scholarly journals A comparative study of interval cholecystectomy and early cholecystectomy in acute cholecystitis

2020 ◽  
Vol 7 (5) ◽  
pp. 1419
Author(s):  
Gursimranjit Singh ◽  
Rana Ranjit Singh ◽  
Darpan Bansal
Keyword(s):  
Hospital Stay ◽  
Acute Cholecystitis ◽  
Early Surgery ◽  
Total Hospital ◽  
Total Cost ◽  
Early Cholecystectomy ◽  
Total Hospital Stay ◽  
Significant Difference ◽  
Delayed Group ◽  
Day By Day

Background: In the whole world including India, the incidence of acute cholecystitis is increasing day by day. Gall stones are the most common cause of acute cholecystitis in 90-95% of the cases. The management of acute cholecystitis was conservative earlier but now there are studies recommending early surgery as the treatment of choice.Methods: Our study was conducted on 60 patients divided into two groups of 30 each to compare the results of early surgery with the delayed surgery.Results: The overall post-operative complication rate was same in both the groups but there was significant difference in the total hospital stay and total cost of the therapy in both the groups. The average total hospital stay in early group was 6.50±4.44 days and in delayed group was 10.80±5.55 days without including the number of days in non-operating admission.Conclusions: So, early cholecystectomy was found to be more economical with less total hospital stay and less total cost of the therapy than interval cholecystectomy in acute cholecystitis. 

scholarly journals Comparative Study Of Open Cholecystectomy In Acute And Chronic Cholelithiasis In Rural Centre Of India.

2021 ◽  
pp. 36
Author(s):  
Keyword(s):  
Acute Cholecystitis ◽  
Open Cholecystectomy ◽  
Gall Stone ◽  
Total Hospital ◽  
Acute Case ◽  
Operative Morbidity ◽  
Gall Stones ◽  
Total Hospital Stay ◽  
Significant Difference ◽  
Day By Day

The incidence of cholecystitis with cholelithiasis is increasing day by day either acute or chronic cases. Gall stones are the most common cause of acute cholecystitis in 90-95% of the cases. The management of acute cholecystitis is still laparoscopic cholecystectomy in urban area of India but in rural area open cholecystectomy is still preferred method of surgery for acute as well as chronic gall stone. Our study was conducted on 100 patients divided into two groups of 50 of each to compare the results of open cholecystectomy between acute and chronic cases. The overall post-operative morbidity was more in acute cases. But there was significant difference in the total hospital stay and total cost of the therapy in both the groups. drain output was also high in first three days in acute case so, acute case cholecystectomy was found to be more expensive overall and higher length stay and more co morbidities than chronic cases.

scholarly journals CT-derived sarcopenia should not preclude surgical stabilization of traumatic rib fractures

2021 ◽  
Vol 5 (1) ◽  
Author(s):  
Derrick A. Doolittle ◽  
Matthew C. Hernandez ◽  
Francis I. Baffour ◽  
Michael R. Moynagh ◽  
Naoki Takahashi ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Hospital Stay ◽  
Frailty Index ◽  
Rib Fractures ◽  
Total Hospital ◽  
Skeletal Muscle Index ◽  
Icu Stay ◽  
Total Hospital Stay ◽  
Significant Difference ◽  
Considerable Morbidity

