Lower Hospitalization Expenses Research Articles

Enhanced recovery after surgery for percutaneous CT-guided microwave ablation of lung tumors: A single-center retrospective cohort study.

The feasibility and safety of enhanced recovery after surgery (ERAS) for percutaneous computed tomography (CT)-guided microwave ablation (MWA) for treating lung nodules remain unclear. A total of 409 patients with lung tumors treated at the Department of Thoracic Surgery, First Affiliated Hospital of Guangxi Medical University from August 2020 to May 2023 were enrolled. Perioperative data, including baseline characteristics, operation time, postoperative pain score (visual analog scale [VAS]), hospitalization expenses, postoperative complications, total hospital stay, and patient satisfaction, were observed and recorded. No perioperative mortality occurred in either group and complete ablation was achieved in all patients. Patients in the ERAS group had significantly shorter hospital stays (P < 0.001), reduced operation times (P = 0.047), lower hospitalization expenses (P < 0.001), lower VAS scores (P < 0.001), and fewer complications (P = 0.047) compared with the traditional group. ERAS for percutaneous CT-guided MWA (ERAA) is safe, effective, and feasible for the treatment of lung nodules.

Effects of the enhanced recovery after surgery (ERAS) protocol on the postoperative stress state and short-term complications in elderly patients with colorectal cancer.

The aim of this study was to evaluate the feasibility and necessity of enhanced recovery after surgery in elderly patients with colorectal cancer by observing inflammatory markers and postoperative complications. Hospitalized colorectal cancer patients from the Affiliated Hospital of Jiangsu University from January 2021 to September 2022 were included in the study and divided into two groups: Enhanced Recovery After Surgery (ERAS) and non-ERAS. Data on postoperative inflammatory markers and complications were also collected. A total of 313 patients with colorectal cancer were included: 182 in the ERAS group and 131 in the non-ERAS group. The patients in the ERAS group had significantly shorter days of postoperative hospitalization, urinary catheter and drainage tube withdrawal times, and recovery of bowel function (P < .05) than those of the non-ERAS group. Moreover, the ERAS group had lower hospitalization expenses than those of the non-ERAS group (P < .05). However, the procalcitonin and tumor necrosis factor (TNF)-α levels in the ERAS group was significantly lower than those in the non-ERAS group on postoperative days 1 and 3 (P < .05), and the interleukin (IL)-6 and IL-10 levels in the ERAS group were significantly lower than those in the non-ERAS group on the 1st, 3rd, and 5th postoperative days (P < .05). The C-reactive protein (CRP) and white blood cell (WBC) levels in the ERAS group were lower than those in the non-ERAS group on postoperative days 3 and 5 (P < .05). However, the hemoglobin levels did not differ significantly (P > .05). The albumin levels did not differ significantly between the two groups before surgery (P > .05); however, the albumin level in the ERAS group was higher than that in the non-ERAS group on postoperative days 3 and 5 (P < .05). The ERAS patients had lower albumin levels after surgery than those of the non-ERAS patients (P < .05). ERAS leads to a series of perioperative optimization measures, thereby reducing the postoperative stress response in elderly patients with colorectal cancer and the occurrence of perioperative complications.

Effectiveness and safety of prophylactic abdominal aortic balloon occlusion for patients with type III caesarean scar pregnancy: a prospective cohort study

BackgroundCaesarean scar pregnancy (CSP) is a special type of ectopic pregnancy with a high risk of massive haemorrhage. Few studies have focused on the efficacy of prophylactic abdominal aortic balloon occlusion as a minimally invasive method in caesarean section. This study aimed to evaluate the effectiveness and safety of prophylactic abdominal aortic balloon occlusion for patients with type III CSP.MethodsThis was a prospective cohort study. Patients with type III CSP in the First Affiliated Hospital of Zhengzhou University from January 2020 to June 2022 were enrolled. Eligible patients received prophylactic abdominal aortic balloon occlusion (defined as the AABO group) or uterine artery embolization (defined as the UAE group) before laparoscopic surgery. Clinical outcomes included intraoperative blood loss, body surface radiation dose, hospitalization expenses, and time to serum β-hCG normalization, and safety were also assessed.ResultsA total of 68 patients met the criteria for the study, of whom 34 patients were in the AABO group and 34 patients were in the UAE group. The median intraoperative blood loss in the AABO and UAE groups was 17.5 (interquartile ranges [IQR]: 10, 45) and 10 (IQR: 6.25, 20) mL, respectively (P = 0.264). The body surface radiation dose of the AABO group was much lower than that of the UAE group (5.22 ± 0.44 vs. 1441.85 ± 11.59 mGy, P < 0.001). The AABO group also had lower hospitalization expenses than the UAE group (2.42 ± 0.51 vs. 3.42 ± 0.85 *10^5 yuan, P < 0.001). The average time to serum β-hCG normalization in the AABO group was 28.9 ± 3.21 d, which was similar to that in the UAE group (30.3 ± 3.72 d, P = 0.099). In addition, the incidence of adverse events in the AABO group was lower than that in the UAE group (5.9% vs. 58.8%, P < 0.001).ConclusionProphylactic AABO was equally as effective as UAE in patients with type III CSP but was safer than UAE during and after the operation.

