Preoperative Hospitalization Days Research Articles

Modified Tracheal Traction Exercise Reduces the Incidence of Dysphagia in Patients with Multilevel Anterior Cervical Discectomy and Fusion.

Dysphagia, an impairment in swallowing, is a frequent and debilitating complication for patients undergoing anterior cervical discectomy and fusion (ACDF), a common surgical treatment for degenerative cervical myelopathy (DCM). This retrospective study aimed to assess the efficacy of modified tracheal traction exercise (MTTE) in alleviating postoperative dysphagia and improving clinical outcomes for these patients. A cohort of 143 patients underwent multilevel fusions, equally distributed between MTTE (n = 75) and traditional tracheal traction exercise (TTTE) (n = 68) groups. Demographic parity was observed in gender distribution, age averages (MTTE: 51.43 ± 11.25 years; TTTE: 52.35 ± 10.43 years), body mass index (BMI), comorbidities, fusion segments, and preoperative hospitalization days. Surgical duration differences were assessed. Clinical outcomes, dysphagia incidence, blood loss, postoperative complications, Cervical Japanese Orthopedic Association (c-JOA) scores, and functional outcome swallowing scale evaluations were conducted. Univariate and multivariate logistic regression analyses were used to explore factors influencing dysphagia. Modified tracheal traction exercise demonstrated advantages with a significantly lower dysphagia incidence (25.33% vs. 44.12%, p = 0.018), reduced blood loss (102.03 ± 17.04 vs. 113.46 ± 14.92, p < 0.001), shorter surgical durations (159.04 ± 9.82 vs. 164.41 ± 12.22 min, p = 0.004), and fewer postoperative complications (choking cough, cerebrospinal fluid leakage, and hoarseness). Postoperative c-JOA scores at 2 and 6 weeks favored MTTE, but no significant differences were observed at 12 and 24 weeks. Functional outcome swallowing scale evaluations favored MTTE with significantly higher percentages of "normal" and lower incidences of "mild" and "moderate dysphagia" at various postoperative intervals compared to TTTE. Factors significantly associated with dysphagia included MTTE, age, and BMI according to logistic regression analyses. Modified tracheal traction exercise demonstrates superior short-term outcomes in multilevel ACDF, showcasing reduced dysphagia incidence, blood loss, and specific postoperative complications. Notably, factors contributing to dysphagia, including operation technique and patient-related variables, emphasize the significance of MTTE and patient characteristics in optimizing postoperative outcomes in multilevel ACDF procedures.

Establishment and Validation of a Nomogram to Predict Hospital-Acquired Infection in Elderly Patients After Cardiac Surgery.

BackgroundHospital-acquired infection (HAI) after cardiac surgery is a common clinical concern associated with adverse prognosis and mortality. The objective of this study is to determine the prevalence of HAI and its associated risk factors in elderly patients following cardiac surgery and to build a nomogram as a predictive model.MethodsWe developed and internally validated a predictive model from a retrospective cohort of 6405 patients aged ≥70 years, who were admitted to our hospital and underwent cardiac surgery. The primary outcome was HAI. Multivariable logistic regression analysis was used to identify independent factors significantly associated with HAI. The performance of the established nomogram was assessed by calibration, discrimination, and clinical utility. Internal validation was achieved by bootstrap sampling with 1000 repetitions to reduce the overfit bias.ResultsIndependent factors derived from the multivariable analysis to predict HAI were smoking, myocardial infarction, cardiopulmonary bypass use, intraoperative erythrocytes transfusion, extended preoperative hospitalization days and prolonged duration of mechanical ventilation postoperatively. The derivation model showed good discrimination, with a C-index of 0.706 [95% confidence interval 0.671–0.740], and good calibration [Hosmer–Lemeshow test P = 0.139]. Internal validation also maintained optimal discrimination and calibration. The decision curve analysis revealed that the nomogram was clinically useful.ConclusionsWe developed a predictive nomogram for postoperative HAIs based on routinely available data. This predictive tool may enable clinicians to achieve better perioperative management for elderly patients undergoing cardiac surgery but still requires further external validation.

