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Shorter Hospital Stay (shorter + hospital_stay)
Selected AbstractsPrimary laparoscopic and open repair of paraesophageal hernias: a comparison of short-term outcomesDISEASES OF THE ESOPHAGUS, Issue 1 2008S. Karmali SUMMARY. The choice of the optimal surgical approach for repairing paraesophaeal hernias (PEH) is debated. Our objective is to evaluate the short-term outcomes of primary laparoscopic and open repairs of PEH performed in the Calgary Health Region. A retrospective review of all patients undergoing repair of PEH between October 1999 and February 2005 was performed. The outcome measures evaluated included intra-operative parameters and post-operative variables, mortality rates, recurrence rates and patient satisfaction. A total of 93 patients underwent either a laparoscopic (n = 46) or open (n = 47) primary PEH repair. The laparoscopic approach was associated with a longer mean operative time (3.1 ± 1.2 hours vs. 2.5 ± 0.7 hours, P = 0.005) but resulted in a shorter overall hospital stay (5 days [2,16 days]vs. 10 days [5,24 days]; P < 0.001), and fewer post-operative complications (10/46 [22%]vs. 25/47 [53%]P = 0.002). Although the follow-up was short (laparoscopic 16 months; open 18 months), a 9% recurrence rate was reported with both approaches. Patient satisfaction using the Gastroesophageal Disease Health-Related Quality Of Life questionnaire was similar in both groups (P = 0.861) with most patients reporting excellent outcomes (laparoscopic: 32/36 [89%]; open 27/35 [77%]). Our review suggests that the laparoscopic approach is safe with shorter hospital stay and recovery. Although early follow-up suggests that recurrence rates and patient satisfaction are similar, long-term follow-up is required to determine whether the laparoscopic approach will become the procedure of choice. [source] Transoral laser surgery for supraglottic cancerHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 5 2008Juan P. Rodrigo MD Abstract The goal of treatment for supraglottic cancer is to achieve cure and to preserve laryngeal function. Organ preservation strategies include both endoscopic and open surgical approaches as well as radiation and chemotherapy. The challenge is to select the correct modalities for each patient. Endoscopic procedures should be limited to tumors that can be completely visualized during diagnostic microlaryngoscopy. If complete resection can be achieved, the oncologic results of transoral laser surgery appear to be comparable to those of classic supraglottic laryngectomy. In addition, functional results of transoral laser resection are superior to those of the conventional open approach, in terms of the time required to restore swallowing, tracheotomy rate, incidence of pharyngocutaneous fistulae, and shorter hospital stay. The management of the neck remains of paramount importance, as survival of patients with supraglottic cancer depends more on cervical metastasis than on the primary tumor. Most authors advocate bilateral elective neck dissection. However, in selected cases (T1,T2 clinically negative [N0] lateral supraglottic cancers), ipsilateral selective neck dissection could be performed without compromising survival. The authors conclude that with careful selection of patients, laser supraglottic laryngectomy is a suitable, and often the preferred, treatment option for supraglottic cancer. © 2008 Wiley Periodicals, Inc. Head Neck, 2008 [source] Meta-analysis of randomized controlled trials on the effectiveness of somatostatin analogues for pancreatic surgery: a Cochrane reviewHPB, Issue 3 2010Rahul S. Koti Abstract Background:, The use of synthetic analogues of somatostatin following pancreatic surgery is controversial. The aim of this meta-analysis is to determine whether prophylactic somatostatin analogues (SAs) should be used routinely in pancreatic surgery. Methods:, Randomized controlled trials were identified from the Cochrane Library Trials Register, MEDLINE, EMBASE, Science Citation Index Expanded and reference lists. Data were extracted from these trials by two independent reviewers. The risk ratio (RR), mean difference (MD) and standardized mean difference (SMD) were calculated with 95% confidence intervals (95% CIs) based on intention-to-treat or available case analysis. Results:, Seventeen trials involving 2143 patients were identified. The overall number of patients with postoperative complications was lower in the SA group (RR 0.71, 95% CI 0.62,0.82), but there was no difference between the groups in perioperative mortality (RR 1.04, 95% CI 0.68,1.59), re-operation rate (RR 1.15, 95% CI 0.56,2.36) or hospital stay (MD ,1.04 