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Factors influencing postoperative length of stay in an enhanced recovery after surgery program for primary total knee arthroplasty

Factors influencing postoperative length of stay in an enhanced recovery after surgery program for primary total knee arthroplasty

The potential variables associated with PLOS including preoperative patient characteristics, perioperative surgi- cal factors, and postoperative complications were all collected during the inpatient hospital stay. Patient demographics of age, gender, BMI, diagnosis, comorbidi- ties, ASA score, and preoperative knee function including flexion range of motion (ROM), varus or valgus deformity, and hospital for special surgery (HSS) knee score were re- corded. Visual analogue scale (VAS) pain score, the serum level of hemoglobin (Hb), albumin, C-reactive protein (CRP), and interleukin-6 (IL-6) were recorded preopera- tively and on postoperative days 1 and 3 (POD1, POD3). Perioperative surgical factors included operative time, sur- gery start time, intravenous fluid volume on day of sur- gery, total blood loss calculated by gross equation [13], utilization of catheter and drainage tube, and time to am- bulate and achieve 90° active knee flexion after surgery. Postoperative complications including wound complica- tions and other minor complications and preoperative LOS were also compared in two groups.
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Postoperative exercise training is associated with reduced respiratory infection rates and early discharge: A case control study

Postoperative exercise training is associated with reduced respiratory infection rates and early discharge: A case control study

Normality testing of each variable was done using the Kolmogorov-Smirnov and Shapiro e Wilk tests and further tests were applied as appropriate. The unpaired t test was used to compare age distribution between the two groups. The Mann e Whitney U test was used to compare the type of sur- geries and ASA grades between the two groups. The Chi Square test was used to compare proportions of Male: Female, the smoking status, and the administration of epidural anal- gesia between the two groups. The Chi Square test was also used to compare the primary outcomes between the cases and the controls. The Fischer's exact test was used to compare primary outcomes between cases and controls with a preop- erative stay of more than one day. The Mann e Whitney U test was used to compare the postoperative length of stay (sec- ondary outcome) of the patients in the two groups. The Wil- coxon Rank test was used to compare the Borg score between the fourth and the second postoperative days. SPSS (SPSS version 22 Armonk, NY: IBM Corp) was used for performing the statistical analysis. A P value of less than 0.05 was considered to be statistically significant.
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<p>Predictors of postoperative outcomes in infants with low birth weight undergoing congenital heart surgery: a retrospective observational study</p>

<p>Predictors of postoperative outcomes in infants with low birth weight undergoing congenital heart surgery: a retrospective observational study</p>

clamp time, and postoperative complications. 15–19 Consistently with Pagowska-Klimek ’ s study, we have not found a close relationship between DHCA time and total postoperative ICU length of stay. 16 Our study con fi rmed the usefulness of STAT risk categories as means of predicting postoperative CICU stay, NICU stay, and total ICU length of stay, which was consistent with Brown et al. 18 CPB time is now well recognized as a risk factor associated with ICU length of stay in both children and adults. 20,21 However, our study found that CPB time was not an independent predictor of postoperative ICU stay in LBW infants. We identi fi ed sex as an independent predictor of postoperative CICU stay, largely due to differences in STAT risk categories between the sexes. LBW infants often suffer from severe morbidity of prematurity and intrauterine growth restriction. 5 The latter raises rates of respiratory distress syndrome and broncho- pulmonary dysplasia in premature babies. 22,23 Also, LBW infants with congenital heart disease tend to be critically ill and their condition complicated by noncardiac malforma- tion. Over the past few decades, numerous single-center studies have documented increased morbidity and mortal- ity correlated with cardiac surgery in LBW infants. 7–9 However, few studies have focused on the impact of LBW on postoperative length of hospitalization. As these LBW infants with varied adverse risk factors start to have advanced survival, the morbidity burden would be aggra- vated with a commensurate rise in the length of hospitali- zation. Our study showed that gestational age, birth weight, and STAT risk categories were signi fi cant predic- tors in postoperative NICU stay and total length of ICU
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Navigated 2-level posterior lumbar fusion: a 5-cm-incision procedure