Epidemiology of irritable bowel syndrome in hospitalized patients with inflammatory bowel disease: Nationwide Inpatient Sample analysis from 2007-2016.

Despite effective treatments for inflammatory bowel disease (IBD), patients in remission may still suffer from gastrointestinal symptoms attributable to overlying irritable bowel syndrome (IBS). In this population-based cohort study, we investigated the epidemiology of IBS in hospitalized IBD patients and explored the differences between hospitalized IBD-IBS vs. IBD patients to distinguish this patient population. Using the Nationwide Inpatient Sample database from 2007-2016, we identified patients with a primary or secondary discharge diagnosis of IBD, with or without IBS, using ICD-9 and ICD-10 codes. We extracted information on demographics, psychological comorbidities, IBD complications, cost and duration of stay of each group, from either discharge records or diagnosis codes. These were analyzed using SAS version 4.0. There was a rise in the prevalence of IBS among inpatients with ulcerative colitis (P=0.025) and Crohn's disease (P=0.0014) over the study period. This study revealed that IBD patients with IBS tend to be female, younger, are less likely to be morbidly obese and have higher rates of psychological disorders (P<0.001) compared to IBD patients with no IBS co-diagnosis. They also have fewer IBD-specific complications, such as strictures, obstruction, fistula and abdominal abscess (P<0.001). Shorter hospital stays (P<0.001) and lower hospital charges (P<0.001) were also noted in these patients. IBD patients with IBS are significantly different from other IBD patients, and are associated with less severe disease, a shorter hospital stay and lower hospital expenses. Early and accurate classification of this patient population may prevent unnecessary treatment and hospitalization in the future.

Subxiphoid-subcostal thoracoscopic thymectomy for seropositive myasthenia offers equivalent remission rates and potentially faster recovery.

OBJECTIVESTo compare the perioperative and follow-up outcomes of patients with myasthenia gravis (MG) receiving subxiphoid-subcostal or unilateral thoracoscopic thymectomy and to identify the factors affecting MG prognosis.METHODSFrom January 2013 to December 2019, a total of 137 consecutive MG patients received subxiphoid-subcostal thoracoscopic thymectomy (STT, n = 65) or conventional unilateral thoracoscopic thymectomy (UTT, n = 72). The primary outcomes of this study were perioperative complications, duration and expenses of hospitalization, VAS score and complete stable remission (CSR).RESULTSThe patients receiving STT had significantly shorter drainage duration and postoperative hospital stay and lower hospitalization expenses (P < 0.01). Pain scores on postoperative Days 1, 3, 7 and 14 were significantly lower in patients undergoing STT (P < 0.01). The average follow-up was 54.3 ± 24.18 months, with a CSR rate of 30.6% and an overall effective rate of 87.3%. Through uni- and multivariable analyses, shorter symptom duration and Myasthenia Gravis Foundation of America (MGFA) class I were independent predictors for CSR in MG patients receiving thymectomy.CONCLUSIONSThe present study not only showed that STT was a safe and feasible technique for MG, with a potentially faster postoperative recovery, lower hospitalization expenses, less postoperative pain and equivalent remission rate, but also revealed that shorter symptom duration and MGFA class I were favourable prognostic factors for CSR.

The novel use of lauromacrogol: A respective study of ultrasound‐guided sclerosant injection for cesarean scar pregnancy

