Mean Hospital-stay Research Articles

Liver Abscesses in Cancer Patients Associated with Poor Prognosis: A Single Center Experience

Background: Liver abscesses are uncommon, but they are associated with a hospital mortality rate of 10% in patients without cancer. However, its relevance in cancer patients in terms of survival and length of hospitalization is unknown. Patients and Methods: We conducted an observational study in order to analyze the impact of liver abscesses in hospitalized cancer patients. Eligible patients were adults with a solid tumor, received antineoplastic treatment and were hospitalized in our department with a diagnosis of liver abscesses. Primary end-points of the study were overall survival (OS) and mean hospital stay (MHS). Secondary end-points were the description of risk factors of liver abscesses, isolated microorganisms and the specific treatment. Results: In our study the incidence of liver abscesses in cancer patients was 1.18%. Median age was 63 years, 60% were men, and the vast majority of patients had an advanced bilio-pancreatic tumor (85%). With a median follow-up of 18 months, median OS was 6 months (95% CI: 1-11); and OS probability at 18-month was 19%. MHS was 27.2 days (95% CI: 20.3-40.7). Risk factors for developing liver abscesses were: a) bilio-pancreatic cancers; b) chemotherapy administration; c) severe malnutrition; and d) biliary drainage/prosthesis. Ten patients (50%) had bacteremia, and the most common isolated microorganism was E.coli (30%). Percutaneous drainage of abscesses was performed in 40% of the patients, and all patients were treated with broad-spectrum antibiotics. Conclusions: Although liver abscesses were uncommon, they were associated with a prolonged hospitalization and poor outcome in cancer patients.

Treatment of reflux esophagitis in patients with cardiofundal, subtotal and total hiatal hernias

To analyze treatment of patients with reflux esophagitis and large hiatal hernia. There were 85 patients with reflux esophagitis and large hiatal hernia. Laparoscopic repair was performed in 33 patients, laparotomy - in 52 cases. All patients underwent fundo- or gastroplication by A.F. Chernousov, correction of large defect of hiatal orifice by cruroraphy was applied in 55 (64.7%) patients. Postoperative morbidity was near 10% after laparoscopic and conventional surgery despite more difficult video-assisted endoscopic technique. Complications Clavien-Dindo grade I-II were noted in 4 (12.1%) patients after laparoscopic treatment and in 6 (11.5%) patients after laparotomy. Medication was effective in all cases. Two patients with subtotal hernias had complications Clavien-Dindo grade IIIB after endoscopic surgery: recurrent hiatal hernia followed by severe reflux esophagitis and dysphagia. These complications required redo surgery. Repair of hiatal orifice is always possible without mesh reinforcement. Posterior cruroraphy is feasible and effective in all patients. Incidence of intraoperative and postoperative complications is comparable in both approaches (p<0.05). Mean hospital-stay after laparotomy was 7.3 days, after laparoscopy - 5.8 days. Endoscopic formation of antireflux cuff by A.F. Chernousov is appropriate and effective in patients with reflux esophagitis and large/giant hiatal hernias.

PMH25 - EARLY ADMINISTRATION OF ARIPIPRAZOLE LONG-ACTING INJECTABLE IN ACUTE INPATIENTS WITH SCHIZOPHRENIA REDUCES THE COST OF HOSPITALIZATION

To evaluate the hospitalization costs of acute inpatients with schizophrenia treated with the long-acting injectable (LAI) antipsychotic aripiprazole based on observed data from a naturalistic study in two Madrid hospitals. The aim was to assess the management costs of patients and observe any procedural differences affecting these costs. Hospitalization costs of 51 inpatients (30 men, 21 women) with schizophrenia, treated with aripiprazole LAI in an acute setting, during the observation period, were calculated. The average duration of hospital stay (HS) for patients treated with LAI aripiprazole according to SmPC in this setting was 21 days. This study showed that the HS was shorter when aripiprazole LAI was administered earlier: Group 1, administered aripiprazole LAI during the first week of admission, resulting in a mean HS of 16.3 days; versus Group 2, administered aripiprazole LAI > 1 week after admission, resulting in a mean HS of 28.4 days. The total costs of Group 2 versus Group 1 showed an incremental charge for the Health System of 7.393 €, according to National Public Fees. This could double the standard in-patient costs due to a mild schizophrenia (7.142 €), according the last published local public prices for specialized care. In the observation sample, it was shown that aripiprazole LAI is an effective treatment for acute inpatients with schizophrenia and a short average HS is observed with the use of this drug. The early use of aripiprazole LAI, during the first week of admission, reduced HS. The shortening of the HS has benefits for patients, improving their quality of life, but also has notable advantages in the reduction of direct costs for the Health System.

