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Patients with Crohn’s disease have longer post-operative in-hospital stay than patients with colon cancer but no difference in complications’ rate

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World Journal of Gastrointestinal Surgery 2019年第5期11卷 261-270页

作者： 2015 European Society of Coloproctology(ESCP)collaborating group Alaa El-Hussuna 不详 Academic Research Consultant SurgeonDepartment of SurgeryAalborg University HospitalHobrovej 18-22Aalborg 9100Denmark

BACKGROUND Right hemicolectomy or ileocecal resection are used to treat benign conditions like Crohn’s disease(CD)and malignant ones like colon cancer(CC).AIM To investigate differences in pre-and peri-operative factors and their impact on post-operative outcome in patients with CC and *** This is a sub-group analysis of the European Society of Coloproctology’s prospective,multi-centre snapshot *** patients with CC and CD undergoing right hemicolectomy or ileocecal resection were *** outcome measure was 30-d post-operative *** outcome measures were post-operative length of stay(LOS)at and *** Three hundred and seventy-five patients with CD and 2,515 patients with CC were *** with CD were younger(median=37 years for CD and 71 years for CC(P<0.01),had lower American Society of Anesthesiology score(ASA)grade(P<0.01)and less comorbidity(P<0.01),but were more likely to be current smokers(P<0.01).Patients with CD were more frequently operated on by colorectal surgeons(P<0.01)and frequently underwent ileocecal resection(P<0.01)with higher rate of de-functioning/primary stoma construction(P<0.01).Thirty-day post-operative mortality occurred exclusively in the CC group(66/2515,2.3%).In multivariate analyses,the risk of post-operative complications was similar in the two groups(OR 0.80,95%CI:0.54-1.17;P=0.25).Patients with CD had a significantly longer LOS(Geometric mean 0.87,95%CI:0.79-0.95;P<0.01).There was no difference in re-admission *** audit did not collect data on post-operative enhanced recovery protocols that are implemented in the different participating *** Patients with CD were younger,with lower ASA grade,less comorbidity,operated on by experienced surgeons and underwent less radical resection but had a longer LOS than patients with CC although complications'rate was not different between the two groups.

关键词： Crohn’s disease Colon cancer Complications Length of stay Bowel resection Right hemicolectomy

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Gastrojejunostomy in patients with unresectable pancreatic head cancer-the use of Roux loop significantly shortens the hospital length of stay

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World Journal of Gastroenterology 2013年第45期19卷 8321-8325页

作者： Dariusz Szymanski Adam Durczynski Michal Nowicki Janusz Strzelczyk Department of General and Transplant Surgery Barlicki University Hospital Medical University of Lodz 0-153 Lodz Poland

AIM:To evaluate the use of the Roux loop on the postoperative course in patients submitted for gastroenteroanastomosis(GE).METHODS:Non-jaundiced patients(n=41)operated on in the Department of General and Transplant Surgery in Lodz,between January 2010 and December 2011 were *** tumor was considered unresectable when liver metastases or major vascular involvement were *** were randomized to receive Roux(n=21)or conventional GE(n=20)on a prophylactic ***:The mean time to nasogastric tube withdrawal in Roux GE group was shorter(1.4±0.75 vs2.8±1.1,P<0.001).Time to starting oral liquids,soft diet and regular diet were decreased(2.3±0.86 vs 3.45±1.19;P<0.001;3.3±0.73 vs 4.4±1.23,P<0.001and 4.5±0.76 vs 5.6±1.42,P=0.002;respectively).The Roux GE group had a lower use of prokinetics(10mg thrice daily for 2.2±1.8 d vs 3.7±2.6 d,P=0.044;total 62±49 mg vs 111±79 mg,P=0.025).The mean hospitalization time following Roux GE was shorter(7.7 d vs 9.6 d,P=0.006).Delayed gastric emptying(DGE)was confirmed in 20%after conventional GE but in none of the patients following Roux ***:Roux gastrojejunostomy during open abdomen exploration in patients with unresectable pancreatic cancer is easy to perform,decreases the incidence of DGE and lowers hospitalization time.

