scholarly journals Video-assissted thoracoscopic thymectomy: experiences from 103 Military Hospital

2018 ◽  
Vol 8 (4) ◽  
Author(s):  
Viet Anh Le ◽  
Keyword(s):  
Length Of Stay ◽  
Operation Time ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Military Hospital ◽  
Female Ratio ◽  
Early Results ◽  
Male Female Ratio ◽  
The Mean ◽  
Vats Thymectomy

Abstract Introduction: To investigate clinical and laboratory characteristics of thymoma and to evaluate the early results of VATS thymectomy for thymoma in Military Hospital 103. Material and Methods: Of 66 thymoma patients with or without myasthenia gravis (MG) underwent VATS thymectomy in Military Hospital 103, from 10/2013 to 5/2018 were enrolled. Results: The mean age was 47.94 ± 6.3. The male : female ratio was 1.0. MG was present in 86.4% patients, mostly at MG stage IIA. There was no in-hospital mortality or major postoperative complication. The mean operation time was 75 ± 35 min, intensive care length of stay 19 ± 5hr, and postoperative hospital length of stay was 6.5 ± 1.3 days. Conclusion: VATS thymectomy for thymoma in Vietnamese patients achieved better cosmesis, and was safe for both non-MG and MG patients.

scholarly journals Impact of a Positive Viral Polymerase Chain Reaction on Outcomes of Chronic Obstructive Pulmonary Disease (COPD) Exacerbations

2020 ◽  
Vol 17 (21) ◽  
pp. 8072 ◽  
Author(s):  
Kulothungan Gunasekaran ◽  
Mudassar Ahmad ◽  
Sana Rehman ◽  
Bright Thilagar ◽  
Kavitha Gopalratnam ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Length Of Stay ◽  
Pulmonary Disease ◽  
Respiratory Virus ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Copd Exacerbations ◽  
The Mean

Introduction: More than 15 million adults in the USA have chronic obstructive pulmonary disease. Chronic obstructive pulmonary disease (COPD) places a high burden on the healthcare system. Many hospital admissions are due to an exacerbation, which is suspected to be from a viral cause. The purpose of this analysis was to compare the outcomes of patients with a positive and negative respiratory virus panel who were admitted to the hospital with COPD exacerbations. Methods: This retrospective cohort study was conducted in the Geisinger Healthcare System. The dataset included 2729 patient encounters between 1 January 2006 and 30 November 2017. Hospital length of stay was calculated as the discrete number of calendar days a patient was in the hospital. Patient encounters with a positive and negative respiratory virus panel were compared using Pearson’s chi-square or Fisher’s exact test for categorical variables and Student’s t-test or Wilcoxon rank-sum tests for continuous variables. Results: There were 1626 patients with a total of 2729 chronic obstructive pulmonary disease exacerbation encounters. Nineteen percent of those encounters (n = 524) had a respiratory virus panel performed during their admission. Among these encounters, 161 (30.7%) had positive results, and 363 (69.3%) had negative results. For encounters with the respiratory virus panel, the mean age was 64.5, 59.5% were female, 98.9% were white, and the mean body mass index was 26.6. Those with a negative respiratory virus panel had a higher median white blood cell count (11.1 vs. 9.9, p = 0.0076). There were no other statistically significant differences in characteristics between the two groups. Respiratory virus panel positive patients had a statistically significant longer hospital length of stay. There were no significant differences with respect to being on mechanical ventilation or ventilation-free days. Conclusion: This study shows that a positive respiratory virus panel is associated with increased length of hospital stay. Early diagnosis of chronic obstructive pulmonary disease exacerbation patients with positive viral panel would help identify patients with a longer length of stay.

scholarly journals Karydakis Flap Procedure in Patients with Sacrococcygeal Pilonidal Sinus Disease: Experience of a Single Centre in Istanbul

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
M. Kamil Yildiz ◽  
Erkan Ozkan ◽  
Hacı Mehmet Odabaşı ◽  
Bülent Kaya ◽  
Cengiz Eriş ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Pilonidal Sinus ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Sinus Surgery ◽  
Pilonidal Sinus Disease ◽  
Sinus Disease ◽  
Satisfaction Rate ◽  
Flap Procedure ◽  
The Mean

