Shorter Hospital Stay Research Articles

Redefining Surgical Boundaries for Obese Patients? Full Endoscopic Lumbar Discectomy Proves Equally Effective With Shorter Hospital Stay in Obese Patients.

This cohort study aims to evaluate the impact of obesity on the outcomes of full endoscopic lumbar discectomy (FELD) in patients with lumbar disc herniation. We conducted a retrospective analysis of 156 adult patients who underwent FELD for lumbar disc herniation from January 2015 to February 2023. Patients were divided into 3 groups: obese endoscopic (n = 71), obese open surgery (n = 31), and nonobese endoscopic (n = 54). Clinical outcomes were assessed using the visual analog scale for leg and back pain, the Oswestry Disability Index, and patient satisfaction rates. Operative time, hospital stay duration, and complication rates were also analyzed. No significant differences were observed in patient-reported outcome measures, operative time, or complication rates between obese and nonobese patients undergoing FELD. The mean operative time was longer in the endoscopic group compared with the open surgery group (70.2 vs 59.8 minutes), but the hospital stay was significantly shorter for endoscopic patients (1.7 vs 2.4 nights, P = 0.0006). Both obese and nonobese groups showed significant improvements in visual analog scale and Oswestry Disability Index scores at the final follow-up, with satisfaction rates of 85.7% in the endoscopic group reporting good to excellent outcomes. FELD is a viable and effective alternative to traditional open surgery for obese patients, offering comparable clinical outcomes and the added benefit of a shorter hospital stay. These findings suggest that obesity does not inherently affect surgical outcomes, underscoring the need for further research with larger sample sizes and longer follow-up periods. FELD offers a viable and effective surgical option for obese patients, with outcomes comparable to traditional surgery but with the added benefit of shorter hospital stays.

EP.07A.14 The Postoperative Chest Tube Drainage Strategy of "Lesstube" Can Reduce Patient Pain and Shorten Hospital Stay

EP.07A.14 The Postoperative Chest Tube Drainage Strategy of "Lesstube" Can Reduce Patient Pain and Shorten Hospital Stay

Preoperative MRCP is not Associated with Lower Complication Rates but Shorter Hospital Stay in Laparoscopic Cholecystectomy

Abstract Background Laparoscopic cholecystectomy is a very common procedure and while preoperative magnetic resonance cholangiopancreatography (pMRCP) is widely used for detection of choledocholithiasis and preoperative planning, the benefits in patients with normal preoperative cholestatic parameters remain unclear. Aims We aimed to investigate a large cohort of patients after laparoscopic cholecystectomy to analyse the impact of pMRCP on complication rates. Methods This retrospective cohort study consecutively includes all patients receiving elective or acute laparoscopic cholecystectomy between 2010 and 2020. Exclusion criteria were conversion to open cholecystectomy and preoperatively elevated cholestatic parameters. Complication rates were recorded and patients stratified depending on the use of pMRCP for preoperative planning. Results 3163 patients underwent laparoscopic cholecystectomy between 2010 and 2020, 2568 of which showed normal cholestatic parameters preoperatively. Of these patients, 684/2568 (27%) were male and 1884/2568 (73%) female. The most frequent indications for laparoscopic cholecystectomy were cholecystolithiasis in 72% (1845/2568) of cases, followed by cholecystitis in 18% (465/2568). The majority of patients (2267/2568, 88%) indeed received pMRCP, while the remaining 301/2568 patients did not. Postoperative complication rates did not significantly differ between the two groups (396/2267 (17%) in the pMRCP group and 58/301 (19%) without pMRCP, p=0.469). One case of pancreatitis occurred in the pMRCP group, versus two reported cases in the other group. Interestingly, the length of hospital stay after cholecystectomy was significantly shorter in the group with pMRCP versus without (4 days (range 1-61 days) versus 7 days (range 1 – 66 days), respectively, p = 0.023). Conclusion Preoperative MRCP seems to not prevent complications in laparoscopic cholecystectomy, since postoperative complication rates were comparable between the two patient groups with and without pMRCP. However, postoperative hospital stay was significantly shorter in patients undergoing pMRCP compared to patients without pMRCP.