days, 95% CI ,2.54 to 0.46). The incidence of pancreatic fistula was lower in the SA group (RR 0.64, 95% CI 0.53,0.78). The proportion of these fistulas that were clinically significant is not clear. Analysis of results of trials that clearly distinguished clinically significant fistulas revealed no difference between the two groups (RR 0.69, 95% CI 0.34,1.41). Subgroup analysis revealed a shorter hospital stay in the SA group than among controls for patients with malignant aetiology (MD ,7.57 days, 95% CI ,11.29 to ,3.84). Conclusions:, Somatostatin analogues reduce perioperative complications but do not reduce perioperative mortality. However, they do shorten hospital stay in patients undergoing pancreatic surgery for malignancy. Further adequately powered trials of low risk of bias are necessary. [source] Anatomic segmental resection compared to major hepatectomy in the treatment of liver neoplasmsHPB, Issue 3 2005THOMAS S HELLING MD Abstract Background. Familiarity with liver anatomy and refinements in operative technique have led to interest in liver conservation when dealing with hepatic tumors. There is thought to be less morbidity, less blood loss (EBL), a shorter hospital stay (LOS), and no penalty for long-term survival with segmental hepatectomy. Methods. One hundred ninety-six patients who underwent segmental (SEG group) (N=70) or major (MAJOR group) (N=126) hepatectomy for liver neoplasms were retrospectively reviewed. Clinical parameters of mortality, morbidity, EBL, LOS, and actuarial survival in patients with colorectal metastases were examined. Results. There were no differences in age or gender between the SEG and MAJOR groups. There were no deaths among 64 non-cirrhotic patients in the SEG group and 4 deaths (3.2%) among 124 non-cirrhotic patients in the MAJOR group (p=0.19). There were 4 postoperative complications in the SEG group (5.6%) and 22 in the MAJOR group (17.3%) (p<0.05). The EBL for the SEG group was 912±842 ml compared to 3675±3110 ml in the MAJOR group (p<0.001). The hospital LOS for the SEG group was 9.4±6.4 days and for the MAJOR group 10.2±5.9 days (p=0.32). Life table analysis of survival for resection of colorectal metastases showed two-year patient survival of 40% in the SEG group (N=17) and 45% for the MAJOR group (N=46). Conclusion. Segmental resections were associated with less EBL and fewer postoperative complications. There was a trend towards fewer deaths in non-cirrhotic patients, and no apparent penalty for a smaller hepatic resection in long-term survival. While sometimes technically more challenging, segmental resections are preferable when feasible and should be utilized in efforts to conserve liver parenchyma. [source] Laparoscopic management of urachal remnants in adulthoodINTERNATIONAL JOURNAL OF UROLOGY, Issue 12 2006TAKATSUGU OKEGAWA Background: The aim of this study was to investigate the outcome of laparoscopic excision of urachal remnants (LUR), and to compare the outcome with that of the traditional open excision of urachal remnants (OUR). Methods: Between February 2001 and December 2005, six patients with a mean age of 23.8 years who had a symptomatic urachal sinus underwent radical LUR. Using 12 mm and 5 mm ports, the caudal stump of the urachus was ligated with an absorbable clip and divided. The peritoneal and preperitoneal tissue between the medial umbilical ligaments was dissected free of the transversalis fascia. Dissection was carried out along the preperitoneal plane toward the umbilicus. The cephalic side of the lesion was ligated at the umbilicus with an endo-loop and divided. In addition, four patients who underwent a traditional OUR were included. Peri- and postoperative records were reviewed to assess morbidity, recovery, and outcome. Results: The operative duration was not significantly shorter for the LUR group than the OUR group, but there was generally a reduction in blood loss (mean 16.5 vs 68.3 mL), an earlier resumption of eating (mean 1.3 vs 2.5 days), and a shorter hospital stay (mean 5.3 vs 10.5 days). There were no intraoperative complications in either the LUR or the OUR group. Mean follow up was 5 (range 4,12) months. There were no postoperative complications. Conclusions: The results suggest that LUR can be safely and satisfactorily performed in adulthood. [source] Laparoscopic Live Donor Nephrectomy with Vaginal Extraction: Initial ReportAMERICAN JOURNAL OF TRANSPLANTATION, Issue 6 2010M. E. Allaf The recent decrease in the total number of living kidney transplants coupled with the increase in the number of candidates on the waiting list underscores the importance of eliminating barriers to living kidney donation. We report