scholarly journals Improved Pancreaticoduodenectomy Outcomes after Starting a Specialized Community Hospital Pancreatic Surgery Program

2020 ◽  
Vol 1 (2) ◽  
Author(s):  
George Younan ◽  
Maged Andrews ◽  
Umadevi Rangarajan ◽  
Danielle Eganhouse ◽  
Robert F. Ahmed ◽  
...  
Keyword(s):  
Pancreatic Surgery ◽  
Community Hospital ◽  
Total Pancreatectomy ◽  
Statistical Significance ◽  
Care Center ◽  
Tertiary Care ◽  
Length Of Hospital Stay ◽  
High Volume ◽  
R0 Resection ◽  
Estimated Blood Loss

Background: Recent trends in centralization of pancreatic surgery happened as a response to improved outcomes in tertiary care institutions. The volume-outcome relationship is true for high volume hospitals and surgeons. Obstacles to patient travelling to high volume institutions and widespread quality care in community hospitals led to establishing a quality specialized pancreatic surgery program in the community. Methods: Two pancreatic surgery specialists relocated their program from a tertiary care center to a community hospital. Results of the first sixty-two pancreaticoduodenectomy and total pancreatectomy procedures were studied. Results: One hundred and seventeen pancreatic surgery cases were analyzed, sixty-two pancreaticoduodenectomy and total pancreatectomy cases were included. Patient demographics were not different in regard to the median age (67 vs. 62 years), gender (65 vs. 62% males), median BMI (26.2 vs. 26 kg/m2), or American Society of Anesthesiologists class, in between the two hospitals. There was a significant decrease in the operative time (350 vs. 281 minutes, p=0.0001), estimated blood loss (409 vs. 156 milliliters, p=0.003), and length of hospital stay (7.2 vs. 5.2 days, p=0.0001). Most patients were operated on for a diagnosis of malignancy (74.2%), and the R0 resection rate was better at the community hospital reaching 95.2%. Transfusions, delayed gastric emptying and leaks tended to be better at the community hospital but did not reach statistical significance. Conclusion: With dedicated institutional support and careful program design, complex procedures such as PD can be successfully relocated to the community where superior results can be achieved.

Feasibility of Pancreaticoduodenectomy in a Nonuniversity Tertiary Care Center: What Are the Key Elements of Success?

2011 ◽  
Vol 77 (5) ◽  
pp. 545-551 ◽  
Author(s):  
Amit Khithani ◽  
Derick Christian ◽  
Kevin Lowe ◽  
A. Joe Saad ◽  
Jeffrey D. Linder ◽  
...  
Keyword(s):  
Operative Time ◽  
Care Center ◽  
Tertiary Care ◽  
High Volume ◽  
Team Approach ◽  
Tertiary Care Center ◽  
Key Factors ◽  
Estimated Blood Loss ◽  
Volume Outcome ◽  
The Mean

It is advocated that a favorable outcome for pancreaticoduodenectomy (PD) is related to a high volume at university centers. This article examines the specific elements that allow an equivalent outcome from PD in a nonuniversity tertiary care center (NUTCC). The study was performed to: 1) evaluate the outcome of PDs done at a NUTCC; 2) study the components of the process that are required to attain success in a NUTCC; and 3) provide a new look at the volume-outcome relationships in complex surgeries in a novel nonuniversity setting. Medical records of patients who underwent PD by a single surgeon between September 2005 and August 2008 at a high-volume NUTCC were analyzed. The records were reviewed with respect to preoperative and postoperative data, 30-day mortality, morbidity, and histopathology data. A total of 122 patients underwent PD. The mean age was 68.2 years. Jaundice was the most common presenting symptom in 57 per cent (69 patients). Thirty-nine patients (32%) underwent a pylorus-preserving PD. The mean operative time was 237 minutes. The mean estimated blood loss was 480 mL. The mean length hospital stay was 13 days. Thirty-day mortality was 3.2 per cent (four patients) and overall morbidity was 49 per cent. The key factors in developing a team dedicated to the care of the patient undergoing PD are discussed. A center of excellence can be developed in a NUTCC resulting in outcomes that meet and indeed may exceed nationally reported benchmarks. The key elements to success include a team approach to the patient undergoing PD.