Abstract Background Rib fractures are associated with considerable morbidity and mortality. Surgical stabilization of rib fractures (SSRF) can be performed to mitigate complications. Sarcopenia is in general known to be associated with poor clinical outcomes. We investigated if sarcopenia impacted number of days of mechanical ventilation, intensive care unit (ICU) stay, and total hospital stay in patients who underwent SSRF. Methods A retrospective single institutional review was performed including patients who underwent SSRF (2009–2017). Skeletal muscle index (SMI) was semiautomatically calculated at the L3 spinal level on computed tomography (CT) images and normalized by patient height. Sarcopenia was defined as SMI < 55 cm2/m2 in males and < 39 cm2/m2 in females. Demographics, operative details, and postoperative outcomes were reviewed. Univariate and multivariate analyses were performed. Results Of 238 patients, 88 (36.9%) had sarcopenia. There was no significant difference in number of days of mechanical ventilation (2.8 ± 4.9 versus 3.1 ± 4.3, p = 0.304), ICU stay (5.9 ± 6.5 versus 4.9 ± 5.7 days, p = 0.146), or total hospital stay (13.3 ± 7.2 versus 12.9 ± 8.2 days, p = 0.183) between sarcopenic and nonsarcopenic patients. Sarcopenic patients demonstrated increased modified frailty index scores (1.5 ± 1.1 versus 0.9 ± 0.9, p < 0.001) compared to nonsarcopenic patients. Conclusions For patients who underwent SSRF for rib fractures, sarcopenia did not increase the number of days of mechanical ventilation, ICU stay, or total hospital stay. Sarcopenia should not preclude the utilization of SSRF in these patients.

scholarly journals Proton Pump Inhibitors Were Associated With Reduced Pseudocysts in Acute Pancreatitis: A Multicenter Cohort Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Shengyu Zhang ◽  
Ziying Han ◽  
Yuelun Zhang ◽  
Xiaomao Gao ◽  
Shicheng Zheng ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Cohort Study ◽  
Hospital Stay ◽  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Control Group ◽  
Total Hospital ◽  
Total Hospital Stay ◽  
Study Results ◽  
Significant Difference

Background: Acute pancreatitis (AP) is a systemic inflammatory disorder with a wide spectrum of clinical symptoms that can range from mild to severe. Previous preclinical study results suggest that proton pump inhibitors (PPIs) can inhibit exocrine pancreatic secretion and exert anti-inflammatory properties, which might in turn improve the outcome of AP.Aim: We conducted this multicenter, retrospective cohort study to investigate the potential effects of PPIs on the mortality, and total duration of hospital stay and local complication occurrence of patients with AP.Methods: A total of 858 patients with AP were included. All patients presented to the hospital within 48 h of symptom onset and were divided into the following two groups: patients who were treated with PPIs (n = 684) and those not treated with PPIs (n = 174). We used propensity score matching (PSM) analysis to reduce confounding bias before comparing the outcomes between the two groups.Results: Before PSM analysis, there were significant differences in a number of parameters between the two groups, including age, sex, hematocrit, blood urea nitrogen, peritonitis signs, Ranson’s score, and Acute Physiology Chronic Health Evaluation II score and organ failure occurrence. Before PSM, the PPIs group had a higher rate of mortality than the control group [RR = 1.065; 95% confidence ratio (CI) 1.045–1.086; p = 0.001]. After PSM, there was no significant difference in mortality (RR = 1.009; 95% CI, 0.999–1.019; p = 0.554) or total hospital stay (p = 0.856), although the PPIs group had a lower occurrence of pancreatic pseudocyst (RR = 0.416; 95% CI 0.221–0.780; p = 0.005).Conclusion: This study showed that PPIs therapy was not associated with reduced mortality or total hospital stay, but was associated with a reduction in the occurrence of pseudocysts in patients with acute pancreatitis.

scholarly journals Comparison of Clinical Safety and Outcomes of Early versus Delayed Laparoscopic Cholecystectomy for Acute Cholecystitis: A Meta-Analysis

2014 ◽  
Vol 2014 ◽  
pp. 1-8 ◽  
Author(s):  
Min-Wei Zhou ◽  
Xiao-Dong Gu ◽  
Jian-Bin Xiang ◽  
Zong-You Chen
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Confidence Interval ◽  
Hospital Stay ◽  
Acute Cholecystitis ◽  
Meta Analysis ◽  
Total Hospital ◽  
Clinical Safety ◽  
Early Laparoscopic Cholecystectomy ◽  
Total Hospital Stay ◽  
Delayed Laparoscopic Cholecystectomy

