Clinical outcomes after carotid endarterectomy: comparison of the use of regional and general anesthetics

2000 ◽  
Vol 92 (2) ◽  
pp. 291-296 ◽  
Author(s):  
Achilles K. Papavasiliou ◽  
Hulda B. Magnadottir ◽  
Tamas Gonda ◽  
Douglas Franz ◽  
Robert E. Harbaugh
Keyword(s):  
Hospital Stay ◽  
Clinical Outcomes ◽  
Perioperative Complications ◽  
Length Of Hospital Stay ◽  
General Anesthetic ◽  
Content Type ◽  
Urological Complications ◽  
Cardiopulmonary Complications ◽  
Regional Anesthetic ◽  
Fine Print

Object. The authors analyzed their series of carotid endarterectomies (CEAs), which were performed after administration of either a general or regional anesthetic, to determine whether the choice of anesthetic affected patients' clinical outcomes and length of hospital stay.Methods. A series of 803 consecutive CEAs performed between July 1990 and February 1999 was reviewed. Cases were analyzed for patient demographics, comorbid medical states, and perioperative complications. Contingency-table statistical analysis was used to compare the incidence of comorbid medical states and perioperative complications between patients who underwent CEA in which either a regional or general anesthetic was used. Student's t-test was used to compare the length of hospital stay and mean patient age.A regional anesthetic was used for 632 CEAs, and a general anesthetic was used for 171 operations. There were no statistically significant intergroup differences in demographics or comorbid medical states. The incidence of perioperative stroke and death did not differ significantly between the regional (2.7%) and the general anesthetic groups (2.3%). However, the incidence of nonneurological, nonfatal complications was significantly less in the regional anesthetic (1.6%) than in the general anesthetic group (14 .6%, p < 0.0001). Patients undergoing CEA in which a regional anesthetic was used had a significantly lower incidence of cardiopulmonary complications (myocardial infarction and postoperative intubation), cervical complications (neck hematomas and cranial nerve injuries), and urological complications (urinary retention) than patients who underwent surgery after receiving a general anesthetic.Conclusions. Patients undergoing CEA in which a regional anesthetic was used had significantly fewer nonneurological, nonfatal complications, particularly cardiopulmonary complications, than similar patients surgically treated after induction of general anesthesia.

scholarly journals Effects of early corticosteroid use in patients with severe coronavirus disease 2019

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jong Hoon Hyun ◽  
Moo Hyun Kim ◽  
Yujin Sohn ◽  
Yunsuk Cho ◽  
Yae Jee Baek ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Clinical Outcomes ◽  
Case Fatality ◽  
Length Of Hospital Stay ◽  
Corticosteroid Treatment ◽  
Threshold Value ◽  
Steroid Use ◽  
Corticosteroid Administration ◽  
Significant Difference ◽  
Early Use

Abstract Background Coronavirus disease 2019 (COVID-19) is associated with acute respiratory distress syndrome, and corticosteroids have been considered as possible therapeutic agents for this disease. However, there is limited literature on the appropriate timing of corticosteroid administration to obtain the best possible patient outcomes. Methods This was a retrospective cohort study including patients with severe COVID-19 who received corticosteroid treatment from March 2 to June 30, 2020 in seven tertiary hospitals in South Korea. We analyzed the patient demographics, characteristics, and clinical outcomes according to the timing of steroid use. Twenty-two patients with severe COVID-19 were enrolled, and they were all treated with corticosteroids. Results Of the 22 patients who received corticosteroids, 12 patients (55%) were treated within 10 days from diagnosis. There was no significant difference in the baseline characteristics. The initial PaO2/FiO2 ratio was 168.75. The overall case fatality rate was 25%. The mean time from diagnosis to steroid use was 4.08 days and the treatment duration was 14 days in the early use group, while those in the late use group were 12.80 days and 18.50 days, respectively. The PaO2/FiO2 ratio, C-reactive protein level, and cycle threshold value improved over time in both groups. In the early use group, the time from onset of symptoms to discharge (32.4 days vs. 60.0 days, P = 0.030), time from diagnosis to discharge (27.8 days vs. 57.4 days, P = 0.024), and hospital stay (26.0 days vs. 53.9 days, P = 0.033) were shortened. Conclusions Among patients with severe COVID-19, early use of corticosteroids showed favorable clinical outcomes which were related to a reduction in the length of hospital stay.

