scholarly journals Abdominal emergency surgery in patients over 90 years old: is it worthwhile? An Italian multicenter retrospective study

2016 ◽  
Author(s):  
Antonio Tarasconi ◽  
Fausto Catena ◽  
Hariscine K. Abongwa ◽  
Belinda De Simone ◽  
Federico Coccolini ◽  
...  
Keyword(s):  
Survival Rate ◽  
Length Of Stay ◽  
Abdominal Surgery ◽  
Surgical Procedures ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Asa Score ◽  
Abdominal Emergency ◽  
Emergency Abdominal Surgery

Unlike other surgical fields, such as cardiac surgery, where many trials have been made about safety, feasibility and outcome of surgical procedures in the elderly, there is lack of literature about emergency abdominal surgery in very old patients, especially in people over 90 years of age. The available data reported survival of about 50% one year after the operation. The aim of the study is to determine the survival rate two years after emergency abdominal surgery in a nonagenarian population and to identify any demographic and surgical parameters that could predict a poor outcome in this type of patient. The study was a retrospective multicenter trial. Patient inclusion criteria were: age 90 years old or older, urgent abdominal surgery. The medical charts reviewed and data collected were: gender, age, the American Society of Anesthesiologists (ASA) score and comorbidities, diagnosis, time elapsed between arrival to the Emergency Room and admission to the Operatory Room, surgical procedures, open versus laparoscopic procedure, type of anesthesia and outcomes with hospital length of stay. Phone call follow-up was performed for patient discharged alive and Kaplan-Meier analysis was used to evaluate survival. We identified 72 (20 males and 52 females) nonagenarian patients who underwent abdominal emergency surgery at 6 Italian hospitals (Parma, Bergamo, Bologna, Brescia, Chiari, Adria). Mean age was 92.5 years [range 90-100, standard deviation (SD) 2.6], median ASA score was 3 (range 2-5, mean 3.32) and only 7 patients were without comorbidities. Mean hospital length of stay was 13 days (range 1-60, SD 11.52); 56 patients (77.7%) were discharged alive; 2 years survival rate was 23% [mean follow-up=10 months (range 1-27)]. Among all the parameters analyzed, only ASA score was significantly correlated with survival. Neither the presence of malignancy nor the absence of comorbidities seems to correlate with survival. Nonagenarian patients undergoing emergent abdominal surgical procedures have a high overall in-hospital mortality rate (23%) and a low 2 years survival rate (51.4%). Except for ASA score, there are no other factors predicting poor outcome. Based on the present study emergency abdominal surgery in frail patients over 90 years of age has to be carefully evaluated: only 1 out 5 patients will be alive after 2 years.

scholarly journals Variation in Hospital Length of Stay Based on Hospital Volume: A Retrospective Cohort Study of Emergency Abdominal Surgery in Ireland

2019 ◽  
pp. 1-6
Author(s):  
Jan Sorensen ◽  
Dara Kavanagh ◽  
Deirdre Nally ◽  
Gintare Valentelyte ◽  
Jan Sorensen ◽  
...  
Keyword(s):  
Sensitivity Analysis ◽  
Length Of Stay ◽  
Abdominal Surgery ◽  
Hospital Volume ◽  
High Volume ◽  
Hospital Length ◽  
Public Hospitals ◽  
Hospital Length Of Stay ◽  
Low Volume ◽  
Emergency Abdominal Surgery