Prevalence, Correlates and Management of Hyperglycemia in Diabetic Non-critically Ill Patients at a Tertiary Care Center in Lebanon

2019 ◽  
Vol 15 (2) ◽  
pp. 133-140 ◽  
Author(s):  
Ghada El Khoury ◽  
Hanine Mansour ◽  
Wissam K. Kabbara ◽  
Nibal Chamoun ◽  
Nadim Atallah ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Care Center ◽  
Descriptive Analysis ◽  
Tertiary Care ◽  
Multivariable Analysis ◽  
Length Of Hospital Stay ◽  
Retrospective Chart Review ◽  
Diabetic Patients

Background: Diabetes Mellitus is a chronic metabolic disease that affects 387 million people around the world. Episodes of hyperglycemia in hospitalized diabetic patients are associated with poor clinical outcomes and increased morbidity and mortality. Therefore, prevention of hyperglycemia is critical to decrease the length of hospital stay and to reduce complications and readmissions. Objective: The study aims to examine the prevalence of hyperglycemia and assess the correlates and management of hyperglycemia in diabetic non-critically ill patients. Methods: The study was conducted on the medical wards of a tertiary care teaching hospital in Lebanon. A retrospective chart review was conducted from January 2014 until September 2015. Diabetic patients admitted to Internal Medicine floors were identified. Descriptive analysis was first carried out, followed by a multivariable analysis to study the correlates of hyperglycemia occurrence. Results: A total of 235 medical charts were reviewed. Seventy percent of participants suffered from hyperglycemia during their hospital stay. The identified significant positive correlates for inpatient hyperglycemia, were the use of insulin sliding scale alone (OR=16.438 ± 6.765-39.941, p=0.001) and the low frequency of glucose monitoring. Measuring glucose every 8 hours (OR= 3.583 ± 1.506-8.524, p=0.004) and/or every 12 hours (OR=7.647 ± 0.704-79.231, p=0.0095) was associated with hyperglycemia. The major factor perceived by nurses as a barrier to successful hyperglycemia management was the lack of knowledge about appropriate insulin use (87.5%). Conclusion: Considerable mismanagement of hyperglycemia in diabetic non-critically ill patients exists; indicating a compelling need for the development and implementation of protocol-driven insulin order forms a comprehensive education plan on the appropriate use of insulin.

scholarly journals Prevalence and risk factors of anemia among pregnant women attending a high-volume tertiary care center for delivery

2015 ◽  
Vol 16 (4) ◽  
pp. 231-236 ◽  
Author(s):  
Cuneyt Eftal Taner ◽  
Atalay Ekin ◽  
Ulas Solmaz ◽  
Cenk Gezer ◽  
Birgul Cetin ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pregnant Women ◽  
Care Center ◽  
Tertiary Care ◽  
High Volume ◽  
Tertiary Care Center

scholarly journals Centralization of Pancreatic Surgery Improves Results: Review

2020 ◽  
Vol 109 (1) ◽  
pp. 4-10 ◽  
Author(s):  
R. Ahola ◽  
J. Sand ◽  
J. Laukkarinen
Keyword(s):  
Pancreatic Surgery ◽  
Length Of Hospital Stay ◽  
High Volume ◽  
Optimal Operation ◽  
Failure To Rescue ◽  
Short Term ◽  
Pancreatic Resections ◽  
The World ◽  
Low Volume ◽  
Active Research