To introduce the novel use of lauromacrogol for cesarean scar pregnancy (CSP), and to compare the clinical efficacy and safety of curettage combined with ultrasound-guided sclerosant injection (USI) and curettage following uterine artery embolization (UAE) in the treatment of CSP. CSP patients undergoing curettage combined with USI (n=72) from December 2014 to May 2020 were compared to patient with curettage following UAE (n=72).The basic clinical findings and clinical outcomes were reviewed between the two groups. For USI group, 69 patients underwent successful treatment (95.8% success rate), while the number of cured patients for the UAE group was 70 (97.2% success rate). Differences between USI group and UAE group in intraoperative blood loss (10.0 [10.0-20.0] vs. 10.0 [10.0-20.0] mL) and time for serum β human chorionic gonadotropin (β-hCG) to reduce to normal (28.0 [21.0-40.0] vs. 28.0 [21.0-35.0] days) were not statistically significant. The hospital stay for USI group was significantly shorter than that for UAE group (4.0 [4.0-6.0] vs. 6.0 [5.0-7.0] days, respectively). Statistically significant decreases were noted in hospitalization expenses and adverse events in USI group, compared to UAE group. There was no difference in live birth rate between the two groups with fertility intentions during the follow-up. For treatment of CSP, curettage combined with USI yielded clinical results comparable to those of curettage following UAE. Curettage combined with USI was associated with lower hospitalization expenses, shorter hospital stay and less complications, and it merited an effective and safe treatment for CSP.

Abstract No. 463 Percutaneous vertebral augmentation in the oldest old: comparative evaluation of comorbidities, outcomes and disparities

The “oldest old” refers to the patient population at the apex of the age pyramid and is classically defined as patients over the age of 85. Recent studies have demonstrated a nonlinear association between patients’ age and surgical complications and outcomes, with the oldest old having noninferior outcomes when compared to youngest-old (age, 65–74 years) and middle-old (age, 75–84 years) patients. However, data regarding outcomes of percutaneous vertebral augmentation (PVA), including vertebroplasty and kyphoplasty, is limited in this age-group. Hospitalizations for the primary purpose of PVA in the setting of vertebral compression fractures were identified using the ICD 9th and 10th version diagnosis and procedure codes in the National Inpatient Sample between 2012 and 2017. Baseline characteristics, associated diagnoses, comorbidities, post-procedure complications (respiratory, cardiovascular, neurologic, infectious, and site-specific/device-related complications), and outcomes (mortality, length of stay, disposition, and hospital charges) were extracted. Multivariate regression modeling was used to calculate adjusted odds ratios (aOR) for the association between age and outcomes. Overall, the estimated number of PVA procedures in the youngest-old, middle-old, and oldest old populations was 29,975 ± 498, 51,475 ± 753, and 42,255 ± 682, respectively (P < 0.01 compared with youngest-old). The incidence of underlying malignancy in each age-group was 16.2% ± 0.6, 11.6% ± 0.4, and 6.8% ± 0.3 (P for trend < 0.01), respectively. In multivariable models adjusted for baseline characteristics and compared to the youngest-olds, the oldest old had similar mortality rates (aOR: 1.1 [0.7–1.8], P: 0.52) [sic], lower risk of post-procedural complications (aOR: 0.5 [0.4–0.7], P < 0.01), shorter hospitalization (aOR: 0.7 [0.6–0.8], P < 0.01) and lower hospital costs (aOR: 0.6 [0.5–0.7], P < 0.01) following PVA. Patients over the age of 85 have similar, if not better, outcomes after PVA with comparable mortality, lower rates of complications, shorter hospital stays, and lower hospital expenses when compared to “younger” older adult patients.

Economic analysis of platelet aggregability-guided surgical revascularization compared with standard of care in ACS patients: subanalysis from PLAT-CABG randomized clinical trial

Abstract Background Dual antiplatelet therapy (DAPT) is recommended for patients with acute coronary syndromes (ACS). Up to 15% are submitted to coronary artery bypass graft (CABG) during the hospitalization for the index event. However, as current guidelines recommend withdrawal of clopidogrel at least 5 days prior to CABG, this waiting time may increase hospital length of stay, thus potentially having negative impacts on costs and clinical outcomes. As previously presented at the ESC 2019 Congress, the PLAT-CABG study showed that the strategy to shortening CABG waiting time guided by platelet function test was non-inferior to the standard of care in terms of perioperative bleeding and led to shorter length of hospital stay among ACS patients. In this subanalysis, we present results regarding the in-hospital expenses for the two strategies. Purpose To determine, from the perspective of the Brazilian Government Health System (BGHS), the hospital expenses of patients undergoing CABG guided by platelet aggregability tests in comparison to the standard of care. Methods The PLAT-CABG study was a randomized and open label clinical trial testing a strategy of platelet aggregability-guided CABG after ACS versus standard-of-care. A total of 185 ACS patients on DAPT (aspirin plus clopidogrel) scheduled for on-pump or off-pump CABG were randomized to clopidogrel withdraw 5 to 7 days prior to CABG (control group) vs. daily measurements of platelet aggregability using Multiplate ADP-test (intervention group). Hospital cost (expressed in Brazilian currency - reais) subanalysis was pre-specified in the main trial statistical analysis plan. All patients had their hospital expenses covered by the BGHS and platelet aggregability tests costs were included in the analysis. Patients randomized to intervention group were allowed to undergo CABG when platelet aggregation recovered (pre-defined as Multiplate ≥46 AUC). In per protocol analysis, only patients who underwent CABG on the day after reaching the pre-specified aggregabilty cut point were analyzed. Results The main results are depicted in Figure 1. In the intention-to-treat analysis, median hospital expenses for the intervention group were R$15,202.33 and for the control group R$16,251.37 (mean difference of R$1,049.04, or 6.4%, P=0.014). In per protocol analysis, the mean hospital expenses for the intervention group were R$14,248.41 and for the control group R$ 16,039.55 (difference of R$ 1,791.14 or 11.2%, P=0.003). For an estimated 70,000 CABG procedures/year in Brazil, we estimate that the implementation of this routine would save up to R$125,370,000.00/year. Conclusion In patients with ACS taking DAPT, a strategy of platelet function-guided timing to CABG resulted in lower hospital expenses compared to a standard of care of waiting at least 5 days after clopidogrel withdrawal. Figure 1. Hospital expenses between groups Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Roche Diagnostica Brazil