Objectives: Emergency abdominal surgery (EAS) refers to high risk intra-abdominal surgical procedures associated with increased mortality risk and long length of hospital stay. The variation between hospital volume and hospital length of stay (LOS) of patients undergoing EAS is poorly understood. Our objective was to explore this relationship across public hospitals in Ireland. Methods: Data for all adult episode discharges from public Irish hospitals in 2014-2017 were obtained from National Quality Assurance Improvement System (NQAIS) Clinical with EAS identified by primary procedure codes. Hospitals were categorised into low (n<200), medium (n=200-400), and high (n>400) volume groups based on the number of EAS episodes during the study period. Negative binomial regression models were applied to standardise for patient case mix. Several adjusted LOS measures were compared across the three volume groups. Sensitivity analysis was conducted to test the robustness of our findings. Results: 8120 hospital episodes across 24 public hospitals providing EAS services were analysed. 7 were categorised as low, 9 as medium, and 8 as high-volume hospitals. High volume hospitals had a significantly longer adjusted LOS (24.7 days) relative to low and medium volume hospitals (18.2 and 18.6 days). Sensitivity analysis consisted of the exclusion of the following hospital episodes: in-hospital death, cancer diagnosis, Charlson comorbidity index (CCI) >0, admission from other hospitals, and discharge to other hospitals. No single variable influenced the observed LOS variation, although when the more complex episodes were excluded, the post-operative LOS at low and medium volume hospitals was significantly shorter compared to high volume hospitals (by 1.1-6.1 days). Intensive care unit (ICU) LOS was similar in all three hospital volume groups although low volume hospitals appeared to have more ICU admissions and longer stay (by up to 1.6 days). Conclusions: Our findings indicate that patients treated at low volume hospitals have shorter LOS and may be discharged earlier than from high volume hospitals. This finding is surprising, suggesting that concentration of services to larger clinical departments may not necessarily reduce LOS and improve the efficiency of resource utilisation and service delivery.

Placement of Surgical Feeding Tubes Among Patients With Severe Traumatic Brain Injury Requiring Exploratory Abdominal Surgery

2020 ◽  
Vol 86 (6) ◽  
pp. 635-642
Author(s):  
Peter I. Cha ◽  
Ronald M. Jou ◽  
David A. Spain ◽  
Joseph D. Forrester
Keyword(s):  
Length Of Stay ◽  
Abdominal Surgery ◽  
Injury Severity ◽  
Unit Length ◽  
Feeding Tube ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Fascial Closure ◽  
Trauma Patients ◽  
Percutaneous Endoscopic Gastrostomy Placement

Objectives The purpose of this study was to identify trauma patients who would benefit from surgical placement of an enteral feeding tube during their index abdominal trauma operation. Methods We performed a retrospective analysis of all patients admitted to 2 level I trauma centers between January 2013 and February 2018 requiring urgent exploratory abdominal surgery. Results Six-hundred and one patients required exploratory abdominal surgery within 24 hours of admission after trauma activation. Nineteen (3% of total) patients underwent placement of a feeding tube after their initial exploratory surgery. On multivariate analysis, an intracranial Abbreviated Injury Scale ≥4 (odds ratio [OR] = 9.24, 95% CI 1.09-78.26, P = .04) and a Glasgow Coma Scale ≤8 (OR = 4.39, 95% CI 1.38-13.95, P = .01) were associated with increased odds of requiring a feeding tube. All patients who required a feeding tube had an Injury Severity Score ≥15. While not statistically significant, patients with an open surgical feeding tube compared with interventional radiology/percutaneous endoscopic gastrostomy placement had lower median intensive care unit length of stay, fewer ventilator days, and shorter median total hospital length of stay. Conclusions Trauma patients with severe intracranial injury already requiring urgent exploratory abdominal surgery may benefit from early, concomitant placement of a feeding tube during the index abdominal operation, or at fascial closure.

scholarly journals 1247. Multicenter Study on Risk Factors for Surgical Site Infection After Exploratory Laparotomy

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S449-S449
Author(s):  
Túlio Alves Jeangregório Rodrigues ◽  
Guilherme Fernandes de Oliveira ◽  
Júlia G C Dias ◽  
Laís Souza Campos ◽  
Letícia Rodrigues ◽  
...  
Keyword(s):  
Risk Factors ◽  
Length Of Stay ◽  
Abdominal Surgery ◽  
Surgical Site Infection ◽  
Exploratory Laparotomy ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Hospital Death ◽  
Site Infection ◽  
The Impact

