Hospital Stay Research Articles

EFFICACY OF INTRAPERITONEAL BUPIVACAINE INSTILLATION FOR POSTOPERATIVE PAIN CONTROL: A QUALITY IMPROVEMENT STUDY

Laparoscopic surgery is associated with better pain experience, reduced Length of Hospital Stay and better scar. However, the resulting postoperative pain is distinct and can be disturbing, hence the need for multimodal analgesia. The side effects of parenteral analgesics and low practice of regional anaesthesia has limited their role in multimodal analgesia. Therefore, strategies that limit the reliance on these pain control modalities will be beneficial. Our study evaluated the efficacy of intraperitoneal instillation of plain bupivacaine after laparoscopic surgeries. The double blinded randomized study enrolled 50 consenting patients who fulfilled recruitment criteria. The bupivacaine group received 20mls of 0.25% plain Bupivacaine while the saline group received 20mls normal saline instillation into the peritoneal cavity via the umbilical port of the laparoscopy device. Visual Analogue Scale (VAS) was assessed at presentation at the Post anaesthesia care unit (PACU) and at 4, 8, 12, 16, 20, 24 hours afterward. In addition, the interval between end of surgery, first request for analgesia and total analgesic requirements were recorded. The VAS at presentation was significantly lower in the Bupivacaine group compared to the saline group, however, there was no statistically significant difference at other times. In addition, there was a significant difference in time to first analgesic request in both groups. The only observed post operative complications were nausea and vomiting. Intraperitoneal Instillation of Bupivacaine is an easy, non-invasive, cheaper and safer method of pain control following laparoscopic surgery in carefully selected patients.

Length of Postpartum Hospital Stays During COVID-19: Findings From a Convergent Parallel Mixed-Methods Study

ObjectivesWe examined the length of postpartum hospitalization for live births during the COVID-19 pandemic and explored how pandemic circumstances influenced postpartum hospital experiences. MethodsWe conducted a cross-provincial, convergent parallel mixed-methods study in Ontario (ON) and British Columbia (BC), Canada. We included birthing persons (BPs) with an in-hospital birth in ON from 1 January to 31 March 2019, 2021, and 2022 (quantitative), and BPs (≥18 years) in ON or BC from 1 May 2020 to 1 December 2021 (qualitative). We linked multiple health administrative datasets at ICES and developed multivariable linear regression models to examine the length of hospital stay (quantitative). We conducted semi-structured interviews using qualitative descriptive to understand experiences of postpartum hospitalization (qualitative). Data integration occurred during design and interpretation. ResultsRelative to 2019, postpartum hospital stays decreased significantly by 3.29 hours (95% CI –3.58 to –2.99; 9.2% reduction) in 2021 and 3.89 hours (95% CI –4.17 to –3.60; 9.0% reduction) in 2022. After adjustment, factors associated with shortened stays included: giving birth during COVID-19, social deprivation (more ethnocultural diversity), midwifery care, multiparity, and lower newborn birth weight. Postpartum hospital experiences were impacted by risk perception of COVID-19 infection, clinical care and hospital services/amenities, visitor policies, and duration of stay. ConclusionsLength of postpartum hospital stays decreased during COVID-19, and qualitative findings described unmet needs for postpartum services. The integration of large administrative and interview data expanded our understanding of observed differences. Future research should investigate the impacts of shortened stays on health service outcomes and personal experiences.

Correlation of Vitamin B12 Levels with Clinical Manifestations, Thrombocytopenia, Hospital Stay, and Platelet Recovery in Dengue Patients

Correlation of Vitamin B12 Levels with Clinical Manifestations, Thrombocytopenia, Hospital Stay, and Platelet Recovery in Dengue Patients

Effects of Periarticular Multimodal Drug Injection on Pain Control, Early Mobilization, and Length of Hospital Stay in Patients Undergoing Total Knee Arthroplasty.

