SURGICAL VERSUS CONSERVATIVE MANAGEMENT OF ACUTE APPENDICITIS DURING THE COVID-19 PANDEMIC

Background: We aim to analyse the management of patients presenting with AA to our institution during the first wave of the pandemic, comparing surgically and conservatively managed patients Method: Patients were categorised into surgically and conservatively managed groups. The primary outcome was the complication rate (post-operative complications vs failure of antibiotic treatment) and the secondary outcomes were length of hospital stay and Alvarado score. Results: Higher complication rates were observed amongst the conservatively managed group, although not found to be statistically significant (16.67% vs 34.78%; p=>0.05). There was no significant difference in length of hospital stay observed between the two groups (surgical: 2.31±1.02 days vs conservative: 2.62±1.12 days). Conclusions: COVID-19 has led to a significant cohort of conservatively managed AA patients. We propose a stratification pathway based on clinical severity, Alvarado score and imaging to facilitate safe selection for conservative management of AA, in order to reduce failure of treatment rates in this patient group. Keywords: Appendicectomy, Appendicitis, Conservative, Coronavirus

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816 Managing Acute Appendicitis During the First Wave of the COVID-19 Pandemic: A Single-Centre Retrospective Study

British Journal of Surgery ◽

10.1093/bjs/znab259.478 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

A Lotfallah ◽

A Aamery ◽

G Moussa

Keyword(s):

Acute Appendicitis ◽

Hospital Stay ◽

Statistical Significance ◽

Length Of Hospital Stay ◽

Interquartile Range ◽

Secondary Outcome ◽

Complication Rates ◽

Alvarado Score ◽

Significant Difference

Abstract Introduction The COVID-19 pandemic provoked a change to normal surgical practice and led to a higher proportion of acute appendicitis (AA) patients being treated conservatively with antibiotics. We aim to analyse patients presenting with AA during the first wave of the pandemic, comparing surgically and conservatively managed patients. Method All patients presenting to our centre with AA between March and July 2020 were included. Six-month follow-up data was collected retrospectively using electronic records. Patients were categorised into surgically and conservatively managed groups. The primary outcome was the complication rate (post-operative complications vs failure of antibiotic treatment) and the secondary outcome was length of hospital stay. Results Fifty-seven patients (n = 57) were admitted with AA, 45.6% (n = 26) managed conservatively compared to 54.4% (n = 31) treated surgically. Higher complication rates were observed amongst the conservatively managed group, although not statistically significant (16% vs 35%; p = 0.131). There was no significant difference in length of hospital stay observed between the two groups (surgical: median, 2; interquartile range, 2-3 vs conservative: median, 3; interquartile range, 2-4). White cell count (WCC) and Alvarado score were higher on admission in the surgical group with statistical significance (p = 0.012 and p = 0.028 respectively). Conclusions Stratification criteria, such as Alvarado score and WCC may identify patients more suitable for conservative management. Longer term follow-up will be carried out, which may alter complication rates in either group. We suggest all patients treated conservatively should undergo computerised tomography (CT) to exclude complicated appendicitis. Further UK-based studies will add to the evidence-base surrounding management of AA during the COVID-19 pandemic.

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Open cystectomy is still alive and well: Outcomes from a single-centre 6-year review

Journal of Clinical Urology ◽

10.1177/2051415818759366 ◽

2018 ◽

Vol 12 (3) ◽

pp. 239-245

Author(s):

Alexios Dosis ◽

Blessing Dhliwayo ◽

Patrick Jones ◽

Iva Kovacevic ◽

Jonathan Yee ◽

...

