Endoscopic transnasal/transoral odontoid resection in children: results of a combined neurosurgical and otolaryngological protocolized, institutional approach

2021 ◽  
pp. 1-8
Author(s):  
Rajiv R. Iyer ◽  
J. Fredrik Grimmer ◽  
Douglas L. Brockmeyer
Keyword(s):  
Length Of Stay ◽  
Blood Loss ◽  
Pediatric Population ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Endoscopic Endonasal ◽  
Sleep Study ◽  
Average Hospital ◽  
Institutional Approach ◽  
Estimated Blood Loss

OBJECTIVE Odontogenic ventral brainstem compression can be a source of significant morbidity in patients with craniocervical disease. The most common methods for odontoidectomy are the transoral and endoscopic endonasal routes. In this study, the authors investigated the use of an institutional protocol for endoscopic transnasal/transoral odontoidectomy in the pediatric population. METHODS From 2007 to 2017, a multidisciplinary institutional protocol was developed and refined for the evaluation and treatment of pediatric patients requiring odontoidectomy. Preoperative assessment included airway evaluation, a sleep study (if indicated), discussion of possible tonsillectomy/adenoidectomy, and thorough imaging review by the neurosurgery and otolaryngology teams. Further preoperative anesthesia consultation was obtained for difficult airways. Intraoperatively, adenoidectomy was performed at the discretion of otolaryngology. The odontoidectomy was performed as a combined procedure. Primary posterior pharyngeal closure was performed by the otolaryngologist. The postoperative protocol called for immediate extubation, advancement to a soft diet at 24 hours, and no postoperative antibiotics. Outcome variables included time to extubation, operative time, estimated blood loss, hospital length of stay, and postoperative complications. RESULTS A total of 13 patients underwent combined endoscopic transoral/transnasal odontoid resection with at least 3 years of follow-up. All patients had stable to improved neurological function in the postoperative setting. All patients were extubated immediately after the procedure. The average operative length was 201 ± 46 minutes, and the average estimated blood loss was 44.6 ± 40.0 ml. Nine of 13 patients underwent simultaneous tonsillectomy and adenoidectomy. The average hospital length of stay was 6.6 ± 5 days. The first patient in the series required revision surgery for removal of a small residual odontoid. One patient experienced pharyngeal flap dehiscence requiring revision. CONCLUSIONS A protocolized, institutional approach for endoscopic transoral/transnasal odontoidectomy is described. The use of a combined, multidisciplinary approach leads to streamlined patient management and favorable outcomes in this complex patient population.

scholarly journals Percutaneous, PMMA-augmented, pedicle screw instrumentation of thoracolumbar ankylotic spine fractures

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Rina E. Buxbaum ◽  
Adi Shani ◽  
Hani Mulla ◽  
Alon Rod ◽  
Nimrod Rahamimov
Keyword(s):  
Length Of Stay ◽  
Blood Loss ◽  
Thoracolumbar Spine ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
High Morbidity ◽  
Spine Fractures ◽  
Average Hospital ◽  
Percutaneous Instrumentation ◽  
The Mean

Abstract Introduction Fractures in the ankylotic spine may have an insidious presentation but are prone to displace with devastating consequences. The long lever arm of ankylosed spine fragments may lead to pulmonary and great vessel injury and is difficult to adequately immobilize. Conservative treatment will produce in many cases poor outcomes with high morbidity and mortality. Open surgical treatment is also fraught with technical difficulties and can lead to major blood loss and prolonged operative times. In recent years, percutaneous instrumentation of non-ankylotic spine fractures has gained popularity, producing similar outcomes to open surgery with shorter operative times and reduced blood loss and hospital length of stay. We describe our experience implementing these techniques in ankylotic spine patients. Methods We retrospectively retrieved from our hospital’s electronic health records all patients treated for thoracolumbar spine fractures between 2008 and 2015 with a diagnosis of ankylosing spondylitis (AS) or diffuse idiopathic skeletal hyperostosis (DISH). Operative and postoperative data, results, and complications were tabulated, and radiographic parameters were evaluated. Results Twenty-four patients with ankylotic spine disease underwent percutaneous augmented instrumentation between 2008 and 2015. The mean age was 76. All patients had at least one comorbidity. The mean number of ankylosed levels was 14. Mean operative time was 131 min. The average postoperative hemoglobin decrease was 1.21 gr/%, with only 4 patients requiring blood transfusion. 45.8% of the patients had postoperative medical complications. One patient (4.2%) had a superficial postoperative infection, and one patient died in hospital. The average hospital length of stay was 14.55 days. All patients retained their preoperative ASIA grades, and 3 improved one grade. All patients united their fractures without losing reduction. Conclusions PMMA-augmented percutaneous instrumentation is an attractive surgical option for this difficult patient subset, especially when compared to other available current alternatives.

