Rate Of Postoperative Hospital Research Articles

Racial/Ethnic Differences in the Risk of Surgical Complications and Posthysterectomy Hospitalization among Women Undergoing Hysterectomy for Benign Conditions

Evaluate whether 30- and 90-day surgical complication and postoperative hospitalization rates after hysterectomy for benign conditions differ by race/ethnicity and whether the differences remain after controlling for patient, hospital, and surgical characteristics. Retrospective cohort study using administrative data. The exposure was race/ethnicity. The outcomes included 5 different surgical complications/categories and posthysterectomy inpatient hospitalization, all identified through 30 and 90 days after hysterectomy hospital discharge, with the exception of hemorrhage/hematoma, which was only identified through 30 days. To examine the association between race/ethnicity and each outcome, we used logistic regression with clustering of procedures within hospitals, adjusting for patient and hospital characteristics and surgical approach. Multistate, including Florida and New York. Women aged ≥18 years who underwent hysterectomy for benign conditions using State Inpatient Databases and State Ambulatory Surgery Databases. Hysterectomy for benign conditions. We included 183 697 women undergoing hysterectomy for benign conditions from January 2011 to September 2014. In analysis, adjusting for surgery route and other factors, black race was associated with increased risk of 30-day digestive system complications (multivariable adjusted odds ratio [aOR], 1.98; 95% confidence interval [CI], 1.78-2.21), surgical-site infection (aOR, 1.34; 95% CI, 1.18-1.53), posthysterectomy hospitalization (aOR, 1.31; 95% CI, 1.22-1.40), and urologic complications (aOR, 1.16; 95% CI, 1.01-1.34) compared with white race. Asian/Pacific Islander race was associated with increased risk of 30-day urologic complications (aOR, 1.48; 95% CI, 1.08-2.03), intraoperative injury to abdominal/pelvic organs (aOR, 1.46; 95% CI, 1.23-1.75), and hemorrhage/hematoma (aOR, 1.33; 95% CI, 1.06-1.67) compared with white race. Hispanic ethnicity was associated with increased risk of 30-day posthysterectomy hospitalization (aOR, 1.11; 95% CI, 1.02-1.20) compared with white race. All findings were similar at 90 days. Black and Asian/Pacific Islander women had higher risk of some 30- and 90-day surgical complications after hysterectomy than white women. Black and Hispanic women had higher risk of posthysterectomy hospitalization. Intervention strategies aimed at identifying and better managing disparities in pre-existing conditions/comorbidities could reduce racial/ethnic differences in outcomes.

Implementing ERAS Protocol in Colorectal Unit in Royal Medical Services, Jordan- An Audit

Objectives: The aim of this audit was to review the advantages and weaknesses of using ERAS (Enhanced Recovery After Surgery) protocol on patients who underwent elective colorectal surgery. Methods: From January 2015 to May 2017, all patients who underwent elective colorectal surgical procedures at the colorectal unit at King Hussein Hospital in Jordan were included in this audit. Data was collected from those patients’ files and follow up notes at the clinic. Results: Two hundred patients were included in our study. There were 115 female (57.5%) and 85 male patients ( 42.5%) with a mean age of 53 years (range 19 – 79 years).The mean duration of postoperative hospital stay was 4 days (range 3 – 9 days). These complications included DVT in 1 patient (0.5%), PE in 1 patient (0.5%) , wound infection in 13 patients (6.5%), enterocutaneous fistula 1 patient (0,5%) , infected vaginal stump 1 patient (0.5%), intestinal obstruction ‘including ileus’ affected 6 patients (3%) and other complications 5 patients ( 2.5% ). 30 days in-hospital mortality 205% (5 patients). The re admission rate for different complications was 15.5% (31 patients). Conclusion: A decrease in the overall rate of postoperative hospital stay and rate of complications was recorded when using ERAS compared to the traditional recovery pathway. Howevere, a higher readmission rate was noted. Thus, we highly recommended to use ERAS when performing colorectal procedures.