Background. The aim of this retrospective study was to evaluate the results of patients with sacrococcygeal pilonidal sinus who underwent surgery using the Karydakis technique.Methods. Two hundred fifty-seven patients with sacrococcygeal pilonidal sinus disease were treated by the Karydakis flap procedure between December 2003 and June 2011. Patients were evaluated with respect to age, gender, preoperative symptoms, duration of preoperative symptoms, history of pilonidal sinus surgery, early postoperative complications, recurrence rates, and cosmetic satisfaction.Results. There were 223 (86.8%) male and 34 (13.2%) female patients. The mean age of the patients was years. The most frequent symptom was seropurulent discharge (57.58%). Postoperative morbidity was noted in 24 patients (9.3%). The mean hospital length of stay was days. The cosmetic satisfaction rate was 91.06%. Recurrences were noted in 6 patients (2.3%).Conclusion. The Karydakis flap procedure is a safe treatment alternative for the surgical treatment of sacrococcygeal pilonidal sinus disease owing to the associated low complication rate, short hospital length of stay, rapid healing, and a high patient satisfaction rate.

It is Not Just Cosmesis: Straight Laparoscopy with Stoma Site Extraction Improves Outcomes in Ulcerative Colitis Patients Undergoing Total Colectomy

2019 ◽  
Vol 85 (10) ◽  
pp. 1194-1197
Author(s):  
Ino Chough ◽  
Karen Zaghiyan ◽  
Gayane Ovsepyan ◽  
Phillip Fleshner
Keyword(s):  
Ulcerative Colitis ◽  
Length Of Stay ◽  
Group Versus ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Study Cohort ◽  
Class Iii ◽  
Total Abdominal Colectomy ◽  
Postoperative Length ◽  
The Mean

Minimally invasive approaches to total abdominal colectomy (TAC) in ulcerative colitis (UC) patients include straight laparoscopy (SL), hand-assisted laparoscopic surgery (HALS), and robotics. In this study, short-term outcomes of patients undergoing SL and HALS TAC were compared. Prospectively collected data on UC patients undergoing TAC were tabulated. The study cohort included 36 (27%) patients in the SL group and 95 (73%) patients in the HALS group. The groups were comparable in terms of preoperative characteristics and demographics. The mean operative time was 151 (range, 73–225) minutes in the SL group versus 164 (range, 103–295) minutes in the HALS group ( P = 0.09). Total 48-hour IV morphine use was 30 (range, 0–186) mg in the SL group compared with 56 (0–275) mg in the HALS group ( P < 0.01). Although overall morbidity was comparable between the groups, Clavien-Dindo Class III complications did not occur in any of the SL group patients versus 11 (11%) of the HALS group patients ( P = 0.03). The postoperative length of stay was 3 (3–21) days in the SL group versus 5 (3–15) days in the HALS group ( P < 0.01). Compared with HALS, SL is associated with lower postoperative narcotic use and hospital length of stay in UC patients undergoing TAC.

scholarly journals Perioperative Outcomes Of Laparoscopic Hysterectomy: Comparison With Abdominal, Vaginal, And Robot-Assisted Surgical Approaches

2015 ◽  
Vol 8 (1) ◽  
pp. 52-60
Author(s):  
Slavcho T. Tomov ◽  
Grigor A. Gortchev ◽  
Latchesar S. Tantchev ◽  
Todor I. Dimitrov ◽  
Chavdar A. Tzvetkov ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Vaginal Hysterectomy ◽  
Operative Time ◽  
Laparoscopic Hysterectomy ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Perioperative Outcomes ◽  
Surgical Approaches ◽  
Significant Linear Correlation ◽  
The Mean