30-Day Outcomes for Total Ankle Arthroplasty in Patients With Anemia

2021 ◽  
pp. 107110072110175
Author(s):  
Jordan R. Pollock ◽  
Matt K. Doan ◽  
M. Lane Moore ◽  
Jeffrey D. Hassebrock ◽  
Justin L. Makovicka ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Univariate Analysis ◽  
Hospital Length ◽  
Total Ankle Arthroplasty ◽  
Hospital Length Of Stay ◽  
Preoperative Anemia ◽  
Improvement Project ◽  
Average Hospital ◽  
Ankle Arthroplasty ◽  
Reoperation Rates

Background: While anemia has been associated with poor surgical outcomes in total knee arthroplasty and total hip arthroplasty, the effects of anemia on total ankle arthroplasty remain unknown. This study examines how preoperative anemia affects postoperative outcomes in total ankle arthroplasty. Methods: A retrospective analysis was performed using the American College of Surgeons National Surgery Quality Improvement Project database from 2011 to 2018 for total ankle arthroplasty procedures. Hematocrit (HCT) levels were used to determine preoperative anemia. Results: Of the 1028 patients included in this study, 114 patients were found to be anemic. Univariate analysis demonstrated anemia was significantly associated with an increased average hospital length of stay (2.2 vs 1.8 days, P < .008), increased rate of 30-day readmission (3.5% vs 1.1%, P = .036), increased 30-day reoperation (2.6% vs 0.4%, P = .007), extended length of stay (64% vs 49.9%, P = .004), wound complication (1.75% vs 0.11%, P = .002), and surgical site infection (2.6% vs 0.6%, P = .017). Multivariate logistic regression analysis found anemia to be significantly associated with extended hospital length of stay (odds ratio [OR], 1.62; 95% CI, 1.07-2.45; P = .023) and increased reoperation rates (OR, 5.47; 95% CI, 1.15-26.00; P = .033). Anemia was not found to be a predictor of increased readmission rates (OR, 3.13; 95% CI, 0.93-10.56; P = .066) or postoperative complications (OR, 1.27; 95% CI, 0.35-4.56; P = .71). Conclusion: This study found increasing severity of anemia to be associated with extended hospital length of stay and increased reoperation rates. Providers and patients should be aware of the increased risks of total ankle arthroplasty with preoperative anemia. Level of Evidence: Level III, retrospective comparative study.

scholarly journals Intravenous versus Oral Step-Down for the Treatment of Staphylococcus aureus Bacteremia in a Pediatric Population

Pharmacy ◽  
2022 ◽  
Vol 10 (1) ◽  
pp. 16
Author(s):  
Sarah Grace Gunter ◽  
Mary Joyce B. Wingler ◽  
David A. Cretella ◽  
Jamie L. Wagner ◽  
Katie E. Barber ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Length Of Stay ◽  
Therapy Group ◽  
Pediatric Population ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Limited Data ◽  
Staphylococcus Aureus Bacteremia ◽  
Secondary Endpoints ◽  
Step Down