Pneumatic Lithotripsy Versus Laser Lithotripsy for Ureteral Stones.

Introduction: Several different modalities are available for ureteral stone fragmentation. From them pneumatic and holmium: yttrium-aluminum-garnet (Ho: YAG) lithotripsy have supportive outcomes. In this study we studied 250 subjects who had ureteroscopic pneumatic lithotripsy (PL) or laser lithotripsy (LL). Methods: Two-hundred fifty patients with ureteral stones underwent ureteroscopic lithotripsy (115 subjects in the PL group, 135 subjects in the LL group) from August 2010 to April 2016. The purpose of this investigation was to evaluate stone-free rate (SFR), mean operation time (MOT), mean hospital stay (MHS), stone migration and complications. Results: Two groups were similar in age, gender, mean size of stones, side of stone, and complications. There was a statistical difference in terms of SFR, stone migration and MHS in favor of the LL group (P ≤ 0.05, P ≤ 0.05 respectively), and MOT in favor of the PL group (P ≤ 0.05). Conclusion: Both the PL and LL techniques were effective and safe for ureteral stones, however a slightly higher SFR was found in the LL group.

Surgical Management of Vesical Stones in Children: A Comparison Between Open Cystolithotomy, Percutaneous Cystolithotomy and Transurethral Cystolithotripsy With Holmium-YAG Laser.

Introduction: Bladder stone is more common in developing countries and it is one of the rare diseases affecting children. In recent years, there is an increasing tendency in urologists to have minimal invasive approaches. The aim of this study was to compare the results of surgical bladder stone management in our single tertiary center. Methods: From 159 children younger than 18 years with vesical stones treated during January 2000 to January 2015 in Shohada-e-Tajrish hospital, Tehran, Iran, 146 subjects entered to the study. According to type of intervention, patients stratified to three groups. First group included 80 patients that open cystolithotomy (OCL) was done for them, second group was 39 patients who underwent percutaneous cystolithotomy (PCCL) and third group was 27 patients who treated by transurethral cystolithotripsy with holmium-YAG laser (TULL). Demographic data, hospital stay, operation time, and post operation complications were recorded and comparison were drawn between the three groups. Results: Mean age was 8.3±5.1 years (8.6±5.1, 6±4.2 years for boys and girls, respectively). Mean stone size (MSS) was 2.76±1.07 cm and no significant differences were found between the three groups but it was larger in OCL group. Mean operative time (MOT) was 29.15±7.12 minutes in separate; MOT in TULL was significantly higher than PCCL and OCL respectively (36.3±5.97, 30.54±5.27 and 26.06±6.32 minutes/P =0.000). Mean hospital stay (MHS) in OCL group was 3.55±1 days that was higher than PCCL and TULL groups significantly (P =0.000). Conclusion: Based on our study, holmium:YAG lithotripsy has a high success rate, and is a minimally invasive management, therefore it is a safe method for children bladder calculi treatment if proper equipment was available and done by expert hands.

The first experience of TAPP and TEP allohernioplasty in patients with inguinal hernias at CRH

To improve the outcomes in patients with inguinal hernias by application of advanced minimally invasive procedures. The article describes an experience of 59 laparoscopic allohernioplasties in 48 patients at the central regional hospital. There were bilateral hernias in 11 cases. Transabdominal preperitoneal (n=49) and extraperitoneal (n=10) placement of polypropylene mesh graft were used. Intraoperative complications such as sigmoid colon lesion occurred in 2 patients with sliding left-sided hernia. Mortality was absent. Mean hospital-stay was 5.4 days, 12-month examination after discharge did not show any recurrent hernias. Positive results of TAPP and TEP hernia repair justify their application as minimally invasive techniques in patients with various inguinal hernias at CRH if appropriate technical training and motivation of surgical team are present.

