (HRQoL) outcome in children with CD who have had ileocolonic resection.Materials and methods: This was a retrospective cross-sectional study on all pediatric patients who had undergone surgery for CD between January 2015 and December 2017 in the Pediatric Surgery and Gastroenterology Units of the University Hospital of Messina. Surgical treatment was represented by laparoscopic ileocecal resection with latero-lateral anastomosis. Patients were asked to fill in a modified version of the IMPACT III questionnaire made up of 15 closed questions before and after surgery. The questionnaire was scored on a five-point scale with 5 reporting “not a problem” and 1 “a very severe problem.” The total score ranged from 15 (worst HRQoL) to 75 (best HRQoL). Frequency of relapses, reoperations, complications during follow-up, and postoperative bowel function were also studied.Results: Data were obtained in 10 patients (9 males), who underwent surgery at a median age of 13.5 years (range 13–18), after a median post-diagnosis period of 2.5 years (range 0–8). Preoperative scores were low in all 4 domains of the questionnaire. Postoperatively, HRQoL measures improved significantly (p &lt; 0.05) about symptoms, school attendance, social and emotional functioning. Overall, nearly all patients were completely satisfied with the surgical outcome.Conclusions: HRQoL is low in CD children referred for possible operation, and surgery may positively affect the overall HRQoL. Collecting HRQoL data provides insight into the impact of treatment on children health status.

Temporal trends and volume-outcome associations after traumatic brain injury: a 12-year study in Taiwan

2013 ◽  
Vol 118 (4) ◽  
pp. 732-738 ◽  
Author(s):  
Hon-Yi Shi ◽  
Shiuh-Lin Hwang ◽  
King-Teh Lee ◽  
Chih-Lung Lin
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Temporal Trends ◽  
High Volume ◽  
Adverse Outcomes ◽  
Hospitalization Cost ◽  
The Mean ◽  
Low Volume ◽  
The Impact ◽  
Very High

Object The purpose of this study was to evaluate temporal trends in traumatic brain injury (TBI); the impact of hospital volume and surgeon volume on length of stay (LOS), hospitalization cost, and in-hospital mortality rate; and to explore predictors of these outcomes in a nationwide population in Taiwan. Methods This population-based patient cohort study retrospectively analyzed 16,956 patients who had received surgical treatment for TBI between 1998 and 2009. Bootstrap estimation was used to derive 95% confidence intervals for differences in effect sizes. Hierarchical linear regression models were used to predict outcomes. Results Patients treated in very-high-volume hospitals were more responsive than those treated in low-volume hospitals in terms of LOS (−0.11; 95% CI −0.20 to −0.03) and hospitalization cost (−0.28; 95% CI −0.49 to −0.06). Patients treated by high-volume surgeons were also more responsive than those treated by low-volume surgeons in terms of LOS (−0.19; 95% CI −0.37 to −0.01) and hospitalization cost (−0.43; 95% CI −0.81 to −0.05). The mean LOS was 24.3 days and the average LOS for very-high-volume hospitals and surgeons was 61% and 64% shorter, respectively, than that for low-volume hospitals and surgeons. The mean hospitalization cost was US $7,292.10, and the average hospitalization cost for very-high-volume hospitals and surgeons was 19% and 22% lower, respectively, than that for low-volume hospitals and surgeons. Advanced age, male sex, high Charlson Comorbidity Index score, treatment in a low-volume hospital, and treatment by a low-volume surgeon were significantly associated with adverse outcomes (p < 0.001). Conclusions The data suggest that annual surgical volume is the key factor in surgical outcomes in patients with TBI. The results improve the understanding of medical resource allocation for this surgical procedure, and can help to formulate public health policies for optimizing hospital resource utilization for related diseases.

scholarly journals Role of radiological parameters in predicting overall shunt outcome after ventriculoperitoneal shunt insertion in pediatric patients with obstructive hydrocephalus

2016 ◽  
Vol 41 (5) ◽  
pp. E4 ◽  
Author(s):  
Devi Prasad Patra ◽  
Shyamal C. Bir ◽  
Tanmoy K. Maiti ◽  
Piyush Kalakoti ◽  
Hugo Cuellar ◽  
...  
Keyword(s):  
Ventriculoperitoneal Shunt ◽  
Pediatric Patients ◽  
Obstructive Hydrocephalus ◽  
Ventricular Volume ◽  
Left Ventricular ◽  
Shunt Malfunction ◽  
Shunt Revision ◽  
Shunt Insertion ◽  
Free Survival ◽  
Occipital Horn