SummarySelection of an appropriate surgical method for hysterectomy in an individual patient is currently an issue that remains open and debatable. This study aimed to analyze perioperative outcomes in gynecologic patients who underwent laparoscopic hysterectomy at a single institution during a 6-year period and to compare the data for simple hysterectomy patients treated with different surgical approaches. The study included a retrospective analysis of demographics, pre- and post-operative characteristics of 1,023 patients, operated on using four types of simple hysterectomy approaches: 635 laparoscopic hysterectomies (62.1%), 289 total abdominal hysterectomies (28.3%), 45 total vaginal hysterectomies (4.4%) and 54 robotic-assisted hysterectomies (5.3%). For the laparoscopic hysterectomy group, the mean operative time was shorter as compared to the abdominal and vaginal hysterectomy groups (p<0.05), as well as a significantly shorter hospital length-of-stay when compared to the abdominal, robotic or vaginal hysterectomy groups (p<0.05). Regression analysis revealed significant linear correlation between operative time and body-mass index of laparoscopic hysterectomy patients (R2 =0.008; p=0.026). Complications emergence and hemotransfusion often prolonged the mean operative time significantly by 17.8 min (p=0.002) and 15.5 min, respectively (p<0.001). The rate of major complications was significantly higher in the laparoscopic vs. abdominal groups (p<0.05). Clinical outcomes in patients operated on with laparoscopic hysterectomy were better than in those operated with total abdominal and vaginal hysterectomy in terms of operative time and hospital length-of-stay. Prospective randomized multi-center studies would be desirable to further define the place of the modern minimally invasive hysterectomy approaches.

scholarly journals Development of an Enhanced Recovery After Surgery (ERAS) approach for lumbar spinal fusion

2017 ◽  
Vol 26 (4) ◽  
pp. 411-418 ◽  
Author(s):  
Michael Y. Wang ◽  
Peng-Yuan Chang ◽  
Jay Grossman
Keyword(s):  
Spinal Fusion ◽  
Surgical Procedure ◽  
Enhanced Recovery ◽  
Lumbar Fusion ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Improvement Program ◽  
Female Ratio ◽  
Open Operation ◽  
The Mean

OBJECTIVE Over the past decade, Enhancing Recovery After Surgery (ERAS) programs have been implemented throughout the world across multiple surgical disciplines. However, to date no spinal surgery equivalent has been described. In this report the authors review the development and implementation of a “fast track” surgical approach for lumbar fusion. METHODS The first 42 consecutive cases in which patients were treated with the new surgical procedure were reviewed. A combination of endoscopic decompression, expandable cage deployment, and percutaneous screw placement were performed with liposomal bupivacaine anesthesia to allow the surgery to be performed without general endotracheal anesthesia. RESULTS In all cases the surgical procedure was performed successfully without conversion to an open operation. The patients' mean age (± SD) was 66.1 ± 11.7 years, the male/female ratio was 20:22, and a total of 47 levels were treated. The mean operative time was 94.6 ± 22.4 minutes, the mean intraoperative blood loss was 66 ± 30 ml, and the mean hospital length of stay was 1.29 ± 0.9 nights. Early follow-up showed a significant improvement in the mean Oswestry Disability Index score (from 40 ± 13 to 17 ± 11, p = 0.0001). Return to the operating room was required in 2 cases due to infection and in 1 case due to cage displacement. An iterative quality improvement program demonstrated areas of improvement, including steps to minimize infection, improve postoperative analgesia, and reduce cage osteolysis. CONCLUSIONS ERAS programs for improving spinal fusion surgery are possible and necessary. This report demonstrates a first foray to apply these principles through 1) a patient-focused approach, 2) reducing the stress of the operation, and 3) an iterative improvement process.

scholarly journals Delirium and Associated Length of Stay and Costs in Critically Ill Patients

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Claudia Dziegielewski ◽  
Charlenn Skead ◽  
Toros Canturk ◽  
Colleen Webber ◽  
Shannon M. Fernando ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Hospital Costs ◽  
Hospital Length ◽  
Mean Difference ◽  
Hospital Length Of Stay ◽  
The Mean ◽  
The Impact

Purpose. Delirium frequently affects critically ill patients in the intensive care unit (ICU). The purpose of this study is to evaluate the impact of delirium on ICU and hospital length of stay (LOS) and perform a cost analysis. Materials and Methods. Prospective studies and randomized controlled trials of patients in the ICU with delirium published between January 1, 2015, and December 31, 2020, were evaluated. Outcome variables including ICU and hospital LOS were obtained, and ICU and hospital costs were derived from the respective LOS. Results. Forty-one studies met inclusion criteria. The mean difference of ICU LOS between patients with and without delirium was significant at 4.77 days ( p < 0.001 ); for hospital LOS, this was significant at 6.67 days ( p < 0.001 ). Cost data were extractable for 27 studies in which both ICU and hospital LOS were available. The mean difference of ICU costs between patients with and without delirium was significant at $3,921 ( p < 0.001 ); for hospital costs, the mean difference was $5,936 ( p < 0.001 ). Conclusion. ICU and hospital LOS and associated costs were significantly higher for patients with delirium, compared to those without delirium. Further research is necessary to elucidate other determinants of increased costs and cost-reducing strategies for critically ill patients with delirium. This can provide insight into the required resources for the prevention of delirium, which may contribute to decreasing healthcare expenditure while optimizing the quality of care.

scholarly journals Are Only A Few Hours Adequate For Hospitalization Following Mini-Incision Open Appendectomy In Pediatric Patients?