Objective.To compare the clinical safety and outcomes of early laparoscopic cholecystectomy versus delayed laparoscopic cholecystectomy for acute cholecystitis.Methods.Pertinent studies were selected from the Medline, EMBASE, and Cochrane library databases, references from published articles, and reviews. Seven randomized controlled trials (early laparoscopic cholecystectomy versus delayed laparoscopic cholecystectomy) were selected. Conventional meta-analysis according to Cochrane Collaboration was used for the pooling of the results.Results.Seven trials with 1106 patients were included. There was no significant difference between the two groups in terms of bile duct injury (Peto odds ratio 0.49 (95% confidence interval 0.05 to 4.72);P=0.54) or conversion to open cholecystectomy (risk ratio 0.91 (95% confidence interval 0.69 to 1.20);P=0.50). The total hospital stay was shorter by 4 days for early laparoscopic cholecystectomy (mean difference −4.12 (95% confidence interval −5.22 to −3.03) days;P<0.00001).Conclusion.Early laparoscopic cholecystectomy during acute cholecystitis is safe and shortens the total hospital stay.

AB0680 SARCOPENIA RATE IN COVID-19 SURVIVORS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1373.1-1373
Author(s):  
D. Levy ◽  
M. Giannini ◽  
W. Oulehri ◽  
M. Riou ◽  
C. Marcot ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Poor Quality ◽  
University Hospital ◽  
Total Hospital ◽  
Total Cohort ◽  
Total Hospital Stay ◽  
Increased Risk ◽  
Significant Difference ◽  
Risk Of Falls ◽  
Hospital Stay Duration

Background:COVID-19 survivors may have high risks of developing sarcopenia, which is associated to handicap, poor quality of life, higher healthcare costs, increased risk of falls, increased mortality (1).Objectives:To assess sarcopenia rate (which has not been described yet) following COVID-19 hospitalization and to highlights features associated with sarcopenic vs. non-sarcopenic patients.Methods:Major confirmed COVID-19 patients undergoing intensive care unit (ICU) or Pneumology Department admission in Strasbourg University Hospital between March and June 2020 were prospectively included. Muscle and cardio-respiratory evaluations were performed 3 months after discharge. Sarcopenic patients were compared to non-sarcopenic ones. A second muscle assessment 6 months after discharge was performed in patients with pathologic muscle tests.Results:127 patients were included, 39 (30.7%) not requiring ICU care, 88 (69.3%) requiring ICU care. The cohort consisted of 71% male patients, with a median age of 63 years [28-82]. Forty-one-percent were obese (BMI>30 kg/m2). Most individuals had preexisting comorbidities (82 patients, 70%), mainly hypertension and diabetes mellitus. The median total hospital stay duration was 22 days and up to 89 days. At the 3 months assessment, 17/127 (13%) patients were diagnosed with sarcopenia which comprised 6/17 (35%) severe sarcopenia (4.7% of the total cohort). At the 6 months assessment, only 4/15 (27%) of the initial sarcopenic patients remained sarcopenic (3% of the total cohort) and 3 of these 4 patients had severe sarcopenia. BMI (26,3 vs. 29,3, p=0.03), COPD (20% vs. 3%, p=0.03), comorbidities (93% vs. 67%, p=0.04), total hospital stay duration (33 vs. 20 days, p=0.03) and ICU stay duration (33 vs. 13 days, p=0.01) were significantly associated with sarcopenic vs. no sarcopenic patients. However, there was no significant difference concerning cardio-pulmonary evaluations between these two groups.Conclusion:We here highlighted a sarcopenia prevalence at 3 and 6 months following a hospitalization for COVID-19 of 13% and 3% respectively, occurring mainly in patients with comorbidities. Sarcopenia was not associated to worse cardio-pulmonary results in comparison with non-sarcopenic patients.References:[1]Di Filippo L, De Lorenzo R, D’Amico M, Sofia V, Roveri L, Mele R, et al. COVID-19 is associated with clinically significant weight loss and risk of malnutrition, independent of hospitalisation: A post-hoc analysis of a prospective cohort study. Clinical Nutrition [Internet]. oct 2020. https://linkinghub.elsevier.com/retrieve/pii/S0261561420305896Disclosure of Interests:None declared

scholarly journals A comparative study of vacuum assisted closure dressing with conventional dressings in the management of infected wounds

