共查询到20条相似文献，搜索用时 46 毫秒
1.
Samuel R. Montgomery Paris D. Butler Chris J. Wirtalla Karole T. Collier Rebecca L. Hoffman Cary B. Aarons Scott M. Damrauer Rachel R. Kelz 《American journal of surgery》2018,215(6):1046-1050
Background
Inflammatory Bowel Disease (IBD) has not historically been a focus of racial health disparities research. IBD has been increasing in the black community. We hypothesized that outcomes following surgery would be worse for black patients.Methods
A retrospective cohort study of death and serious morbidity (DSM) of patients undergoing surgery for IBD was performed using data from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP 2011–2014). Multivariable logistic regression modeling was performed to evaluate associations between race and outcomes.Results
Among 14,679 IBD patients, the overall rate of DSM was 20.3% (white: 19.3%, black 27.0%, other 23.8%, p?<?0.001). After adjustment, black patients remained at increased risk of DSM compared white patients (OR: 1.37; 95% CI 1.14–1.64).Conclusions
Black patients are at increased risk of post-operative DSM following surgery for IBD. The elevated rates of DSM are not explained by traditional risk factors like obesity, ASA class, emergent surgery, or stoma creation. 相似文献2.
W.W. Sheaffer R.W. Day K.L. Harold J.T. Kidwell J.L. Tiede T.R. Benjamin S. Bersoux J.A. Madura 《American journal of surgery》2018,215(3):452-455
Objective
Enhanced recovery has been utilized to decrease length of stay and cost in bariatric surgery. We have recently focused efforts on pre-operative education with regards to discharge on the first post-operative day. The aim of this study was to determine the effectiveness of pre-operative education on discharge timing and readmission rates.Methods
A retrospective review was conducted after revising discharge expectation education. Patients undergoing first time bariatric operations were included. Early group education focused on average patient stay of 2 postoperative days. Revised education informed patients they could go home on the first post-operative day.Results
A total of 125 patients met inclusion criteria. Implementation of preoperative education was associated with a decrease in mean LOS and greater percentage of patients discharged on post-operative day one. There was no difference in readmission and complication rates.Conclusion
Effective pre-operative education can decrease length of stay in first time laparoscopic bariatric surgery. 相似文献3.
Steve R. Siegal James P. Dolan Elizabeth N. Dewey Alexander R. Guimaraes Brandon H. Tieu Paul H. Schipper John G. Hunter 《American journal of surgery》2018,215(5):813-817
Background
Sarcopenia is associated with increased morbidity and mortality in hepatic, pancreatic and colorectal cancer. We examined the effect of sarcopenia on morbidity, mortality, and recurrence after resection for esophageal cancer.Methods
Retrospective review of consecutive esophagectomies from 2010 to 2015. Computed tomography studies were analyzed for sarcopenia. Morbidity was analyzed using Fischer's test and survival data with Kaplan Meier curves.Results
The sarcopenic group (n?=?127) had lower BMI, later stage disease, and higher incidence of neoadjuvant radiation than those without sarcopenia (n?=?46). There were no differences in morbidity or mortality between the groups (p?=?.75 and p?=?.31, respectively). Mean length of stay was similar (p?=?.70). Disease free and overall survival were similar (p?=?.20 and p?=?.39, respectively).Conclusion
There is no association between sarcopenia and increased morbidity, mortality and disease-free survival in patients undergoing esophagectomy for cancer. Sarcopenia in esophageal cancer may not portend worse outcomes that have been reported in other solid tumors. 相似文献4.
Duraid Younan Russell Griffin Ahmed Zaky Jean-Francois Pittet Bernard Camins 《American journal of surgery》2018,215(4):678-681
Background
The Centers for Disease Control and Prevention (CDC) replaced its definition for ventilator-associated pneumonia (VAP) in 2013. The aim of the current study is to compare the outcome of burn patients with ventilator associated events (VAEs).Methods
Burn patients with at least two days of ventilator support were identified from the registry between 2013 and 2016. Kruskal-Wallis and Fisher's exact tests were utilized for continuous and categorical variables, respectively. A logistic regression was used for the association between VAE and in-hospital mortality.Results
243 patients were admitted to our burn center, of whom 208 had no VAE, 8 had a VAC, and 27 had an IVAC or PVAP. There was no difference in hospital length of stay, ICU length of stay and ventilator support days between those with no VAE and a VAC. Those with IVAC-plus had significantly worse outcomes compared to patients with no VAEs.Conclusions
Burn patients with IVAC-plus had significantly longer hospital and ICU lengths of stay, days on ventilator compared with patients with no VAEs. 相似文献5.