We investigated the effects of periarticular multimodal drug injection (PMDI) on postoperative pain control, patients' mobilization, and length of hospital stay in patients undergoing total knee arthroplasty (TKA). We retrospectively enrolled patients who underwent unilateral TKA between 2019 and 2020. The formula for PMDI included 0.5 mL epinephrine (1 mg/mL), 1 mL ketorolac (30 mg/mL), 0.5 mL morphine (10 mg/mL), and 20 mL bupivacaine hydrochloride (5 mg/mL), mixed with 60 mL normal saline. The outcomes of interest included (1) the amount of patient-controlled anesthesia (PCA) consumption in the first 24 h after the surgery, (2) early mobilization within 24 h after the surgery, and (3) the length of hospital stay. A total of 127 patients were analyzed. Compared with patients who did not receive PMDI, those who received PMDI had lower consumption of PCA in the first 24 h (β coefficient -29.9, 95% CI -51.9 to -7.9, p = 0.008), higher odds of early mobilization within 24 h (odds ratio 8.263, 95% CI 3.041 to 22.453, p < 0.001), and shorter length of hospital stay (β coefficient -0.705, 95% CI -1.158 to -0.252, p = 0.003). We suggest that PMDI may be considered for patients undergoing TKA to improve the quality of care and shorten their length of hospital stay.

Comparison of Oral Anticoagulant Users with Non-users Admission Laboratory Parameters, Length of Hospital Stay and Outcomes in COVID-19 Infection

Comparison of Oral Anticoagulant Users with Non-users Admission Laboratory Parameters, Length of Hospital Stay and Outcomes in COVID-19 Infection

Effect of a Point-of-Care Ultrasound-Driven vs Standard Diagnostic Pathway on 24-Hour Hospital Stay in Emergency Department Patients with Dyspnea-Protocol for A Randomized Controlled Trial.

Point-of-care ultrasound (POCUS) helps emergency department (ED) physicians make prompt and appropriate decisions, but the optimal diagnostic integration and potential clinical benefits remain unclear. We describe the protocol and statistical analysis plan for a randomized controlled trial. The objective is to determine the effect of a POCUS-driven diagnostic pathway in adult dyspneic ED patients on the proportion of patients having a hospital stay of less than 24 hours when compared to the standard diagnostic pathway. This is a multicenter, randomized, investigator-initiated, open-labeled, pragmatic, controlled trial. Adult ED patients with chief complaint dyspnea are eligible. Patients are randomized (1:1) to the POCUS-driven diagnostic pathway or standard diagnostic pathway, with 337 patients in each group. The primary outcome is the proportion of patients having a hospital stay (from ED arrival to hospital discharge) of less than 24 hours. Key secondary outcomes include hospital length-of-stay, 72-hour revisits, and 30-day hospital-free days. Sparse evidence exists for any clinical benefit from a POCUS-integrated diagnostic pathway. The results from this trial will help clarify the promising signals for POCUS to influence patient care among ED patients with dyspnea.

Postoperative Day 1 Dangling Protocol with Tissue Oximetry Guidance Decreases Hospital Stay in Lower Extremity Fasciocutaneous Free Flaps: Early Experience.

Postoperative Day 1 Dangling Protocol with Tissue Oximetry Guidance Decreases Hospital Stay in Lower Extremity Fasciocutaneous Free Flaps: Early Experience.

Adherence to the Mediterranean Diet Mitigates Inflammation and Hospital Stay in Frail Elderly Patients: A Moderation Analysis.

We conducted two-way ANOVA and multiple regression analysis to evaluate the effects of nutritional status and MD adherence on the CRP levels and LOS in a cohort of 117 frail elderly patients aged 65 years or older. Patients with cancer or acute infection were excluded. Adherence to the MD was assessed using the 14-item PREDIMED questionnaire. Significant interactions were found between nutritional status and MD adherence for both the CRP and LOS. The patients with low-level MD adherence and a poor nutritional status exhibited higher CRP levels and longer hospital stays compared to those with high MD adherence. Specifically, a statistically significant interaction was observed for the CRP (F (1, 113) = 7.36, p = 0.008) and LOS (F (1, 113) = 15.4, p < 0.001), indicating the protective effect of high-level MD adherence. Moderation analysis confirmed that high-level MD adherence mitigates the adverse effects of malnutrition on both the inflammatory response and LOS. These findings highlight the importance of promoting the MD, particularly in malnourished elderly patients, to improve health outcomes and reduce hospitalization duration. Further longitudinal studies are warranted to establish causality and explore the underlying mechanisms.