2021 ◽  
Author(s):  
Paiboon Sookpotarom ◽  
Vichack Chakrapan Na Ayudhya ◽  
Vorapatu Tangsirapat
Keyword(s):  
Length Of Stay ◽  
Medical Records ◽  
Pediatric Patients ◽  
Open Appendectomy ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Open Technique ◽  
The Mean ◽  
Surgical Condition ◽  
Mini Incision

Abstract Purpose- A very short hospital length of stay following an open appendectomy in children with acute simple appendicitis has never been mentioned yet in literature. The authors reviewed the outcome of these pediatric patients who were treated with the open technique.Methods -We retrospectively reviewed the medical records of the 115 consecutive patients who underwent open appendectomy from June 2017 to July 2021.Results- There were 84 patients whose appendices were inflammatory or suppurative and appendectomies were done only through McBurney’s point. Of these, the average age was 9.11 ± 2.67 years. The mean length of the incision was 1.95 ± 0.48 centimeters. Nearly one-third (25/85) could be discharged with 3 hours following surgery. Of the remaining cases, 9 patients were discharged within the same day.Conclusion- There were increased percentages of patients who were eligible for our criteria in each year. The confidence of both parents and the therapeutic team on this concept is of paramount importance affecting a shift of paradigm of this treatment of this very common surgical condition.

scholarly journals Effect of length time to surgery on postoperative hospital length of stay among neurosurgical patients

2020 ◽  
Vol 11 ◽  
pp. 144
Author(s):  
Yahya H. Khormi ◽  
Andrew Nataraj
Keyword(s):  
Length Of Stay ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Outcome Variable ◽  
University Of Alberta ◽  
Postoperative Stay ◽  
Urgent Surgery ◽  
Neurosurgical Patients ◽  
Before And After ◽  
The Mean

Background: In most hospitals, inpatient urgent surgery is triaged based on the degree of urgency and time of surgical booking. A longer wait for semi-urgent surgery due to sharing resources between specialties might impact the postoperative course. The objective of this study is to determine the effect of length time to semi- urgent surgery on postoperative hospital length of stay among neurosurgical patients. Methods: A retrospective cohort study was conducted included all admitted adult patients placed on semi-urgent University of Alberta Hospital surgical list between 2008 and 2013. Linear and logistic regression analyses were performed. The main exposure variable was time from surgical booking to the time of surgery, and the outcome variable was time from surgery to discharge. Results: A total of 1367 neurosurgical cases were included in the study. The mean age was 54.3 years. The mean length of time in the hospital before and after surgery was 1.2 and 12.5 days, respectively. Overall, the time from booking to surgery did not affect the time from surgery to discharge. Increased age, higher ASA score, and surgeries performed after 24 h from booking in the group of patients who were discharged to another facility were associated with a longer postoperative stay. Conclusion: Neurosurgery patients booked for surgery to be done within 24 h waited longer to have their procedure completed. Overall, there was no significant association between length of time waiting for surgery and postoperative stay, although there was an increase in postoperative stays among patients who were discharged to another facility and had their surgeries performed after 24 h.

scholarly journals 216. Association Between Days to Initiate Appropriate Therapy and Hospital Length of Stay Among Adult Hospitalized Patients With Gram-negative Bloodstream Infections (GN-BSI)

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S127-S127
Author(s):  
Thomas Lodise ◽  
Hemanth Kanakamedala ◽  
Wei-Chun Hsu ◽  
Bin Cai
Keyword(s):  
Length Of Stay ◽  
Cohort Analysis ◽  
Hospital Length ◽  
Cox Proportional Hazards ◽  
Hospitalized Patients ◽  
Hospital Length Of Stay ◽  
Healthcare Database ◽  
Kaplan Meier ◽  
Appropriate Therapy ◽  
The Mean