Resident involvement in laparoscopic procedures does not worsen clinical outcomes but may increase operative times and length of hospital stay

2015 ◽  
Vol 30 (9) ◽  
pp. 3783-3791 ◽  
Author(s):  
Jennifer Jolley ◽  
Daniel Lomelin ◽  
Anton Simorov ◽  
Carl Tadaki ◽  
Dmitry Oleynikov
Keyword(s):  
Hospital Stay ◽  
Clinical Outcomes ◽  
Length Of Hospital Stay ◽  
Laparoscopic Procedures ◽  
Resident Involvement

EP.TH.959Meta-analysis of temporary loop ileostomy closure during or after adjuvant chemotherapy following rectal cancer surgery: An ongoing dilemma

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Shahin Hajibandeh ◽  
Shahab Hajibandeh ◽  
Pratik Bhattacharya ◽  
Reza Zakaria ◽  
Christopher Thompson ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Adjuvant Chemotherapy ◽  
Surgical Site Infection ◽  
Hospital Stay ◽  
Perioperative Complications ◽  
Loop Ileostomy ◽  
Length Of Hospital Stay ◽  
Ileostomy Closure ◽  
Site Infection ◽  
Cancer Resection

Abstract Aims To evaluate comparative outcomes of temporary loop ileostomy closure during or after adjuvant chemotherapy following rectal cancer resection. Methods We systematic searched MEDLINE; EMBASE; CINAHL; CENTRAL; the World Health Organization International Clinical Trials Registry; ClinicalTrials.gov; ISRCTN Register, and bibliographic reference lists. Overall perioperative complications, anastomotic leak, surgical site infection, ileus and length of hospital stay were the evaluated outcome parameters. Combined overall effect sizes were calculated using fixed-effect or random-effects models. Results We identified 4 studies reporting a total of 436 patients comparing outcomes of temporary loop ileostomy closure during (n = 185) or after (n = 251) adjuvant chemotherapy following colorectal cancer resection. There was no significant difference in overall perioperative complications (OR 1.39; 95% CI 0.82-2.36, p = 0.22), anastomotic leak (OR 2.80; 95% CI 0.47-16.56, p = 0.26), surgical site infection (OR 1.97; 95% CI 0.80-4.90, p = 0.14), ileus (OR 1.22; 95% CI 0.50-2.96, p = 0.66) or length of hospital stay (MD 0.02; 95% CI -0.85-0.89, p = 0.97) between two groups. Between-study heterogeneity was low in all analyses. Conclusions The meta-analysis of best, albeit limited, available evidence suggests that temporary loop ileostomy closure during adjuvant chemotherapy following rectal cancer resection may be associated with comparable outcomes to closure of ileostomy after adjuvant chemotherapy. We encourage future research to concentrate on completeness of chemotherapy and quality of life which can determine appropriateness of either approach.

P5504Comparison of in-hospital clinical outcomes of acute myocardial infarction between nonagenarians and octogenarians: a propensity-score matched analysis

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Seguchi ◽  
K Sakakura ◽  
K Yamamoto ◽  
Y Taniguchi ◽  
H Wada ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Propensity Score ◽  
Hospital Stay ◽  
Propensity Score Matching ◽  
Clinical Outcomes ◽  
Length Of Hospital Stay ◽  
Hospital Death ◽  
Very Elderly ◽  
Hospital Outcomes

Abstract Background Acute myocardial infarction (AMI) in the very elderly is associated with high morbidity and mortality. Because the majority of study population in clinical researches focusing on the very elderly with AMI were octogenarians, clinical evidences regarding AMI in nonagenarians are sparse. The aim of the present study was to compare in-hospital clinical outcomes of AMI between octogenarians and nonagenarians. Methods We included consecutive 415 very elderly (≥80 years) patients with AMI, and divided into the nonagenarian group (n=38) and the octogenarian group (n=377). Clinical characteristics and in-hospital outcomes were compared between the 2 groups. Furthermore, we used propensity-score matching to find the matched octogenarian group (n=38). Results Percutaneous coronary interventions (PCI) to the culprit of AMI were similarly performed between the nonagenarian (86.8%) and octogenarian (87.0%) groups The incidence of in-hospital death in the nonagenarian group (13.2%) was similar to that in the octogenarian group (14.6%) (P=0.811). The length of hospital stay was significantly shorter in the nonagenarian group (7.4±4.2 days) than that in the octogenarian group (15.4±19.4 days) (P<0.001). After using the propensity-score matching, the incidence of in-hospital death was less in the nonagenarian group (13.2%) than in the matched octogenarian group (21.1%) without reaching statistical significance (P=0.361). The length of hospitalization was significantly shorter in the nonagenarian group (7.4±4.2 days) than in the matched octogenarian group (17.8±37.0 days) (P=0.01). Clinical outcomes Nonagenarian group (n=38) Octogenarian group (n=377) P value In-hospital death, n (%) 5 (13.2) 55 (14.6) 0.811 Length of hospital stay (days) 7.4±4.2 15.4±19.4 <0.001 Length of CCU stay (days) 3.3±2.5 4.7±5.1 0.109 LVEF (%) 48.2±9.2 50.8±13.7 0.152 Peak CPK (U/L) 1424.8±1580.8 1640.1±2394.4 0.912 CCU indicates Coronary care unit; LVEF, Left ventricular ejection fraction; CPK, Creatine kinase. Flow-chart Conclusions The in-hospital mortality of nonagenarians with AMI was comparable to that of octogenarians with AMI. In-hospital outcomes in nonagenarians with AMI may be acceptable as long as acute medical management including PCI to the culprit of AMI is performed. Acknowledgement/Funding None