Évaluation de la pratique de la chirurgie ambulatoire en urologie : expérience d’un centre

Ambulatory surgery is an alternative to traditional hospitalisation and an opportunity for savings for the healthcare system. Here, we analyze our experience in outpatient surgery in urology over a year. A prospective database concerning outpatient activity was established in 2009, gathering age, ASA score, type of intervention, discharge and recovery for each patient. An individual questionnaire was sent retrospectively in February 2010, to collect data about history of outpatient surgery, overall satisfaction, preference for traditional hospitalization and emergency department visits within 48 hours after surgery. In 2009, 465 patients aged of 52±16 years (15-98) underwent urologic surgery on an outpatient basis. Median ASA score was 2 (1-3). Types of intervention were mainly endo-urology (44.5%), surgery for urinary incontinence (32.5%), and circumcision (12.3%). The postoperative hospitalization rate was 4.5%. The questionnaire response rate was 28%. Forty-six percent of the patients had already been supported in ambulatory, overall satisfaction was 3.3 out of 4 (±1.06) and 24% of patients would have preferred a traditional hospitalization. 11% of patients required emergency department care within 48 hours whatever the surgery undergone. An important part of urological procedures has been done on an outpatient basis without compromising quality of care and patient satisfaction.

Transient advanced mental impairment: An underappreciated morbidity after aortic surgery

Objectives: To determine the incidence, risk factors, and associated morbidity of transient advanced mental impairment (TAMI) after aortic surgery. Methods: We retrospectively studied the charts of 188 consecutive patients undergoing elective aortic reconstruction during a recent 6-year period at a university hospital. All patients were lucid on admission and nonintubated at the time of evaluation at least 2 days after operation. TAMI was defined as disorientation or confusion on 2 or more postoperative days. Preoperative, intraoperative, and postoperative clinical variables were examined statistically for associations with TAMI. Results: Fifty-three patients (28%) had development of TAMI 3.9 ± 2.8 days after operation. Stepwise logistic regression analysis selected the following independent predictors for TAMI: age >65 years (odds ratio [OR], 7.9; 95% confidence interval [CI], 2.7 to 23.7), American Society of Anesthesiology physical status classification >3 (OR, 2.8; 95% CI, 1.3 to 5.9), diabetes mellitus (OR, 3.4; 95% CI, 1.2 to 9.8), old myocardial infarction (OR, 2.4; 95% CI, 1.1 to 5.3), and hypertension (OR, 2.3; 95% CI, 1.0 to 5.3). Alcohol consumption was not significantly associated with TAMI. In the postoperative period, patients with TAMI were more likely to have hypoxia (P <.001), a need for reintubation (P <.001), pneumonia (P <.001), congestive heart failure (P =.003), and kidney failure (P =.05). In addition, patients with TAMI had a longer duration of endotracheal intubation (3.7 ± 7.8 vs 0.6 ± 1.2 days, P <.001), stay in the intensive care unit (8.9 ± 9 vs 3.9 ± 2 days, P <.001), and postoperative hospital stay (14.8 ± 11 vs 9.2 ± 5 days, P <.001) than patients without TAMI. Twenty (38%) patients with TAMI were discharged to intermediate-care facilities, compared with 11 (8%) patients without TAMI (P <.001). Postoperative variables conferring the largest relative risks for development of TAMI included oxygen saturation less than 92% (5.4), the need for reintubation (3.3), congestive heart failure (3.3), and pneumonia (3.2). TAMI, conversely, conferred the largest relative risks for development of postoperative congestive heart failure (15.3), the need for reintubation (9.3), pneumonia (7.1), and the need for ICU readmission (3.8). Conclusions: These data show that TAMI is prevalent among patients undergoing aortic reconstruction and is associated with dramatically increased morbidity and postoperative hospitalization rates. (J Vasc Surg 2002;35:376-81.)