The clinical application of enhanced recovery after surgery protocol in perioperative period of laparoscopic nephron sparing surgery.

BackgroundThe enhanced recovery after surgery (ERAS) program is focused on improving surgical outcomes and enhancing the patient experience before, during and after surgery. We performed this study to evaluate the effect of ERAS in perioperative period of laparoscopic nephron sparing surgery (LNSS).MethodsA retrospective analysis of 287 consecutive patients with localized renal cell carcinoma (RCC) who underwent LNSS from December 2015 to June 2017 was conducted. Our study design included two cohorts. Patients underwent conventional care in one group (n=136), and ERAS protocol in the other group (n=151). The data of recovery of gastrointestinal function, catheter and drainage tube removal time, length of stay (LOS), hospitalization expenses and incidence of postoperative complications were compared between the two groups.ResultsCompared with conventional group, cases in ERAS group presented with shorter time of recovery of gastrointestinal function (P<0.05) and LOS (P<0.05), shorter catheter and drainage tube removal time (P<0.05), lower hospitalization expenses and lower perioperative complications (P<0.05).ConclusionsProgram of ERAS used in perioperative period of LNSS can apparently accelerate the time of postoperative recovery, reduce complications, shorten time stay in hospital and cut down the total cost, finally improve patients’ satisfaction.

Clinical evaluation of modified invaginated pancreaticojejunostomy for pancreaticoduodenectomy

BackgroundPancreaticoduodenectomy (PD) remains the major curative operation for malignant neoplasm of pancreas or cancerous tumors near the pancreas. Despite advancements in recent years, the postoperative recurrence rate of these neoplasms and tumors remains high. Moreover, overall morbidity remains high due to clinically relevant postoperative pancreatic fistula (POPF).MethodsTo compare the clinical outcomes of modified invaginated anastomosis and mucosa-to-mucosa anastomosis, this retrospective study included 343 patients who underwent PD from January 2008 to January 2019 at Beijing Friendship Hospital, Capital Medical University. The patients’ general conditions and disease status were preoperatively evaluated. The surgical procedure was recorded, and operative management was appropriately performed.ResultsCompared with mucosa-to-mucosa anastomosis, modified invaginated anastomosis resulted in a higher intraoperative blood transfusion rate (P < 0.001) and lower hospitalization expenses (P = 0.049). However, no significant differences were found in operation time (P = 0.790), intraoperative bleeding (P = 0.428), postoperative recovery exhaust time (P = 0.442), time to normal flow of food (P = 0.163), and hospitalization time (P = 0.567). Operation time was a risk factor for POPF (odds ratio 1.010; 95% confidence interval 1.003–1.016; P = 0.003). The incidence of pancreatic fistula (grades B and C) was lower in the patients who underwent modified invaginated anastomosis (14.1%) than in those who underwent mucosa-to-mucosa anastomosis (15.3%). The operation time was greater in the POPF group than in the non POPF group among the patients who received modified invaginated anastomosis (P = 0.003) and mucosa-to-mucosa anastomosis (P = 0.002).ConclusionModified invaginated pancreaticojejunostomy for PD resulted in a decreased incidence of POPF; it may serve as a new approach for PD while managing patients who have undergone PD.

Comparison of Remifentanil-Based Fast-Track and Fentanyl-Based Routine Cardiac Anesthesia for Intraoperative Device Closure of Atrial Septal Defect (ASD) in Pediatric Patients.