Keyword(s):

Blood Loss ◽

Hospital Stay ◽

Radical Cystectomy ◽

Length Of Hospital Stay ◽

Categorical Variables ◽

Complication Rates ◽

Intraoperative Blood Loss ◽

Single Centre ◽

Significant Difference ◽

Duration Of Surgery

Objectives: To compare perioperative and oncological outcomes between open and laparoscopic radical cystectomy in a single-centre setting. Materials and methods: This study was a retrospective cohort (level 2b evidence) non-randomised review of 228 radical cystectomies that were performed between January 2010 and February 2016. Primary outcome measures were operative time, complications, blood loss and length of hospital stay. Statistical analysis was performed using the SPSS v21.0. Quantitative values were compared with Student’s t-test; categorical variables with the chi-square test. Statistical significance was considered a result of an alpha value less than 0.05. A Kaplan–Meier survival analysis was also conducted. Results: Intraoperative blood loss was lower in laparoscopic surgery (855±673 vs. 716±570 mL, P=0.15), which had a significant impact on transfusion rates ( P=0.02). Operative times were lower in open surgery (339±52.9 vs. 353.1±67.1 minutes, P=0.10), while hospital stay was lower in the laparoscopic group (14.2±11.2 vs. 16.0±13.6 days, P=0.28). Five-year survival rates were superior for patients who underwent an open procedure but were not statistically significant ( P=0.10). Conclusion: This is, so far, the largest cohort to compare laparoscopic and open radical cystectomy. The laparoscopic approach can reduce the need for transfusion; however, there was no statistically significant difference in complication rates, duration of surgery, length of hospital stay or intraoperative blood loss, survival and margin positivity. Level of evidence: Not applicable for this multicentre audit.

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Feasibility of short term drainage for diagnostic thoracoscopy

Monaldi Archives for Chest Disease ◽

10.4081/monaldi.2009.361 ◽

2016 ◽

Vol 71 (2) ◽

Author(s):

D.P. Breen ◽

S. Mallawathantri ◽

A. Fraticelli ◽

L. Greillier ◽

P. Astoul

Keyword(s):

Hospital Stay ◽

Length Of Hospital Stay ◽

Economic Benefits ◽

Optimal Time ◽

Chest Drain ◽

Complication Rates ◽

Short Term ◽

Drainage Time ◽

Drain Removal ◽

Significant Difference

Background and Aim. Thoracoscopy is a diagnostic tool superior to other available techniques for the assessment of pleural effusions. There are numerous publications that describe the technique in detail but there is very little published on the optimal time of chest drain removal post procedure. Our aim was to retrospectively study all cases of diagnostic thoracoscopy and to ascertain the time of chest drain removal, length of hospital stay and associated complications. Methods. All patients who underwent thoracoscopy during a 6-year period were identified from a computerised database. Patients who received talc for pleurodesis were excluded as they required longer drainage time. A review of the remaining patients’ charts and radiology was performed to ascertain the predefined outcomes. Results. 124 patients had a diagnostic thoracoscopy. The time to chest drain removal was documented as less than four hours, four to 24 hours, 24 to 48 hours and greater than 48 hours in 66 (53.2%), 29 (23.4%), 12 (9.7%) and 17 (13.7%) of patients respectively. The median length of stay for all patients was one day (interquartile range, 1-4 days). There was a statistically significant difference in overall length of hospital stay between the early (48 hours) chest drain removal groups, p=0.0028. The overall complication rate was 15.9%. There was no statistical difference in complication rates between the two groups. Conclusion. This retrospective series demonstrates that early chest drain removal post diagnostic thoracoscopy is possible and safe. This is likely to confer economic benefits.

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Laparoscopic Versus Open Simple Nephrectomy Our Initial Experiences

Bangladesh Journal of Urology ◽

10.3329/bju.v23i1.50290 ◽

2020 ◽

Vol 23 (1) ◽

pp. 52-55

Author(s):

Md Naushad Alam ◽

Md Shawkat Alam ◽

Khan Nazrul Islam ◽

Md Latifur Rahman Miah ◽

Anup Roy Chowdhury ◽

...

