Feasibility of short term drainage for diagnostic thoracoscopy

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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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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The effect of short term peripheral parenteral nutrition on treatment outcomes and mortality in critically ill pediatric canine patients

Irish Veterinary Journal ◽

10.1186/s13620-021-00194-2 ◽

2021 ◽

Vol 74 (1) ◽

Author(s):

Cesar Augusto Flores Dueñas ◽

Soila Maribel Gaxiola Camacho ◽

Martin Francisco Montaño Gómez ◽

Rafael Villa Angulo ◽

Idalia Enríquez Verdugo ◽

...

Keyword(s):

Weight Loss ◽

Adverse Effects ◽

Parenteral Nutrition ◽

Hospital Stay ◽

Critically Ill ◽

Energy Requirement ◽

Length Of Hospital Stay ◽

Short Term ◽

Clinical Complications ◽

Significant Difference

Abstract Background Peripheral parenteral nutrition (PPN) is increasingly considered as an alternative to central parenteral nutrition (CPN) given the higher cost and more frequent clinical complications associated with the latter. However, the assessment of potential risks and benefits of PPN in critically ill pediatric canine patients has not been extensively performed. In this study, we aimed to explore the effect of short-term, hypocaloric PPN on weight loss, length of hospital stay, the incidence of complications, adverse effects, and mortality in critically ill pediatric canine patients. Results Between August 2015 and August 2018, a total of 59 critically ill pediatric canine patients aged from 1 to 6 months admitted at the Veterinary Sciences Research Institute of the Autonomous University of Baja California were included in this non-randomized clinical trial. Canine pediatric patients were initially allocated to 3 groups: 11 in group 1 receiving parenteral nutrition (PN) supplementation equivalent to 40% of the resting energy requirement (RER), 12 in group 2 receiving supplementation of 50% of the RER, and 36 in group 3 receiving no PN supplementation. After establishing that there was no significant difference between 40 and 50% of PN supplementation, these groups were not separated for downstream analysis. Similar lengths of hospital stays were noted among study subjects who received PN supplementation and those who did not (4.3 ± 1.5 vs. 5.0 ± 1.5, days, p = 0.097). No metabolic-, sepsis- or phlebitis-related complications were observed in any animal in the PPN supplemented group. Higher mortality (19.4% vs. 0%, p = 0.036), and a greater percentage of weight loss (9.24% vs. 0%, p < 0.001) were observed in patients who received no supplementation. Conclusion Even though short-term, hypocaloric PPN did not reduce the length of hospital stay, it was associated with lower mortality and resulted in mitigation of weight loss. In contrast to previous studies evaluating central and peripheral parenteral nutrition protocols, we observed a lower frequency of metabolic, septic, and phlebitis complications using a 40–50% parenteral nutrition treatment. The parenteral nutrition therapeutic intervention used in our study may reduce PN-related adverse effects and promote a favorable disease outcome in critically ill canine patients. Larger studies will be needed to confirm these observations.

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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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O148 SHORT-TERM RESULTS OF A RANDOMIZED CONTROLLED TRIAL OF STANDARD VS. PROLONGED TIME TO SURGERY AFTER NEOADJUVANT CHEMORADIATION FOR CANCER

Diseases of the Esophagus ◽

10.1093/dote/doz092.148 ◽

2019 ◽

Vol 32 (Supplement_2) ◽

Author(s):

K Nilsson ◽

F Klevebro ◽

E Szabo ◽

I Halldestam ◽

E Johnsson ◽

...

Keyword(s):

Hospital Stay ◽

Postoperative Mortality ◽

Length Of Hospital Stay ◽

Postoperative Outcomes ◽

Standard Group ◽

Median Length ◽

Short Term ◽

Time To Surgery ◽

Prolonged Time ◽

Significant Difference

Abstract Aim The aim of this study was to clarify if prolonged time to surgery (TTS) improves postoperative outcomes in the curative intended treatment of an junctional cancer. Background & Methods sophagectomy is conventionally performed 4-6 weeks after completed neoadjuvant chemoradiotherapy (nCRT). However, studies have shown that prolonged TTS might be favourable. A randomized multicentre clinical trial was performed with allocation to 4-6 or 10-12 weeks between finished nCRT and surgery. All patients received nCRT according to CROSS. Primary outcome of thstudy was postoperative. Smortality, need for intensive care, and length of hospital stay. Results The study randomized 248 patients, 202have to date undergone esophagectomy 98 patients were allocated to prolonged TTS, and the groups were well matched concerning baseline characteristics. Postoperative complications were reported in 106 patients (52.5%).There was no difference in postoperative Clavien-Dindo score.In the standardgroup 17 (16.4%) patients had anastomotic leak compared to 19 (19.4%) in the prolongedgroup (P=0.572). Conduit necrosis was reported in 9 (4.5%) patients, esophago-bronchial fistula in 1 (0.5%) patient,chyle leak in 5 (2.5%) neumoni in 54 (26.7%) patients and respiratory insufficiency in 36 (17.8%) patients without significant difference . In the standard group 5 (4.8%) patients had postoperative mortality due to a complication, compared to 2 (2.0%) patients in the prolonged group (P=0.446). Median length of hospital stay was 14 days in the standard group and 17.5 days in the prolonged group (P=0.040). Conclusion In this we found no significant differences in postoperative mortality comparing standard to prolonged TTS after nCRT. Although, an observandum is that the median length of hospital stay was significantly longer in the prolonged group. We need to compare response and survival to properly evaluate prolonged TTS, but these results suggest that timing is not cardinal in short-term postoperative outcomes.