BackgroundThe aim of this study was to evaluate the effectiveness and safety of remifentanil-based fast-track anesthesia for intraoperative device closure of atrial septal defects (ASDs).Material/MethodsThe clinical data of 152 pediatric patients who received intraoperative device closure of ASD in our hospital from January 2015 to December 2017 were retrospectively analyzed. Patients were divided into 2 groups: group F (remifentanil-based fast-track anesthesia group, n=72) and group C (fentanyl-based routine anesthesia group, n=80). The relevant data from 2 groups were collected and analyzed.ResultsNo significant differences were found in the preoperative data or intraoperative hemodynamic index between these 2 groups. Group C was significantly inferior to group F regarding the duration of mechanical ventilation, length of intensive care unit (ICU) stay, length of hospital stay, and hospitalization expenses (P<0.05). In terms of postoperative complications, no death, third-degree atrioventricular block, occluder detachment, or residual leakage was reported in either group. The incidence of lung infections and bronchospasm was significantly higher in group C than in group F. There were no anesthetic-related complications.ConclusionsThe application of remifentanil-based fast-track anesthesia for intraoperative device closure of ASD is as effective and safe as fentanyl-based routine anesthesia. Moreover, remifentanil-based fast-track anesthesia has the advantages of shorter duration of mechanical ventilation, shorter length of hospital and ICU stay, fewer postoperative complications, and lower hospitalization expenses, and is therefore worthy of promotion in clinical practice.

Clinical efficacy of endoscopic resection versus laparoscopic resection and open resection for gastric stromal tumor

Objective To investigate the clinical efficacy of endoscopic resection, laparoscopic resection and open resection in the treatment of gastric stromal tumor (GIST). Methods The retrospective cross-sectional study was conducted. The clinicopathological data of 254 GIST patients who were admitted to the First Affiliated Hospital of Army Medical University between January 2007 and June 2017 were collected. The endoscopic submucosal dissection (ESD) and laparoscopic or open wedge resection of GIST were performed according to the patients′ conditions. Observation indicators: (1) surgical and postoperative recovery situations; (2) postoperative pathological examination; (3) follow-up and survival situations. Follow-up using outpatient examination and telephone interview was performed to detect postoperative adjuvant therapy and survival up to June 2017. Measurement data with normal distribution were represented as ±s. Measurement data with skewed distribution were described as M (range). Results (1) Surgical and postoperative recovery situations: of 254 patients, 112 underwent ESD, including 111 with successful operation and 1 with intraoperative conversion to open surgery due to excessive bleeding-induced blurred operating view, 93 underwent successful laparoscopic wedge resection of GIST and 49 underwent successful open wedge resection of GIST. The operation time, volume of intraoperative blood loss, time for initial fluid diet intake, duration of hospital stay and hospital expenses were respectively (75±21) minutes, (6.9±0.5)mL, (2.8±0.9)days, (5.5 ± 0.2)days, (22 167±1 364)yuan in patients with ESD and (137±65)minutes, (48.1±2.6)mL, (3.9±1.4)days, (8.3 ± 2.2)days, (32 937±1 823)yuan in patients with laparoscopic operation and (168±60)minutes, (157.2±10.3)mL, (5.8±1.7)days, (11.3±3.5)days, (38 462±1 961) yuan in patients with open operation. Two patients with ESD had subcutaneous emphysema and didn′t receive special treatment, and then emphysema disappeared after 2 days. No complication was detected in patients with laparoscopic or open operations. (2) Postoperative pathological examination: tumor diameter in patients with ESD, laparoscopic operation and open operation was respectively (2.6±1.6)cm, (6.1±2.2)cm and (6.4±2.3)cm. The cases with positive CD117, discovered on GIST-1 (DOG1), CD34 and smooth muscle actin (SMA) were 106, 105, 86, 17 with ESD and 89, 87, 59, 11 with laparoscopic operation and 46, 47, 30, 8 with open operation, respectively. The extremely low risk, low risk, medium risk and high risk were respectively detected in 67, 42, 3, 0 patients with ESD and 16, 36, 23, 18 patients with laparoscopic operation and 7, 20, 14, 8 in patients with open operation. (3) Follow-up and survival situations: 210 of 254 patients were followed up for 6.0-120.0 months, with an average time of 36.0 months, including 86 with ESD, 82 with laparoscopic operation and 42 with open operation. During the follow-up, of patients with ESD, 3 patients with medium risk respectively received imatinib therapy for 7.0 months, 1.5 years and 2.0 years, and postoperative gastroscopy reexaminations every 6 months, without tumor recurrence; 81 with extremely low risk and low risk received postoperative gastroscopy reexaminations every 6 months and didn′t receive targeted therapy, without tumor recurrence; 2 died of non-stromal tumor. The postoperative average survival time, 1-, 3- and 5-year survival rates were respectively 56.3 months, 98.8%(81/82), 91.5%(75/82), 74.4% (61/82) in patients with laparoscopic surgery and 52.4 months, 97.6%(41/42), 85.7% (36/42), 81.0%(34/42) in patients with open surgery. Conclusions According to patients′ conditions, endoscopic resection, laparoscopic resection and open resection are safe and feasible in the treatment of GIST. Endoscopic resection of GIST should be selectively applied to patients with smaller diameter, with advantages of lower hospitalization expenses and better long-term prognosis. Key words: Gastric neoplasms; Stromal neoplasms; Endoscopic submucosal dissection; Surgical procedures, operative; Open resection; Laparoscopy