Abstract Background Exploratory laparotomy surgery is abdominal operations not involving the gastrointestinal tract or biliary system. The objective of our study is to answer three questions: (a) What is the risk of surgical site infection (SSI) after exploratory abdominal surgery? (b) What is the impact of SSI in the hospital length of stay and hospital mortality? (c) What are risk factors for SSI after exploratory abdominal surgery? Methods A retrospective cohort study assessed meningitis and risk factors in patients undergoing exploratory laparotomy between January 2013 and December 2017 from 12 hospitals at Belo Horizonte, Brazil. Data were gathered by standardized methods defined by the National Healthcare Safety Network (NHSN)/CDC procedure-associated protocols for routine SSI surveillance. 26 preoperative and operative categorical and continuous variables were evaluated by univariate and multivariate analysis (logistic regression). Outcome variables: Surgical site infection (SSI), hospital death, hospital length of stay. Variables were analyzed using Epi Info and applying statistical two-tailed test hypothesis with significance level of 5%. Results A sample of 6,591 patients submitted to exploratory laparotomy was analyzed (SSI risk = 4.3%): Hospital length of stay in noninfected patients (days): mean = 16, median = 6, std. dev. = 30; hospital stay in infected patients: mean = 32, median = 22, std. dev. = 30 (P < 0.001). The mortality rate in patients without infection was 14% while hospital death of infected patients was 20% (P = 0.009). Main risk factors for SSI: ügeneral anesthesia (SSI = 4.9%, relative risk – RR = 2.8, P < 0.001); preoperative hospital length of stay more than 4 days (SSI=3.9%, RR=1.8, P = 0.003); wound class contaminated or dirty (SSI = 5.4%, RR = 1.5, P = 0.002); duration of procedure higher than 3 hours (SSI = 7.1%, RR = 2.1, P < 0.001); after trauma laparotomy (SSI = 7.8%, RR = 1.9, P = 0.001). Conclusion We identified patients at high risk of surgical site infection after exploratory laparotomy: trauma patients from contaminated or dirty wound surgery, submitted to a procedure with general anesthesia that last more than 3 hours have 13% SSI. Patients without any of these four risk factors have only 1.2% SSI. Disclosures All authors: No reported disclosures.

scholarly journals Predisposing factors and impact of healthcare-associated infections in patients with status epilepticus

2021 ◽  
Vol 79 (3) ◽  
pp. 209-215
Author(s):  
Dannys RIVERO RODRÍGUEZ ◽  
Claudio SCHERLE MATAMOROS ◽  
Daniela DICAPUA SACOTO ◽  
Sara GARCIA-PTACEK ◽  
Yanelis PERNAS SANCHEZ ◽  
...  
Keyword(s):  
Status Epilepticus ◽  
Survival Rate ◽  
Length Of Stay ◽  
Hospital Length ◽  
Predisposing Factors ◽  
Hospital Length Of Stay ◽  
Healthcare Associated Infections ◽  
Prolonged Hospital ◽  
Healthcare Associated ◽  
The Impact

ABSTRACT Background: Few studies have evaluated the incidence, predisposing factors and impact of healthcare-associated infections (HCAIs) in relation to outcomes among patients with status epilepticus (SE). Objective: To investigate the variables associated with development of HCAIs among patients with SE and the impact of factors relating to HCAIs on mortality at three months. Methods: This study was a retrospective analysis on our prospectively collected dataset, from November 2015 to January 2019. The sample included all consecutive patients diagnosed with SE who were treated at Hospital Eugenio Espejo during that period. In total, 74 patients were included. Clinical variables such as age, etiology of SE, Charlson comorbidity index (CCI), hospital length of stay, refractory SE (RSE) and outcomes were analyzed. Results: HCAIs were diagnosed in 38 patients (51.4%), with a preponderance of respiratory tract infection (19; 25.7%). Prolonged hospital length of stay (OR=1.09; 95%CI 1.03-1.15) and CCI≥2 (OR=5.50; 95%CI 1.37-22.10) were shown to be independent variables relating to HCAIs. HCAIs were associated with an increased risk of mortality at three months, according to Cox regression analysis (OR=2.23; 95%CI 1.08-4.58), and with infection caused by Gram-negative microorganisms (OR=3.17; 95%CI 1.20-8.39). Kaplan-Meier curve analysis demonstrated that HCAIs had a negative impact on the survival rate at three months (log rank=0.025). Conclusions: HCAIs are a common complication among Ecuadorian patients with SE and were related to a lower survival rate at three months. Prolonged hospital length of stay, RSE and CCI≥2 were associated with the risk of developing HCAIs.

scholarly journals Duodenum-preserving pancreatic head resections for surgical treatment of paraduodenal pancreatitis

2020 ◽  
Vol 49 (4) ◽  
pp. 51-54
Author(s):  
O. Yu. Usenko ◽  
V. M. Kopchak ◽  
I. V. Khomiak ◽  
A. I. Khomiak ◽  
A. V. Malik
Keyword(s):  
Surgical Treatment ◽  
Length Of Stay ◽  
Pain Score ◽  
Pain Control ◽  
Pancreatic Head ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Study Group ◽  
Paraduodenal Pancreatitis