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A simple size-tailored algorithm for the removal of chest drain following minimally invasive lobectomy: a prospective randomized study

Surgical Endoscopy ◽

10.1007/s00464-021-08905-0 ◽

2021 ◽

Author(s):

Davor Stamenovic ◽

Michael Dusmet ◽

Thomas Schneider ◽

Eric Roessner ◽

Antje Messerschmidt

Keyword(s):

Hospital Stay ◽

Current Practice ◽

Randomized Study ◽

Length Of Hospital Stay ◽

Pleural Space ◽

Chest Drain ◽

Chest Drainage ◽

Vats Lobectomy ◽

Drain Removal ◽

Registration Number

Abstract Background The pleural space can resorb 0.11–0.36 ml/kg of body weight/hour (h) per hemithorax. There are only a limited number of studies on thresholds for chest drain removal (CDR) and all are based on arbitrary amounts, for example, 300 ml/day. We studied an individualized size-based threshold for CDR–specifically 5 ml/kg, a simple, easily applicable measure. Methods This is a single-center prospective randomized trial enrolling 80 patients undergoing VATS lobectomy. There were two groups: an experimental (E) group, in which once the daily output went down to 5 ml/kg the chest drain was removed and a control (C) group, with chest drain removal as per our current practice of less than 250 ml/day. Results The groups did not differ in pre- and peri- and postoperative characteristics, except for chest drain duration (mean, SD 2.02 ± 0.97 vs. 3.25 ± 1.39 days, p < 0.001) and length of hospital stay (median, IQR 4.5; 3 vs. 6; 2.75 days, p = 0.008) in favor of E group. The re-intervention rate was the same in both groups (once in each group). Conclusion The new threshold for chest drain removal following thoracoscopic lobectomy of 5 ml/kg/d leads to both shorter chest drainage and hospital stay without apparent increase in morbidity. (Clinical registration number: DRKS00014252).

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Effect of Flap Selection on the Postoperative Success of Sacral Pressure Injuries: A Retrospective Analysis

WOUNDS A Compendium of Clinical Research and Practice ◽

10.25270/wnds/091721.01 ◽

2021 ◽

Vol 33 (10) ◽

pp. 271-276

Author(s):

Serhat Şibar ◽

Kemal Findikcioglu ◽

Kirdar Guney ◽

Serhan Tuncer ◽

Suhan Ayhan

Keyword(s):

Hospital Stay ◽

Chronic Wounds ◽

Length Of Hospital Stay ◽

Long Term Results ◽

Drain Removal ◽

Significant Difference ◽

Group 3 ◽

The Mean ◽

Group 2

Introduction. Pressure injuries (PIs) continue to be a substantial problem and burden for the present-day health care system and are the leading cause of chronic wounds worldwide. There is no current consensus on the long-term results of the use of flaps in sacral PI reconstruction and optimal flap choice. Objective. This study aimed to evaluate whether flap selection influences postoperative results in sacral PI reconstruction. Materials and Methods. Patients who underwent surgery for PIs in the authors’ clinic between 2002 and 2016 were retrospectively analyzed. A total of 63 patients with stage 3/stage 4 sacral PIs and who underwent reconstruction with fasciocutaneous (FC) flaps (group 1), musculocutaneous (MC) flaps (group 2), or perforator (P) flaps (group 3) were included in the study. The mean duration of the follow-up period was 14.4 months, and patients were evaluated in terms of their demographic data, length of hospital stay, complications, and recurrence. Results. The mean age, sex distribution, and ambulatory status were similar between the groups. In group 2 (MC), the mean length of hospital stay and mean drain removal time were significantly longer. The mean daily drainage amount was significantly higher in group 2 (MC) than in the other groups, and long-term relapses were less frequently observed in group 3 (P). A significant difference was observed between groups 2 (FC) and 3 (MC) in terms of wound dehiscence. The authors determined that P flaps were associated with a reduced mean length of hospital stay and daily drainage. Conclusions. For these patients, P flaps appear to be the optimal flap choice for sacral area reconstruction. However, new prospective randomized studies are needed to support these findings.

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

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v5i8.2138 ◽

2021 ◽

Vol 5 (8) ◽

Author(s):

Dharmpal Godara ◽

Mamta Choudhary

Keyword(s):

Hospital Stay ◽

Conservative Management ◽

Primary Outcome ◽

Length Of Hospital Stay ◽

Clinical Severity ◽

Complication Rates ◽

Alvarado Score ◽

Significant Difference ◽

Operative Complications ◽

Selection For

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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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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