Comparison of Treatment Outcomes of Endoscopic Stenting and Laparoscopic Gastrojejunostomy for Malignant Gastric Outlet Obstruction

To compare the clinic outcomes of endoscopic stenting and laparoscopic gastrojejunostomy (LGJ) for patients with malignant gastric outlet obstruction (GOO). We retrospectively reviewed 63 patients with malignant GOO that underwent endoscopic stenting [Stent Group (SG), n = 29] or LGJ [Laparoscopic Group (LG), n = 34]. Then, we evaluated the medical effects, postoperative hospital stay, and hospitalization expenses in both groups. Compared to LG, SG has a shorter operation time [SG: (41.1 ± 9.3) minutes vs LG: (137.4 ± 21.7) minutes, P = 0.000], less intraoperative blood loss [(23.7 ± 9.0) mL vs (121.1 ± 24.3) mL, P = 0.000], relatively lower hospitalization expenses [(2272.7 ± 413.9) $ vs (5182.4 ± 517.3) $, P = 0.000]. Besides, the median intake time was significantly shorter in the SG than that in the LG [(0.9 ± 0.3) days vs (4.1 ± 0.6) days, P = 0.000]. However, there were no significant differences between SG with LG in surgical success rate (100 vs 100%, P = 1.000), length of hospital stay [(6.1 ± 3.3) days vs (10.9 ± 4.7) days, P = 0.422], recurrent obstructive rate (37.9 vs 26.5%, P = 0.949) and median survivals [(141.4 ± 81.4) days vs (122.7 ± 88.8) days, P = 0.879]. Endoscopic stenting and LGJ are both relatively safe and effective treatments for patients with malignant GOO. But we suggest that endoscopic stenting should be considered first in patients with malignant GOO because it has many advantages over LGJ.

Percutaneous endoscopic interlaminar discectomy of L5\u2013S1 disc herniation: a comparison between intermittent endoscopy technique and full endoscopy technique

BackgroundPercutaneous endoscopic laminar discectomy is a typical minimally invasive discectomy operation that is classified into the percutaneous endoscopic transforaminal discectomy and the percutaneous endoscopic interlaminar discectomy. Based on whether the surgeon chooses to deal with the ligamentum flavum under endoscope guidance, percutaneous endoscopic discectomy by the interlaminar approach can be performed with a full endoscope technique with the intermittent endoscope technique. To our knowledge, there is no study comparing these two techniques in regard to their surgical effects and advantages. Therefore, we conducted this study to compare the cost, safety, and efficacy between the intermittent endoscopy technique and full endoscopy technique of endoscopic interlaminar lumbar discectomy at the L5–S1 level.MethodsFrom September 2014 to March 2015, a total of 126 patients with radiculopathy due to L5–S1 disc herniation who were treated by a full endoscopy technique (65 patients) or intermittent endoscopy technique (61 patients) were included. Relevant data, such as duration time of the operation, hospitalization expenses, postoperative bed rest time, length of hospitalization, and complication rates, were recorded. Clinical outcomes were assessed by the visual analog scale score, modified MacNab criteria, and Oswestry disability index.ResultsIn the full endoscope (FE) group, the mean duration time of surgery was 75.0 ± 11.9 min. The postoperative bed rest time was 6.5 ± 1.1 h, length of hospitalization was 3.8 ± 1.1 days, and complication rate was 7.69%. In the intermittent endoscopy (IE) group, the mean duration time of surgery was 43.0 ± 16.4 min. The postoperative bed rest time was 5.0 ± 1.1 h, length of hospitalization was 3.6 ± 1.2 days, and complication rate was 6.60%. The average hospitalization expenses of the FE group and IE group, respectively, were 32,069 ± 1086 RMB and 22,665 ± 899 RMB. There were significant differences in the surgical duration and hospitalization expenses (P < 0.01), but no differences between the two groups in postoperative bed rest time, length of hospitalization, or complication rates (P > 0.05). The postoperative Oswestry disability index and VAS were clearly improved in both groups compared with those of preoperation (P < 0.01). These two procedures have the same clinical outcomes (P > 0.05).ConclusionsBoth the full endoscopy technique and intermittent endoscopy technique achieved good outcomes, whereas the intermittent endoscopy technique is a more effective option for a shorter duration surgery and lower hospitalization expenses.