DIAGNOSTICS AND TREATMENT OF INTERNAL PANCREATIC FISTULA IN ACUTE PANCREATITIS

Aim. To study pancreatic changes in acute pancreatitis with internal pancreatic fistula and to assess the results of retroperitoneoscopic sanations for this pathology. Material and Methods. Contrast-enhanced CT was made in 30 patients. Localization and depth of necrosis were evaluated in sagittal, axial and coronal sections. Swelling and infiltration of retroperitoneal fat up to pelvic floor aperture were the criteria for evaluating severity of retroperitoneal fat lesion. All patients were divided into two groups. The first group included 15 patients with pancreatic head or isthmus necrosis and viable parenchyma of body and tail who underwent retroperitoneoscopic drainage of retroperitoneal fat in 4–5 hours after disease onset. The second group consisted of 15 patients with various forms of pancreatic necrosis who were operated only at the stage of infected pancreatic necrosis. Results. In the first group hospital-stay was 45 ± 5.3 days. External pancreatic fistula was observed in all patients that was closed within 4.8 ± 1.1 months after surgery. Deaths were absent. Postoperative ventral hernia was not observed. Pancreatic pseudocysts occurred in 3 (20%) patients. Mean hospital-stay in the second group was 80 ± 5.3 days, mortality rate – 33.3%. External pancreatic fistula formed in 2 (13%) patients, postoperative ventral hernia – in 3 (20%) cases, pancreatic pseudocyst – in 3 (20%) cases. Conclusion. Contrast-enhanced computed tomography visualizes internal pancreatic fistula and gives information for differentiated surgical approach in acute pancreatitis patients. External drainage of retroperitoneal fat is pathogenetically proved treatment of patients with internal pancreatic fistula and acute severe pancreatitis.

Modern Approaches to the Treatment of Chronic Pancreatitis Complicated by Pancreatic Pseudocysts

Aim. Retrospective analysis of conventional and endoscopic surgical treatment of patients with chronic pancreatitis complicated by pancreatic pseudocysts. Material and Methods. For the period from 2011 to May 2017 two hundred and eighty-two patients were treated for chronic pancreatitis. In 91 (32.3%) patients disease was complicated by post-necrotic pancreatic cysts. 38 patients underwent conventional or laparoscopic surgical treatment. Minimally invasive surgical treatment including endosonography-assisted cystogastro-/ cystoduodenostomy was offered to 38 patients. 15 patients with symptomless pancreatic pseudocysts ≤ 5 cm are under follow-up. Results. Mean hospital-stay was 11.2 and 6.4 days after cystojejunostomy and endoscopic drainage respectively. Postoperative morbidity was 10.5% (n = 4) per each group. There were more severe complications after conventional procedures: Clavien–Dindo grade II in 1 patient, grade IIIb in 3 patients. At the same time endoscopic surgeries were followed by complications grade II in 3 patients and grade IIIb in 1 patient. Mean life quality score was 70.2 and 74.3 after traditional and endoscopic interventions respectively. Postoperative follow-up was 3 years for all patients. Conclusion. Internal endosonography-assisted endoscopic drainage of pancreatic pseudocysts may be preferable in patients with chronic pancreatitis.

Radical oncological stomach, liver and pancreatic surgery in patients over 80 years old

To analyze the results of radical surgery for upper GI cancer in patients ≥80 years old. For the period November 2010 - June 2015 there were 14 radical operations in elderly (≥80 years) patients with gastric, liver and pancreatic tumors. There were 4 Whipple procedures, 4 total and 2 distal gastrectomies, 1 total pancreatectomy as well as a central liver resection, one laparoscopic 5 segment resection and one 2, 3, 7 segment resection. We analyzed blood loss, duration of surgery, 90-day mortality, morbidity (Dindo-Clavien scoring), length of hospital-stay. Blood loss ranged from 0 to 1500 ml, mean duration of surgery - from 150 to 560 min. There was one case of in-hospital mortality: one patient after a Whipple procedure died in 17 days after surgery due to massive arrosive bleeding. Complications developed in 8 patients, 3 of them required reoperation. Mean hospital-stay was 15±6 (8-29) days. Advanced upper GI surgery for cancer is feasible in octagenarians and does not lead to inappropriate mortality and morbidity. Comprehensive preoperative examination alongside with enhanced recovery protocol are prerequisites for this type of surgery.