Keyword(s):

Hospital Stay ◽

Operative Time ◽

Kidney Diseases ◽

Laparoscopic Nephrectomy ◽

Complication Rates ◽

Significant Group ◽

Female Ratio ◽

Significant Difference ◽

Operative Complications ◽

Open Nephrectomy

Background: Nephrectomy is indicated in patients with an irreversibly damaged kidney. The nephrectomy can be performed through open or laparoscopic procedure. Although there is evidence that laparoscopy is the preferred choice, additional evidence is indicated. Objective: To compare the outcomes of nephrectomy through open and laparoscopic procedures. Methods: This prospective observational study was conducted in the Department of Urology, National Institute of Kidney Diseases and Urology, Sher-e-Bangla Nagar, Dhaka from July 2017 to December 2019 over a period of two and half years. In this study, 13 patients had laparoscopic nephrectomy and 17 patients had open nephrectomy. Operative time, length of hospital stay, loss of bleeding, transfusion requirement, peri and post-operative complications were recorded and compared. SPSS 12 was used for analysis. Categorical data were compared with Chi-square test and numerical data were compared with unpaired t test. Results: Maximum patients were more than 40 year old and mean age was 43.53 ± 5.55 years & 41.46 ± 6.31 years in open & laparoscopic nephrectomy group respectively. Male and female ratio was almost similar in both groups. Operative time for open nephrectomy was significantly lower than operative time for laparoscopic nephrectomy (147.9 ± 34.2 vs 184.6 ± 33.3 min; p=0.004). Mean length of post-operative hospital stay was significantly longer for patients receiving open surgery than for patients receiving laparoscopy (7.06 ± 3.67 days vs 3.92 ± 0.86 days; p = <0.001). There was no significant difference in mean postoperative time to oral intake for patients receiving open and laparoscopic nephrectomy (24.71 ± 2.91 hours and 24.00 ± 0.00 hours; p = 0.391). Per-operative complications occurred in 9 (52.9%) patients in the open nephrectomy group and in 3 (23.1%) patients in laparoscopic nephrectomy group. There was no significant group difference in complication rates (P = 0.098). Pain was reduced significantly in both groups. In each follow up, VAS was significantly lower in laparoscopic nephrectomy group than open nephrectomy group groups. Conclusion: The overall outcomes of the two procedures were similar. Pain was significantly less in laparoscopic nephrectomy. Bangladesh Journal of Urology, Vol. 23, No. 1, January 2020 p.52-55

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Intravenous Immunoglobulin-based Adjuvant Therapy for Severe COVID-19: a Single-center Retrospective Cohort Study

10.21203/rs.3.rs-258587/v1 ◽

2021 ◽

Author(s):

Xiao Hou ◽

Li Tian ◽

Lei Zhou ◽

Xinhua Jia ◽

Li Kong ◽

...

Keyword(s):

Mechanical Ventilation ◽

Cohort Study ◽

Adjuvant Therapy ◽

Hospital Stay ◽

Retrospective Cohort ◽

Primary Outcome ◽

Length Of Hospital Stay ◽

Confounding Factors ◽

Single Center ◽

Significant Difference

Abstract Objective Coronavirus disease 2019 (COVID-19) is a major challenge facing the world. Certain guidelines recommend intravenous immunoglobulin (IVIG) for adjuvant treatment of COVID-19. However, there is a lack of clinical evidence to support the use of IVIG.Methods This single-center retrospective cohort study included all adult patients with laboratory-confirmed severe COVID-19 in the Respiratory and Critical Care Unit of Dabie Mountain Regional Medical Center, China. Patient information, including demographic data, laboratory indicators, the use of glucocorticoids and IVIG, hospital mortality, the application of mechanical ventilation, and the length of hospital stay was collected. The primary outcome was the composite end point, including death and the use of mechanical ventilation. The secondary outcome was the length of hospital stay.Results Of the 285 patients with confirmed COVID-19, 113 severely ill patients were included in this study. Compared with the non-IVIG group, more patients in the IVIG group reached the composite end point [12 (25.5%) vs 5 (7.6%), P=0.008]. However, there was no statistically significant difference in the primary outcome between the two groups (P=0.167) after adjusting for confounding factors. Patients in the IVIG group had a longer hospital stay [23.0 (19.0-31.0) vs 16.0 (13.8-22.0), P<0.001]. After adjusting for confounding factors, there was still a statistically significant difference between the two groups (P=0.041).Conclusion Adjuvant therapy with IVIG did not improve the in-hospital mortality rate or the need for mechanical ventilation in patients with severe COVID-19. In contrast, the application of IVIG was related to a longer hospital stay.