The Impact of Perioperative Glutamine-supplemented Parenteral Nutrition on Outcomes of Patients Undergoing Abdominal Surgery: A Meta-analysis of Randomized Clinical Trials

2013 ◽  
Vol 79 (5) ◽  
pp. 506-513 ◽  
Author(s):  
Chao Yue ◽  
Weiliang Tian ◽  
Wei Wang ◽  
Qian Huang ◽  
Risheng Zhao ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Abdominal Surgery ◽  
Parenteral Nutrition ◽  
Hospital Stay ◽  
Clinical Outcomes ◽  
Nitrogen Balance ◽  
Infectious Complication ◽  
Meta Analysis ◽  
Length Of Hospital Stay ◽  
The Impact

The objective of this study was to evaluate the impact of perioperative glutamine-supplemented parenteral nutrition (GLN-PN) on clinical outcomes in patients undergoing abdominal surgery. MEDLINE, EMBASE, and the Cochrane Controlled Clinical Trials Register were searched to retrieve the eligible studies. Eligible studies were randomized controlled trials (RCTs) that compared the effect of GLN-PN and standard PN on clinical outcomes in patients undergoing abdominal surgery. Clinical outcomes of interest were postoperative mortality, length of hospital stay, morbidity of infectious complication, and cumulative nitrogen balance. Statistical analysis was conducted by RevMan 5.0 software from the Cochrane Collaboration. Sixteen RCTs with 773 patients were included in this meta-analysis. The results showed a significant decrease in the infectious complication rates of patients undergoing abdominal surgery receiving GLN-PN (risk ratio [RR], 0.48; 95% confidence interval [CI], 0.32 to 0.72; P = 0.0004). The overall effect indicated glutamine significantly reduced the length of hospital stay in the form of alanyl-glutamine (weighted mean difference [WMD], -3.17; 95% CI, -5.51 to -0.82; P = 0.008) and in the form of glycyl-glutamine (WMD, -3.40; 95% CI, -5.82 to -0.97; P = 0.006). A positive effect in improving postoperative cumulative nitrogen balance was observed between groups (WMD, 7.40; 95% CI, 3.16 to 11.63; P = 0.0006), but no mortality (RR, 1.52; 95% CI, 0.21 to 11.9; P = 0.68). Perioperative GLN-PN is effective and safe to shorten the length of hospital stay, reduce the morbidity of postoperative infectious complications, and improve nitrogen balance in patients undergoing abdominal surgery.

scholarly journals Statin Use and COVID-19 Infectivity and Severity in South Korea: Two Population-Based Nationwide Cohort Studies (Preprint)

2021 ◽  
Author(s):  
Seung Won Lee ◽  
So Young Kim ◽  
Sung Yong Moon ◽  
In Kyung Yoo ◽  
Eun-Gyong Yoo ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Hospital Stay ◽  
Clinical Outcomes ◽  
Length Of Hospital Stay ◽  
Population Based ◽  
Adjusted Relative Risk ◽  
Invasive Ventilation ◽  
Independent Population ◽  
Statin Use