The Impact of a Short Hospital Stay on Readmission Rate after Laparoscopic Colorectal Cancer Surgery under the Enhanced Recovery after Surgery Protocol

Objective: The aim of this study is to examine the safety of discharge after a one or two day hospital stay following laparoscopic colorectal cancer surgery under the enhanced recovery after surgery protocol. Methods: This retrospective study was conducted at the colorectal unit in the King Hussein Military Hospital. All patients who underwent laparoscopic resection of colorectal cancer between January 2020 and December 2023 were included and grouped according to their hospital stay: Group A had a short stay of one to two days, and Group B a stay of more than two days. Demographic information, type of surgery performed, postoperative complications, and readmission data were collected from the colorectal unit and hakeem data base. Results: Two hundred and eighty patients were included in this study: 104 patients in Group A and 176 patients in Group B. The mean age in Group A was 57.7 ± 12.82 years and in Group B 58.42 ± 13.04 years. In Group A, 46.1% were female, compared to 39.2% in Group B. The mean body mass index was similar in both groups. In Group A, 34.6% of patients were smokers, compared to 29% in Group B. The readmission rate was 9.6% in Group A and 11.4% in Group B. Conclusion: Early discharge of patient within two days following laparoscopic colorectal cancer resection is safe and was not associated with increased rates of readmission.

Mean Operative Time And Stay In Hospital Between Transurethral Removal Using Nephroscope And Percutaneous Cyst-lithotripsy In The Treatment Of Large Bladder Calculi

Background: urinary bladder stones comprise 5% of cases of urolithiasis1, with single calculi being identified in most instances but numerous calculi in 25% of cases2. With the development of endourological fiberoptic equipment and extracorporeal shockwave lithotripsy (swl), there have been notable modifications to managing and treating vescicolithiasis3. Thanks to this Study, we shall know the local amount of hospital stay and operating time between the two operations. We will suggest the method that results in a shorter surgical time and a shorter hospital stay since both have been successfully documented in the literature. Objective: to compare the length of hospital stay and average operating time for transurethral removal of big bladder calculi using a nephroscope with percutaneous cystolithotripsy. Study design : A randomized controlled trial Duration and place of study: from January 1, 2020, to December 31, 2020, at the Department of Urology, Institute of Kidney Diseases and Transplant, Peshawar Methodology: The Study used a randomized controlled trial (RCT) strategy, examining 60 individuals (30 in each group). The study covered all patients aged 20 to 65 years, female or male, presenting with bladder stones larger than 3 cm and with any number of rocks. All of the individuals who presented with renal insufficiency (defined as creatinine more than 3 mg/dl), active renal tract infection (defined as a fever greater than 38.5°c and positive urine culture), and obesity (defined as BMI greater than 30) were not included in the Study. The included patients were split into two groups using permitted blocks and blocked randomization. Patients in group b had percutaneous cystolithotripsy, whereas patients in group A underwent transurethral removal using a nephroscope. Following the operation, the length of hospital stay was calculated by tracking each patient until they decided to be discharged. After entering all of the data on the proforma into the statistical program SPSS version 23.0, a comparison analysis was carried out. Results: according to our analysis, nine patients (30%) in group A were between the ages of 20 and 40, and 21 patients (70%) were between the ages of 41 and 65. In contrast, 15 (50%) patients in group b were between 20 and 40, and 15 (50%) were between 41 and 65. Seven patients (23%) and 23 patients (77%) in Group A were female, and in contrast, six patients (20%) and 24 patients (80%) in Group B were female. Group A had an average surgical duration of 35.06 minutes (sd ± 5) and an average hospital stay of 2.6 days (sd ± 0.9). In contrast, group b saw an average surgical duration of 44.06 minutes (sd ± 7) and an average hospital stay of 3.4 days (sd ± 1.02). Conclusion: The Results Of Our Study Indicate That, When Treating Big Bladder Calculi, Transurethral Removal With A Nephroscope Had A Shorter Mean Operation Time And Hospital Stay Than Percutaneous Cystolithotripsy. Keywords: Mean Operative Time, Hospital Stay, Nephroscope, Percutaneous Cystolithotripsy, Bladder

Improvement of Russian clinical guidelines and reduction of mortality in perforated ulcers