Clinical pathway combined with enhanced recovery after surgery in patients with chronic cholecystitis and gallstones

Objective To investigate the effect of enhanced recovery after surgery (ERAS) on the clinical pathway of laparoscopic cholecystectomy in patients with chronic cholecystitis and gallstones. Methods From June 2017 to December 2017, 94 patients with chronic cholecystitis and cholecystolithiasis underwent laparoscopic cholecystectomy in the Department of General Surgery of First Hospltal of Huainan City were analyzed retrospectively. All patients were included in clinical pathway management. According to whether the perioperative period was combined with ERAS, there were 45 cases in the study group and 49 cases in the control group. The study group was combined with ERAS during perioperative period, while the control group received traditional perioperative management. The preoperative hospitalization days, operative time, intraoperative bleeding volume, total hospitalization days, postoperative complications, hospitalization costs, postoperative hospitalization days, clinical pathway completion rate and positive and negative variation rates were compared between the two groups. The measurement data were expressed by (Mean±SD), and the comparisons between groups were performed by t test; Comparisons of count data were analyzed using chi-square test or Fisher exact probability. Results Preoperative hospitalization days, operation time, intraoperative bleeding volume, total hospitalization days and postoperative complications in the study group were (3.3±1.2) d, (63.1±24.3) min, (9.4±3.9) ml, (7.1±1.5) d and 1 case respectively, while those in the control group were (3.2±1.5) d, (68.4±25.4) min, (9.5±2.9) ml, (8.4±1.8) d and 2 cases respectively, and the differences between the two groups ware not statistically significant (P>0.05). Postoperative hospitalization days, hospitalization expenses and shortened hospitalization days in the study group were (2.9±0.8) d, (9 407.2±500.9) yuan and 64.4%(29/45) respectively, while those in the control group were (4.5±1.1) d, (10 594.9±792.3) yuan and 36.7%(18/49) respectively. The difference between the two groups was statistically significant (P<0.05). Conclusion Laparoscopic cholecystectomy for chronic cholecystitis with cholecystolithiasis combined with ERAS during the implementation of clinical pathway can shorten postoperative hospital stay, reduce hospitalization costs, increase the positive variation rate of clinical pathway without increasing postoperative complications. Key words: Enhanced recovery after surgery; Cholecystolithiasis; Clinical pathway

Application effect of selective hospitalization management in patients with thyroid tumor and breast cancer

Objective To retrospectively compared the hospitalization days and hospitalization costs of patients with thyroid tumor and breast cancer between patients who accepted selective hospitalization management and patients who accepted routine hospital management, and analyze the effect of selective hospitalization management to shorten the average hospitalization days. Methods A total of 419 patients with thyroid tumor and 318 patients with breast cancer who were treated in Fujian Provincial Hospital from March 2013 to February 2016 were chosen as the study object, and they were divided into the control group and the study group according to whether accepting the selective hospitalization management. Evaluating indicators included the total hospitalization days, preoperative hospitalization days, postoperative hospitalization days and hospitalization costs. Results Compared with the control group, the average total hospitalization days [(6.56±2.94)d vs (8.09±3.71)d, (12.44±3.91)d vs (14.73±6.66)d)] and preoperative hospitalization days[(2.42±1.94)d vs (4.17±2.68)d, (2.98±1.70) vs (5.29±4.00)d] in the study group were all reduced (P 0.05). Conclusions Selective hospitalization management could effectively shorten the hospitalization days of patients undergoing selective operation, and increase beds turnover rate. So the new management method would produce good social and economic benefits for the hospital. Key words: Breast tumor; Thyroid tumor; Length of stay; Selective hospitalization management; Cost

Silver-impregnated hydrofiber dressing followed by delayed surgical closure for management of infants born with giant omphaloceles