YALE OBSERVATION SCALE AS A PREDICTOR OF BACTEREMIA AND FINAL OUTCOME IN 3-36 MONTHS OLD FEBRILE CHILDREN ADMITTED IN TERTIARY HEALTH CENTRES: A HOSPITAL-BASED CROSS-SECTIONAL STUDY

ABSTRACTObjectives: The objective of the study was to assess predictability of bacteremia in febrile children in the age group of 3-36 months by application ofYale observation scale (YOS) and to predict clinical course during hospital stay and final outcome by YOS.Methods: A hospital-based cross-sectional study was carried out at Kasturba Medical College, Mangalore, Karnataka, for a period of 2 years(September 2013-September, 2015) in 100 febrile children in the age group of 3-36 months with probable infectious etiology admitted in ward/PICU.Children with any non-infectious causes of fever (vaccination, autoimmune, and immunodeficiency disorder) were excluded from the study. Caseswere selected by simple random sampling. The primary study outcome was bacteremia based on positivity on blood culture and sensitivity sampledrawn at admission. Secondary outcomes are clinical course in the hospital, use of antibiotics, need for mechanical ventilation, hospital stay, andmortality.Results: 100 cases were included in the study out of which 18 cases were bacteremic with a mean YOS of 26 (non-bacteremic - 11), mean hospitalstay 19.5 days (non-bacteremic - 12 days). All 18 bacteremic children had YOS ≥20, but YOS ≥20 had 8 false positives cases. There was no significantinterobserver variability in YOS assessment (Cronbach’s alpha - 0.993 showing good correlation with intraclass correlation coefficient - 0.986).Higher YOS scores had good sensitivity, specificity, positive and negative likelihood ratios, and area under curve for prediction of bacteremia atYOS &gt;20 (100%, 90.2%, 10.2, 0.00, and 0.970), need for mechanical ventilation at YOS &gt;21 (100%, 91.7%, 12.04, 0.00, and 0.969), need for scaling upantibiotics at YOS &gt;21 (70.4%, 94.4%, 12.5, 0.31, and 0.822), and mortality at YOS &gt;21 (90.9%, 85.4%, 6.2, 0.106, 0.878).Conclusion: YOS is a good tool to rule out bacteremia and to prognosticate the clinical course at the first visit. This simple scale can be of value inmonitoring admitted patients for deteriorating clinical state and for assessing the need for referral to higher centers for further management.Keywords: Yale observation scale, Bacteremia, Febrile patients.

Laparoscopic cholecystectomy in short-stay hospital

To develop the protocol of surgical management of cholelithiasis in short-stay hospital. Surgical treatment of 161 patients with cholelithiasis was analyzed. All of them underwent elective cholecystectomy. Short-stay hospital group included 41 patients. 120 patients were operated in surgical department (group 2). Incidence of intraoperative complications was 2.4% and 3.4% in both groups respectively (p>0.05). Postoperative complications were more frequent in group 2 (8.3% vs. 2.4%, p<0.05). Mean hospital-stay was 1 and 4.4 days in both groups respectively. Treatment of chronic calculous cholecystitis is advisable in short-stay hospital. Indications for this approach and its safety in certain patients were determined. The protocol of surgical management of chronic cholecystitis in short-stay hospital was develped.

Total mesorectal excision in rectal cancer management: laparoscopic or transanal?

To evaluate and compare intraoperative features, early surgical outcomes, quality of excised specimen after laparoscopic and transanal total mesorectal excision (LA-TME and TA-TME). Prospective randomized study included 45 patients with confirmed rectal adenocarcinoma (cT2-4N0-2M0) since October 2013. LA-TME and TA-TME groups consisted of 23 and 22 patients respectively. Inclusion criteria were patients with primary-operable rectal cancer and satisfactory response after neoadjuvant chemo- and radiotherapy. Both groups were comparable in stages of cancer, age and body mass index (BMI). Median length from anal edge was 6.5 cm and 7 cm in TA-TME and LA-TME groups respectively. There was significantly greater number of patients after chemo- and radiotherapy in TA-TME group (86% vs. 48%, p=0.006). Surgery time was 305 and 320 minutes in LA-TME and TA-TME groups recpectively, median blood loss -- less than 100 ml. Mean hospital-stay was 8.0 days in both groups. Each group had 1 conversion including laparoscopic procedure in TA-TME group. Transanal extraction of specimen was performed in 86% vs. 48% in TA-TME and LA-TME groups respectively (p=0.021). Complications (Clavien-Dindo sclale) were observed in 27% and 26% in TA-TME and LA-TME groups respectively without statistically significance. Complications IIIb, IVb and V degrees were not diagnosed in TA-TME group. Also in this group «good», «satisfactory» and «unsatisfactory» quality of TME was obtained in 68%, 14% and 18% of cases. At the same time in LA-TME group these values were 74%, 9% and 17% respectively (p=0.859). One of operated patients had «positive» lateral edge (TA-TME). Median distal edge of resection was 21 mm and 23 mm in TA-TME and LA-TME groups respectively. Preliminary data show comparable early outcomes after transanal and laparoscopic techniques. Laparotomy and associated compications are avoided in case of transanal extraction of specimen. Further researches are necessary to study functional and long-term results.