Barrett A. Kielhorn Anthony J. Senagore Theodor Asgeirsson 《American journal of surgery》2018,215(3):373-376
Background
Perioperative insulin resistance is associated with significant hyperglycemia-related morbidity in patients undergoing major surgery. We sought to assess the effect of preoperative loading with a low-dose maltodextrin/citrulline solution compared to a commercially available sports drink on glycemic levels in an established colorectal enhanced recovery program.Methods
Retrospective analysis was undertaken of elective non-diabetic colectomies and enterectomies from January 2016–March 2017. Cohorts included simple (SIM) and complex carbohydrate (COM) groups. Statistical analysis was performed with linear and logarithmic regression.Results
83 patients were included (42 SIM, 41 COM). SIM group was older (61.7 vs 52.7 p = 0.012) Glycemic variability was less in the COM group (7.6% vs 21.4% P = 0.034). The frequency of hyperglycemia, postoperative complications, and length of stay trended higher in the SIM group.Conclusions
This retrospective analysis identifies significant improvement in the perioperative glycemic variability with preoperative low dose complex carbohydrate loading compared to simple carbohydrate loading in colorectal surgery patients. 相似文献6.
Background
Much attention in the volume-outcomes literature has focused on the empirical impact of surgical caseload on outcomes. However, relevant studies on the association between surgical volume and variables that potentially contribute to healthcare costs are limited. The objective of this study was to systematically elucidate a contemporary analysis of the empirical relationship between hospital esophagectomy volume and postoperative length of stay, a cost-related outcome.Data sources
OvidSP, PubMed, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), ISI Web of Science and OpenGrey were searched for relevant articles published from 2000 to 2016.Results
High hospital esophagectomy volume was associated with reduced postoperative length of stay (mean: 3 days; 95%CI: 2.8, 3.2) and risk of prolonged length of stay (RR: 0.80, 95%CI: 0.74, 0.87) in a dose-response fashion.Conclusions
Complex surgeries performed at high surgical volume centers may be associated with overall decrease in postoperative length of stay, a cost-related outcome. 相似文献7.
Benjamin C. Jordan Joseph Brungardt Jared Reyes Stephen D. Helmer James M. Haan 《American journal of surgery》2018,215(1):48-52
Background
The specific contribution of dementia towards mortality in trauma patients is not well defined. The purpose of the study was to evaluate dementia as a predictor of mortality in trauma patients when compared to case-matched controls.Methods
A 5-year retrospective review was conducted of adult trauma patients with a diagnosis of dementia at an American College of Surgeons-verified level I trauma center. Patients with dementia were matched with non-dementia patients and compared on mortality, ICU length of stay, and hospital length of stay.Results
A total of 195 patients with dementia were matched to non-dementia controls. Comorbidities and complications (11.8% vs 12.4%) were comparable between both groups. Dementia patients spent fewer days on the ventilator (1 vs 4.5, P = 0.031). The length of ICU stay (2 days), hospital length of stay (3 days), and mortality (5.1%) were the same for both groups (P > 0.05).Conclusions
Dementia does not appear to increase the risk of mortality in trauma patients. Further studies should examine post-discharge outcomes in dementia patients. 相似文献8.
Richard J. Hanly Salman K. Marvi Sarah L. Whitehouse Ross W. Crawford 《The Journal of arthroplasty》2017,32(9):2712-2716
Background
It is increasingly apparent that the effect of obesity in arthroplasty is joint-specific. This study evaluates the effects of morbid obesity on primary total knee arthroplasty by comparing short-term outcomes between a morbidly obese (body mass index ≥40 kg/m2) and a normal weight (body mass index 18.5-<25 kg/m2) cohort at our institution between January 2003 and December 2010.Methods
One hundred seventeen morbidly obese patients were compared with 94 normal weight patients. Operative time, length of stay, complications, 30-day readmission, and readmission length were compared.Results
Morbid obesity conveyed no significant increase in 30-day readmission. Operative time was increased at 100 minutes in the morbidly obese group, compared with 90.5 minutes (P = .026).Conclusion
Morbid obesity conveyed no increased risk of length of stay or readmission in this cohort. 相似文献9.