Respiratory Worsening at the End of a Hospital Stay for Severe Covid19 Pneumonia Revealing Pulmonary Tuberculosis

The coexistence of a viral and tuberculous respiratory infection increases mortality and the transition to a severe form in both directions. We report an observation for a 55-year-old woman with untreated diffuse interstitial pnuemopathy, investigated by immunological and infectious tests, and found negative for pulmonary tuberculosis. Bronchial biopsies revealed non-specific inflammation, responsible for chronic dyspnea. Having presented ten days previously with myalgias, fatigue, dry cough and fever, with worsening of basic dyspnoea, without digestive or neurological manifestations, she was referred to the emergency department, where physical examination showed SpO2 at 80% on room air, reduced to 92% under 15 L/mn delivered via a high-concentration mask, polypnoea at 40 cycles per minute with bilateral diffuse crackling rales on auscultation, scattering just the anterior quadrants. The initial evolution was favorable, with clinical improvement in oxygen saturation to 94% on two liters per minute of oxygen delivered by nasal cannula, with respiratory rate at 23 cycles per minute with modest effort tolerance. On day 18 of hospitalization, she presented with a febrile peak of 38.3°C, polypnoea at 33 cycles per minute, increased oxygen requirements with a flow rate of 6l/m by face mask to reach an oxygen saturation of 92%, tachycardia at 130 beats per minute, and was therefore readmitted to intensive care with high-flow nasal oxygen therapy and antibiotic therapy with imipenem and amikacin. Multiplex PCR showing no germ, and a PCR test for pulmonary tuberculosis on a sputum sample which was positive, prompting the introduction of antibacillary treatment based on a fixed quadric-association of rifampicin, isoniaside, pyrazinaamide and ethombutol. Non-specific antibiotic therapy was discontinued after improvement of the inflammatory syndrome, and antibacillary treatment is still ongoing. Conclusion: Through this observation we discuss the difficulties in terms of diagnosis, management and outcome of a coinfection by SARS-COV 19 and mycobacterium tuberculosis.

Effect of Alvimopan on Postoperative Ileus and Length of Hospital Stay in Patients Undergoing Bowel Resection: A Systematic Review and Meta-Analysis.

The aim is to investigate the effect of alvimopan on postoperative ileus and length of hospital stay in patients undergoing bowel resection. The PRISMA statement standards were followed to conduct a systematic review and meta-analysis. The available literature was searched to identify all studies comparing alvimopan with no alvimopan in patients undergoing bowel resection. Postoperative ileus and length of hospital stay were the primary outcomes, and time to first bowel motion was the secondary outcome. Random-effects modeling was applied for analyses. Analysis of 94833 patients from 26 studies showed that alvimopan was associated with lower risk of postoperative ileus (OR: .57, 95% CI .48 to .67, P <.00001; high GRADE certainty), shorter length of hospital stay (MD: -1.08 day, 95% CI -1.36 to -.81, P < .00001; moderate GRADE certainty), and shorter time to first bowel motion (MD: -.43 day, 95% CI -.58 to -.28, P < .00001; moderate GRADE certainty). Separate analyses of randomized controlled trials and observational studies showed similar findings. Subgroup analyses suggested consistent findings in patients undergoing elective bowel resection, emergency bowel resection, and open surgery; however, alvimopan did not improve the outcomes in patients undergoing minimally invasive surgery. Robust evidence supports the routine use of alvimopan in patients undergoing open bowel resection as indicated by lower risk of postoperative ileus and shorter length of hospital stay. We support incorporation of alvimopan into enhanced recovery after surgery programs for the procedures involving open bowel resection. The role of alvimopan in minimally invasive bowel resection needs more research.