Navigated 2-level posterior lumbar fusion: a 5-cm-incision procedure

Posterior lumbar fusion (PLF) is a commonly performed spine surgery. The length of incision for a 2-level PLF usually ranges from 8 to 12 cm, depending on not only patient ’ s size but also surgeon ’ s preference and skills. Such techniques as percutaneous pedicle screw place- ment and expandable retractor system have been applied in PLF procedures in the last decade, aiming to lessen approach-related morbidity. However, such minimally invasive techniques always require totally four to seven incisions, and one of these incisions has to be around 4 cm in length so that an expandable retractor can be inserted [1 – 9].
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Enhanced recovery after surgery (ERAS) program for lumbar spine fusion

Enhanced recovery after surgery (ERAS) program for lumbar spine fusion

New ERAS protocols not only focus on specific peri- operative interventions by surgeons and anesthesiolo- gists, but they have expanded to focus on preoperative patient education, building more effective team care models, improving patient satisfaction, and improved discharge planning. Our ERAS protocol focused on some of these expanded ideas to improve patient educa- tion and interdepartmental teamwork. Preoperative pa- tient education has become an important part of improving patient care perioperatively. Educating pa- tients about expectations postoperatively can improve postoperative patient satisfaction and decrease patient morbidities and pain scores after lumbar surgery (Archer et al. 2011). Smoking cessation is also an important issue included in the preoperative patient education. Smokers experience a higher rate of postoperative pseudarthrosis and infection after spinal fusion. Smoking cessation can help decrease these complications depending on the tim- ing of smoking cessation (Jackson 2nd and Devine 2016). Smoking cessation was reiterated at both the
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Comparative outcomes of peripheral nerve blocks versus general anesthesia for hip fractures in geriatric Chinese patients

Comparative outcomes of peripheral nerve blocks versus general anesthesia for hip fractures in geriatric Chinese patients

To create the cohort of patients aged 65 years or more, we selected all discharges with a principal or secondary diag nosis code for FNF, including pathologic fractures and traumas. To restrict our sample, we excluded patients who were diagnosed with multiple traumas and those who underwent a secondary surgical procedure during their hospital stay. To eliminate the influence of the operation and anesthesia types, patients who had undergone internal fixation (n = 39), total hip arthroplasty (n = 68), or no surgery (n = 28) were excluded, and patients who had received EA (n = 113) were also excluded. Finally, the remaining 217 subjects for hemiarthroplasty who received GA or PNBs were completed and used for further analysis (Figure 1).
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Alteration in emergency theatre prioritisation does not alter outcome for acute appendicitis: comparative cohort study

Alteration in emergency theatre prioritisation does not alter outcome for acute appendicitis: comparative cohort study

Nevertheless NCEPOD report in 2003 suggested that only 58% of all NHS hospitals (in the UK), had a designated theatre for emergency surgery during daytime [10]. Fur- thermore, even the presence of a single dedicated emer- gency operating theatre may not be sufficient for a tertiary referral centre, catering to a diverse, socio-economically deprived population and offering specialist trauma surgi- cal services (which takes precedence over most other urgent surgical procedures) [11]. We have previously shown that precisely for this particular reason, common operations such as abscess drainage and appendicectomy stay longer in hospital [11].
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Early Feeding After a Total Abdominal Hysterectomy