Avinash Bhakta Owen Glotzer Ashar Ata Marcel Tafen Steven C. Stain Paul T. Singh 《American journal of surgery》2018,215(4):643-646
Background
Postoperative pain management is a major contributor to recovery and discharge in bariatric surgery. Local anesthetic agents are of particular interest: they're non-sedating and may reduce postoperative pain and hospital length of stay (LOS).Design
Researchers queried the Bariatric Surgery Service Database for patients undergoing laparoscopic weight loss surgery from January 2012–December 2014. Patients were divided between those who did and did not receive liposomal bupivacaine intra-operatively. Measures included demographics, narcotic use, LOS, antiemetic use, and pain scales.Results
The liposomal group consisted of 233 patients and the PCA group consisted of 243 patients. The liposomal group had significantly less narcotic use than the PCA group in terms of IV morphine equivalents. This did not translate into a reduction in LOS in the liposomal group.Conclusions
TAP block using liposomal bupivacaine provides effective analgesia comparable to PCA. 相似文献10.
Carlos J. Lavernia Anneliese D. Heiner Jesus M. Villa Jose C. Alcerro Mark D. Rossi 《The Journal of arthroplasty》2017,32(1):6-10
Background
The purpose of this study was to determine the influence of preoperative glycemic control in diabetic patients undergoing a primary total hip or knee arthroplasty. We wanted to study patient-perceived outcomes in the medium term, the length of stay, hospital costs, and rate of short-term postoperative complications.Methods
One hundred twenty consecutive primary total joint arthroplasties (TJAs) performed in type 2 diabetic patients were stratified into 2 groups representing optimal and suboptimal preoperative glycemic control, based on serum levels of glycated hemoglobin (HbA1c), and those groups compared.Results
The mean follow-up time was 5.9 years (range, 2.1-10.7 years). Both groups demonstrated improvement in all patient-perceived outcome measures after TJA, with no significant difference detected in any change of a measure between the groups. No significant difference was detected in the length of stay, hospital costs, or rate of short-term postoperative complications between the groups.Conclusion
Preoperative glycemic control in type 2 diabetic patients undergoing TJA did not affect patient-perceived outcomes in the medium term. Optimal vs suboptimal glycemic control in these patients also had no effect on the length of stay, hospital costs, or rate of short-term postoperative complications. 相似文献11.
Background
The optimal timing for performing appendectomy in adults remains controversial.Method
A one-year retrospective review of adult patients with acute appendicitis who underwent appendectomy. The cohort was divided by time-to-intervention into two groups: patients who underwent appendectomy within 8 h (group 1), and those who had surgery after 8 h (group 2). Outcome measures including perioperative morbidity and mortality, post-operative length of stay, and the 30-day readmission rate were compared between the two groups.Results
A total of 116 patients who underwent appendectomy met the inclusion criteria: 75 patients (65%) in group 1, and 41 (35%) in group 2. There were no differences between group 1 & 2 in perioperative complications (6.7% vs. 9.8%, P = 0.483), postoperative length of stay (median [IQR]; 19.5 [11.5–40.5] vs. 20.0 [11.25–58.5] hours, P = 0.632), or 30-day readmission rate (2.7% vs. 4.9%, P = 0.543). There were no deaths in either group.Conclusion
Delayed appendectomy performed more than 8 h was not associated with increased perioperative complications, postoperative length of stay, 30-day readmission rate, or mortality. 相似文献12.
A. Faulkner M.J. Reidy P.S.E. Davies W. Wang N. Buddhadev L. Johnston B. Clift 《The surgeon》2018,16(4):227-231
Introduction
10-year study examining differences in total knee arthroplasty (TKA) functional outcomes and survivorship in patients operated on by consultant and trainee orthopaedic surgeons.Method
Data was prospectively collected from all elective TKAs performed at our three linked institutions. Patient demographics, surgeon grade, and length of hospital stay were recorded. Outcomes pre-operatively and at 1, 3, 5, 7 and 10 years included mortality, need for revision surgery and function as documented by the patients’ Knee Society Score.Results
686 patients were included in the study. 450 (65.5%) patients were operated by consultant surgeons and 236 (34.4%) by trainees. On multivariate analysis no significant differences were observed between groups in length of hospital stay (p = 0.695), implant survival (p = 0.422), and function (p = 0.507) at 10 years. On Cox regression analysis no significant difference was observed in mortality (p = 0.209) at 10 years. 4 patients over this time period were lost to formal follow up.Conclusion
No significant difference was observed in the TKA outcomes between consultants and trainees 10 years post-operatively. 相似文献13.