2020 ◽  
Vol 8 (1) ◽  
pp. 97
Author(s):  
Karanvir Singh ◽  
Gurlal Singh Puar ◽  
Vikas Kakkar ◽  
Rana Ranjit Singh
Keyword(s):  
Hospital Stay ◽  
Wound Management ◽  
Vacuum Assisted Closure ◽  
Average Hospital ◽  
Total Hospital Stay ◽  
Significant Difference ◽  
Infected Wounds ◽  
Group A ◽  
Group B ◽  
Day By Day

Background: In the whole world including India, incidence of infected wounds is increasing day by day. Trauma is the most common cause of wounds and number of other factors contribute to wound infection there on. Wound management and care thus carry an important role for such patients in the form of dressings, debridement etc. Many conventional dressings are being used these days, but vacuum assisted closure (VAC) dressing as widely gained acceptance now.Methods: Our study was conducted on 60 patients divided in 2 groups of 30 each to compare VAC dressing with conventional dressings.Results: There was significant difference in total hospital stay, no. of debridement done, granulation tissue fill up and graft take up in both groups, for example, the average hospital stay in group A was 21.8±7.61 and in group B was 26.47±9.55.Conclusions: So, VAC dressing was found to be more beneficial and patient friendly with lesser hospital stay and thus lesser cost than conventional dressings.

scholarly journals Outcome of early laparoscopic cholecystectomy versus delayed laparoscopic cholecystectomy for patients with acute cholecystitis

2020 ◽  
Vol 7 (4) ◽  
pp. 1212 ◽  
Author(s):  
Zahid Mohd Rather ◽  
Nighat Ara Majid ◽  
Mohd Nazrull Islam ◽  
Raja Waseem Mohd
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Hospital Stay ◽  
Acute Cholecystitis ◽  
Operating Time ◽  
Total Hospital ◽  
Average Hospital ◽  
Early Laparoscopic Cholecystectomy ◽  
Total Hospital Stay ◽  
Delayed Laparoscopic Cholecystectomy ◽  
The Cost

Background: This prospective randomized study was undertaken to to assess the outcomes of early versus delayed cholecystectomy for patient’s acute cholecystitis.Methods: 70 patients with acute cholecystitis were prospectively randomized to either an early laparoscopic cholecystectomy (n=35) or a delayed laparoscopic cholecystectomy group (n=35). The mean operative time, conversion rate, total hospital stay, intra-operative and post-operative complications, average hospital cost were evaluated between the two groups.Results: A total of 70 patients were enrolled, 35 patients in each group. There was no significant difference in the conversion rates (early, 8.57% vs delayed, 5.71%) and postoperative complications (early, 25% vs delayed, 20%). At the cost of an increased operating time (early, 81 minutes vs delayed, 78 minutes) and blood loss (early, 180.33ml vs delayed, 108.00 ml), early laparoscopic cholecytectomy significantly shortened the total hospital stay (early, 1.5 days vs. delayed, 7.95 days) and  average hospital cost (early 9240 INR vs delayed, 12251 INR).Conclusions: The safety and efficacy of early and delayed laparoscopic cholecystectomy for acute cholecystitis were comparable in terms of morality, morbidity and conversion rate. However early laparoscopic cholecystectomy allows significantly shorter  total hospital stay and reduction in days away from work at the cost of  longer operating time and blood loss and offers definitive treatment at initial admission. Moreover it avoids repeated admissions for recurrent symptoms has both medical as well as socioeconomic benefits and should be the preferred approach for patients managed by surgeons with adequate experience in laparoscopic cholecystectomy.