Background and Aims: The effect of operation volume on the outcomes of pancreatic surgery has been a subject of research since the 1990s. In several countries around the world, this has led to the centralization of pancreatic surgery. However, controversy persists as to the benefits of centralization and what the optimal operation volume for pancreatic surgery actually is. This review summarizes the data on the effect of centralization on mortality, complications, hospital facilities used, and costs regarding pancreatic surgery. Materials and Methods: A systematic librarian-assisted search was performed in PubMed covering the years from August 1999 to August 2019. All studies comparing results of open pancreatic resections from high- and low-volume centers were included. In total 44, published articles were analyzed. Results: Studies used a variety of different criteria for high-volume and low-volume centers, which hampers the evaluating of the effect of operation volume. However, mortality in high-volume centers is consistently reported to be lower than in low-volume centers. In addition, failure to rescue critically ill patients is more common in low-volume centers. Cost-effectiveness has also been evaluated in the literature. Length of hospital stay in particular has been reported to be shorter in high-volume centers than in low-volume centers. Conclusion: The effect of centralization on the outcomes of pancreatic surgery has been under active research and the beneficial effect of it is associated especially with better short-term prognosis after surgery.

scholarly journals P.138 Corrective Adult Spinal Deformity Procedures in a community hospital: a single institution review

2016 ◽  
Vol 43 (S2) ◽  
pp. S52-S52
Author(s):  
S Yuh ◽  
M Warren ◽  
E Frangou ◽  
D Warren
Keyword(s):  
Spinal Deformity ◽  
Community Hospital ◽  
De Novo ◽  
Adult Spinal Deformity ◽  
Tertiary Care ◽  
High Volume ◽  
Complication Rates ◽  
Hardware Failure ◽  
Operative Care ◽  
Perioperative Complication

Background: Adult spinal deformity (ASD) are typically managed in tertiary care centres due to their complexity in surgical planning and peri-operative care. Methods: A retrospective analysis of consecutive corrective ASD surgery performed by a single surgeon at a community based centre performed between 2012 and 2014. Inclusion criteria were age ≥ 18 years with a minimum of 1 year follow-up. We reviewed age, aetiology, mortality, medical and neurological deficit. All standard radiographic deformity parameters were also evaluated and analysed. Results: n=32 corrective spinal deformity procedures were performed. The most common aetiology was de novo degenerative scoliosis. The mean length of stay was 11.94 days. The most common levels fused from T1-pelvis (n=13). L5/S1 was the most common level requiring interbody fusion (n=17). There were n=10 who required a PSO. Only n=4 patients had EBL greater than 3500cc.There were a total of 9 medical complications with post-operative hypotension being the most common (n=3). Hardware failure across the PSO site was the most common long term complication (n=7). There were n=2 death. There were no reported deep infections requiring revisions. Radiographic parameters analysed showed significant improvement. Conclusions: ASD surgery perioperative complication rates in a community hospital are similar to those done in high volume academic centre.

Timing of robotic hysterectomy after cervical excisional procedure

2019 ◽  
Vol 29 (7) ◽  
pp. 1110-1115
Author(s):  
Anna K. Melnikoff ◽  
David W. Doo ◽  
Alexander C. Cohen ◽  
Emily Landers ◽  
Christen Walters-Haygood ◽  
...  
Keyword(s):  
Surgical Intervention ◽  
Care Center ◽  
Tertiary Care ◽  
Complication Rates ◽  
Robotic Hysterectomy ◽  
Operative Complication ◽  
Operative Outcomes ◽  
Gynecology And Obstetrics ◽  
Estimated Blood Loss ◽  
Early Surgical Intervention