SUN-PP191: Relationship between the Nutritional Risk Screening 2002 (Nrs-2002) and Mean Hospital Stay, Mortality and Readmissions in Patients Hospitalized in Generalhospital (GH) of Parc Sanitari Sant Joan De Déu (PSSJD) From Sant Boi De Llobregat, Barcelona

SUN-PP191: Relationship between the Nutritional Risk Screening 2002 (Nrs-2002) and Mean Hospital Stay, Mortality and Readmissions in Patients Hospitalized in Generalhospital (GH) of Parc Sanitari Sant Joan De Déu (PSSJD) From Sant Boi De Llobregat, Barcelona

Prevalence of protein-energy malnutrition in hospital patients over 75 years of age admitted for hip fracture

IntroductionOne percent of falls in over-75years old cause hip fracture (HF). Protein-energy malnutrition (PEM) is associated with falls and fracture. PEM screening and perioperative nutritional management are recommended by the European Society of Parenteral and Enteral Nutrition, yet data on nutritional status in elderly HF patients are sparse. The Mini Nutritional Assessment (MNA) score is presently the most effective screening tool for PEM in over-75years old. ObjectiveThe principal objective of the present study was to determine the prevalence on MNA of PEM in patients aged over 75years admitted for HF. Secondary objectives were to identify factors associated with PEM and its role as a factor of evolution. Materials and methodsA prospective observational epidemiological study included 50 patients aged over 75years admitted for HF in an 8-bed orthopedic surgery department with a geriatric follow-up unit. PEM was defined by MNA<17/30. Assessment systematically comprised associated comorbidity (Cumulative Illness Rating Scale-Geriatric [CIRS-G]), cognitive status on the Mini Mental State Examination (MMSE), functional status on activities of daily life (ADL), and mean hospital stay (MHS). Scores were compared on quantitative tests (Student t) with the significance threshold set at P<0.05. ResultsMean age for the 50 patients was 86.1years (range, 77–94years). Prevalence of PEM was 28%; a further 58% of patients were at risk for PEM. PEM was associated with elevated CIRS-G (P<0.006), greater numbers of severe comorbidities (P=0.006), more severe cognitive disorder (P=0.005) and functional dependence (P=0.002), and 8 days’ longer MHS (P=0.012). DiscussionThe present study confirmed the high prevalence of PEM in HF patients aged over 75years, supporting longer hospital stay. MNA is a diagnostic gold standard, not to be replaced by albuminemia or body-mass index in this perioperative clinical situation. Given the present economic stakes relating to geriatric trauma patients’ hospital stay, it is essential to prevent, diagnose and treat PEM in elderly subjects. Level of evidenceLevel IV; prospective cohort study.

Total Robotic Pancreaticoduodenectomy

Context The “da Vinci” surgical system reintroduces much of the operative dexterity lost during laparoscopic operations and offers the unique opportunity to verify if pancreaticoduodenectomy (PD) can be safely performed through a minimally invasive approach. Objective We report our technique for total robotic PD employed in 39 consecutive patients. This experience was earned at a high-volume center of pancreatic surgery, having extensive experience in advanced laparoscopy and robotic surgery. Methods Our technique for total robotic PD is unique in several respects: pure laparoscopy is not used at any stage; only the right colonic flexure is mobilized; a total of five ports are used; the camera port is placed along the right pararectal line to allow optimal view of the uncinate process (UP); the third robotic arm is placed on the patient’s left side and it is used to “hang” the duodenum during dissection of the UP; the gallbladder is used to retract the liver; the first jejunal loop is fully mobilized but it is not sectioned until the specimen is ready for removal, to facilitate jejunal rotation behind the mesenteric vessels. Results No PD was converted to open surgery or laparoscopy, despite 3 patients required segmental resection of the mesenteric vein and reconstruction by a jump graft. Mean operative time was 597 minutes (range: 420-960 minutes). Thirty-day operative mortality was nil. No pseudoaneurysm of the gastroduodenal artery was noted. Only 4 patients developed grade B pancreatic fistulas and none grade C fistulas. Mean hospital-stay was 23 days (range: 10-86 days). Malignant tumors were diagnosed in 51% of the patients. Overall, the mean number of lymph nodes retrieved was 32 (range 15-76). None of the margins was positive. Conclusions In selected patients total robotic PD is feasible. As compared to hybrid techniques, coupling laparoscopic dissection with robotic reconstruction, a total robotic procedure spares unnecessary dissections and allows optimal control of large peripancreatic vessels permitting segmental vein resection and tailored reconstruction. Technology refinements and improvement of surgical technique could make robotic PD an appealing alternative to open PD in selected patients.