Adrian W. Ong Nick R. Jaisingh Susan Butler Adam Sigal Forrest B. Fernandez 《American journal of surgery》2018,215(3):419-422
Introduction
The consequences of discharging anemic geriatric trauma patients are not well studied. We hypothesize that anemia at discharge is associated with adverse outcomes.Methods
A 1-year retrospective review of patients ≥65 years was performed. Hemoglobin levels at admission (HbA), discharge (HbD) and the lowest inpatient level (HbL) were recorded. Severity of anemia was categorized as mild (Hb ≥ 10.0 g/dl), moderate (Hb < 10.0 and ≥ 8.5 g/dl) and severe (Hb < 8.5 g/dl). The study endpoint was death or unplanned readmission 60 days following discharge. Univariate and multivariable analysis were used to determine if anemia predicted the outcome. A p value of 0.05 was considered significant.Results
550 patients were included. Moderate and severe anemia for HbA each predicted the study endpoint. Both HbD and HbL were highly correlated with HbA but did not predict the study endpoint.Conclusion
The degree of discharge anemia was not predictive of 60-day mortality or unplanned admissions in geriatric trauma patients. 相似文献14.
Andres X. Samayoa Thai Vu Tanya Olszewski Michael Bova Qi Yan Orlando Kirton 《American journal of surgery》2018,215(6):1000-1003
Introduction
Managing trauma in the elderly is challenging and requires a multidisciplinary team approach. The aim of this study is to characterize and compare outcomes in patients 90 years and older in the last two decades.Methods
Retrospective review of trauma patients 90 years and older admitted from 1996 to 2015. The patients were divided into two groups: Early Decade (ED) and Late Decade (LD).Results
A total of 1697 patients were recorded, 551 (ED) and 1146 (LD). The mean age was 92.92?±?8(90–108)[ED] and 92.9?±?2.7(90–105)[LD] years. The most common mechanism and type of injury was falls and extremity trauma. Hospital length of stay (LOS) was shorter in the LD. There was no significant difference in in-hospital mortality or ICU LOS.Conclusion
Trauma admission has increased in the last decade. However, in-hospital mortality remains low. It is important for multidisciplinary teams to allocate resources to treat this elderly population. 相似文献15.
Antònia Dalmau Noelia Fustran Imma Camprubi Resurrección Sanzol Susana Redondo Emilio Ramos Jaume Torras Antoni Sabaté 《American journal of surgery》2018,215(1):138-143
Background
Surgical wound is source of pain in hepatectomy with laparotomy. Continuous wound infusion of ropivacaine may provide effective analgesia.Methods
This prospective, randomized trial, patients scheduled for hepatectomy received a 48-h preperitoneal continuous wound infusion of either 0.23% ropivacaine or 0.9% saline at 5 ml/h. Primary endpoint was 48 h morphine consumption.Results
53 patients included in the ropivacaine group and 46 in the saline group. Morphine consumption was 24.63 mg in the ropivacaine group, and 26.78 mg (p = 0.669) in the saline group. Pain was comparable between groups and there were no differences in solid food intake, ambulation, or length of hospital stay. No local or systemic complications were recorded.Conclusions
Continuous wound infusion with ropivacaine is safe, but it neither reduced morphine consumption nor enhanced recovery in patients undergoing hepatectomy. Success of enhanced recovery in hepatectomy is not influenced by the analgesic regimen if pain is well controlled. 相似文献16.
Tom Schmidt-Braekling Andrew D. Pearle David J. Mayman Geoffrey H. Westrich Wenzel Waldstein Friedrich Boettner 《The Journal of arthroplasty》2017,32(3):965-967
Background
Although venous thromboembolism is one of the leading causes of morbidity after knee arthroplasty, little data exist on the risk of deep venous thrombosis (DVT) after unicompartmental knee arthroplasty (UKA).Methods
We prospectively enrolled 112 patients undergoing UKA to determine the incidence of DVT utilizing aspirin 325 mg twice a day (BID) for 4 weeks postoperatively as DVT prophylaxis. The data were compared with a recent randomized controlled trial of patients undergoing total knee arthroplasty utilizing aspirin and Lovenox in conjunction with pneumatic compression devices.Results
One patient (0.9%) had an asymptomatic DVT, and none developed clinical symptoms of either DVT or pulmonary embolus. The incidence of asymptomatic and symptomatic DVT was 0.9% and 0%, respectively.Conclusion
Our data suggest that 325 mg of aspirin BID for 4 weeks results in a very low risk of DVT for patients undergoing UKA. 相似文献17.