To analyze the results of laparoscopic surgery in patients with perforated ulcers using evidence-based medicine approaches. We compared the efficacy and effectiveness of laparoscopic and open surgeries in patients with perforated ulcers. Meta-analysis of mortality after laparoscopic surgeries (randomized controlled trials) and trial sequential analysis were carried out. We clarified the differences between the efficacy and effectiveness of laparoscopic surgeries regarding postoperative mortality. In the Russian Federation, mortality after laparoscopic surgery is 9-11 times lower compared to open procedures. According to evidence-based researches (efficacy of laparoscopic interventions in 10 meta-analyses), these differences are less obvious (1.4-3.0 times) and not significant. The diversity-adjusted required information size to draw reasonable conclusions about differences in mortality in trial sequential analysis was 68 181 participants. Meta-analyses of RCTs also demonstrate lower incidence of wound complications (1.8-5.0% after laparoscopic surgery and 6.3-13.3% after laparotomy), shorter hospital-stay (mean difference from -0.13 to -2.84) and less severe pain syndrome (mean difference in VAS score from -2.08 to -2.45) after laparoscopic technologies. The obvious advantage of laparoscopic surgery in patients with perforated ulcers is fast-truck recovery following shorter hospital-stay, mild pain and rarer wound complications. Comparison of postoperative mortality regarding efficacy and effectiveness is difficult due to insufficient introduction of laparoscopic technologies in clinical practice and diversity-adjusted required information size.

Early Initiation of Dapagliflozin during Hospitalization for Acute Heart Failure Is Associated with a Shorter Hospital Stay.

Objective Sodium-glucose co-transporter-2 inhibitors (SGLT2is), such as dapagliflozin, have a diuretic effect, and their early initiation to treat acute heart failure (AHF) may improve outcomes; however, the significance of the timing of starting dapagliflozin after hospital admission remains unclear. Methods We performed a post hoc analysis of a prospective, observational registry. Participants were divided into the early (E) group and late (L) group using the median time to the initiation of dapagliflozin (6 days) as the cut-off. We evaluated the relationship between the time to the initiation of dapagliflozin after hospital admission and patient characteristics and the length of the hospital stay. Patients Study subjects were 118 patients with AHF admitted between January 2021 and April 2022 who were started on dapagliflozin treatment (10 mg/day). Results Patients were divided into the E group (n=63) and L group (n=55). The HF severity as evaluated by the New York Heart Association class and the N-terminal pro-brain natriuretic peptide level was not significantly different between the groups. The time to the initiation of dapagliflozin and length of hospital stay showed a significant positive correlation (p<0.001, r=0.46). The hospital stay was significantly shorter in group E [median, 16.5 days; interquartile range (IQR): 13-22 days] than in group L (median, 22 days; IQR: 17-27 days; p=0.002). A multivariate logistic regression analysis showed that the early initiation of dapagliflozin was independently associated with a shorter hospital stay, even after multiple adjustments. Conclusion Early initiation of dapagliflozin after hospital admission is associated with a shorter hospital stay, suggesting it is a key factor for shortening hospital stays.

Early Initiation of Sodium-Glucose Cotransporter 2 Inhibitor Leads to a Shorter Hospital Stay in Patients With Acute Decompensated Heart Failure.

Background: The efficacy of sodium-glucose cotransporter 2 inhibitors (SGLT2i) in patients with acute chronic heart failure (HF) is increasingly being reported. However, it is not clear when SGLT2i should be initiated in patients with acute decompensated HF (ADHF) after hospitalization. We retrospectively analyzed ADHF patients with newly prescribed SGLT2i. Methods and Results: Among the 694 patients hospitalized due to HF between May 2019 and May 2022, data were extracted for 168 patients with newly prescribed SGLT2i during the index hospitalization. These patients were divided into 2 groups: and early group (92 patients who started SGLT2i within 2 days of admission) and a late group (76 patients who started SGLT2i after 3 days). Clinical characteristics were comparable between the 2 groups. The date of cardiac rehabilitation initiation was significantly earlier in the early than late group (2.5±1.2 vs. 3.8±2.2 days; P<0.001). Hospital stay was significantly shorter in the early group (16.4±6.5 vs. 24.2±16.0 days; P<0.001). Although there were significantly fewer HF readmissions within 3 months in the early group (2.1% vs. 10.5%; P=0.044), the association disappeared in a multivariate analysis including clinical confounders. Conclusions: Early initiation of SGLT2i may shorten hospital stays.