High Flow Nasal Cannula Therapy in Infant Bronchiolitis: A Developing Perspective, and A Long-Term Assessment of the Effects on Length of Hospital Stay

High Flow Nasal Cannula Therapy in Infant Bronchiolitis: A Developing Perspective, and A Long-Term Assessment of the Effects on Length of Hospital Stay

Utility of Hemogram-based Parameter in Predicting Hospital Stay in Liver Cirrhosis: A 2-year Prospective Observational Study

Abstract Introduction: Hospitalized cirrhosis patients are a major financial burden on health-care systems. In this study, we attempted to evaluate the regular laboratory parameter like absolute eosinophil count (AEC), in liver cirrhosis in relation to length of hospital stay and severity grading systems such as the Child–Turcotte–Pugh (CTP) score and the model for end-stage liver disease (MELD). Materials and Methods: A prospective observational study was done in patients at a rural tertiary care hospital in central India, from October 2019 to September 2020. Calculation of AEC was done by automated complete blood counts in hemogram. Demographics of the patient, laboratory investigations, and outcomes of hospital stay were taken into consideration in the study. To identify predictors of hospital stay, a multivariate Cox regression analysis was used. Results: Among hemogram, with a cutoff value of ≤138, the AEC was found to be a significant predictor of lengthy hospital stays (≥7 days), with a 63.70% likelihood of properly predicting such stays. If AEC ≤138, then there was a 69.80% probability of prolonged hospital stays. Distribution of CTP score was comparable between hospital stay duration, i.e. &lt;7 days and ≥7 days. Proportion of patients with MELD score with ≤9, was significantly higher if duration of hospital stay was &lt;7 as compared to hospital stay duration ≥7 in MELD score 10-19. Conclusions: In hospitalized cirrhotic patients, among the hemogram, the AEC may be used as a low-cost warning indicator for clinical outcomes such as hospital stay.

615 Audit of Documentation of Operation Name During Hospital Stay

615 Audit of Documentation of Operation Name During Hospital Stay

276 Clinical and Demographic Factors Influencing Length of Hospital Stay in Pancreatitis: A Retrospective Study

276 Clinical and Demographic Factors Influencing Length of Hospital Stay in Pancreatitis: A Retrospective Study

138 Intravenous Morphine Negatively Affects the Length of Hospital Stay in Elective Laparoscopic Major Colorectal Surgery

138 Intravenous Morphine Negatively Affects the Length of Hospital Stay in Elective Laparoscopic Major Colorectal Surgery

1162 Extended Hospital Stays: Awaiting Social Care Packages - an Interim Challenge or a New Norm?

1162 Extended Hospital Stays: Awaiting Social Care Packages - an Interim Challenge or a New Norm?

ANALYSIS OF EFFICACY OF COLLAGEN DRESSING VERSUS CONVENTIONAL DRESSING IN CHRONIC WOUND

A breach in continuity of the covering epithelium either of skin or of mucus membrane is defined as ulcer. Chronic or non-healing ulcers are defined as ulcers that are unresponsive to initial treatment or that persist for more than 3 weeks after appropriate care and management. Chronic nonhealing ulcers not only have a medical challenge but have social, economical and occupational effects on the patient. Ulcers have been treated conventionally by cleansing, debridement and removal of necrotic and infected tissue which was followed by dressing with topical antiseptic like Povidone iodine, antibiotic ointment, silver ointment, etc. Collagen is a group of naturally occurring proteins found in all phases of wound healing. Collagen is a key component of extracellular matrix which plays critical roles in the regulation of the phases of wound healing in its native fibrillar conformation or as a soluble component.Collagen helps wound healing through deposition and organisation of freshly formed fibres and granulation tissue in the wound bed which creates a good environment for wound healing.Collagen sheets when applied to a wound promote angiogenesis and also enhance bodyÂ’s repair mechanisms Our Aim is To compare the efficacy of the conventional dressing and collagen dressing in chronic wound in terms of Average time required for appearance of Granulation tissue, Requirement of Skin Grafting and mean Hospital Stay. Based on the type of dressing used, patients were divided into 2 groups, Group A(49) patients were dressed with conventional dressing, Group B patients (51) were dressed with collagen making a total of 100 patients. Appearance of healthy granulation tissue was observed to be significantly earlier among patients of collagen dressing group as compared to other group .The observed difference between number of days of hospital stay of patients with collagen dressing was statistically significant as compared to other group Thus Collagen based dressing were observed to be superior from conventional dressings in terms of aspects of healing viz. appearance of healthy granulation tissue.