ObjectiveWe successfully employed silver-impregnated hydrofiber dressing for management of giant omphaloceles (GO) followed by delayed surgical closure. Study designBetween 2005 and 2008, eight consecutive GO infants were cared for at Driscoll Children’s Hospital. Four patients had additional congenital anomalies including Beckwith–Wiedemann (n=1), tetralogy of Fallot (n=1), pulmonary hypoplasia (n=1), and ruptured omphalocele (n=1). Infants underwent amnion epithelization using a silver-impregnated hydrofiber dressing over the course of several months followed by delayed surgical closure. Mean±SD of parameters including maternal age, gestational age, infant weight, size of GO, preoperative intubation, preoperative hospitalization, time to epithelization, days to surgical closure, postoperative hospitalization, postoperative intubation and months of follow-up were studied. ResultsFive patients underwent successful closure, 2 were lost to follow-up and 1 was lost because of withdrawal of support. The maternal age, gestation age and weight of infant were 28±5.3years, 34±4weeks and 2.5±0.62kg, respectively. The GO size was 11cm in length and 11cm in width, respectively. Preoperative hospitalization days were 78±74days. Preoperative intubation was 3.5±3.1days with 2 neonates requiring tracheostomy and home ventilation owing to additional congenital abnormalities. Time to epithelization was 2.9±0.9months. Days to surgical closure and postoperative hospitalization were 331±119days and 5±3.4days, respectively. Average follow-up was 37±27months. No treatment associated morbidities are noted. ConclusionsSilver-impregnated hydrofiber mediated epithelization of GO followed by delayed surgical closure is safe for management of infants.

A Discussion on the Reasons for Excessive Average Preoperative Hospitalization Days

Objective. To discuss the factors influencing the standard test indexes of the average length of stay of a patient before elective surgery. Methods. The reasons were identified by analyzing cases o...

The Jarvik 2000 is associated with less infections than the HeartMate left ventricular assist device.

Device-related infections remain a considerable problem of left-ventricular support. We compared the device-related-infections between the HeartMate left ventricular assist device (LVAD) and the Jarvik 2000 permanent LVAD, a device with a novel retroauricular power-supply. Between December 2000 and September 2002 we implanted the HeartMate-vented, electrical-system in 11 patients and the permanent Jarvik 2000 in six patients. Total support time was 1626 patient-days (HeartMate, 26-271 days) versus 1246 patient-days (Jarvik 2000, 8-411 days). As potential risk factors for infection we analyzed age, preoperative hospital-days, total protein, cardiac index, maximal oxygen uptake, use of inotropes, LVAD risk-score-index and Aaronson-Mancini-score, intubation time, and intensive care unit stay. We used the Center of Disease Control definitions for surgical site infections. HeartMate-patients were younger than Jarvik 2000 patients (46+/-13 versus 58+/-6 years, P=0.056), there were no other differences in the risk factors. Four HeartMate-patients needed late (>or=48 h) surgical revisions for bleeding/hematomas versus no revisions in the Jarvik 2000 patients. In the HeartMate-patients, there were seven (64%) driveline-infections, five (45%) device-pocket infections, and three (27%) bloodstream-infections, or 0.43 device-related infections/100 patient-days. Infections occurred early (34+/-31 days). Three patients required urgent transplantation due to bloodstream infection. There were no adverse outcomes in the HeartMate-group due to infection. In the Jarvik 2000 patients, there was one driveline-infection (16%) after 270 days of support (0.08 device-related infections/100 patient-days), significantly less than in the HeartMate-group (P=0.044). Driveline infections resolved with antibiotics and local wound care in the Jarvik 2000 patient, but only in one of seven HeartMate-patients. Implantation of the Jarvik 2000 is associated with less device-related infections than the HeartMate-LVAD. The power-supply of the permanent Jarvik 2000 is suitable for long-term mechanical support.