Venkat Boddapati Michael C. Fu David J. Mayman Edwin P. Su Peter K. Sculco Alexander S. McLawhorn 《The Journal of arthroplasty》2018,33(2):521-526
Background
Periprosthetic joint infection (PJI) after primary total knee arthroplasty (TKA) is a devastating complication. The short-term morbidity profile of revision TKA performed for PJI relative to non-PJI revisions is poorly characterized. The purpose of this study is to determine 30-day postoperative outcomes after revision TKA for PJI, relative to primary TKA and aseptic revision TKA.Methods
The American College of Surgeons National Surgical Quality Improvement Program from 2005 to 2015 was queried for primary and revision TKA cases. Revision TKA cases were categorized into PJI and non-PJI cohorts. Differences in 30-day outcomes including postoperative complications, readmissions, operative time, and length of stay were compared using bivariate and multivariate analyses.Results
In total, 175,761 TKAs were included in this study, with 162,981 (92.7%) primary TKAs and 12,780 (7.3%) revision TKAs, of which 2196 (17.2%) revisions were performed for PJI. When compared to aseptic revision TKA, multivariate analysis demonstrated that PJI revisions had a significantly higher risk of major early postoperative complications including death (adjusted odds ratio [OR] 3.25) and sepsis (OR 8.73). In addition, nonhome discharge (OR 1.75), readmissions (OR 1.67), and length of stay (+2.1 days) were all greater relative to non-PJI revisions.Conclusion
Utilizing a large, prospectively collected, national database, we found that revision TKA for PJI has a greater risk of short-term morbidity and mortality and requires a higher utilization of healthcare resources. These results have implications for patient counseling and alternative payment models that may eventually include revision TKA. 相似文献18.
Michael E. Sellan Brent A. Lanting Emil H. Schemitsch Steven J. MacDonald Edward M. Vasarhelyi James L. Howard 《The Journal of arthroplasty》2018,33(3):878-881
Background
Periprosthetic femur fractures around total hip (THA) and total knee (TKA) arthroplasties are difficult complications to manage. With native hip fractures, delay to fixation has been correlated with an increase in postoperative mortality. The effect of time to definitive fixation of periprosthetic femur fractures around THA and TKA is not well established. The aim of our study is to evaluate the effect of time to definitive fixation on postoperative length of stay and mortality for patients with periprosthetic femur fractures around THA and TKA.Methods
A review of 2537 arthroplasty patient charts yielded 235 patients who were diagnosed with a periprosthetic femur fracture at our institution from 2005 to 2014. Time to surgical management, length of stay, demographics, referral status, fracture classification, and fixation modality along with mortality was recorded for all patients.Results
One hundred eighty patients met study inclusion (111 THAs, 69 TKAs). Average age was 79.2 years and 72.2% were female. The average time from admission to definitive fixation was 96.5 hours with 31.1% of patients having surgery within 48 hours after presenting to hospital. Postoperative length of stay and mortality were not affected by time to definitive fixation greater than 48 hours for either of the periprosthetic TKA or THA patient cohorts. Postoperative mortality within 1 year was 5.5% for all patients (6.3% THA, 4.3% TKA).Conclusion
The timing of fixation of periprosthetic femur fractures does not appear to affect postoperative length of stay or mortality within 1 year. 相似文献19.
Sergio M. Navarro Eric Y. Wang Heather S. Haeberle Michael A. Mont Viktor E. Krebs Brendan M. Patterson Prem N. Ramkumar 《The Journal of arthroplasty》2018,33(12):3617-3623
Background
Value-based and patient-specific care represent 2 critical areas of focus that have yet to be fully reconciled by today’s bundled care model. Using a predictive naïve Bayesian model, the objectives of this study were (1) to develop a machine-learning algorithm using preoperative big data to predict length of stay (LOS) and inpatient costs after primary total knee arthroplasty (TKA) and (2) to propose a tiered patient-specific payment model that reflects patient complexity for reimbursement.Methods
Using 141,446 patients undergoing primary TKA from an administrative database from 2009 to 2016, a Bayesian model was created and trained to forecast LOS and cost. Algorithm performance was determined using the area under the receiver operating characteristic curve and the percent accuracy. A proposed risk-based patient-specific payment model was derived based on outputs.Results
The machine-learning algorithm required age, race, gender, and comorbidity scores (“risk of illness” and “risk of morbidity”) to demonstrate a high degree of validity with an area under the receiver operating characteristic curve of 0.7822 and 0.7382 for LOS and cost. As patient complexity increased, cost add-ons increased in tiers of 3%, 10%, and 15% for moderate, major, and extreme mortality risks, respectively.Conclusion
Our machine-learning algorithm derived from an administrative database demonstrated excellent validity in predicting LOS and costs before primary TKA and has broad value-based applications, including a risk-based patient-specific payment model. 相似文献20.
Zhamak Khorgami William J. Fleischer Yuen-Jing A. Chen Nasir Mushtaq Michael S. Charles C. Anthony Howard 《American journal of surgery》2018,215(4):727-734