Association of a Multimodal Intervention With Decreased Opioid Prescribing After Neck Dissection for Malignant Thyroid Disease With Short Hospital Stay

ImportancePrescribing practices for opioid medication after thyroid surgery have been well-studied and established; however, the need for pain management with opioid medication following lateral neck dissection for malignant thyroid disease with a short hospital stay has not been established.ObjectiveTo evaluate a multimodal opioid reduction intervention and its association with a decrease in prescribing of opioid medication at hospital discharge for patients after a lateral neck dissection for thyroid cancer.Design, Setting, and ParticipantsThis was a retrospective cohort study of patients treated from 2011 to 2021 by a tertiary academic institution that performs a high volume of thyroid cancer surgeries annually. We evaluated the electronic health records of 417 patients who had undergone lateral neck dissection for malignant thyroid disease from June 1, 2011, to June 30, 2021, and had a short hospital stay (≤3 days). Patients with longer stays (>3 days) or additional surgical procedures were excluded. Group 1 comprised patients who underwent a neck dissection before the intervention; and group 2, those who underwent the procedure after implementation of the intervention.InterventionA multimodal intervention composed of 3 components to reduce opioid prescribing at hospital discharge home after neck dissection for malignant thyroid disease with a short hospital stay.Main Outcomes and MeasuresThe primary outcome was the quantity of opioid medication prescribed in the postoperative period, measured as oral morphine milliequivalents (MME). The eta-squared effect size (η2ES) metric was used to determine the association of the intervention with a reduction in the MME quantities of opioid medication administered to inpatients and prescribed at discharge. An estimated need for opioids was established for the average patient undergoing lateral neck dissection for thyroid cancer based on the upper range of prescribing after intervention. The data were analyzed from January to March 2022.ResultsThe total study population was 417 patients: group 1 with 171 patients (mean [SD] age , 47.1 [15.6] years; 104 [61%] women; 144 [84%] non-Hispanic White) and group 2 with 246 patients (mean [SD] age , 46.2 [17.4] years; 146 [60%] women; 206 [83.7%] non-Hispanic White). The median MME prescribed at discharge for group 1 per patient was 225 MME compared with 0 MME for group 2, a large effect-size difference. There was a moderate association between the dose amount administered to an inpatient and the prescription dose they received at discharge (r, 0.33). Multiple linear regression analysis of sex, age, race and ethnicity, extent of surgery, and opioid reduction intervention showed that the intervention had a large clinically meaningful association with decreasing opioid prescriptions and dosage amounts at discharge (η2ES, 0.26; 95% CI, 0.19-0.33).Conclusions and RelevanceThe findings of this retrospective cohort study suggest that patients undergoing lateral neck dissections for thyroid cancer with short hospitalization needed very small amounts, if any, postoperative opioid medication for pain management. Adequate postoperative pain control was achieved using nonopioid interventions. Implementing an intervention to decrease the quantity of unnecessarily prescribed opioid medications during hospital discharge may help to reduce the risk of opioid addiction and overdose in patients after surgery.

High-Normal Preoperative Potassium Level Is Associated with Reduced 30-Day Morbidity and Shorter Hospital Stay after Radical Cystectomy.

Background: Radical cystectomy has high complication rates and, consequently, a high socioeconomic burden. The association between preoperative electrolyte levels and postoperative outcomes after radical cystectomy has not been investigated. Therefore, we aimed to investigate the association between preoperative potassium level and clinical (30-day morbidity) and economical (length of hospital stay) postoperative outcomes of patients undergoing radical cystectomy. Materials and Methods: We retrospectively evaluated clinical data of 317 patients who had undergone radical cystectomy for bladder cancer. Univariate and multivariate logistic regression analyses were performed to determine whether preoperative patient clinical factors influence clinical (30-day morbidity according to the Clavien-Dindo classification) and economical (length of hospital stay) postoperative outcomes. Results: In univariate analysis, low Charlson comorbidity score (p = 0.011), low ASA score (p = 0.015), no aspirin intake (p = 0.048) and high-normal preoperative potassium level (p = 0.034) were associated with reduced 30-day morbidity. In multivariate analysis, only high preoperative potassium remained an independent predictive factor for a reduced risk of postoperative complications (odds ratio 0.67, 95% confidence interval (0.48, 0.92), p = 0.014). Furthermore, high-normal preoperative potassium was the only preoperative factor associated with a shorter hospital stay ≤21 days (p = 0.007). Conclusions: High-normal preoperative potassium level was associated with better clinical (lower 30-day morbidity) and economical (shorter hospital stay) outcomes in patients undergoing radical cystectomy. We recommend that a randomized controlled trial be performed to investigate whether there is a causal relationship between preoperative potassium supplementation and postoperative complications and length of hospital stay.