1029 ATP-binding Cassette Transporter Inhibition by Tyrosine Kinase Inhibitor Nilotinib

s / Pancreatology 12 (2012) 502–597 550 Introduction: Da Vinci surgical system overcomes most of technical limitations of laparoscopy and provides the unique opportunity to test whether this approach can improve outcomes of pancreatic resections. Aim: In selected patients laparoscopic robot-assisted pancreatic resection can be safely performed. Methods: 105 consecutive robotic pancreatectomies were performed between 10/2008 and 02/2012. There were 40 males and 65 females, with mean age of 58 yrs. 39 patients underwent pancreaticoduodenectomy (PD), 49 distal pancreatectomy (DP), 9 total pancreatectomy, 5 tumor enucleation, 3 central pancreatectomy. Since our activity spans over a 3year period, data were analyzed to verify the learning curve. Results: No conversion were performed. Mean operative time (OT) was 437.8 minutes. In the first year OT was 512 min for PD and 420 for DP. The meannumberof lymphnodes (LN) examinedwas 16.8. Pancreaticfistula (PF) occurred in41%of patients. In the secondyearOTwas596min for PDand402 forDP. The LNexaminedwas16.7. PFoccurred in36.3%ofpatients. In the third year OT was 443 min for PD and 394 for DP. The LN examined was 28.7. PF occurred in 37% of patients. 61 patients were diagnosed with benign or lowgrade tumors, 44 with cancer. Surgical margins were always negative. Postoperative mortality was nil, morbidity 52%. Mean hospital-stay was 16 days. Conclusions: Despite the existence of a learning curve, experienced pancreatic surgeons are not expected to pay to robotics the same price that they would have been asked for by laparoscopy.

Risk analysis and outcome of mediastinal wound and deep mediastinal wound infections with specific emphasis to omental transposition

BackgroundTo report our experience, with Deep mediastinal wound infections (DMWI). Emphasis was given to the management of deep infections with omental flapsMethodsFrom February 2000 to October 2007, out of 3896 cardiac surgery patients (prospective data collection) 120 pts (3.02%) developed sternal wound infections. There were 104 males & 16 females; (73.7%) CABG, (13.5%) Valves & (9.32%) CABG and Valve.ResultsSuperficial sternal wound infection detected in 68 patients (1.75%) and fifty-two patients (1.34%) developed DMWI. The incremental risk factors for development of DMWI were: Diabetes (OR = 3.62, CI = 1.2-10.98), Pre Op Creatinine > 200 μmol/l (OR = 3.33, CI = 1.14-9.7) and Prolong ventilation (OR = 4.16, CI = 1.73-9.98). Overall mortality for the DMWI was 9.3% and the specific mortality of the omental flap group was 8.3%. 19% of the "DMWI group", developed complications: hematoma 6%, partial flap loss 3.0%, wound dehiscence 5.3%. Mean Hospital Stay: 59 ± 21.5 days.ConclusionPost cardiac surgery sternal wound complications remain challenging. The role of multidisciplinary approach is fundamental, as is the importance of an aggressive early wound exploration especially for deep sternal infections.

