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The Effect of Early versus Traditional Hospital Discharge on Activities of Daily Living for Women Undergoing Elective Cesarean Section. An Observational Cohort Study

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Open Journal of Obstetrics and Gynecology 2023年第3期13卷 642-653页

作者： Ahmed Mohammed Elmaraghy rasha elhoseny yehia Ahmed Hamdy Naguib Department of Obstetrics and Gynecology Faculty of Medicine Ain Shams University Cairo Egypt Department of Obstetrics and Gynecology The National Medical Institute of Damanhour Ministry of Health Cairo Egypt

Background: Cesarean section is one of the most common surgeries performed worldwide and its consequences and complications represent a major public health concern. The policy of enhanced recovery after surgery has been implemented after cesarean section to optimize perioperative care. Enhanced recovery also aims to reduce the length of hospital stay, which might imply substantial healthcare savings. Rising hospital costs are one of the factors in early discharge. Patients & Methods: This was a prospective cohort study. 158 patients met the inclusion criteria of the study, 81 patients were discharged after 48 hours and 77 patients were discharged after 24 hours. All patients received the same postoperative care and instructions. All the study participants received a phone call 1, 3, and 5 days after discharge to objectively assess the activities of daily living through Katz index of independence in activities of daily living. All patients were offered a postpartum visit 1 week after discharge during which the wound was assessed by the Southampton wound assessment scale. Moreover, other maternal complications such as mastitis, puerperal sepsis, or pyelonephritis were assessed and cases who were readmitted were documented. Initiation of successful breastfeeding and neonatal readmission were reported as well. Results: 158 patients met the inclusion/exclusion criteria of the study. There was no significant difference between the two arms of the study regarding baseline characteristics. Katz index of independence showed that the resumption of activities of daily living after CS was similar in both arms of the study on days 1, 3 and 5 after discharge. Time till the passage of flatus and stool after the cesarean section was significantly shorter among the early discharge arm (9.31 VS 14.68, p value < 0.001 & 13.25 VS 24.82, p value < 0.001 respectively). Maternal readmission was not significantly higher among the early discharge arm and at the 1-week postpartum visit, objective wound assessment by Southampton wound scor

关键词： Cesarean Section Early Discharge Katz Index of Independence in Activities of Daily Living

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Biliary fistula and late recurrence of liver hydatid cyst:Role of cystobiliary communication:A prospective multicenter study

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World Journal of Methodology 2023年第4期13卷 272-286页

作者： Tamer A A M Habeeb Mauro Podda Boris Tadic Vishal G Shelat Yaman Tokat Mohamed Ibrahim Abo Alsaad Abd-Elfattah Kalmoush Mohammed Shaaban Nassar Fawzy Metwally Mustafa Mahmoud Hassib Morsi Badawy Mohamed Sobhy Shaaban Tarek Zaghloul Mohamed Mohammed Ibrahim El Sayed Henish Hamdi Elbelkasi Mahmoud Abdou Yassin Abdelshafy Mostafa Amr Ibrahim Waleed A-Abdelhady TamerMohamed Elshahidy Mohamed Ibrahim Mansour Adel Mahmoud Moursi Mohamed Abdallah Zaitoun EhabShehata Abd-Allah Ashraf Abdelmonem Elsayed rasha S Elsayed Ahmed M yehia Amr Abdelghani Mohamed Negm Heba Alhussein Abo-Alella Mostafa M Elaidy Department of General Surgery Faculty of Medicine Zagazig UniversitySharkia 44511Egypt Department of Surgical Science University of CagliariCagliari 09126Italy Clinic for Digestive Surgery–First Surgical Clinic University Clinical Centre of SerbiaBelgrade 11000Serbia Department of General Surgery Tan Tock Seng HospitalSingapore 018971Singapore Department of Liver Transplantation and Hepatobiliary Surgery IstanbulTurkeyInternational Liver Centerand Acibadem Hospital GroupIstanbul 34000Turkey Department of General Surgery Faculty of Medicine-Merit UniversitySohag 82511Egypt Department of General Surgery Faculty of MedicineAl-Azher UniversityCairo 11765Egypt Department of General Surgery Mataryia Teaching HospitalCairo 11765Egypt

BACKGROUND Hydatid cyst disease(HCD)is common in certain locations.Surgery is associated with postoperative biliary fistula(POBF)and recurrence.The primary aim of this study was to identify whether occult cysto-biliary communication(CBC)can predict recurrent HCD.The secondary aim was to assess the role of cystic fluid bilirubin and alkaline phosphatase(ALP)levels in predicting POBF and recurrent HCD.AIM To identify whether occult CBC can predict recurrent HCD.The secondary aim was to assess the role of cystic fluid bilirubin and ALP levels in predicting POBF and recurrent HCD.METHODS From September 2010 to September 2016,a prospective multicenter study was undertaken involving 244 patients with solitary primary superficial stage cystic echinococcosis 2 and cystic echinococcosis 3b HCD who underwent laparoscopic partial cystectomy with omentoplasty.Univariable logistic regression analysis assessed independent factors determining biliary complications and recurrence.RESULTS There was a highly statistically significant association(P≤0.001)between cystic fluid biochemical indices and the development of biliary complications(of 16 patients with POBF,15 patients had high cyst fluid bilirubin and ALP levels),where patients with high bilirubin-ALP levels were 3405 times more likely to have biliary complications.There was a highly statistically significant association(P≤0.001)between biliary complications,biochemical indices,and the occurrence of recurrent HCD(of 30 patients with recurrent HCD,15 patients had high cyst fluid bilirubin and ALP;all 16 patients who had POBF later developed recurrent HCD),where patients who developed biliary complications and high bilirubin-ALP were 244.6 and 214 times more likely to have recurrent hydatid cysts,respectively.CONCLUSION Occult CBC can predict recurrent HCD.Elevated cyst fluid bilirubin and ALP levels predicted POBF and recurrent HCD.

关键词： Cysto-biliary communication Echinococcus granulosus Hydatid disease recurrence Hydatid fluid analysis Laparoscopy

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