Early Feeding After a Total Abdominal Hysterectomy

Dietary management of total abdominal hysterectomy patients has traditionally involved a postoperative progression of clear fluids to full fluids to regular diet at the Richmond Hospital. With the change made to eliminate the full fluid step on the clinical pathway for TAH, the tolerance of an earlier regular diet was observed within this comparative group of 164 patients. Although 37-48% of patients experienced nausea and vomiting postoperatively in this study, the majority of it was experienced in the first 24 hours of surgery. The results demonstrated a similar or slightly better tolerance of a regular diet on the second day postoperatively in the early fed group compared with the traditionally fed group, who received full fluids.
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<p>Effect Of Surgical Safety Checklists On Gastric Cancer Outcomes: A Single-Center Retrospective Study</p>

<p>Effect Of Surgical Safety Checklists On Gastric Cancer Outcomes: A Single-Center Retrospective Study</p>

This study is subject to several limitations. First, this study was a single-center study with a limited sample size, which may result in bias during analysis. A multicenter study with a larger sample size is needed to con fi rm our results. Second, our research design lacked data on SSC compliance. Although our center has very high SSC implementation rate, the effect of SSC compliance on the negative results of this study cannot be completely excluded. Third, as a retrospec- tive analysis, our study lacked complete statistical data on all postoperative complications, including mild to moderate postoperative complications. More speci fi c prospective stu- dies are needed on the effect of SSC on varying degrees of complications, and more accurate subgroup analysis for post- operative complications should be performed on the basis of the Clavien – Dindo scoring system. Fourth, unfortunately the quality of postoperative follow-up is not good enough, that ’ s a problem in the process of database construction in the early years. Some cases were lack of follow-up records and even lost follow-up. In the data collection process, the follow-up data was collected by electronic medical record system to minimize the data deviation as much as possible.
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Parecoxib prevents complications in hepatocellular carcinoma patients receiving hepatic transarterial chemoembolization: a prospective score-matched cohort study

Parecoxib prevents complications in hepatocellular carcinoma patients receiving hepatic transarterial chemoembolization: a prospective score-matched cohort study

Parecoxib sodium is the inactive, water-soluble precursor of valdecoxib, which exerts antipyretic, analgesic, and anti-inflammatory effects by selectively inhibiting cyclo-oxygenase-2 (COX-2). This inhibition of COX-2 blocks the conversion of arachidonic acid into prostaglandins. Several clinical studies have shown that parecoxib sodium has a good adjuvant analgesic effect on postoperative pain after nasal endoscopy, orthopedic surgeries, and prostate and gastrointestinal surgeries [6–9]. It was also demonstrated that parecoxib sodium relieves fever and inflammatory responses. In the present study we conducted a prospective non-randomized controlled
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Length of Stay, Jaundice, and Hospital Readmission

Length of Stay, Jaundice, and Hospital Readmission

We conclude that the major reason for readmission to hospital in the first 2 weeks of life is hyperbiliru- binemia (incidence 4.2 per 1000 discharges). Signifi- cant jaundice, and dehydration/failure to thrive (0.2 per 1000 discharges) are the only causes of readmis- sion that are potentially susceptible to intervention in the first few days of life. Attempts to decrease the risk of hyperbilirubinemia and dehydration/failure to thrive should be directed at the early establish- ment of effective lactation and closer surveillance for those infants who have risk factors for readmission such as gestation ,38 weeks, jaundice in the nursery, length of stay , 72 hours, male sex, and breastfeed- ing. The risk of readmission is similar for infants discharged , 48 hours or $ 48 to , 72 hours, suggest- ing that any infant discharged at ,72 hours should be seen by a health care professional within 2 to 3 days of discharge.
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Sodium bicarbonate in the prevention of cardiac surgery associated acute kidney injury: a systematic review and meta analysis

Sodium bicarbonate in the prevention of cardiac surgery associated acute kidney injury: a systematic review and meta analysis

cost and even minimal increases in sCr were associated with poor prognosis [14]. SBIC could induce a metabolic alkalosis, as was also indicated by our meta-analysis, and consequently lead to prolonged duration of ventilation [5]. Additionally, two studies reported that SBIC could cause decreased arterial blood pressure [4,23], which was some- times an emergency situation for postoperative patients. Thus, combining findings of primary and secondary outcomes with the biomarkers of AKI, it can be conclu- ded that SBIC shows no benefits on the prevention of CSA-AKI, and even induces potential harms.
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Comparison of Double Incision Laparoscopic  Cholecystectomy and Needlescopic Cholecystectomy