Middle Pancreatectomy

To evaluate the indications, perioperative, and long-term outcomes of a large cohort of patients who underwent middle pancreatectomy (MP). MP is a parenchyma-sparing technique aimed to reduce the risk of postoperative exocrine and endocrine insufficiency. Reported outcomes after MP are conflicting. : Patients who underwent MP between 1990 and 2005 at the Massachusetts General Hospital and at the University of Verona were identified. The outcomes after MP were compared with a control group that underwent extended left pancreatectomy (ELP) for neoplasms in the mid pancreas. A total of 100 patients underwent MP. The most common indications were neuroendocrine neoplasms, serous cystadenoma, and branch-duct IPMNs. Comparison with 45 ELP showed that intraoperative blood loss and transfusions were significantly higher for ELP. The 2 groups showed no differences in overall morbidity, abdominal complications, overall pancreatic fistula, and grade B/C pancreatic fistula rate (17% in MP and 13% in ELP), but the mean hospital-stay was longer for MP patients (P = 0.005). Mortality was zero. In the MP group, 5 patients affected by IPMNs had positive resection margins and 3 had recurrence. After a median follow-up of 54 months, incidence of new endocrine and exocrine insufficiency were significantly higher in the ELP group (4% vs. 38%, P = 0.0001 and 5% vs. 15.6%, P = 0.039, respectively). MP is a safe and effective procedure for treatment of benign and low-grade malignant neoplasms of the mid pancreas and is associated with a low risk of development of exocrine and endocrine insufficiency. MP should be avoided in patients affected by main-duct IPMN.

An audit of surgical admissions to the intensive care unit of the Lagos University Teaching Hospital (1997 - 2002)

To review the pattern of adult surgical admissions into the Intensive Care Unit (ICU) of Lagos University Teaching Hospital (LUTH). A six-year retrospective review of data of patients above 12 years old admitted to the ICU of LUTH was performed. 290 patients representing 82.6% of the total ICU admissions (351) during the study period were evaluated. 251 (86.6% ) were surgical and 39 (13.4% ) non-surgical. The overall mortality was 40.3% (Surgical - 37.8% , Medical 62.9% ). Emergency admissions accounted for 221 (76.2% ) while electives were 69(33.8% ). The Mean hospital stay (MHS) was 4.8 +/- 0.4 days (Surgical: Medical - 3.9 +/- 0.2:10.1 +/- 2.5). The highest admissions were as a result of trauma (32.1% ) and obstetric complications (9.7% ). Cardiorespiratory monitoring (57.2% ) and respiratory distress (34.1% ) were the main indications for admission. Emergency admission and artificial ventilation contributed significantly to the observed mortality (p < 0.0001) At LUTH, trauma and obstetric complications constituted the major causes for ICU adult surgical admissions.

Estimating hospital costs attributable to prolonged air leak in pulmonary lobectomy☆

Prolonged air leak (PAL) after pulmonary surgery is a frequent occurrence and is reported to cause increased length of stay (LOS) and hospital costs although the costs directly attributable to PAL have never been published. The present study aims to compare the prevalence of pulmonary complications (atelectasis, pneumonia and pleural empyema) in patients with or without PAL and to quantify economic costs directly incurred by PAL in a series of pulmonary lobectomies. A series of 238 patients scheduled for pulmonary lobectomy (January 2001-December 2003) have been reviewed. PAL was defined as air leakage which prevented hospital discharge for 5 postoperative days or over. Hospital costs (excluding operating room) for pulmonary lobectomies have been obtained and calculated as mean daily costs. Age, body mass index, diagnosis, Charlson co-morbidity index, ppoFEV1 and major post-operative cardio-pulmonary morbidity have been used to construct a Cox-regression model for hospital stay, considering deaths as censored cases. Individual risk function has been used as a new variable and expected LOS calculated for each case. This data has been used to estimate total excess hospital stay and costs incurred by cases with PAL. Prevalence of PAL was 23 cases (9, 7%). Mean daily hospital cost for lobectomy was 632.49. For the whole series, mean hospital stay was 5 days (10 days for patients with PAL). PAL cases had more postoperative pulmonary morbidity (risk-ratio: 2.78). Variables showing independent influence on stay were: diagnosis of non-malignant disease (P=0.001); FEV1ppo (P=0.032) and cardio-respiratory morbidity (P<0.001). Calculated total excess stay for PAL patients was 62 days. A total expense of 39,437.39 (38,724.96 hospital and 712.43 pharmacy charges) were estimated to result from postoperative air-leak. PAL patients are prone to developing major postoperative morbidity. PAL calculated costs are over 13,000 per year. This data is useful for designing technical cost-effective strategies to avoid post-lobectomy PAL.