Responsibility of the anaesthesiologist in the preoperative risk evaluation

Correct indications are essential to perform surgical procedures. However, appropriate timing to achieve minimal rates of complications even in high-risk patients or major surgery is at the top of the priority list. Perioperative responsibility is divided between anaesthesiologists and surgeons. While the surgeon is accountable for the surgical procedure, the anaesthesiologist is responsible for preoperative risk evaluation, perioperative management, and maintenance of vital organ functions. Both of these medical specialities must weigh the urgency of the procedure against patient-associated risk factors. Goals are optimal patient safety, efficient preoperative evaluation and subsequent optimisation to reduce the burden for the health care systems. For most patients without underlying diseases, a thorough history and physical examination is sufficient. In teaching hospitals, some laboratory results for screening of organ function are advisable. Patients can be stratified on clinical grounds into low-, medium-, and high-risk categories. Use of these categories, along with consideration of the type and urgency of surgery, allows for a reasonable approach to preoperative testing. Testing directed towards assessment of organ system functional reserve and identification of organs at risk rather than the diagnosis of a specific disease, is the primary goal of preoperative evaluation prior to surgery. These results are essential to prepare an effective anaesthetic plan. Along with increased patient comfort, the number of preoperative hospital days can be reduced by outpatient preoperative evaluation clinics.

Effect of center volume on outcome of ventricular septal defect closure and arterial switch operation

This study evaluates the effects of surgical volume and preoperative patient characteristics on length of stay following ventricular septal defect (VSD) repair and arterial switch operation (ASO). Twenty-four centers contributed data on 16,795 consecutive surgical procedures from January 1, 1992 to December 31, 1996 to the Pediatric Cardiac Care Consortium Registry. The following variables were used in the analysis: center, center volume, age, weight, date of operation, preoperative hospital days, presence of trisomy 21, and significant coexisting heart defects (risk). For VSD, all variables were associated with length of stay in the univariate analyses; however, in the multivariate model, center volume did not retain significance. Length of stay for ASO was associated with center, center volume, and preoperative days in the univariate analysis. In the multivariate analysis for ASO, center and center volume were significant variables for predicting length of stay. These findings suggest that length of stay for uncomplicated surgical procedures is not related to surgical volume; however, for technically demanding procedures, length of stay tends to be shorter in centers with more experience.

Is academic managed care an oxymoron?

Background: A review of 1993 data on length of stay (LOS) and charges for diagnosis-related group (DRG) 195 (complicated cholecystectomies) showed that Maricopa Medical Center charged more and had longer LOS than all other area hospitals. Methods: Twenty DRG 195 charts were analyzed for the causes of the inefficiencies. The remaining cholecystectomy DRGs were similarly analyzed. Results: Analysis of the charts for DRG 195 showed that 55% of the patients had laparoscopic conversions. Charges and LOS varied significantly because of the conversions, increased preoperative hospital days and increased operative times. Moreover, 30% of patients were more than 70 years old. Comparisons of other cholecystectomy DRGs showed similar inefficiencies, indicating a hospital system's problem. Conclusions: Diagnosis-related group delta analysis is a powerful performance improvement tool. Once problem areas are identified and corrected, monitoring prospective data produces rapid analysis of quality of care and cost improvements. The models can serve as a means for teaching hospitals to become more competitive and satisfy the Joint Commission on Accreditation of Healthcare Organizations requirements for patient-care improvements.

Preoperative Whole-Gut Lavage vs. Traditional Three-Day Bowel Preparation in Left Colon Surgery

Isotonic, isosmotic lavage is a safe and effective means of mechanical preparation of the large bowel for left colon surgery. In this prospective, randomized trial comparing lavage with a more traditional three-day bowel preparation, the lavage was well tolerated, led to decreased preoperative hospital days, and produced no higher incidence of infectious complications when compared to the traditional three-day technique.

Screening Clinic for the Presurgical Patient

To the Editor.— Janis and Downs (223: 692, 1973) point out the usefulness of the anesthesia screening clinic as a potential for expansion to include preadmission evaluation of patients to be admitted to the hospital for elective surgery.... The Ambulatory Care Service and the Department of Anesthesiology at the Bronx Municipal Hospital Center have had just such a service since July 1972. Since that time, 559 patients scheduled for elective general, gynecological, or urological surgical procedures have been evaluated in the Screening Clinic of the Center within two to seven days prior to their scheduled day of admission. We plan to present our data later this year, but preliminary review indicates a significant reduction in the number of preoperative hospital days. This program allows for better bed utilization and will be an integral part of our Ambulatory Surgical Unit currently under development in this institution.