Epidemiology and One-Year Follow-Up of Neonates with CDH-Data from Health Insurance Claims in Germany

Congenital diaphragmatic hernia (CDH) is a major congenital malformation with high mortality. Outcome data on larger unselected patient groups in Germany are unavailable as there is no registry for CDH. Therefore, routine data from the largest German health insurance fund were analyzed for the years 2009–2013. Main outcome measures were incidence, survival and length of hospital stay. Follow-up was 12 months. 285 patients were included. The incidence of CDH was 2.73 per 10,000 live births. Overall mortality was 30.2%. A total of 72.1% of the fatalities occurred before surgery. Highest mortality (64%) was noted in patients who were admitted to specialized care later as the first day of life. Patients receiving surgical repair had a better prognosis (mortality: 10.8%). A total of 67 patients (23.5%) were treated with ECMO with a mortality of 41.8%. The median cumulative hospital stay among one-year survivors was 40 days and differed between ECMO- and non-ECMO-treated patients (91 vs. 32.5 days, p < 0.001). This is the largest German cohort study of CDH patients with a one-year follow-up. The ECMO subgroup showed a higher mortality. Another important finding is that delayed treatment in specialized care increases mortality. Prospective clinical registries are needed to elucidate the treatment outcomes in detail.

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Evaluation of Rib Fractures due to Trauma

Current Journal of Applied Science and Technology ◽

10.9734/cjast/2021/v40i731328 ◽

2021 ◽

pp. 46-50

Author(s):

Suphi Aydin ◽

Ahmet Dumanli ◽

Adem Gencer

Keyword(s):

Gastrointestinal Bleeding ◽

Hospital Stay ◽

Traffic Accidents ◽

Length Of Hospital Stay ◽

Mortality Rates ◽

Rib Fractures ◽

The Mean ◽

One Year ◽

The One

Introduction and Aim: We aimed to evaluate the one-year mortality rates and the effect of comorbid diseases on mortality in patients with trauma and isolated rib fractures. Materials and Methods: Ninety patients who had trauma, isolated rib fracture between January 2016 and December 2016 and could be reached after one year after the trauma were included in the study. The files of the patients were scanned retrospectively. Age, gender, and length of hospital stay were recorded. After one-year follow-up, they were contacted by phone to evaluate the rates of additional disease and mortality. Results: 27 of the patients were female (30%), 63 of them were male (70%). Regarding the causes of injury, there were falls in 42 patients at most and in-vehicle traffic accidents in 35 patients. The mean age was 56.85 ± 16.33, the mean hospital stay was 4.04 ± 4.55 days. The most common comorbidities were diabetes mellitus in 13 patients and hypertension in 11 patients. The least detected additional diseases are; Ulcerative colitis, epilepsy, arrhythmia, gastroesophageal reflux, gastrointestinal bleeding, rheumatism, Alzheimer and Familial Mediterranean Fever in 1 patient each. One patient died who had gastrointestinal bleeding. Mortality rate was 1.11%. Conclusions: Post-traumatic rib fractures disrupt people's quality of life and cause morbidity and mortality. Although the risk of comorbid mortality increases, close follow-up is important in preventing or reducing mortality rates.

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Relationship of Volume of Lesion to Length of Hospital Stay and Outcome at One Year in Stroke Patients

Scottish Medical Journal ◽

10.1177/003693300104600609 ◽

2001 ◽

Vol 46 (6) ◽

pp. 178-183 ◽

Cited By ~ 1

Author(s):

J.M. Maddox ◽

R.S. MacWalter ◽

A.D. McMahon

Keyword(s):