关键词： Unresectable pancreatic cancer Roux and conventional gastroeneteroanastomosis Gastroenteroanastomosis Delayed gastric emptying Hospital length of stay

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Isolated sacral injuries: Postoperative length of stay, complications, and readmission

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World Journal of Orthopedics 2015年第8期6卷 629-635页

作者： Vasanth Sathiyakumar Hanyuan Shi Rachel V Thakore Young M Lee David Joyce Jesse Ehrenfeld William T Obremskey Manish K Sethi the Vanderbilt Orthopaedic Institute Center for Health Policy Medical Center East

AIM: To investigate inpatient length of stay(LOS), complication rates, and readmission rates for sacral fracture patients based on operative ***: All patients who presented to a large tertiary care center with isolated sacral fractures in an 11-year period were included in a retrospective chart review. Operative approach(open reduction internal fixation vs percutaneous) was noted, as well as age, gender, race, and American Society of Anesthesiologists' score. Complications included infection, nonunion and malunion, deep venous thrombosis, and hardware problems; 90-d readmissions were broken down into infection, surgical revision of the sacral fracture, and medical complications. LOS was collected for the initial admission and readmission visits if applicable. Fisher's exact and non-parametric t-tests(Mann-Whitney U tests) were employed to compare LOS, complications, and readmissions between open and percutaneous ***: Ninety-four patients with isolated sacral fractures were identified: 31(30.4%) who underwentopen reduction and internal fixation(ORIF) vs 63(67.0%) who underwent percutaneous fixation. There was a significant difference in LOS based on operative approach: 9.1 d for ORIF patients vs 6.1 d for percutaneous patients(P = 0.043), amounting to a difference in cost of $13590. Ten patients in the study developed complications, with no significant difference in complication rates or reasons for complications between the two groups(19.4% for ORIF patients vs 6.3% for percutaneous patients). Eight patients were readmitted, with no significant difference in readmission rates or reasons for readmission between the two groups(9.5% percutaneous vs 6.5% ORIF).CONCLUSION: There is a significant difference in LOS based on operative approach for sacral fracture patients. Given similar complications and readmission rates, we recommend a percutaneous approach.

关键词： Sacral fractures Open reduction and internal fixation Percutaneous complications Readmissions Length of stay

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Anomaly Detection Algorithm for stay Cable Monitoring Data Based on Data Fusion

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Journal of Harbin Institute of Technology(New Series) 2016年第3期23卷 39-43页

作者： Xiaoling Liu Qiao Huang Yuan Ren School of Transportation Southeast University

In order to improve the accuracy and consistency of data in health monitoring system,an anomaly detection algorithm for stay cables based on data fusion is *** monitoring data of Nanjing No.3 Yangtze River Bridge is used as the basis of ***,an adaptive processing framework with feedback control is established based on the concept of data *** data processing contains four steps:data specification,data cleaning,data conversion and data *** processing information offers feedback to the original data system,which further gives guidance for the sensor maintenance or ***,the algorithm steps based on the continuous data distortion is investigated,which integrates the inspection data and the distribution test ***,a group of cable force data is utilized as an example to verify the established framework and *** results show that the proposed algorithm can achieve high detection accuracy,providing a valuable reference for other monitoring data processing.

关键词： stay cable health monitoring anomaly detection data fusion manual inspection

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Nurse practitioner coverage is associated with a decrease in length of stay in a pediatric chronic ventilator dependent unit

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World Journal of Clinical Pediatrics 2016年第2期5卷 191-197页

作者： Courtney M Rowan A Ioana Cristea Jennifer C Hamilton Nicole M Taylor Mara E Nitu Veda L Ackerman Department of Pediatrics Section of Critical Care Indiana University School of Medicine Riley Hospital for Children at Indiana University Health Department of Pediatrics Section of Pulmonology Indiana University School of Medicine Riley Hospital for Children at Indiana University Health Department of Psychology University of Indianapolis Indianapolis