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Effects of perioperative enteral glutamine on surgical outcome in gastrointestinal cancer patients

International Surgery Journal ◽

10.18203/2349-2902.isj20190822 ◽

2019 ◽

Vol 6 (3) ◽

pp. 903

Author(s):

Raghavendra . ◽

Raghupathi S.

Keyword(s):

Hospital Stay ◽

Anastomotic Leak ◽

Gastrointestinal Cancer ◽

Gastrointestinal Surgery ◽

Length Of Hospital Stay ◽

Complication Rates ◽

Ultrasound Guided ◽

Significant Difference ◽

Group A ◽

Group B

Background: Previous trials have shown that perioperative glutamine could protect patients from infectious complications after gastrointestinal cancer operations.Methods: 54 patients with a planned elective operation for gastrointestinal cancer were divided into two groups: GROUP A: patients given glutamine enriched enteral nutrition perioperatively (n=27), GROUP B: patients given enteral feed without glutamine (n=27). Patients were assessed in terms of post-operative complications like infective complications, anastomotic leak, need for reintervention, length of hospital stay and mortality.Results: In group A seven patients and in group B six patients had surgical site infection post operatively (p=0.750). In group A five patients and in group B three patients had lung and urinary tract infection post operatively (p=0.444). In group A three patients and in group B five patients had intra-abdominal abscess/collection post operatively (p=0.444). In group A one patient and in group B three patients had anastomotic leak post operatively (p=0.299). In group A three patients and in group B three patients had reintervention in form of ultrasound guided aspiration and ultrasound guided pigtail aspiration for intra-abdominal collection (p=1.000). In group A and in group B mean length of hospital stay was 26 days and 23 days respectively (p=0.346). In group A and in group B mean length of post-operative hospital stay was 13 and 12 days respectively (p=0.642). There was no mortality in our study. No significant difference between the groups was found in complication rates, length of hospital stay.Conclusions: Routine perioperative glutamine to the patients undergoing major gastrointestinal surgery is not beneficial.

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Outcome of Photoselective Vaporization of the Prostate with the GreenLight-XPS 180 Watt System Compared to Transurethral Resection of the Prostate

Journal of Clinical Medicine ◽

10.3390/jcm8071004 ◽

2019 ◽

Vol 8 (7) ◽

pp. 1004 ◽

Cited By ~ 3

Author(s):

Maximilian Reimann ◽

Nikita Fishman ◽

Isabel Lichy ◽

Laura Wiemer ◽

Sebastian Hofbauer ◽

...

Keyword(s):