what we believe to be the first pure right-sided laparoscopic live donor nephrectomy with extraction of the kidney through the vagina. The warm ischemia time was 3 min and the renal vessels and ureter of the procured kidney were of adequate length for routine transplantation. The donor did not receive any postoperative parenteral narcotic analgesia, was discharged home within 24 h and was back to normal activity in 14 days. The kidney functioned well with no complications or infections. Laparoscopic live donor nephrectomy with vaginal extraction may be a viable alternative to open and standard laparoscopic approaches. Potential advantages include reduced postoperative pain, shorter hospital stay and convalescence and a more desirable cosmetic result. These possible, but yet unproven, advantages may encourage more individuals to consider live donation. [source] Does an acute care surgical model improve the management and outcome of acute cholecystitis?ANZ JOURNAL OF SURGERY, Issue 6 2010Christopher W. Lehane Abstract The aim of this study was to compare the management and outcome of acute cholecystitis in an acute care surgery (ACS) model to that of the traditional home-call attending surgeon. The ACS model is one in which a consultant led team manage all emergency surgical presentations. The consultant is involved with every decision made including theatre allocation. Records of all patients who underwent an emergency cholecystectomy in the 2 years before and after introduction of an ACS model were reviewed. A total of 202 patients were recruited into this study. The groups were matched for sex, age and insurance status. There was a decrease in the median time to theatre (1 versus 2 days) and total length of stay (4 versus 6 days) in the ACS group. There was no significant difference in the conversion rate between the groups. However, there was a decreased complication rate in the ACS group (8.7 versus 17.2%). There were no differences in the histological findings. Consultant presence in theatre was higher in the ACS group (73.9 versus 56.3%), and they were more often assisting (30.4 versus 4.6%). Results suggest that an ACS model is beneficial to patient care with shorter hospital stay and a decreased complication rate. This may reflects a greater input to patient assessment and management by the on-site consultant. In addition, the ACS model provides greater consultant supervision to the trainee. [source] MINIMALLY INVASIVE APPROACH IN THE MANAGEMENT OF CHILDHOOD INTUSSUSCEPTIONANZ JOURNAL OF SURGERY, Issue 9 2007Sing T. Cheung Background: Intussusception is one of the most common causes of intestinal obstruction in infancy. Non-operative reduction using air enema or other hydrostatic reduction methods has been the standard treatment in most cases. However, if the non-operative method is not indicated or fails, open surgery is still necessary. With the tremendous development of the minimally invasive approach in handling surgical conditions in children in the last decade, this has been applied recently for the reduction of intussusception in children. We herein reviewed our experience of using the combined approach, namely, pneumatic reduction and, if failed, laparoscopic reduction in the management of childhood intussusception. Methods: We carried out a retrospective analysis of all children with intussusception managed at Prince of Wales Hospital between December 1998 and December 2004. The minimally invasive approach was used as far as possible. The method of reduction, success rate and the incidence of complication were analysed. Results: Over a 6-year period, there were 146 patients with 167 episodes of intussusception. Pneumatic reduction was carried out in 160 occasions and was successful in 134 (83.8%). In 33 patients, operative reduction was required. Of these, laparoscopic reduction was attempted in 15 and was successful in 13 (86.7%). In those with either pneumatic or laparoscopic reduction, no procedure-related complication was encountered and they had a significant shorter hospital stay (median 3.0 day) than those requiring laparotomy (median 8.0 day) (t -test, P < 0.0001). Conclusion: The minimally invasive approach, that is, pneumatic and/or laparoscopic reduction, was successful in reducing intussusception in 88% of patients with minimal morbidity and shorter hospital stay. [source] Laparoscopic repair of ventral incisional herniaANZ JOURNAL OF SURGERY, Issue 4 2002Keith B. Kua Background: Laparoscopic repair of ventral incisional hernias was first reported in 1993. Since then, there have been sporadic case reports and small series published about this procedure, but it has not been widely adopted. Newer