AIM: To hypothesize a dedicated critical care nurse practitioner(NP) is associated with a decreased length of stay(LOS) from a pediatric chronic ventilator dependent unit(PCVDU).METHODS: We retrospectively reviewed patients requiring care in the PCVDU from May 2001 through May 2011 comparing the 5 years prior to the 5 years post implementation of the critical care NP in 2005. LOS and room charges were obtained. RESULTS: The average LOS decreased from a median of 55 d [interquartile range(IQR): 9.8-108.3] to a median of 12(IQR: 4.0-41.0) with the implementation of a dedicated critical care NP(P < 1.0001). Post implementation of a dedicated NP, a savings of 25738049 in room charges was noted over 5 ***: Our data demonstrates a critical care NP coverage model in a PCVDU is associated with a significantly reduced LOS demonstrating that the NP is an efficient and likely cost-effective addition to a medically comprehensive service.

关键词： Nurse practitioners Length of stay Cost effective health care Ventilation Pediatrics

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Evaluation of Length of Hospital stay Joining Educational Programs for Type 2 Diabetes Mellitus Patients: Can We Control Medical Costs in Japan?

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Health 2015年第2期7卷 256-269页

作者： Kazumitsu Nawata Koichi Kawabuchi Graduate School of Engineering University of Tokyo Tokyo Japan Graduate School of Medical and Dental Sciences Tokyo Medical and Dental University Tokyo Japan

Diabetes has become a growing concern in Japan, both medically and financially. The medical cost of diabetes was estimated at 1215 billion yen for fiscal year 2011. We analyzed the length of stay (LOS) in a hospital for type 2 diabetes mellitus patients who participated in educational programs to determine factors affecting LOS. Data on 991 patients obtained from 28 Red Cross hospitals in 2008 were used. For the analysis, we used the Box-Cox transformation model and Hausman test. The results revealed that patients aged 75 years and above and those with comorbidities and complications were prone to longer LOS. The analysis also revealed significant differences in LOS across the hospitals, even after controlling for patient characteristics. Finally, we applied the least squares method to determine the effects of hospital and regional factors and revealed that patients’ LOS was affected by the region’s average LOS. Regional corporations and networks appeared to be important in improving educational programs.

关键词： Medical Cost Diabetes Type 2 Diabetes Mellitus Patients Length of stay (LOS) Educational Program Box-Cox Transformation Model

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Reducing Hospitalization for Long stay Patients

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Case Reports in Clinical Medicine 2017年第8期6卷 221-226页

作者： Mary Luziani Ronald Lagoe Shelly Littau St. Joseph’s Hospital Health Center Syracuse NY USA Hospital Executive Council Syracuse NY USA

This case study described the structure and preliminary impact of a hospital program to improve efficiency by reducing long stays for adult medicine inpatients. The program focused resources on these patients, including an experienced case management staff, effective relationships with long term care providers, and Subacute and Complex Care services. The program caused the total number of adult medicine patient days associated with these patients to decline by 1593, or 4780 on an annual basis.

关键词： Hospitals Hospital Lengths of stay Long Term Care

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Addressing hospital length of stay outlier patients: A community wide approach

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Advances in Bioscience and Biotechnology 2014年第3期5卷 188-196页

作者： Ronald Lagoe Louise Pernisi Mary Luziani Shelly Littau Hospital Executive Council Syracuse USA St. Joseph’s Hospital Health Center Syracuse USA Upstate University Hospital SUNY UMU Syracuse USA

Length of stay outlier patients, who remain in hospitals for extended periods of time, is an important challenge to the improvement of health care efficiency. This study identified outlier patients and programs to address them in the metropolitan area of Syracuse, New York. It demonstrated that, during 2013, outlier patients accounted for 2.4 percent of adult medicine discharges and an excess average daily census of 53.3 patients in the Syracuse hospitals. During 2013, outlier patients accounted for 4.3 percent of adult surgery discharges and an excess average daily census of 44.1 patients. In two studies, the Syracuse hospitals identified the need for multiple intravenous therapy, extensive wound care, and total parenteral nutrition in the community, as major causes of outlier stays in hospitals. Each of the hospitals has developed a program with a long term care facility to address these needs. Efforts to address outlier lengths of stay are also focusing on Potentially Preventable Complications in Syracuse. The mean length of stay for inpatients with post admissions complications was almost three times the stay for the medical/surgical population during 2013.