BACKGROUND Basic studies suggest that statins as add-on therapy may benefit patients with COVID-19; however, real-world evidence of such a beneficial association is lacking. OBJECTIVE We investigated differences in SARS-CoV-2 test positivity and clinical outcomes of COVID-19 (composite endpoint: admission to intensive care unit, invasive ventilation, or death) between statin users and nonusers. METHODS Two independent population-based cohorts were analyzed, and we investigated the differences in SARS-CoV-2 test positivity and severe clinical outcomes of COVID-19, such as admission to the intensive care unit, invasive ventilation, or death, between statin users and nonusers. One group comprised an unmatched cohort of 214,207 patients who underwent SARS-CoV-2 testing from the Global Research Collaboration Project (GRCP)-COVID cohort, and the other group comprised an unmatched cohort of 74,866 patients who underwent SARS-CoV-2 testing from the National Health Insurance Service (NHIS)-COVID cohort. RESULTS The GRCP-COVID cohort with propensity score matching had 29,701 statin users and 29,701 matched nonusers. The SARS-CoV-2 test positivity rate was not associated with statin use (statin users, 2.82% [837/29,701]; nonusers, 2.65% [787/29,701]; adjusted relative risk [aRR] 0.97; 95% CI 0.88-1.07). Among patients with confirmed COVID-19 in the GRCP-COVID cohort, 804 were statin users and 1573 were matched nonusers. Statin users were associated with a decreased likelihood of severe clinical outcomes (statin users, 3.98% [32/804]; nonusers, 5.40% [85/1573]; aRR 0.62; 95% CI 0.41-0.91) and length of hospital stay (statin users, 23.8 days; nonusers, 26.3 days; adjusted mean difference –2.87; 95% CI –5.68 to –0.93) than nonusers. The results of the NHIS-COVID cohort were similar to the primary results of the GRCP-COVID cohort. CONCLUSIONS Our findings indicate that prior statin use is related to a decreased risk of worsening clinical outcomes of COVID-19 and length of hospital stay but not to that of SARS-CoV-2 infection.

scholarly journals Enhanced recovery care versus traditional non- ERAS  care following osteotomies in developmental dysplasia of the hip in children : a retrospective case-cohort study

2020 ◽  
Author(s):  
Jin Li ◽  
Saroj Rai ◽  
Renhao Ze ◽  
Xin Tang ◽  
Ruikang Liu ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Enhanced Recovery ◽  
Perioperative Complications ◽  
Length Of Hospital Stay ◽  
Developmental Dysplasia ◽  
Control Group ◽  
Postoperative Fever ◽  
Vas Score ◽  
Significant Difference ◽  
Dysplasia Of The Hip

Abstract Background: Enhanced recovery after surgery (ERAS) has been shown to shorten the length of hospital stay and reduce the incidence of perioperative complications in many surgical fields. However, there has been a paucity of research examining the application of ERAS in major pediatric orthopedic surgeries. This study aims to compare the perioperative complications and length of hospital stay after osteotomies in children with developmental dysplasia of the hip (DDH) between ERAS and traditional non-ERAS group. Methods: The ERAS group consisted of 86 patients included in the ERAS program from January 2016 to December 2017. The Control group consisted of 82 DDH patients who received osteotomies from January 2014 to December 2015. Length of hospital stay, physiological function, postoperative visual analogue scale (VAS) score, and postoperative complications were compared between the two groups. Results: The mean duration of hospital stay was significantly reduced from 10.0±3.1 in the traditional care group to 6.0±0.8 days in the ERAS(P<0.001). The VAS score in 3-day was significantly lower in ERAS group (2.9±0.8) than traditional non-ERAS group (4.0±0.8) (P<0.001). However, there was no significant difference in the frequency of breakout pain (VAS >4) between two groups (29.5±6.3 vs.30.6±6.5, P=0.276). The frequency of postoperative fever was lower in the ERAS group. The frequency of urinary tract infection in both groups were not noticeable because the catheter was removed promptly after the surgery. Conclusion: The ERAS protocol is both safe and feasible for pediatric DDH patients undergoing osteotomies, and it can shorten the length of hospital stay without increasing the risk of perioperative complications.