Does improved medication adherence reduce inpatient hospital expenditures?

PurposeThis study aims to assess whether patients [who receive community pharmacy services at locations where routine medication therapy management (MTM) care is reimbursed] who were adherent to their medications generated lower inpatient hospitalization expenses.Design/methodology/approachThis is a retrospective, descriptive and cross-sectional study using administrative claims data drawn from 84 community pharmacies in North Dakota. The included patients were enrolled in a Blue Cross Blue Shield of North Dakota insurance plan and were taking one or more of eight groups of medications (metformin, antidepressants, anti-asthmatics, ACEs/ARBs, beta-blockers, calcium channel blockers, diuretics and statins) commonly prescribed to treat chronic conditions filled between July 1, 2014 and June 30, 2015. Community pharmacists used software that allowed the pharmacists to provide and bill for MTM services. Data from these sources were used to calculate medication adherence and inpatient costs.FindingsPatients prescribed a beta blocker, a calcium channel blocker, and a diuretic or an anti-diabetic medication, and those who are fully adherent to their medications were associated with significantly lower inpatient hospitalization costs (as measured by insurance payments to hospitals) as compared to non-adherent patients. Patients who were fully adherent to their medications had no statistically significant differences in patient-specific costs compared to non-adherent patients.Originality/valuePatients receiving services at a community pharmacy that offers MTM services and those who were adherent to their medication regimens generate lower health care expenses. Most of the savings come from lower hospitalization expenses, rather than patient-paid expenses.

A Comparative Study of Transvaginal Repair and Laparoscopic Repair in the Management of Patients With Previous Cesarean Scar Defect

Study ObjectiveThe study objective was to compare transvaginal intervention and laparoscopic repair for correcting the uterine defect in patients with previous cesarean scar defect (PCSD). DesignRetrospective study (Canadian Task Force classification). SettingPrevious studies have reported that transvaginal surgery and laparoscopic surgery are available treatment options for patients with PCSD. However, the two methods have not been compared before. PatientsA total of 124 patients with PCSD were included in the retrospective study between December 2010 and December 2014. InterventionsIn the study, 65 patients received transvaginal repair, and 59 patients received laparoscopic repair. Measurements and main resultsOperation time, blood loss, hospital stay length and hospitalization expense, clinical syndromes and healing of uterine defect 3 months postoperatively were compared between the two surgical approaches. Patients receiving transvaginal repair exhibited significantly shorter operation time and lower hospitalization expenses than the patients receiving laparoscopic repair. Follow-up data showed that prolonged menstrual bleeding syndrome was obviously improved in 89% of patients undergoing transvaginal intervention and 86% of patients undergoing laparoscopic repair. The uterine defect disappeared or was substantially reduced in 87% of patients undergoing transvaginal intervention and 86% of patients undergoing laparoscopic repair. The differences between the two surgical approaches were insignificant. ConclusionTransvaginal repair is comparably effective to the laparoscopic repair and may be a more cost-effective and convenient surgical approach in the management of patients with PCSD.

Evaluation of tri-endoscopy for choledocholithiasis accompanied with cholecystolithiasis

Objective To evaluate a method namedone-step i. e., combined duodenoscopy, laparoscopy and choledochoscopy for choledocholithiasis accompanied with cholecystolithiasis. Methods Fifty-three cases with gallbladder stones combined with common bile duct stones diagnosed from February 2012 to February 2014 were assigned to two groups, 29 cases inone-step proceduregroup, who underwent duodenoscopy, laparoscopy and choledochoscopy in one operation, and 24 cases in the control group, who firstly underwent endoscopic sphincterotomy to remove common bile duct stones, and then LC was performed after several days. The rate of complications related to the procedure, success rate of complete stone removal, length of hospital stay and hospitalization expenses were compared between the two groups. Results All 53 patients underwent the surgery and ERCP procedure successfully. There were no significant differences between theone-step proceduregroup and the control group in complication rates[3.4%(1/29)VS 12.5%(3/24), P=0.21], complete stone removal rates[96.6%(28/29)VS 100.0%(24/24), P=0.37]. Differences were significant in length of hospital stay (6.7±1.3d VS 10.9±1.6d, P<0.01) and hospitalization expenses(15 724±1 613 yuan VS 19 829±2 433 yuan, P<0.05)between theone-step proceduregroup and the control group. Conclusion Theone-step the combined duodenoscopy, laparoscopy and choledochoscopy, is safe, effective, and has smaller length of hospital stay and lower hospitalization expenses. Key words: Choledocholith; Choledocholithiasis; Cholangiopancreatography, endoscopic retrograde; Laparoscope