关键词： Hospital Utilization Hospital Lengths of stay Hospital Outcomes

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Decrease in the Hospital stay of Neonates with Suspected Nosocomial Sepsis with the Use of a Molecular Biology Technique

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Journal of Biosciences and Medicines 2019年第3期7卷 44-51页

作者： Jesús Reyna-Figueroa María Fernanda Rodríguez-Sánchez Pilar Miyoko Martínez Matsumoto Federico Javier Ortiz-Ibarra Ana Elena Limón-Rojas Hospital Central Sur de Alta Especialidad Petróleos Mexicanos Mexico City Mexico Hospital ángeles del Pedregal Mexico City Mexico

Introduction: Diagnostic alternatives that allow microbial identification in blood, such as molecular biology;have shown utility in neonatal sepsis. Objective: To evaluate the impact of a Light Cycler SeptiFast test (LCSF) on days of hospital stay and the use of newborn (NB) antibiotics with suspected sepsis. Methods: We included NB with LCSF test and blood culture (cases) and NB with only blood culture (controls). We evaluated the days of stay, days of antimicrobial use and number of deaths. Statistic analysis: Descriptive statistics was used. The association between the use of LCSF and variables such as mortality, days of stay, use of antimicrobials, and use of mechanical ventilation was analyzed by odds ratio with 95% CI. Results: We included 20 subjects in the case group and 40 in the control group. 8 (40%) of the cases were positive vs 6 (15%) of the controls in the control group. In the controls, the average days of stay were 65 + 15 vs 35 + 10 days of the cases (p Conclusions: The LCSF test influences the days of hospital stay, but does not impact mortality or the use of antimicrobials.

关键词： Sepsis Newborns Inpatient stay SeptiFast

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Expedited Discharge of Patients with Diabetic Ketoacidosis in an Emergency Department Short stay Unit

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Open Journal of Internal Medicine 2019年第4期9卷 112-120页

作者： Parampil Thulasidharan Shibu Kandalam Salem Abo Salah Peter Alistair Cameron Jignesh Dhirajlal Trivedi Muhammed Kunhi Kayakool Shahsad Ramachan Parambath Pradeep Radhakrishnan Joe Varghese Mathew Jaseem Sirajudeen Department of General Internal Medicine Hamad General Hospital Doha Qatar Department of Epidemiology & Preventive Medicine Monash University Melbourne Australia

Aim: Review of presentation, management and outcome of patients admitted with Diabetic Ketoacidosis (DKA) to an emergency department short stay unit with expedited discharge. Methods: All admitted patients with a discharge diagnosis of “Diabetic Ketoacidosis”, were identified by the file auditing section in the Emergency Department. Data obtained from the medical records were collected using an explicit chart review from January 2012 to June 2013. Data included clinical monitoring, investigations performed, the type and amount of intravenous fluids given, the insulin regime, potassium supplementation and outcome. Results: Out of a total of 120 patients labelled as DKA or hyperglycaemia on arrival, hundred patients fulfilled the criteria for DKA. In the population studied the mean age was 25 years with a male predominance. Eighty-two patients suffered from Type 1 Diabetes Mellitus (T1DM) whilst eighteen patients had Type 2 Diabetes Mellitus (T2DM). Sixteen patients were newly diagnosed during the present admission. Seventy-six (76%) patients were on insulin. The insulin regimen and potassium supplementation were followed as per protocol in all patients. All the patients except one were given intravenous fluid according to protocol. Parameters were monitored adequately except fluid input and output monitoring. The median length of stay in the short stay unit was 1.5833 days. There was no return visit within one week of discharge. Conclusion: The median length of stay was short and there were no documented complications or deaths during the stay. There was poor compliance with documentation of fluid input and output. In this population, the short stay model of care appeared to be safe and efficient.

关键词： Diabetes Mellitus Diabetic Ketoacidosis DKA Audit Emergency Department Expedited Discharge Length of stay

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