Correlates of lengthy stay in a mental health hospital

2018 ◽  
Vol 11 (1) ◽  
pp. 13-31
Author(s):  
Mostafa Mohamed Al Sayed ◽  
Michael Elnemais Fawzy
Keyword(s):  
Mental Health ◽  
Linear Regression ◽  
Hospital Stay ◽  
Mental Hospital ◽  
Length Of Hospital Stay ◽  
Content Type ◽  
Significant Difference ◽  
Group A ◽  
Inpatient Group ◽  
Main Factors

Purpose The purpose of this paper is to study the role of social factors that determine the length of stay in a mental hospital and also understand the main factors leading to the phenomena as a step to solve it. Design/methodology/approach A case-control cross-sectional observational study is performed which studies correlates for the lengthy stay in a mental hospital. The study population consists of two groups: Group A (94 patients), taken from the patients hospitalized for more than one year, further subdivided into schizophrenia and schizoaffective inpatient group and bipolar affective inpatient group; and Group B (94 patients), receiving their treatment at the outpatient clinic after being admitted for less than six months, this group was further subdivided into same categories as Group A. Findings The study showed that the positive score in positive and negative symptoms scale (PANSS) showed highly statistically significant (p<0.01) correlation with the length of hospital stay for the schizophrenic and schizoaffective patients in the inpatient group. The results showed no statistically significant difference (p>0.05) between the inpatient schizophrenic cases and the inpatient affective cases regarding the length of hospital stay. Research limitations/implications The linear regression model was used to understand the predictors of increased length of hospital stay. The linear regression analyzing the scale data of schizophrenic and schizoaffective patients found that the length of hospital stay for the schizophrenic and schizoaffective patients depends on the patient’s age and his positive PANSS score. On the other hand, linear regression model for bipolar affective patients in the study found no statistically significant attributes of the length of hospital stay. Practical implications The study found that the length of hospital stay for schizophrenic and schizoaffective patients depends on the patient’s age and his positive PANSS score. Social implications The need for this study stems from the large numbers of mental inpatients who have been lengthily admitted in mental health hospitals in Egypt, while trying to understand main factors leading to the phenomena as a step to solve it. The study found that there is a highly significant difference between inpatient group and outpatient group regarding the marital status, education level, and psychosocial class, with inpatient group having more single, illiterate, and very low social class cases. Originality/value Research in the area of chronic psychiatric hospitalization and its effect on the course and prognosis of mental illness is still scarce, especially in the Arab world; therefore, the research will open the door for further research efforts in the future with a larger sample of patients to study the pros and cons of deinstitutionalization taking into account the past experience of health systems in other countries.

scholarly journals Efficacy of Tolvaptan in Elderly Patients with Heart Failure and Preserved Ejection Fraction

2019 ◽  
Vol 5 (2) ◽  
pp. 59-65
Author(s):  
Yoriyasu Suzuki ◽  
Akira Murata ◽  
Satoshi Tsujimoto ◽  
Yusuke Ochiumi ◽  
Tatsuya Ito
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Elderly Patients ◽  
Hospital Stay ◽  
Clinical Outcomes ◽  
Rest Period ◽  
Length Of Hospital Stay ◽  
Bed Rest ◽  
Preserved Ejection Fraction ◽  
Patients With Heart Failure

Abstract Background: There is no known therapy with proven efficacy for improving clinical outcomes in elderly patients with heart failure (HF) and preserved ejection fraction (HFpEF). In this study, we aimed to evaluate the efficacy of tolvaptan (TLV) in elderly HFpEF patients. Methods: This retrospective observational study involved 100 consecutive elderly HFpEF patients hospitalized at the Nagoya Heart Center, Japan. Inclusion criteria were: (1) patients aged ≥75 years; (2) first hospitalization secondary to HF; (3) received medical therapy for HF, without invasive treatment; and (4) clinical follow-up for >6 months after discharge. The primary endpoint was rehospitalization due to worsening HF, and the secondary endpoint was worsening renal function (WRF) during hospitalization and at 6 months after discharge. Sixty background-matched HFpEF patients were divided into 2 groups: with TLV therapy (TLV (+), n = 29) and without TLV therapy (TLV (–), n = 31). In the TLV (+) group, TLV therapy was continued after discharge. Clinical outcomes of these patients were evaluated. Results: Bed rest period and length of hospital stay were significantly shorter in the TLV (+) group than in the TLV (−) group. The dose of loop diuretics, mean serum creatinine levels, and incidence of WRF development were significantly lower in the TLV (+) group. Incidence of rehospitalization was also significantly lower in the TLV (+) group (log-rank test; p = 0.018). The multivariate logistic regression analysis demonstrated that TLV therapy reduces the incidence of rehospitalization in elderly patients with HFpEF. Conclusions: TLV therapy reduced the bed rest period, length of hospital stay, and rate of rehospitalization without WRF in elderly HFpEF patients, suggesting that TLV could represent an effective therapy for this group of patients.

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