Comparison of Double Incision Laparoscopic Cholecystectomy and Needlescopic Cholecystectomy

There is a report that postoperative analgesia require- ments for the LC with needlescopic instruments, which has smaller ports, were 70% lower than for the conven- tional LC [20]. It is expected that a slightly bigger wound to construct multichannel port for DILC caused strong pain, but our study showed a different result. The effect of number or size of ports on postoperative pain remains an open question.

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Predictive factors for major postoperative complications related to gastric conduit reconstruction in thoracoscopic esophagectomy for esophageal cancer: a case control study

Predictive factors for major postoperative complications related to gastric conduit reconstruction in thoracoscopic esophagectomy for esophageal cancer: a case control study

thoracoscopic esophagectomy (TE) have reduced severe pulmonary complications after esophagectomy [8]. However, postoperative complications related to gastric conduit reconstruction are still common after esopha- gectomy [9]. Regarding cervical anastomotic complica- tions after esophagectomy, leak and stricture formation are major issues [10, 11]. In particular, ischemia of the proximal portion of the graft predisposes these patients to a high incidence of anastomotic complications after esophagectomy [12]. Less commonly, severe graft ische- mia can lead to transmural necrosis. Thus, early diagno- sis of an ischemic reaction may facilitate appropriate
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Length of Stay and Cost of Pediatric Readmissions

Length of Stay and Cost of Pediatric Readmissions

WHAT’S KNOWN ON THIS SUBJECT: Despite the low rate of readmissions in children, readmission metrics are being adopted to adjust reimbursement payments. Although attention has been given to readmission rates in children, little is known about the length of stay (LOS) and cost of readmissions. WHAT THIS STUDY ADDS: Readmissions are associated with episode LOS and costs that are approximately double those of index admissions without readmission. Readmission metrics that incorporate episode LOS may provide a better estimate of resource use than readmission rate alone.

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Enhanced recovery after surgery (ERAS) protocols for colorectal cancer in Japan

Enhanced recovery after surgery (ERAS) protocols for colorectal cancer in Japan

in the length of hospital stay (LOS). Several meta- analyses of randomized trials in colorectal surgery showed a decrease in LOS with ERAS, compared with traditional care, without compromising patient safety [5]. However, LOS as a surrogate measure of recovery has some issues, as it is influenced by a number of non- clinical factors that differ by country, including cultural and traditional background and insurance status. It should also be noted that previous reports on the out- comes of ERAS have been largely limited to European countries and the United States [6, 7], with few studies conducted in Japan and other Asian countries [8]. In fact, some elements of ERAS do not always fit well in the Japanese setting [9].
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Renal surgery for kidney cancer in Germany 2005–2006: length of stay, risk of postoperative complications and in-hospital death

Renal surgery for kidney cancer in Germany 2005–2006: length of stay, risk of postoperative complications and in-hospital death

patients who received a blood transfusion as a surro- gate of perioperative bleeding and found that this propor- tion ranges between 6.8% and 18.0% [21]. If we used this definition, the risk of perioperative bleeding in Germany would be 19.1%. However, the coding of bleeding plus blood transfusion occurred in only 4.5%. This risk is in line with previous tertiary center studies [8,22]. When we also used codes that indicated the acute consequence of bleeding (acute postoperative haemorrhagic anemia), this risk increased to 18.4%. Kim et al. defined bleeding as the occurrence of haemorrhage or acute post haemorrhagic anemia and observed a rate of 8.5%, 5.3%, and 7.0% for open radical, laparoscopic radical, and open partial neph- rectomy respectively [23]. These rates are still considerably Table 2 Surgical approaches of nephrectomy, crude risks of in-hospital complications and adjusted relative risks of complications in Germany 2005-2006
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The impact of epidural analgesia compared to systemic opioid-based analgesia with regard to length of hospital stay and recovery of bowel function: retrospective evaluation of 1555 patients undergoing thoracotomy