Hospital Stay ◽

Functional Outcome ◽

Univariate Analysis ◽

Length Of Hospital Stay ◽

Lesion Volume ◽

Functional Outcome Measures ◽

One Year ◽

Relationship Of ◽

The Relationship

The aim of this study was to investigate the relationship between the volume of lesion (VOL) in patients with stroke and the associated length of hospital stay (LOS), as well as longer-term functional outcome. Computerised tomography (CT) scans were used to measure the volume, region and type of lesion, volume being measured by planimetry. LOS and other patient details were obtained from the Dundee Stroke Database. The total LOS was associated with the VOL on univariate analysis (p=0.004) and after adjustment for the other variables (p-0.006) due to a larger lesion being associated with longer stay in hospital. Patient follow-up confirmed that the VOL was also highly significant when related to functional outcome measures of impairment, disability and handicap at one year, as determined by Orgogozo (p=0.03), Barthel (p<0.01) and Rankin scores (p<0.01) respectively. The VOL is related to the length of stay in hospital and outcome at one year. This is of particular interest with the increasing use of thrombolysis and development of neuroprotectant agents designed to limit VOL.

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Comparison of Survival Between Patients Receiving General Ambulatory Palliative Care and Patients Receiving Other Palliative Care - Analysis of Data of a Statutory Health Insurance Data

10.21203/rs.3.rs-1003758/v1 ◽

2021 ◽

Author(s):

Kilson Moon ◽

Laura Rehner ◽

Wolfgang Hoffmann ◽

Neeltje van den Berg

Keyword(s):

Palliative Care ◽

Health Insurance ◽

Median Survival ◽

Statutory Health Insurance ◽

Survival Curves ◽

Specialized Care ◽

Group A ◽

One Year ◽

Group B

Abstract Background The care of palliative patients takes place as non-specialized and specialized care, in both ambulatory and stationary settings. However, palliative care is largely provided as non-specialized care in the ambulatory sector (AAPV). This study aimed to investigate whether the survival curves of AAPV patients differed from those of the more intensive palliative care modalities and whether AAPV palliative care was appropriate in terms of timing.Methods The study is based on claims data from a large statutory health insurance. The analysis included 4,177 patients who received palliative care starting in 2015 and who were fully insured one year before and one year after palliative care or until death. The probability of survival was observed for 12 months. Patients were classified into group A, which consisted of patients who received palliative care only with AAPV, and group B including patients who received stationary or specialized ambulatory palliative care. Group A was further divided into two subgroups. Patients who received AAPV on only 1 day were assigned to Subgroup A1, and patients who received AAPV on two or more days were assigned to Subgroup A2. The survival analysis was carried out using Kaplan-Meier curves. The median survival times were compared with the log-rank test.Results The survival curves differed between groups A and B, except in the first quartile of the survival distribution. The median survival was significantly longer in group A (137 days, n=2,763) than in group B (47 days, n=1,424, p<0.0001) and shorter in group A1 (35 days, n=986) than in group A2 (217 days, n=1,767, p<0.0001). The survival rate during the 12-month follow-up was higher in group A (42%) than in group B (11%) and lower in group A1 (38%) than in group A2 (44%).Conclusions The results of the analysis revealed that patients who received the first palliative care shortly before death suspected insufficient care, especially patients who received AAPV for only 1 day and no further palliative care until death or 12-month follow-up. Palliative care should start as early as necessary and be continuous until the end of life.

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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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Abdominal sacrohysteropexy UV prolapse and preservation of reproduction.

The Professional Medical Journal ◽

10.29309/tpmj/2021.28.05.4562 ◽

2021 ◽

Vol 28 (05) ◽

pp. 652-655

Author(s):

Robina Ali ◽

Riffat Ehsan ◽

Ghazala Niaz ◽

Fatima Abid

Keyword(s):