types of composite prosthetic mesh may reduce the potential problem of bowel adhesion. Methods: Thirty cases of laparoscopic ventral incisional hernia repairs (carried out by two surgeons or their senior registrars) have been retrospectively reviewed and reported in this article. The data were obtained from patient records and subsequent phone surveys. Results: Thirty patients between 29 and 82 years (mean: 58 years) underwent this procedure. There were 14 men and 16 women. The average weight of the patients was 81 kg. The hernias were up to 6 or 7 cm in diameter. Mesh was used in 28 cases (polypropylene in 25 cases, expanded polytetrafluoroethylene in two cases and composite mesh in one case). Most meshes were laid intraperitoneally and fixed into position with laparoscopic spiral tacks. Twenty-nine cases were completed laparoscopically. One operation (3.3%) was converted to an open procedure because of severe bowel adherence to the hernia sac. The mean operating time was 52 min for laparoscopic ventral incisional hernia repairs only. All but two patients tolerated an oral diet within 24 h. The postoperative hospital stay ranged from 0 to 11 days, with 17 patients (57%) staying overnight and eight patients (27%) staying another day. Over 80% of the patients returned to house duties within a week. There was no mortality, and minor complications occurred in four patients (14%). One patient had a small bowel obstruction treated successfully by repeat laparoscopy with division of fibrinous adhesions to polypropylene mesh on day four. Follow up ranged from 1 to 69 months (mean: 12 months). One patient did not attend follow-up appointments. There were three cases of hernia recurrence (10%). Conclusion: The results suggest that laparoscopic repair of ventral incisional hernias is a safe, effective and technically feasible operation for small- to medium-sized hernias allowing shorter hospital stay, early recovery and resumption of normal activities. However, recurrence rates are comparable to open mesh hernioplasty especially for larger hernias. [source] The benefits and problems associated with minimal access surgeryAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 3 2002Ray Garry ABSTRACT The place of minimal access surgery (MAS) in current gynaecological practice remains controversial. As a consequence, MAS techniques have been subject to a significant amount of prospective, evidence-based assessment. The ultimate results of these comparative trials will undoubtedly have a profound impact on the future direction of our speciality. It is timely, therefore, to review the currently available data. Evidence from 2195 patients in 23 randomised clinical trials of five different treatment modalities (ectopic, ovarian cysts, myomectomy, colposuspension and hysterectomy) clearly demonstrates that uncomplicated MAS procedures produce patient-friendly benefits, at least in the short term. No matter what operation is performed, the laparoscopic approach is associated with less pain, shorter hospital stay and shorter recovery. These immediate patient-orientated benefits are a generic consequence of replacing the manoeuvres of open surgery through laparotomy incisions with minimal access. These benefits must be offset against significant disadvantages. Minimal access surgery procedures always require the use of expensive, high technology equipment and usually take longer to perform. Such procedures may be more costly than current open procedures and costs will, in part, be dependent on the amount of disposable equipment employed. Patients undergoing MAS procedures may be at risk of new and/or increased risk of traditional complications. The longer-term results of most MAS procedures have not yet been determined. These potential benefits and disadvantages of MAS require that each procedure is carefully and individually assessed. This paper seeks to review the current evidence. [source] Adnexectomy for benign pathology at vaginal hysterectomy without laparoscopic assistanceBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 12 2002Shirish S. Sheth Of 166 consecutive women with a benign adnexal mass scheduled for vaginal hysterectomy with adnexectomy, the operation was successful in 158 (95%). Preoperatively, attempts were made to ascertain that adnexal mass was benign and either freely mobile or with only slightly restricted mobility. Laparotomy was required in eight women, in five for adhesions and in three for malignancy detected during the operation. No woman required laparoscopic-assisted surgery. The 158 women who had successful vaginal hysterectomy with adnexectomy were compared with 100 similar women who had a