Length of Hospital Stay in Patients Related with Moderate Fluid Resuscitation and Aggressive Fluid Resuscitation in Acute Pancreatitis

Length of Hospital Stay in Patients Related with Moderate Fluid Resuscitation and Aggressive Fluid Resuscitation in Acute Pancreatitis

Comparison of Mean Hospital Stay after Nebulization with 3% Hypertonic Saline vs Salbutamol in Treatment of Bronchiolitis

Abstract: Background: With an estimated prevalence of 33% in children age &gt;2years and owing to 1 in 10th cause of hospitalization in children, Bronchiolitis is a major factor for morbidity and mortality. Varying nebulization doses have been shown to produce different clinical outcomes in patients with bronchiolitis. Objective: To compare mean hospital stay after nebulization with 3% hypertonic saline compared to the salbutamol among patients of bronchiolitis Materials and Methods: This was a randomized control study done at pediatric medicine ward, Services Hospital, Lahore. The study was done during 8th May 2018 to 8th November 2018. Data was collected from 68 children of age &gt;3 months to &lt; 2 years of both genders i.e. (34 in each group) fulfilling inclusion criteria. SPSS software was used for data entry and analysis. For quantitative variables age, mean and standard deviation were used whereas for qualitative variables like gender, frequency and percentages were used. Independent sample t-test was used for comparing mean hospital stay among the two groups taking p-value&lt;0.05 as significant. Result: Average age in Salbutamol group was 1.06 ± 0.50 years and in Hypertonic solution mean age was 1.24 ± 0.55 years. There was significant difference in mean hospital stay with relatively lesser in hypertonic solution vs the Salbutamol group [3.18 ± 1.11 vs 4.44 ± 1.08 ; p-value &lt;0.001]. Upon post-stratification analysis, the mean hospital stay was found to be significantly lower in the Hypertonic group vs. Salbutamol group with respect to age, gender and the duration of the disease (p-values&lt;0.05 for all). Conclusion: This study concludes that the mean hospital stay was statistically lower in the hypertonic solution group vs the Salbutamol group. Moreover, the clinical efficacy of the hypertonic saline can be utilized in future to gain early recovery of Bronchiolitis and hence it can reduce the hospital stay and related cost. Keywords: Bronchiolitis, Salbutamol, Hypertonic saline, Hospital stay, Severity, Duration, Treatment.

Acute Diarrhoea in Children Aged Up to 2 Years Age Group: Assessment of Therapeutic Strategies and Hospital Stay Variance, in Tertiary Care Rural Hospital – An Observational Study

Acute Diarrhoea, it is one of the leading causes of under 5 childrens’ morbidity and mortality in India. It is most common in children especially those between 6 months and 2 years. Antimicrobials are mostly used drug for acute diarrhoeal cases according to many studies but according to WHO antibiotics are not required for all the diarrhoeal cases except few bacterial diarrhoeas. Other way, WHO recommends Zinc with low osmolarity ORS for acute diarrhoea. So, this study was designed for assessing the treatment pattern and its outcome in our setup. Objectives: - To assess the use of antibiotics and Zinc among children under 2 years suffering from acute Diarrhoea by analysing average of use and hospital stay. Materials and Methods: - This observational study includes 76 patients, admitted under Paediatric Department of Mahatma Gandhi Institute of Medical Sciences, in the period of 6 months. All the patients admitted during the study period having acute Diarrhoea with moderate dehydration as per definition of WHO was included in the study. Patients with other existing diseases, bloody diarrhoea and seriously ill were excluded. Data was collected from Paediatric ward and was analysed by using GraphPad software. Results: - Over all among the 76 patients, 25(32.89%) patients received antimicrobials only and 31(40.79%) received Zinc only and11(14.47%) patients received both. Hospital stay difference was not statistically significant in culture negative acute diarrhoea cases with the use of zinc and antimicrobials (p = 0.08) but it was significant in culture positive cases (p = 0.03). Conclusion: - In culture negative acute diarrhoeal cases Zinc was mostly used and hospital stay was not found to be significant with and without antimicrobials. Implication: - Uncomplicated acute diarrhoeal cases may be treated with Zinc alone effectively.