IntroductionWhile traditional teaching has been to wait 6 weeks between cervical excisional procedure and hysterectomy, studies have produced conflicting evidence, with data supporting a delay of anywhere between 48 hours to 6 weeks depending on surgical approach. Our study sought to evaluate if the time between cervical excisional procedure and robotic hysterectomy impacts peri-operative complication rates.MethodsA retrospective cohort of patients who underwent robotic hysterectomy from August 2006 to December 2013 for cervical dysplasia or International Federation of Gynecology and Obstetrics (FIGO) 2009 stage IA1–B1 cervical cancer at a single tertiary care center was performed. Patients were categorized into three groups: early surgical intervention (<6 weeks from excisional procedure), delayed surgical intervention (≥6 weeks from excisional procedure), and no excisional procedure. Secondary analysis was performed by hysterectomy type (simple vs radical). Peri-operative outcomes and complications were compared. Statistical analysis included Chi-square, Fisher’s exact test, and Wilcoxon rank sum test.ResultsA total of 160 patients were identified. Of these, 32 (20.0%) had early surgical intervention, 52 (32.5%) had delayed surgical intervention, and 76 (47.5%) had no excisional procedure. There was no difference between groups in complication rates, including average estimated blood loss (82 vs 55 vs 71 mL; p=0.07), urologic injury (0% in all groups; p=1.0), anemia (3% vs 0% vs 1%; p=0.47), infection (0% vs 2% vs 3%; p=1.0), vaginal cuff separation (0% in all groups; p=1.0), or venous thromboembolism (0% vs 0% vs 1%; p=1.0). Additionally, there were no differences in length of stay (p=0.18) or 30-day readmission rates (p=1.0). Finally, there were no significant differences in peri-operative outcomes when stratified by radical versus simple hysterectomy.DiscussionWaiting 6 weeks between cervical excisional procedure and robotic hysterectomy does not impact peri-operative complication rates. This suggests that the time from excisional procedure should not factor into surgical planning for those who undergo robotic hysterectomy.

ERCP quality indicators: The experience of a high-volume tertiary care center in Saudi Arabia

2019 ◽  
Vol 20 (1) ◽  
pp. 32-37
Author(s):  
Shahem Abbarh ◽  
Mostafa Seleem ◽  
Areej Al Balkhi ◽  
Abdullah Al Mtawa ◽  
Abdullah Al Khathlan ◽  
...  
Keyword(s):  
Saudi Arabia ◽  
Quality Indicators ◽  
Care Center ◽  
Tertiary Care ◽  
High Volume ◽  
Tertiary Care Center

scholarly journals Spectrum of cytological patterns in cervical PAP smears in a tertiary care center of Western region of Nepal

2019 ◽  
Vol 4 (1) ◽  
pp. 2-8
Author(s):  
Pragya Gautam Ghimire ◽  
Durga BC Rawat ◽  
Kavita Sinha ◽  
Kamar Jahan ◽  
Richa Shrestha
Keyword(s):  
Cervical Cancer ◽  
Epithelial Cell ◽  
Pap Smear ◽  
Statistical Significance ◽  
Care Center ◽  
Tertiary Care ◽  
Pap Smears ◽  
Low Grade ◽  
Squamous Intraepithelial Lesion ◽  
Intraepithelial Lesion

Introduction: Cervical cancer is a common health problem in Nepal. There is paucity of data regarding the spectrum of findings in cervical Pap in western Nepal. This study was aimed to study the cytological patterns in cervical Pap smears in patients in a tertiary hospital of Nepal. Methods: This is a prospective, cross sectional, hospital based study. Clinical features of patients who had presented with Pap smear was noted in a structured proforma. Pap smears were studied by a senior pathologist and reported based on revised Bethesda system (2014). Results: Most of the cases belonged to 31-40 years 399 (42.8%). Unsatisfactory/ inadequate sample was present in 133(14.05%) with obscuration due to inflammatory exudate being most common cause. Negative for intraepithelial lesion or malignancy rate was noted in 798 (85.54%) with 477(51.2%) being normal findings. Epithelial cell abnormalities were noted in 116 (14.5 %) smears. Low-grade squamous intraepithelial lesion constituted 321(34.5%), High grade squamous intraepithelial lesion 273(29.3 %) and Atypical squamous cells of undetermined significance 153(16.4%) of epithelial cell abnormalities. Squamous cell carcinoma was present in 9(1%) of all reviewed smears. There was no statistical significance between the age and abnormalities of Pap smear (p=0.9). Conclusions: Pap smear is pivotal in cervical cancer screening in developing countries. It also identifies various inflammatory, infective, benign and malignant pathologies at the earliest thereby decreasing the morbidity and mortality.

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