Limited data are available regarding optimal antimicrobial therapy for Staphylococcus aureus bacteremia (SAB) in pediatric patients. The purpose of this study was to assess clinical characteristics and outcomes associated with intravenous (IV) versus oral step-down treatment of pediatric SAB. This study evaluated patients aged 3 months to 18 years that received at least 72 h of inpatient treatment for SAB. The primary endpoint was 30-day readmission. Secondary endpoints included hospital length of stay and inpatient mortality. One hundred and one patients were included in this study. The median age was 7.9 years. Patients who underwent oral step-down were less likely to be immunocompromised and more likely to have community-acquired SAB from osteomyelitis or skin and soft tissue infection (SSTI). More patients in the IV therapy group had a 30-day readmission (10 (25.6%) vs. 3 (5.3%), p = 0.006). Mortality was low (5 (5%)) and not statistically different between groups. Length of stay was greater in patients receiving IV therapy only (11 vs. 7 days, p = 0.001). In this study, over half of the patients received oral step-down therapy and 30-day readmission was low for this group. Oral therapy appears to be safe and effective for patients with SAB from osteomyelitis or SSTIs.

scholarly journals 2286. Evaluating the Impact of Ceftolozane/Tazobactam on Clinical Outcomes in Patients with Multi-Drug-resistant Pseudomonas aeruginosa Pneumonia

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S783-S784
Author(s):  
Matthew Mills ◽  
Ashley MacWhinnie ◽  
Timmy Do
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Length Of Stay ◽  
Clinical Cure ◽  
Standard Of Care ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Multi Drug Resistance ◽  
Average Hospital ◽  
Definitive Therapy ◽  
The Impact

Abstract Background Ceftolozane/tazobactam is a novel cephalosporin and β-lactamase inhibitor antibiotic that has shown to have potent activity against Pseudomonas aeruginosa including strains exhibiting multi-drug resistance (MDR). The purpose of this study was to evaluate ceftolozane/tazobactam efficacy in MDR P. aeruginosa pneumonia compared with historical standard of care. Methods This was a retrospective cohort study of patients hospitalized across AdventHealth Central Florida campuses with MDR P. aeruginosa pneumonia from January 1, 2017 through December 31, 2018. This study included patients ≥ 18 years of age with a diagnosis of pneumonia and a positive respiratory culture with MDR P. aeruginosa. The primary outcome of this study was the rate of clinical cure by day 14 of definitive therapy. Secondary outcomes included 30-day readmission rate, average hospital length of stay (LOS), cost of admission, average ICU LOS after initiation of definitive antibiotic, and total days of antibiotic exposure for pneumonia. Data were analyzed with statistical computer software utilizing independent samples t-test and chi square tests of independence as appropriate. Results A total of 115 patients were included in the final analysis, 62 patients treated with ceftolozane/tazobactam and 53 patients treated with historical standard of care. Rate of clinical cure was similar between patients treated with ceftolozane/tazobactam, 72.6% (n = 45), and those treated with historical standard of care, 67.9% (n = 36), {X2 (1) = 0.297, p = 0.683}. Other outcomes assessed were also similar between groups except for average hospital length of stay (42.7 days vs. 30.3 days t(113) = 2.054, p = 0.042), and cost of admission ($78,550 vs. $47,681, t(113) = 2.458, p = 0.016), which were significantly greater in the ceftolozane/tazobactam treatment group. Conclusion In patients diagnosed with MDR P. aeruginosa pneumonia, clinical cure rates were not significantly different between those treated with ceftolozane/tazobactam compared with historical standard of care. Significantly greater hospital length of stay and cost of admission was associated with use of ceftolozane/tazobactam, although many patient factors may have influenced these results. Disclosures All authors: No reported disclosures.

scholarly journals Single-institution case series of pituitary biopsy for suspected germinoma in the pediatric population: diagnostic utility, operative risks, and biopsy approaches

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Emily L. Day ◽  
Edward R. Smith ◽  
Katie P. Fehnel
Keyword(s):  
Length Of Stay ◽  
Blood Loss ◽  
Pediatric Population ◽  
Intraoperative Complications ◽  
Pituitary Stalk ◽  
Diagnostic Utility ◽  
Surgical Morbidity ◽  
Icu Stay ◽  
Estimated Blood Loss ◽  
Pituitary Stalk Thickening