Hospital Stay ◽

Transurethral Resection ◽

Length Of Hospital Stay ◽

Patient Reported Outcome ◽

Treatment Modalities ◽

Complication Rates ◽

Significant Difference ◽

Patient Reported ◽

Photoselective Vaporization

The aim of this paper was to compare the perioperative and postoperative results of photoselective vaporization of the prostate with the GreenLight-XPS 180 Watt System (PVP) and transurethral resection of the prostate (TURP). This retrospective study included 140 men who underwent PVP and 114 men who underwent TURP for symptomatic benign prostate enlargement (BPE) between June 2010 and February 2015. The primary outcome measures were the patient reported outcome, operative results, International Prostate Symptom Score-Quality of Life (IPSS-QoL), complication rates, catheterization time, and length of hospital stay. The median follow-up times were 27 months (range 14–44) for the PVP group and 36 months (range 25–47) for the TURP group. The patient characteristics were well balanced in both groups with a median age of 71 years (PVP group) vs. 70 years (TURP group) and a comparable prostate volume (median 50 mL in the PVP group vs. 45 mL in the TURP group). The IPSS-QoL was significantly higher in the PVP group than in the TURP group (median 22 + 4; range 16–27 + 3−5 vs. median 19 + 3; range 15−23 + 3−4; p = 0.02). Men undergoing PVP were more likely to be on anticoagulants (PVP group n = 23; 16% vs. TURP group n = 2; 2%, p < 0.001). The median operation time (OT; min) for both procedures was comparable with 68 min (PVP group; range 53–91) vs. 67 min (TURP group; range 46–85). The rate of severe intraoperative bleeding was significantly lower in the PVP group than in the TURP group (n = 7; 5% vs. n = 16; 14%; p = 0.01). The postoperative catheterization time and length of hospital stay was significantly lower in the PVP group (median 1–2 days; range 1–4) vs. the TURP group (median 2–4 days; range 2–5; both p < 0.001). Complication rates (Clavien-Dindo classification ≥III) based on the follow-up data showed no statistically significant difference between the PVP group and the TURP group (n = 6; 4% vs. n = 6; 5%; p = 0.28). The IPSS on follow-up showed an equivalent reduction in symptoms for both treatment modalities (IPSS-QoL of 5 + 1; range 2–11 + 0−2 for both). There were no differences concerning urge (PVP group n = 3; 2% vs. TURP group n = 3; 3%; p = 0.90) and men were similarly satisfied with the postoperative outcome (PVP group 92% vs. TURP group 87%; p = 0.43). The PVP group was associated with a shorter hospitalization time and showed a reduced risk of bleeding, despite patients remaining on anticoagulants, without increasing the overall operative time. There was no difference in the patient reported outcome for both procedures.

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Transoral versus Transcervical Drainage of Pharyngeal Abscesses in Children: Post-Operative Complications

Annals of Otology Rhinology & Laryngology ◽

10.1177/0003489421990161 ◽

2021 ◽

pp. 000348942199016

Author(s):

Christopher A. Maroun ◽

Habib G. Zalzal ◽

Ayman A. Mustafa ◽

Michele Carr

Keyword(s):

Hospital Stay ◽

Length Of Hospital Stay ◽

Perioperative Outcomes ◽

Improvement Program ◽

Surgical Quality ◽

Ventilator Support ◽

Significant Difference ◽

Operative Complications ◽

Baseline Characteristics ◽

Post Operative Complications

Introduction: The objective of this study was to compare complications and other perioperative outcomes between intraoral and transcervical drainage of both retropharyngeal and parapharyngeal abscesses. Materials and Methods: This was a retrospective study that analyzed data from the 2012 to 2016 National Surgical Quality Improvement Program (NSQIP)-Pediatric public use files. Baseline characteristics and perioperative outcomes including postoperative complications and length of hospital stay (LOS) were compared between intraoral and transcervical drainage groups. Multivariable logistic regression was performed to inspect predictors of having an extended LOS, defined as LOS greater than 3 days. Results: A total of 1174 patients were included. Mean age was 5.1 ± 3.8 years in the intraoral group (N = 1063) and 4.2 ± 4.3 years in the transcervical group (N = 111, P < .001). There was no significant difference in the rate of post-operative complications between groups (5.7% intraoral vs 8.1% transcervical, P = .316). LOS was significantly longer in the transcervical group (>3 days in 36.2% of intraoral vs 49.5% of transcervical, P = .006). Patients in the transcervical group had 1.59 times the odds of extended LOS, after adjusting for age, pre-operative ventilator support, asthma, structural pulmonary disease, hematologic disorders, and all post-operative complications ( P = .024). Conclusion: There does not appear to be a significant difference in the rate of post-operative complications after intraoral versus transcervical drainage for pharyngeal abscesses in children. However, transcervical drainage was associated with an extended hospital stay. Further prospective studies will be needed to determine the reasons for this.