Hospital Stay ◽

Length Of Hospital Stay ◽

Uterovaginal Prolapse ◽

Prolapse Recurrence ◽

Gynecology And Obstetrics ◽

Duration Of Surgery ◽

Operative Complications ◽

Operative Recovery ◽

Post Operative Complications

Objectives: The purpose of this study was to assess the safety of sacrohystcopxy by determining intraoperative and post-operative complications and its effectiveness by pelvic organ prolapse recurrence on follow up. Study Design: Prospective study. Setting: Department of Gynecology and Obstetrics Unit-II DHQ Hospital PMC, Faisalabad. Period: Jan-2014 to Jan-2017. Material & Methods: Patients with uterovaginal prolapse, admitted through OPD were selected for abdominal sacrohysteropexy. Variables of study including duration of surgery, any intra-operative and post operative complications, need of intra operative blood transfusion, post operative hospital stay; recurrence of POP, number of pregnancies in 06 moths follow up were recorded. Results: During this study period, 319 patients were admitted with uterovaginal prolapse. 32 (10.03%) cases were selected for abdominal sacrohysteropexy. In these 32 patients, 03 (9.37%) were <30years of age, 21(65.62%) were between 30-35 years and 8 (25%) were between 35-40 years of age. About 2(6.25%) were unmarried, while 30(93.7%) were married. In these married women 14(43.75%) were multiparas, another 14(43.75%) were para 1 or 2, while 4(12.5%) were para 3 or more. Duration of surgery was 40-45 minutes in 31(96.87%) patients. In 28(87.5%) cases per operative blood loss was <150ml while in 4(12.5%) it was estimated to be >150ml but less than 300ml. Post operatively only 1(3.12%) case developed wound sepsis and it was the only one (3.12%) who was discharged on 7th post operative day, while rest 31(96.87%) were discharged on 3rd post operative day. No recurrence was noticed in 06 moths follow up, while 2(6.25%) patients became pregnant. Conclusion: Abdominal sacrohysteropexy is a safe and an effective treatment in terms of overall anatomical and functional outcome, complications, post operative recovery, length of hospital stay and sexual functioning, in women who desire uterine and hence fertility preservation.

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Locked intramedullary nailing technique of the femur without brilliance amplifier at the trauma and orthopedics department of the university hospital of peace series on 35 cases during 1 year

MOJ Orthopedics & Rheumatology ◽

10.15406/mojor.2021.13.00556 ◽

2021 ◽

Vol 13 (5) ◽

pp. 95-97

Author(s):

Augustin Delange Hendrick ◽

Almenord Pharol ◽

Khawly Clifford PG ◽

Augustin Delange ◽

Pierre Marie Woolley

Keyword(s):

Hospital Stay ◽

Intramedullary Nailing ◽

Femoral Fractures ◽

Length Of Hospital Stay ◽

University Hospital ◽

Patient Morbidity ◽

Duration Of Hospitalization ◽

The Cost ◽

The University

Femoral fractures increase the length of hospital stay for our patients for several reasons such as lack of blood, economic resources, and lack of infrastructure. The use of a C-arm has been shown to reduce patient morbidity due to early functional recovery and reduced hospital stay. Objective: To develop an intramedullary nailing technique without c-arm with a closed focus to reduce the duration of hospitalization of its patients as well as the cost related to the equipment used for follow-up. Methodology: prospective study on 35 patients for 1 year August 2020 to August 2021 Results: We followed 35 patients in which the mean age was 37.83 years with extremes of 18 and 78 years. The male sex predominates 21 against 14 women or 60% against 40% respectively. The sex ratio is 1.5. A total of 19 diaphyseal fractures (54.3%) were nailed, 9 supracondylar (25.7%) and 7 subtrochanteric (20%). Twenty-seven were closed fractures (71.1%), and 8 were open fractures (22.9%). The length of hospitalization was less than 3 days for 30 patients (85.7%), and more than 3 days for 5 patients (14.3%). Conclusion: We recommend that we promote this closed-hearth technique because it improves the postoperative follow-up of patients. Additionally, it would reduce exposure to radiation from c-arm in hospitals that have this equipment.

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Abstract TP170: Persistently Elevated Factor VIII In Acute Ischemic Stroke Is Associated With Higher CRP, Lower Baseline NIHSS, And Longer Length Of Hospital Stay

Stroke ◽

10.1161/str.44.suppl_1.atp170 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Adrianne M Dorsey ◽

Amelia K Boehme ◽

Laurie Schluter ◽

Karen C Albright ◽

Tiffany R Chang ◽

...