OBJECTIVE Despite significant advances in the medical field and shunt technology, shunt malfunction remains a nightmare of pediatric neurosurgeons. In this setting, the ability to preoperatively predict the probability of shunt malfunction is quite compelling. The authors have compared the preoperative radiological findings in obstructive hydrocephalus and the subsequent clinical course of the patient to determine any association with overall shunt outcome. METHODS This retrospective study included all pediatric patients (age < 18 years) who had undergone ventriculoperitoneal shunt insertion for obstructive hydrocephalus. Linear measurements were taken from pre- and postoperative CT or MRI studies to calculate different indices and ratios including Evans' index, frontal horn index (FHI), occipital horn index (OHI), frontooccipital horn ratio (FOHR), and frontooccipital horn index ratio (FOIR). Other morphological features such as bi- or triventriculomegaly, right-left ventricular symmetry, and periventricular lucency (PVL) were also noted. The primary clinical outcomes that were reviewed included the need for shunt revision, time interval to first shunt revision, frequency of shunt revisions, and revision-free survival. RESULTS A total of 121 patients were eligible for the analysis. Nearly half of the patients (47.9%) required shunt revision. The presence of PVL was associated with lower revision rates than those in others (39.4% vs 58.2%, p = 0.03). None of the preoperative radiological indices or ratios showed any correlation with shunt revision. Nearly half of the patients with shunt revision required early revision (< 90 days of primary surgery). The reduction in the FOHR was high in patients who required early shunt revision (20.16% in patients with early shunt revision vs 6.4% in patients with late shunt revision, p = 0.009). Nearly half of the patients (48.3%) requiring shunt revision ultimately needed more than one revision procedure. Greater occipital horn dilation on preoperative images was associated with a lower frequency of shunt revision, as dictated by a high OHI and a low FOIR in patients with a single shunt revision as compared with those in patients who required multiple shunt revisions (p = 0.029 and 0.009, respectively). The mean follow-up was 49.9 months. Age was a significant factor affecting shunt revision–free survival. Patients younger than 6 months of age had significantly less revision-free survival than the patients older than 6 months (median survival of 10.1 vs 94.1 months, p = 0.004). CONCLUSIONS Preoperative radiological linear indices and ratios do not predict the likelihood of subsequent shunt malfunction. However, patients who required early shunt revision tended to have greater reductions in ventricular volumes on postoperative images. Therefore a greater reduction in ventricular volume is not actually desirable, and a ventricular volume high enough to reduce intracranial pressure is instead to be aimed at for long-term shunt compliance.

scholarly journals The impact of nutritional status on the outcome of Indian patients undergoing neurosurgical shunt surgery

2007 ◽  
Vol 98 (5) ◽  
pp. 944-949 ◽  
Author(s):  
Gaurav Jain ◽  
Gaurav Mukerji ◽  
Anupam Dixit ◽  
Novin Manshani ◽  
Y. R. Yadav
Keyword(s):  
Nutritional Status ◽  
Postoperative Mortality ◽  
Shunt Infection ◽  
Adverse Outcomes ◽  
Shunt Revision ◽  
Shunt Surgery ◽  
Significant Independent Predictor ◽  
Indian Patients ◽  
High Prevalence ◽  
The Impact

Undernutrition is common in surgical patients, is frequently unrecognised and is strongly associated with adverse outcomes such as high rates of complications and mortality, worsening functional status and prolonged hospitalisation. Owing to the associated infection and symptoms such as repeated vomiting, a high prevalence of undernutrition is expected in hydrocephalus patients, which may contribute to their poor surgical outcomes. The aim of this study was to evaluate the influence of preoperative nutritional status on the outcome of Indian patients with hydrocephalus undergoing neurosurgical shunt surgery. One hundred and twenty-four consecutive patients undergoing scheduled hydrocephalus shunt surgery were studied prospectively. All patients underwent nutritional screening according to different parameters prior to surgery. The patients were classified into normally nourished and undernourished groups. The undernourished group was further subdivided into moderately and severely undernourished. The surgical outcome was compared between these groups. A high prevalence (53 %) of undernutrition was observed in these patients. Postoperative complications such as shunt infection (P = 0·0023), shunt revision (P = 0·0074) and mortality (P = 0·0003) were significantly more common in undernourished patients compared with normally nourished patients. Serum albumin emerged as the most significant independent predictor of postoperative mortality. The present study demonstrated a high prevalence of undernutrition in hydrocephalus patients in India and its adverse influence on the outcome of shunt surgery. Early preoperative nutritional status screening and its optimisation may decrease the morbidity and mortality of shunt surgery for hydrocephalus.

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