Higher Adherence to ERAS Society® Recommendations is Associated with Shorter Hospital Stay Without an Increase in Postoperative Complications or Readmissions in Bariatric Surgery: the Association Between Use of Enhanced Recovery After Surgery Protocols and Postoperative Complications after Bariatric Surgery (POWER 3) Multicenter Observational Study.

The effectiveness of enhanced recovery after surgery (ERAS) pathways in patients undergoing bariatric surgery remains unclear. Our objective was to determine the effect of the ERAS elements on patient outcomes following elective bariatric surgery. Prospective cohort study in adult patients undergoing elective bariatric surgery. Each participating center selected a single 3-month data collection period between October 2019 and September 2020. We assessed the 24 individual components of the ERAS pathways in all patients. We used a multivariable and multilevel logistic regression model to adjust for baseline risk factors, ERAS elements, and center differences RESULTS: We included 1419 patients. One hundred and fourteen patients (8%) developed postoperative complications. There were no differences in the incidence of overall postoperative complications between the self-designated ERAS and non-ERAS groups (54 (8.7%) vs. 60 (7.6%); OR, 1.14; 95% CI, 0.73-1.79; P = .56), neither for moderate-to-severe complications, readmissions, re-interventions, mortality, or hospital stay (2 [IQR 2-3] vs. 3 [IQR 2-4] days, 0.85; 95% CI, 0.62-1.17; P = .33) Adherence to the ERAS elements in the highest adherence quartile (Q1) was greater than 72.2%, while in the lowest adherence quartile (Q4) it was less than 55%. Patients with the highest adherence rates had shorter hospital stay (2 [IQR 2-3] vs. 3 [IQR 2-4] days, 1.54; 95% CI, 1.09-2.17; P = .015), while there were no differences in the other outcomes CONCLUSIONS: Higher adherence to ERAS Society® recommendations was associated with a shorter hospital stay without an increase in postoperative complications or readmissions. ClinicalTrials.gov Identifier: NCT03864861.

Comprehensive Nursing Intervention Can Reduce Postoperative Complications and Shorten Hospital Stay of Children with Cleft Lip and Palate Repair Surgery

This research aims to probe into the impact of people-oriented comprehensive nursing intervention on children with cleft lip and palate repair surgery. Totally 112 lip cleft children who underwent surgical treatment in our hospital from June 2017 to March 2019 were randomized into routine and intervention groups. Among them, 55 in the former underwent routine nursing intervention, and 57 in the latter obtained comprehensive nursing intervention additionally. The hospital stay and complications of the two groups were observed. The hospital stay and complications in the latter were less than those in the former. Comprehensive nursing intervention can reduce postoperative complications and shorten hospital stay in children with cleft lip and palate repair surgery.

Early Feeding Shortens Hospital Stay in Patients with Mild or Moderate Pancreatitis

Based on moderate-quality evidence from several previous clinical trials, the American Gastroenterological Association recommends that oral feeding be

Greater Compliance With Early Sepsis Management is Associated With Safer Care and Shorter Hospital Stay.

This retrospective, cross-sectional study of U.S. hospitals in Medicare's Inpatient Quality Reporting Program aimed to determine whether variation in Sepsis/Septic Shock (Bundle SEP-1) compliance is linked to hospital size and measures of safety and operational efficiency. Two thousand six hundred and fifty-three acute care hospitals in Medicare's Hospital Compare online database were included in the study. Relationships between SEP-1 bundle compliance, hospital size, and indices of operational excellence (including Patient Safety Index [PSI-90], average length of stay [ALOS] and readmission rate) were analyzed. SEP-1 compliance score was inversely associated with staffed bed number (r = -.14, p < .001), PSI-90 (r = -.01, p < .001), and ALOS (r = -.13, p < .001) in a multivariate analysis. Hospitals in the lowest versus highest quartile by bed number had SEP-1 compliance score of 49.8 ± 20.2% versus 46.9 ± 16.8%, p < .001. Hospitals in the lowest versus highest quartile for SEP-1 score had an ALOS of 5.0 ± 1.2 days versus 4.7 ± 1.1 days and PSI-90 rate of 1.03 ± 0.22 versus 0.98 ± 0.16, p < .001 for both. Although this does not establish a causal relationship, it supports the hypothesis that the ability of hospitals to successfully implement SEP-1 is associated with superior performance in key measures of operational excellence.