Keyword(s):

Ischemic Stroke ◽

Factor Viii ◽

Hospital Stay ◽

Acute Ischemic Stroke ◽

Acute Phase ◽

Clinical Course ◽

Length Of Hospital Stay ◽

Lower Baseline ◽

Persistent Elevation

Objective: We sought to determine the proportion of patients with elevated factor VIII (FVIII) levels whose FVIII levels remain elevated after the acute phase of stroke, and the patient characteristics that predict sustained elevation of FVIII levels. Background: Factor VIII plays a major role in the fluid phase of blood coagulation. Elevated FVIII has been shown to increase risk of venous and arterial thrombosis. The importance of screening for elevated FVIII after a first thrombotic event especially acute ischemic stroke (AIS) has not been adequately investigated. Design/Methods: We reviewed FVIII levels taken at baseline and follow-up in patients with AIS treated at our stroke center from July 2008 to June 2012. Elevated FVIII was defined as >150%. Baseline demographics, laboratory data, clinical course, outcomes, and time to follow-up were collected in patients with elevated FVIII at baseline and data was compared in patients who had normalized FVIII with patients whose FVIII remained elevated at least 7 days later. Results: Repeat FVIII levels were available for 34/111 patients with elevated FVIII level with AIS. FVIII remained elevated in 68% after a median interval of 110 days. Factors associated with persistent elevation included higher baseline FVIII level (239 vs 185%, p=0.015), elevated CRP (73.3 vs 12.5%, p=0.008), lower baseline NIHSS (4 vs 8, p=0.046), and longer length of hospital stay (8 vs. 3, p=0.0063). Normalization of FVIII was associated with tPA use (54.5% vs 13%, p=0.016). No relationship was found between persistently elevated FVIII and baseline demographics, clinical course and outcomes. Conclusion: Persistently elevated FVIII after AIS may be predicted by higher baseline levels and elevations in CRP. Despite worse baseline stroke severity, patient with normalization of FVIII had similar outcomes as those with persistent elevation, which may be explained by the higher use of tPA in the normalized group. The relevance of elevated FVIII in stroke is not well understood. Our preliminary results suggest elevations persist in the majority and may not merely represent an acute phase reactant.

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Children With Encopresis: A Study of Treatment Outcome

PEDIATRICS ◽

10.1542/peds.58.6.845 ◽

1976 ◽

Vol 58 (6) ◽

pp. 845-852 ◽

Cited By ~ 1

Author(s):

Melvin D. Levine ◽

Harry Bakow

Keyword(s):

Treatment Outcome ◽

Treatment Program ◽

Marked Improvement ◽

Medical Center ◽

Outcome Data ◽

Careful Monitoring ◽

Maintenance Program ◽

Pediatric Treatment ◽

One Year

A pediatric treatment program for encopresis was established in a large medical center. This consisted of counseling and education, initial bowel catharsis, a supportive maintenance program to potentiate optimum evacuation, retraining, and careful monitoring and follow-up. A group of 127 children received care for this problem. At the end of one year, outcome data were obtained on 110 patients. Of these, 51% had not had "accidents" for more than six months. Another 27% showed marked improvement and were having only rare episodes of incontinence. 14% of these children showed some improvement, but continued to have incontinence, while 8% showed no improvement whatsoever during the treatment year. These four outcome groups were compared with respect to a large number of demographic, developmental, psychosocial, and clinical variables.