The impact of epidural analgesia compared to systemic opioid-based analgesia with regard to length of hospital stay and recovery of bowel function: retrospective evaluation of 1555 patients undergoing thoracotomy

During their stay in hospital all patients are visited daily by a pain specialized anesthetist and pain medication is adjusted to the state of recovery. Moreover numeric rating scale (NRS) at rest and on coughing are documented by the nurses on the wards every 6 h, implicating that the rescue medication (parecoxib 40 mg IV) has been admin- istered by the nurse when NRS scores >3 at rest and >5 on coughing. Thirty min after administration of rescue medication the NRS has to be re-assessed. If pain score is again >5 on coughing, the nurse has to contact the anesthetist responsible for postoperative pain therapy.
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Original Article Value of laparoscopic and fast-track surgery in the application of sigmoid colon cancer resection

Original Article Value of laparoscopic and fast-track surgery in the application of sigmoid colon cancer resection

Results of this present study demonstrated that laparoscopic surgery combined with FTS (experimental group A) was significantly superi- or to conventional large-open surgery (experi- mental group C) in terms of intraoperative and postoperative indicators. Compared with lapa- roscopic surgery alone (experimental group B), there were no significant differences in intraop- erative indicators, suggesting that laparos- copic surgery can reduce the degree of body damage in patients with sigmoid colon cancer. Compared with traditional open surgery, it has higher application value. Combined with appli- cation of the FTS model, it can effectively improve prognosis and is the best choice for treatment of sigmoid colon cancer among the three methods. Laparoscopic surgery, using the latest technology, can achieve a more pre- cise surgical incision, with less severe surgical trauma, better internal environment stability, and shorter postoperative recovery times. It can not only greatly increase the visual field of small lesions during surgery and enhance the integrity of lesion resection and lymphatic dis- section, but also ensure the stability of pa- tient internal environments through a smaller traumatic incision, reduce stress response caused by surgery, and minimize incidence of postoperative complications and risk of infec- tion [23]. This study also compared incidence of postoperative complications among the th- ree groups of patients. However, laparoscopic surgery requires that surgeons have higher pro- fessional quality knowledge to improve suc- cess rates of surgery. Application of FTS is based on laparoscopic surgery and requires a series of physiological arrangements before surgery to reduce patient insulin resistance and decomposition of metabolic capacity. The- se include strict intraoperative control and adjustment of patient anesthesia and fluid sup- plements to reduce unforeseen accidents dur- ing surgery and postoperative assistance en- abling patients to undergo timely rehabilitation training, promoting healing of muscles and inci- sions, and improving the body’s immune me- tabolism [24]. In the process of patient admis- sion, FTS requires nurses to pay close atten- tion to patient vital signs and increase the time of communication with patients [25]. This not only allows patients to be more fully prepared during surgery but also improves patient psy- chological states, promoting prognosis. Intake of an appropriate diet as soon as possible after
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Perioperative Nutritional Support or Perioperative Fasting? A narrative review

Perioperative Nutritional Support or Perioperative Fasting? A narrative review

Abstract: Traditionally, overnight fasting before elective surgery has been the routine in medical practice for risk reduction of pulmonary aspiration of gastric contents. Several original study and international societies recommend a 2‐h preoperative fast for clear fluids and a 6‐h fast for solids in most elective patients. We conducted a narrative review of the literature, searching electronic databases (Medline and CINAHL). We used PICO approach. The results of our review suggest that nutrition support in the perioperative period is very important to reduce length of hospital stay and reduced postoperative complication.
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