Abstract Little has been reported on the safety and efficacy of pituitary biopsy in the pediatric population for suspected germinoma. An updated review is needed. Patients who underwent biopsy (endoscopic endonasal vs. open craniotomy) for isolated pituitary stalk thickening were identified. Age, pre- and post-operative endocrine status, surgical approach, length of surgery, estimated blood loss, surgical morbidity, length of ICU stay, total length of stay, and pathology reports were reviewed. Nine patients met inclusion criteria. Germinoma diagnosis was rendered in 7 of 9 patients; 1 patient required two biopsy attempts. Two-patients had histology consistent with inflammation and a subsequently self-limited disease course. Average operative time, blood loss, ICU stay and overall length of stay was just over 2 h, 28 mL, 1.6 days and 3.7 days respectively. There were no intraoperative complications and all patients were discharged home. One patient developed new diabetes insipidus post-operatively. Patients who underwent endoscopic biopsy had decreased operative times and shorter hospitalizations. Biopsy for isolated pituitary stalk thickening for suspected germinoma is generally safe with high diagnostic utility. Importantly, 22% of presumed germinomas on imaging yielded alternative diagnoses on biopsy, adding support for pathology-proven data to guide treatment in relevant cases.

Minimally Invasive Esophagectomy: Early Experience and Outcomes

2006 ◽  
Vol 72 (8) ◽  
pp. 677-683 ◽  
Author(s):  
Christopher K. Senkowski ◽  
Micheal T. Adams ◽  
Angela N. Beck ◽  
Steven T. Brower
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Length Of Stay ◽  
Blood Loss ◽  
Minimally Invasive ◽  
Hospital Length ◽  
Esophageal Surgery ◽  
Hospital Length Of Stay ◽  
Indications For Surgery ◽  
Total Esophagectomy

Minimally invasive esophageal surgery has the potential to improve mortality, hospital stay, and functional outcomes when compared with open methods. Although technically complex, combined laparoscopic and thoracoscopic esophageal resection is feasible. A case series of 20 patients who underwent minimally invasive total esophagectomy is presented. This study was a review of a prospective database. The purpose was to evaluate early results with laparoscopic total esophagectomy for benign and malignant disease. Between January 2003 and November 2005, 20 patients underwent minimally invasive esophageal surgery. All operations were performed by the same two surgeons. Age, gender, indications for surgery, pathologic stage, operative time, blood loss, transfusion requirements, intensive care unit length of stay, hospital length of stay, postoperative complications, and mortality were recorded. Diet progression, dysphagia, and need for stricture management were also recorded. Of the 20 minimally invasive total esophagectomies performed, 18 (90%) were completed successfully. The average age of the patients was 53 years. Indications for surgery were malignancy (n = 13), carcinoma in situ in the setting of Barrett's esophagus (n = 2), and benign stricture (n = 3). The average operating time was 467 minutes (range 346–580 min). Median blood loss was 350 mL (range 150–500 mL). The median intensive care unit stay was 2 days, and the median hospital length of stay was 12 days. Pathology revealed that 7 per cent of patients had stage I disease, 27 per cent of patients had stage II disease, and 53 per cent of patients had stage III disease. There was a single mortality (5%), a cervical leak in two patients (10%), a gastric tip necrosis in one patient (5%), and tracheoesophageal fistula in one patient (5%). Major complications occurred in eight patients (40%) and minor complications in nine (50%). Thirteen (72%) patients were discharged on enteral tube feeds to supplement caloric intake. The application of minimally invasive techniques in the arena of esophageal surgery continues to evolve. This approach has the potential to improve mortality, hospital stay, and other outcomes when compared with open methods. Although technically complex, laparoscopic total esophagectomy is feasible.

scholarly journals 1951. Extended Infusions of Β-lactam Antibiotics are Feasible and May Improve Mortality in the Pediatric Population

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S59-S60
Author(s):  
Rachael L Schortemeyer ◽  
Tracy N Zembles ◽  
Glenn Bushee ◽  
Evelyn Kuhn ◽  
Michelle L Mitchell
Keyword(s):  
Length Of Stay ◽  
Clinical Outcomes ◽  
Critically Ill ◽  
Interim Analysis ◽  
Pediatric Population ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Readmission Rates ◽  
Drug Concentrations ◽  
All Cause Mortality