Analysis of Nosocomial Infections in Post–Cardiac Surgery Extracorporeal Membrane Oxygenation Support Therapy

2018 ◽  
Vol 21 (5) ◽  
pp. E387-E391 ◽  
Author(s):  
Binfei Li ◽  
Geqin Sun ◽  
Zhou Cheng ◽  
Chuangchuang Mei ◽  
Xiaozu Liao ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Cardiac Surgery ◽  
Extracorporeal Membrane Oxygenation ◽  
Hospital Stay ◽  
Nosocomial Infections ◽  
Total Hospital ◽  
Secondary Infections ◽  
Total Hospital Stay ◽  
Mechanical Ventilation Time ◽  
Post Cardiac Surgery

Objectives: This study aims to analyze the nosocomial infection factors in post–cardiac surgery extracorporeal membrane oxygenation (ECMO) supportive treatment (pCS-ECMO). Methods: The clinical data of the pCS-ECMO patients who obtained nosocomial infections (NI) were collected and analyzed retrospectively. Among the 74 pCS-ECMO patients, 30 occurred with NI, accounting for 40.5%; a total of 38 pathogens were isolated, including 22 strains of Gram-negative bacteria (57.9%), 15 strains of Gram-positive bacteria (39.5%), and 1 fungus (2.6%). Results: Multidrug-resistant strains were highly concentrated, among which Acinetobacter baumannii and various coagulase-negative staphylococci were the main types; NI was related to mechanical ventilation time, intensive care unit (ICU) residence, ECMO duration, and total hospital stay, and the differences were statistically significant (P < .05). The binary logistic regression analysis indicated that ECMO duration was a potential independent risk factor (OR = 0.992, P = .045, 95.0% CI = 0.984-1.000). Conclusions: There existed significant correlations between the secondary infections of pCS-ECMO and mechanical ventilation time, ICU residence, ECMO duration, and total hospital stay; therefore, hospitals should prepare appropriate preventive measures to reduce the incidence of ECMO secondary infections.

scholarly journals Comparison of the effects of intravenous propofol and inhalational desflurane on the quality of early recovery after hand-assisted laparoscopic donor nephrectomy: a prospective, randomised controlled trial

BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e039881
Author(s):  
Jaesik Park ◽  
Minhee Kim ◽  
Yong Hyun Park ◽  
Jung-Woo Shim ◽  
Hyung Mook Lee ◽  
...  
Keyword(s):  
Randomised Controlled Trial ◽  
Hospital Stay ◽  
Controlled Trial ◽  
Early Recovery ◽  
Total Hospital ◽  
Kidney Donors ◽  
Living Kidney Donors ◽  
Total Hospital Stay ◽  
Randomised Controlled

ObjectivesWe compared early recovery outcomes between living kidney donors who received total intravenous (IV) propofol versus inhalational desflurane during hand-assisted laparoscopic nephrectomy.DesignA single-centre, prospective randomised controlled trial.SettingUniversity hospital.ParticipantsStudy participants were enrolled between October 2019 and February 2020. A total of 80 living donors were randomly assigned to an intravenous propofol group (n=40) or a desflurane group (n=40).InterventionPropofol group received intravenous propofol and desflurane group received desflurane, as a maintenance anaesthetic.Primary and secondary outcome measuresThe quality of postoperative functional recovery was primarily assessed using the Korean version of the Quality of Recovery-40 (QoR-40K) questionnaire on postoperative day 1. Secondarily, ambulation, pain score, rescue analgesics, complications and total hospital stay were assessed postoperatively.ResultsOur study population included 35 males and 45 females. The mean age was 46±13 years. The global QoR-40K score (161 (154–173) vs 152 (136–161) points, respectively, p=0.001) and all five subdimension scores (physical comfort, 49 (45–53) vs 45 (42–48) points, respectively, p=0.003; emotional state, 39 (37–41) vs 37 (33–41) points, respectively, p=0.005; psychological support, 30 (26–34) vs 28 (26–32) points, respectively, p=0.04; physical independence, 16 (11–18) vs 12 (8-14) points, respectively, p=0.004; and pain, 31 (28–33) vs 29 (25-31) points, respectively, p=0.021) were significantly higher in the intravenous propofol group than the desflurane group. The early ambulation success rate and numbers of early and total steps were higher, but the incidence of nausea/vomiting was lower, in the intravenous propofol group than the desflurane group. The total hospital stay after surgery was shorter in the intravenous propofol group than the desflurane group.ConclusionsIntravenous propofol may enhance the quality of postoperative recovery in comparison to desflurane in living kidney donors.Trial registration numberKCT0004365.

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