Introduction. Up to date, no consensus exists on the surgical treatment of paraduodenal pancreatitis (PDP). Most authors prefer to perform pancreaticoduodenectomy when surgical treatment is indicated. However, such an aggressive approach may not always be justified for the treatment of benign disease. The aim of our study was to investigate the results of duodenum-preserving pancreatic head resections (DPPHR) for the treatment of PDP. Materials and methods. We performed a retrospective analysis of a database consisting of 112 patients with PDP treated in Shalimov National Institute of Surgery and Transplantology from 2014 to 2019. A total of 45 patients after DPPHR were included to the study. Such modifications of DPPHR as Frey’s, Beger’s and Berne’s procedures were used. The primary study endpoint was pain control assessed according to the Izbicki pain score before surgery and at follow-up visits. Secondary endpoints were defined as complication rate (Clavien — Dindo >2), hospital length of stay and 90-day mortality. All patients were followed-up for the assessment of pain cessation with a median of 33 months (range 8–54 months). Results. There were 42 males (93.3%) and 3 females (6.7%) in the study group. Preoperative Izbicki pain score result was 52.6 points. Follow-up pain score results were significantly lower at 11.7 points. Postoperative complication rate (Clavien — Dindo >2) was measured at 8.9%. Median hospital length of stay was 17.4 days. No mortality was recorded in the study group. All results were statistically significant (p<0.05). Conclusion. Application of DPPHR for the surgical treatment of PDP allows to achieve excellent results in terms of pain control (52.6 and 11.7 points on the Izbicki pain score before surgical intervention and at follow-up), while maintaining low complication (8.9%) and mortality (0%) rates.

Abstract W P351: A Stroke Above the Rest: A Reengineering of the Interdisciplinary Plan of Care

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Noella J West
Keyword(s):  
Length Of Stay ◽  
Patient Participation ◽  
Stroke Survivor ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Steady Increase ◽  
Quality Enhancement ◽  
Phone Calls ◽  
Stroke Team

Background and Purpose: Patients who are newly diagnosed with a stroke are often overwhelmed due to the devastating nature of their condition. The post-acute phase frequently involves a significant amount of education regarding new medications, treatments, recovery and follow up. Ineffective education may be associated with poor outcomes; therefore information from healthcare professionals should be easily understood by patients and their families. The purpose of this evidence based nursing practice and quality enhancement initiative was to improve the patient outcomes and provide tools to assist patients for reentry into the community. Methods: The reengineered plan of care was implemented by the interdisciplinary Stroke Team. Individual education packets were developed based on diagnosis and specific comorbidities, and took into consideration the concept of health literacy. Communication with the primary care provider as well as providing patients with a thirty-day filled prescription prior to discharge assisted with continuity of care. Follow up phone calls reinforced education. Creation of a listserv provided notification of monthly stroke support group meetings and our yearly stroke retreat. Both programs are tailored to the stroke survivor and caregiver, and have been beneficial to the community. Results: This interdisciplinary initiative contributed to a steady increase in patient’s ratings of communication with doctors, and with a decrease in hospital length of stay for patients who were treated by the Interdisciplinary Stroke Team. In addition, patient participation in the annual Stroke Retreat and patient participation in community stroke programs have increased.Conclusions : Reengineering of the interdisciplinary plan of care improved not only the patient experience, but also better prepared patients and their caregivers for discharge. This quality enhancement initiative was vital in decreasing length of stay and quality of care in the stroke population.

Impact of the Surviving Sepsis Campaign protocols on hospital length of stay and mortality in septic shock patients: Results of a three-year follow-up quasi-experimental study*

2010 ◽  
Vol 38 (4) ◽  
pp. 1036-1043 ◽  
Author(s):  
Álvaro Castellanos-Ortega ◽  
Borja Suberviola ◽  
Luis A. García-Astudillo ◽  
María S. Holanda ◽  
Fernando Ortiz ◽  
...  
Keyword(s):  
Experimental Study ◽  
Septic Shock ◽  
Length Of Stay ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Surviving Sepsis Campaign ◽  
Quasi Experimental
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