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Effect of Chewing Gum on Bowel Motility in Women Undergoing Post-Operative Cesarean Section

International Journal of Innovative Research in Medical Science ◽

10.23958/ijirms/vol03-i06/04 ◽

2018 ◽

Vol 3 (06) ◽

Author(s):

Dr.Randa Mohammed AboBaker

Keyword(s):

Cesarean Section ◽

Hospital Stay ◽

Demographic Data ◽

Length Of Hospital Stay ◽

Chewing Gum ◽

Control Group ◽

Controlled Clinical Trial ◽

Bowel Motility ◽

Gum Chewing ◽

Significant Difference

Postoperative Ileus (POI) is one of the most common problems after obstetrics, gynecologic and abdominal surgeries. Sham feeding, such as gum chewing, accelerates the return of bowel function and the length of hospital stay. The present study aims to evaluate the effect of chewing gum on bowel motility in women undergoing post-operative cesarean section. Intervention study was used at the Postpartum Department of Maternity and Children Hospital, KSA. A randomized controlled clinical trial research design. Through a convenience technique, 80 post Caesarian Section (CS) women were included in the study. Data were collected through three tools: Tool (I): Socio-demographic data and reproductive history interview schedule. Tool (II): Postoperative Assessment Sheet. Tool (III): Outcomes of gum chewing and the length of hospital stay. Method: subjects were assigned randomly into two groups of (40) the experimental and (40) the control. Subjects in the study group were asked to chew two pieces of sugarless gum for 30 min/three times daily in the morning, noon, and evening immediately after recovery from anesthesia and in Postpartum Department; while subjects in the control group followed the hospital routine care. Each woman in both groups was tested abdominally using a stethoscope to auscultate the bowel sounds and asked to report immediately the time of either passing flatus or stool. Results: illustrated that a highly statistically significant difference was observed between the two groups concerning their gum chewing outcomes. Where, P = 0.000. The study concluded that gum chewing is safe, well tolerated and appears to be effective in reducing the incidence and consequences of POI following CS.

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Implementation of enhanced recovery after surgery in gynecological operations: a randomized controlled trial

Ain-Shams Journal of Anesthesiology ◽

10.1186/s42077-020-00116-4 ◽

2020 ◽

Vol 12 (1) ◽

Author(s):

Amr Nady Abdelrazik ◽

Ahmad Sameer Sanad

Keyword(s):

Hospital Stay ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Controlled Trial ◽

Length Of Hospital Stay ◽

Gynecologic Surgery ◽

Complication Rates ◽

Control Groups ◽

Analog Scale ◽

Randomized Controlled

Abstract Background To investigate the effects of enhanced recovery after surgery (ERAS) in patients undergoing gynecologic surgery on length of hospital stay, pain management, and complication rate. Results The length of hospital stay was reduced in ERAS groups when compared with the control groups (3.46 days vs 2.28 days; P < 0.0001; CI − 1.5767 to − 0.7833 for laparotomy groups and 2.18 vs 1.76 days; P = 0.0115; CI − 0.7439 to − 0.0961 for laparoscopy groups respectively). Intraoperative fluid use was reduced in both ERAS groups compared to the two control groups (934 ± 245 ml and 832 ± 197 ml vs 1747 ± 257 ml and 1459 ± 304 respectively; P < 0.0001) and postoperative fluid use was also less in the ERAS groups compared to the control groups (1606 ± 607 ml and 1210 ± 324 ml vs 2682 ± 396 ml and 1469 ± 315 ml respectively; P < 0.0001). Pain score using visual analog scale (VAS) on postoperative day 0 was 4.8 ± 1.4 and 4.1 ± 1.2 (P = 0.0066) for both laparotomy control and ERAS groups respectively, while in the laparoscopy groups, VAS was 3.8 ± 1.1 and 3.2 ± 0.9 (P = 0.0024) in control and ERAS groups respectively. Conclusion Implementation of ERAS protocols in gynecologic surgery was associated with significant reduction in length of hospital stay, associated with decrease intravenous fluids used and comparable pain control without increase in complication rates.

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