A COMPARITIVE STUDY OF ONLAY – SUBLAY MESHPLASTY (PHS) vs. LICHTENSTEIN MESHPLASTY OF INGUINAL HERNIA

Introduction: A Hernia is the protrusion of part of the abdominal contents beyond the abdominal wall's normal connes. In this study, an attempt is made to compare the results of two different modalities of hernia repair–Lichtenstein repair and repair of hernia with Polypropylene hernia system. Aim: The study aims to ascertain the Polypropylene hernia system's safety and benets for hernia repair against conventional Lichtenstein tension-free mesh repair technique. Materials and methods: The prospective clinical study comprises 30 patients presenting with inguinal hernia attending OPD and admitted to the General Surgery Department of King George Hospital, Visakhapatnam, during the study period of September 2018 to October 2020. Results: Age distribution between 10-90, most of the 50-70 age group (14 cases). Visual analog scale (VAS) score for PMR 4.55 ± 1.18 and LMR 6.06 1.27 (p-value &lt;0.05). Wound infection for PMR 1 case and LMR 2 cases. Duration of surgery for PMR 65.40 ± 7.84 and LMR 51.33 ± 13.51 (p-value &lt;0.05). Type of surgery and duration of hospital stay for PMR 4.93 ± 1.27 LMR 6.73 ± 2.12. Type of surgery and return to work for PMR 5.93 ± 1.27 and LMR 7.73 ± 2.12(p-value &lt;0.05).Recurrence in PMR 0 % and LMR 6.67%. Conclusion: PHS repair is superior to Lichtenstein mesh repair about safe, tension-free method, shorter hospital Stay, early return to work, least recurrence rates, and a high subjective success rate and satisfaction rate.

Early Outcomes: A Comparison between Biportal Endoscopic Spine Surgery and Open Lumbar Discectomy for Single-Level Lumbar Disc Herniation

Objective: To compare early outcomes between biportal endoscopic spine surgery (BESS) and open lumbar discectomy (OLD) for treating single-level lumbar disc herniation. Materials and Methods: A retrospective cohort study was conducted in 80 cases of single-level lumbar disc herniation that underwent either BESS or OLD. The author compared the perioperative data between BESS and OLD, including operative time (OT), level, side, estimated blood loss (EBL), surgical drain output, hospital stay (HS), hospital costs, visual analogue scale (VAS) scores, morphine consumption, complication, and McNab’s satisfaction outcome. Results: Forty-three patients underwent BESS and 37 underwent OLD. There was 55% female and 45% male. The mean age was 37.8±9.5 years. The BESS group showed significantly (a) lower median morphine consumption than the OLD group (five mg versus nine mg, p&lt;0.001), (b) lower postoperative pain (VAS) at 2-, 4-, 12-, 24-, 48- (p&lt;0.001), and 72-hours post-surgery (p=0.017), and (c) shorter HS (4.8±2.9 days versus 7.4±4.6 days, p=0.003). McNab’s satisfaction outcome of a good or excellent result was comparable between BESS and OLD group (97.7% versus 86.5%, p=0.090). The BESS group, however, had a longer OT than the OLD group (100.4±28.5 versus 67.9±23.2 minutes, p&lt;0.001), and had a higher hospital cost (1,256±360.9 USD versus 910.6±269.8 USD, p&lt;0.001). Complications were not significantly different between the BESS and OLD groups. Conclusion: BESS for single-level lumbar discectomy had less postoperative pain for up to 72 hours, less opioid consumption, and shorter HS, but longer OT and higher hospital costs than OLD. Patient satisfaction outcomes were comparable between the two groups. Keywords: Biportal endoscopic spine surgery, Unilateral biportal endoscopic discectomy, Open lumbar discectomy, Single-level lumbar disc herniation