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Neurogenic claudication associated with posterior vertebral rim fractures in children

Journal of Neurosurgery Pediatrics ◽

10.3171/2012.5.peds1247 ◽

2012 ◽

Vol 10 (3) ◽

pp. 241-245 ◽

Cited By ~ 4

Author(s):

Jonathan G. Thomas ◽

Jerome Boatey ◽

Alison Brayton ◽

Andrew Jea

Keyword(s):

Blood Loss ◽

Hospital Stay ◽

Length Of Hospital Stay ◽

Signs And Symptoms ◽

Leg Pain ◽

Neurogenic Claudication ◽

Pediatric Age Group ◽

Fractures In Children ◽

The Mean

Object Outside of the patient population with achondroplasia, neurogenic claudication is rare in the pediatric age group. Neurogenic claudication associated with posterior vertebral rim fracture is even more uncommon but nonetheless causes pain and disability in affected children and adolescents. The purpose of this study was to describe the surgical results of 3 adolescents presenting with neurogenic claudication and posterior vertebral rim fracture when treated with laminectomy alone. Methods The medical and operative records of the 3 pediatric patients were retrospectively reviewed. Presenting signs and symptoms and CT findings, such as the interpedicular distances between T-12 and L-5, were obtained. Perioperative results were assessed, including operative time, blood loss, length of hospital stay, and complications. Findings at latest follow-up were also recorded, including a patient satisfaction survey. Results The 3 patients (1 girl and 2 boys) had a mean age of 14.7 years (range 14–15 years) and underwent follow-up for a mean of 11.3 months (range 5–18 months). Notable preoperative signs and symptoms included back pain (all patients), leg pain (all patients), leg numbness (1 patient), and leg weakness (1 patient). No patient presented with bowel and/or bladder dysfunction. The mean blood loss during laminectomy was 123 ml (range 20–300 ml), and the mean length of hospital stay was 4.3 days (range 3–6 days). On average, decompression was performed at 2.2 levels (range 2–2.5 levels). All 3 patients reported at most recent follow-up that they were “satisfied” with the surgery. There was 1 complication of instability from an iatrogenic pars fracture, which required reoperation and posterior instrumented fusion. Conclusions To the best of the authors' knowledge, this report represents the first surgical series of pediatric neurogenic claudication associated with posterior vertebral rim fractures. Pediatric neurosurgeons may infrequently encounter neurogenic claudication associated with a posterior vertebral rim fracture in children. To treat children with neurogenic claudication associated with posterior vertebral rim fractures, a simple laminectomy may be a safe and efficacious alternative to discectomy and removal of fracture fragments.

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Depression risk in patients with heart failure in primary care practices in Germany

International Psychogeriatrics ◽

10.1017/s1041610216000867 ◽

2016 ◽

Vol 28 (11) ◽

pp. 1889-1894

Author(s):

Marcel Konrad ◽

Jens Bohlken ◽

Michael A Rapp ◽

Karel Kostev

Keyword(s):

Heart Failure ◽

Primary Care ◽

Health Insurance ◽

Control Group ◽

Patients With Heart Failure ◽

Study Population ◽

Care Practices ◽

One Year ◽

Primary Care Practices

ABSTRACTBackground:The goal of this study was to estimate the prevalence of and risk factors for diagnosed depression in heart failure (HF) patients in German primary care practices.Methods:This study was a retrospective database analysis in Germany utilizing the Disease Analyzer® Database (IMS Health, Germany). The study population included 132,994 patients between 40 and 90 years of age from 1,072 primary care practices. The observation period was between 2004 and 2013. Follow-up lasted up to five years and ended in April 2015. A total of 66,497 HF patients were selected after applying exclusion criteria. The same number of 66,497 controls were chosen and were matched (1:1) to HF patients on the basis of age, sex, health insurance, depression diagnosis in the past, and follow-up duration after index date.Results:HF was a strong risk factor for diagnosed depression (p < 0.0001). A total of 10.5% of HF patients and 6.3% of matched controls developed depression after one year of follow-up (p < 0.001). Depression was documented in 28.9% of the HF group and 18.2% of the control group after the five-year follow-up (p < 0.001). Cancer, dementia, osteoporosis, stroke, and osteoarthritis were associated with a higher risk of developing depression. Male gender and private health insurance were associated with lower risk of depression.Conclusions:The risk of diagnosed depression is significantly increased in patients with HF compared to patients without HF in primary care practices in Germany.

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