The relationship between physician case volume and in-hospital mortality of critically ill children with a diagnosis of pneumonia: A cross-sectional observational analytical study

PurposeThe aim of this study is to examine the relationship between physician case volume and the outcomes of critically ill children with pneumonia. Materials and methodsThis is a population-based cohort study analyzed data provided from by the National Health Insurance Research Database of Taiwan, 2006-2009. Children (aged 3 months to 17 years) having records of intensive care unit (ICU) admission and a diagnosis of pneumonia were included. A total of 9754 critically ill children and 1042 attending physicians were enrolled. The children were assigned to 1 of 4 groups based on the physician's pneumonia case volume. ResultsThe patients in the very high case volume group had a significantly lower length of hospital stay, in-hospital mortality rate, and hospitalization expenses, and a significantly higher ratio of ICU to hospital stays than the other 3 groups (P < .001). The probability of death tended to be lower when the physician's case volume was higher. The risk-adjusted odds ratio for in-hospital mortality of very-high case volume group was 0.48 (95% confidence interval, 0.35-0.65; P < .001) compared to low case volume group. ConclusionsA higher physician's pneumonia case volume is associated with a lower length of hospital stay, lower in-hospital mortality rate, and lower hospitalization expenses among critically ill children with pneumonia.

The effects of comprehensive mental intervention on the recovery time of patients with postsurgical gastroparesis syndrome

To explore the effects of comprehensive mental intervention on the recovery time and symptoms of depression in patients with postsurgical gastroparesis syndrome. Postsurgical gastroparesis syndrome may occur after abdominal surgery. The development of postsurgical gastroparesis syndrome is believed to be influenced by neuropsychiatric factors, manifest as psychological dysfunction and distress. Randomised controlled trial. A total of 120 patients with postsurgical gastroparesis syndrome were randomly divided into a mental intervention group (n = 60) and a control group (n = 60) by odd or even numbers. The mental intervention group received comprehensive mental intervention including support, counselling, music and massage plus all aspects of conventional therapy. The control group received only conventional therapy, including a three-cavity gastric tube, fasting, parenteral/enteral nutrition, routine care and health guidance. Pre intervention and postintervention depression levels were assessed in both groups by the Center for Epidemiological Survey Depression Scale. Gastric function recovery was assessed in all patients. Postintervention depression scores were significantly reduced in the mental intervention group, and pre-/postdifferences were significantly greater compared to control group scores. The mental intervention group had significantly shorter times for symptom disappearance (nausea, vomiting, abdominal distention), extubation duration, eating recovery, gastric drainage volume >600 ml/day, gastroparesis recovery, as well as shorter hospital stays and lower hospital expenses. Comprehensive mental intervention improved negative emotions and depression and shortened recovery time of patients with postsurgical gastroparesis syndrome. Mental intervention is important to postsurgical recovery, and primary nurses are encouraged to understand how to care for postsurgical patients physically and psychologically, with at least one nurse in the postsurgical setting trained to provide mental intervention.

The evaluation of health economics on the clinical pathway to infantile rotavirus enteritis

Objective To explore the influence of the clinical pathway to control on hospital stay and medical expenses of pediatric rotavirus enteritis.Methods 245 infants with IRE were randomly assigned into two groups,109 in research group,136 in control group.All were treated with conventional therapy,for research group with clinical pathway.136 patients with previous medical routine therapy patients in the control group were compared.Compared two sets of average day in hospital,cure rate and cost,expenses for medicine and checking expenses proportion.Results The results shwed that the observation group of children's average hospital stay was lower than the control group,the cure rate higher than that in the control group,each time of total cost,expenses for medicine,each day medicine reducing( P ＜ 0.05 ).Checking expenses proportion was increased ( P ＜ 0.05),as to therapeutic effect,there was significant difference between two groups( P ＜ 0.05 ).Both expenses of drug ratio and ratio of the average daily expenses of drug are reduced.Conclusion Clinical pathway is applied in pediatric rotavirus enteritis can improve recovery rate,reduce hospitalization time and lower hospitalization fees and expenses,charges,medicine and inspection charge proportion.And can improve health education effect and patient satisfaction. Key words: Clinical pathway; Pediatric rotavirus enteritis; Medical expenses