Abstract Background The deleterious outcomes associated with delay receipt of appropriate therapy are well documented. However, scant data exists on the consequences of each day delay of appropriate therapy and subsequent outcomes among adult hospitalized patients with GN-BSIs. Methods Study design: a retrospective cohort analysis. Study population: consecutive adult, hospitalized patients with a GN-BSI (11 most prevalent pathogens) in 1 of 181 institutions contributing microbiology data to the Premier Healthcare Database (October 2010–Sep 2015). Exclusion criteria: age < 18 years; diagnosis of pregnancy or cystic fibrosis, died or discharged within 2 days of index GN-BSI culture, lack of sufficient antibiotic susceptibility or treatment data to determine appropriateness. Day of initiating appropriate therapy was defined as the first day when the patient received an antibiotic with in vitro activity against the GN-BSI post index culture. Results were summarized by Kaplan–Meier estimates, and Cox Proportional-Hazards (CPH) analyses modeling discharge to home were conducted. Time to initiate appropriate therapy (0, 1–2 days, 3–4 days, ≥5 days) was included in the CPH model as an ordinal variable. Results A total of 40,549 patients met selection criteria. Mean (SD) age was 67.5 (16.1) years and 54% were female. E. coli and K. pneumoniae were the most common GN-BSI (58.0% and 18.3%, respectively). Approximately 30% of patients were in the ICU at index GN-BSI and in-hospital mortality was 6.8%. The mean (SD) time to receive appropriate therapy post index GN-BSI culture was 0.6 (2.7) days, and 69.7%, 22.5%, 5.7% and 2.1% received appropriate therapy in 0, 1–2, 3–4, and ≥5 days of index GN-BSI, respectively. The mean/median LOS post index GN-BSI by 0, 1–2, 3–4, and ≥5 days delays in appropriate treatment were 8.3/6, 9.8/7, 11.5/8, and 19.2/11 days respectively. Kaplan–Meier plots are shown in Figure 1. In the CPH model, each interval delay in appropriate therapy was associated with a 21% decrease in the likelihood of being discharged home for patients with GB-BSIs. Conclusion Hospital length of stay was found to increase when appropriate therapy was delayed. These findings highlight the critical need for early appropriate therapy among patients with GN-BSIs. Disclosures All authors: No reported disclosures.

Successful Transition to Robotic-Assisted Lobectomy With Previous Proficiency in Thoracoscopic Lobectomy

2019 ◽  
Vol 14 (3) ◽  
pp. 263-271 ◽  
Author(s):  
Robert E. Merritt ◽  
Peter J. Kneuertz ◽  
Desmond M. D’Souza
Keyword(s):  
Length Of Stay ◽  
Lymph Nodes ◽  
Learning Curve ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Complication Rates ◽  
Robotic Assisted ◽  
Thoracoscopic Lobectomy ◽  
Surgeon Experience ◽  
The Mean

Objective The learning curve and the advantages of transitioning to robotic-assisted lobectomy by a surgeon who is proficient in thoracoscopic lobectomy is currently unknown. The cost of robotic lobectomy has been reported to be higher than thoracoscopic lobectomy and there is no significant decrease in hospital length of stay. Methods This is a retrospective review of 228 patients diagnosed with lung carcinoma who underwent minimally invasive lobectomy from March 2014 to May 2018. A total of 114 patients underwent thoracoscopic lobectomy and 114 patients underwent robotic-assisted lobectomy. The data collected included patient demographics, tumor characteristics, morbidity, mortality, operative times, and hospital length of stay. Results A total of 114 patients underwent thoracoscopic lobectomy and 114 patients underwent robotic-assisted lobectomy. The patients in each group were similar in age, gender, smoking status, FEV-1, tumor histology, and pathologic stage. The mortality and complication rates were similar. The mean number of total lymph nodes and N2 lymph nodes were significantly higher in the robotic lobectomy group ( P < 0.0001). The mean operative time was shorter in the robotic group. The median hospital length of stay (4 days) was similar between the 2 groups ( P = 0.99). Conclusion The results of this report suggest that thoracoscopic and robotic-assisted lobectomy have similar outcomes when a surgeon proficient in the thoracoscopic technique completely transitions to the robotic-assisted technique. The learning curve was relatively accelerated in this single-surgeon experience. There may be an advantage for robotic-assisted lobectomy in the total number of lymph nodes harvested.

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