Abstract Background Infections due to multi-drug-resistant organisms (MDRO) are associated with poor clinical outcomes. Due to limited treatment options for MDROs, it is essential to improve the delivery of available antibiotics. Optimal efficacy of β-lactam antibiotics can be achieved when free drug concentrations exceed the minimum inhibitory concentration of the organism for at least 50% of the dosing interval. This is more feasible when extending the duration of infusion. Adult literature supporting the use of extended infusion β-lactams (EIBL) is robust; however, pediatric data are limited. Furthermore, extended infusions (EI) may be more difficult to achieve in pediatric patients due to limited intravenous line access. The purpose of this study was to determine the feasibility of EIBLs as the standard of care and compare clinical outcomes between standard infusions (SI) and extended infusions (EI). Methods This retrospective chart analysis included hospitalized patients less than 18 years old between October 1, 2017 and March 31, 2019 who received at least 72 hours of cefepime, piperacillin/tazobactam, or meropenem. Patients weighing less than 3.5 kg or requiring continuous renal replacement therapy were excluded. EI were defined as antibiotic delivery over 3–4 hours, while SI were delivered over 30 minutes. The percent of patients completing therapy utilizing EI was measured. Clinical outcomes compared hospital length of stay; time to blood culture clearance, defervescence, inflammatory marker normalization; 30-day readmission rates; and 30-day all-cause mortality between the SI and EI groups. Results A total of 560 patients were included in the interim analysis. Over 90% of patients were able to complete therapy utilizing EI (Figure 1). The EI group had lower readmission rates, but the interim analysis has not yet controlled for planned admissions. A sub-analysis of critically ill patients requiring vasopressors identified a lower mortality rate (5.1% vs. 23.1%, P = 0.023) and decreased the length of stay (554 vs. 1,055 hours, P = 0.035) in the EI compared with SI group (Table 1). Conclusion EIBLs are feasible in the pediatric population and may lead to improved outcomes including decreased all-cause mortality and hospital length of stay, especially in critically ill children. Disclosures All Authors: No reported Disclosures.

Advancing the Use of Laparoscopy in Trauma: Repair of Intraperitoneal Bladder Injuries

2019 ◽  
Vol 85 (12) ◽  
pp. 1402-1404 ◽  
Author(s):  
Michael R. Arnold ◽  
Caroline D. Lu ◽  
Bradley W. Thomas ◽  
Gaurav Sachdev ◽  
Kyle W. Cunningham ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Injury Severity ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Bladder Rupture ◽  
Trauma Patients ◽  
Average Hospital ◽  
Early Return ◽  
Significant Difference ◽  
Intraperitoneal Bladder Rupture

Traumatic intraperitoneal bladder rupture (IBR) requires surgical repair. Traditionally performed via laparotomy, experience with laparoscopic bladder repair (LBR) after blunt trauma is limited. Benefits of laparoscopy include decreased length of stay (LOS), less pain, early return to work, fewer adhesions, and lower risk of incisional hernia. The aim of this series is to demonstrate the potential superiority of LBR in select trauma patients. This is a retrospective review performed of all IBR patients from 2008 to 2016. Demographics, clinical management, outcomes, and follow-up were compared between LBR and open bladder repair (OBR) patients. Twenty patients underwent OBR, and seven underwent LBR. There was no significant difference in gender, age, or Injury Severity Score. There were no deaths or reoperations in either group. Average hospital length of stay and ICU days were similar between groups. There was one patient with UTI and one with readmission in each group. There were two incisional hernias and two bowel obstructions in the OBR group, with one patient requiring operative intervention. No such complications occurred in the LBR group. LBR for traumatic IBR can be safely performed in select patients, even in those with multiple extra-abdominal injuries.

Average Hospital Length of Stay, Nurses’ Work Demands, and Their Health and Job Outcomes

2014 ◽  
Vol 46 (3) ◽  
pp. 199-206 ◽  
Author(s):  
Sung-Hyun Cho ◽  
Mihyun Park ◽  
Sang Hee Jeon ◽  
Hyoung Eun Chang ◽  
Hyun-Ja Hong
Keyword(s):  
Length Of Stay ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Work Demands ◽  
Job Outcomes ◽  
Average Hospital
Sign in / Sign up

Export Citation Format

Share Document