Laparoscopic Distal Pancreatectomy Shortens Hospital Stay: Results from a Single-Center, Randomized Controlled Trial (LAPOP)

Introduction: Nonrandomized retrospective studies have suggested that laparoscopic distal pancreatectomy (LDP) is advantageous compared to open (ODP) regarding hospital stay, blood loss and recovery. The only randomized study is available shows enhanced functional recovery after LDP. Methods: Sixty patients, evaluated at a multidisciplinary tumor board and planed for standard distal pancreatectomy were prospectively randomized to LDP or ODP in a parallel group, single-center superiority trial. The primary outcome was postoperative hospital stay with the hypothesis that LDP would shorten it. Results: Fifty-eight patients, 34 male and 24 female, were assigned to LDP (n=29, mean age 68 years) vs. to ODP (n=29, mean age 63 years) and included in a intention-to-treat analysis. The postoperative hospital stay was 5 (IQR 4-5) days in the LDP group vs. 6 (5-7) days in the ODP group (P=0.002). Functional recovery was reached after 4 (2-6) vs. 6 (4-7) days (P=0.007), and the operation time was 120 minutes in both groups (P=0.48). Blood loss was reduced with LDP, 50 (25-150) compared to 100 mL (100-300) (P=0.018). No difference was found in the complication rates with 4 vs. 8 patients in the LDP and ODP groups respectively experiencing complication of Clavien-Dindo grade 3 or higher. Similarly, the rate of post pancreatectomy fistula did not differ between the groups (9 vs. 11 patients). Conclusions: LDP is associated with shorter hospital stay, enhanced functional recovery and less bleeding as compared to ODP, and should therefore be considered the as the treatment standard for patients in need of distal pancreatectomy.

Early Initiation of Treatment with Rivipansel for Acute Vaso-Occlusive Crisis in Sickle Cell Disease (SCD) Achieves Earlier Discontinuation of IV Opioids and Shorter Hospital Stay: Reset Clinical Trial Analysis

Early Initiation of Treatment with Rivipansel for Acute Vaso-Occlusive Crisis in Sickle Cell Disease (SCD) Achieves Earlier Discontinuation of IV Opioids and Shorter Hospital Stay: Reset Clinical Trial Analysis

Robotic-Assisted Surgery Results in a Shorter Hospital Stay Following Revisional Bariatric Surgery.

Revisional surgery is rapidly growing within the field of bariatric surgery. The use of robotic assisted surgery, considered controversial by many, may offer advantages in revisional bariatric surgery (RBS). There are few studies comparing laparoscopic and robotic-assisted RBS. The aim of this study is to compare the safety and outcome of laparoscopic and robotic RBS in a single accredited center. A retrospective analysis of data collected prospectively on patients undergoing either laparoscopic (L-RBS) or robotic (R-RBS) RBS between January 1, 2017 and December 31, 2019 was performed. The primary outcomes included length of stay (LOS), 30-day major and minor complication rates, readmission rates, and mortality rates. A total of 167 patients were included in our analysis. Fifty-two patients underwent R-RBS (31%), and 115 underwent L-RBS (69%). Thirty-day major and minor complication rates for R-RBS and L-RBS were 1.9% and 5.8% vs 5.2% and 5.2%, respectively (p > .05). There was no difference in readmission rates (3.8% vs 8.7%, p > 0.05) or intraoperative blood loss (35.5mL vs 37.4mL, p > .05) between R-RBS and L-RBS. R-RBS resulted in a shorter length of stay when compared with L-RBS (40.2h vs 62.6h, p < .05). R-RBS has a decreased, albeit non-significant, rate of 30-day major complications with no difference in minor complications, readmission rates, or intraoperative blood loss when compared with L-RBS. R-RBS resulted in a decreased length of stay when compared with L-RBS. Randomized clinical trials are needed to better elucidate our findings.

Focus on application of dermabrasion in the treatment of deep partial-thickness burn wound at early stage

There are several advantages in using dermabrasion to treat burn wound of deep-partial thickness at early stage, including accurate positioning, little damage to normal tissue, partial-damaged tissue preservation, easy to operate, no limited by burn wound location and area, fast wound healing, short hospital-stay, less hospitalization cost, slight scarring, wide indications, etc. It is of important clinical value for the treatment of deep partial-thickness burn wound at early stage.