laparotomy performed by same single operator. The vaginal group had a lower morbidity, speedier recovery and shorter hospital stay. [source] Intraoperative radiotherapy during radical prostatectomy for intermediate-risk to locally advanced prostate cancer: treatment technique and evaluation of perioperative and functional outcome vs standard radical prostatectomy, in a matched-pair analysisBJU INTERNATIONAL, Issue 11 2009Bernardo Rocco OBJECTIVE To evaluate a novel approach with intraoperative radiotherapy (IORT) administered in the surgical field, after pelvic lymphadenectomy (PL) and before radical retropubic prostatectomy (RRP), evaluating acute and late toxicity, complications and biochemical progression-free survival (bPFS), as the adequate treatment of locally advanced prostate cancer is still a controversial issue. PATIENTS AND METHODS Between June 2005 and October 2007, 33 consecutive patients with intermediate-risk or locally advanced prostate cancer were selected for PL + IORT + RRP. IORT was delivered by a mobile linear accelerator in the operating room (electron beam, 12 Gy at 90% isodose). According to the pathological findings further adjuvant radio- or hormone therapy could be administered. The median follow-up was 16 months. This group was compared retrospectively with a historical group of 100 patients who had undergone RRP and further adjuvant therapy, selected with equivalent criteria. The comparison was conducted as a matched-pair analysis. The perioperative outcomes (surgical time, estimated blood loss, blood transfusions, days of catheterization, days of drainage, days of hospitalization), continence as the functional outcome, acute and late toxicity, rate of complications and bPFS were evaluated and compared. RESULTS The baseline characteristics of the two groups were equivalent but the node count and the number of positive lymph nodes was higher in the IORT group. The IORT group had longer surgery, and a shorter hospital stay and catheterization. There were no differences in continence rate, and no major complications in either group. The acute and late toxicity and bPFS were equivalent. A retrospective comparison and the short follow-up were the major limitations. CONCLUSIONS IORT administered before RRP seems a feasible approach, with little effect on the variables evaluated. [source] Simultaneous bilateral percutaneous nephrolithotomy in childrenBJU INTERNATIONAL, Issue 1 2005Morshed A. Salah In the paediatric section, two papers relating to the upper urinary tract are presented. The first, from Hungary, describes simultaneous bilateral percutaneous nephrolithotomy in 13 patients, where it was deemed feasible; this is the first such report. Authors from London report on unilateral nephrectomy in patients with nephrogenic hypertension, and found that it was successful in normalising blood pressure in patients with renal hypertension with a normal contralateral kidney. OBJECTIVE To evaluate the efficacy of removing bilateral kidney stones simultaneously from children, in one session. PATIENTS AND METHODS Thirteen patients (three girls and 10 boys, 26 kidneys; mean age 8 years, range 3,14) underwent simultaneous bilateral percutaneous nephrolithotomy (PCNL) in the same session, under general anaesthesia, starting with ureteric catheter insertion into both kidneys and using a 26 F adult nephroscope. The mean (range) stone diameter was 2 (1,3.5) cm. Three patients had staghorn stones in one of their kidneys. Ultrasonic disintegration was used; two patients had bilateral and two others unilateral endopylotomy, and one patient had percutaneous suprapubic cystolithotomy in the same session. The mean (range) operative duration was 65 (55,90) min. RESULTS All patients were rendered stone-free; there was no severe bleeding or any other complication. On one side in one of the patients, a second session was needed because of residual stone. The nephrostomy tubes were removed 3 and 4 days after PCNL and the hospital stay was 6 (1,11) days. CONCLUSION The advantages of simultaneous bilateral PCNL are reduced psychological stress, one cystoscopy and anaesthesia, less medication and a shorter hospital stay and convalescence, with considerable savings in cost. In experienced hands this method can be used not only in adults but also in children. To our knowledge this is the only report of this technique in children. [source] Randomized clinical trial of single-incision laparoscopic cholecystectomy versus minilaparoscopic cholecystectomyBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 7 2010P.-C. Lee Background: Transumbilical single-incision laparoscopic cholecystectomy (SILC) and minilaparoscopic cholecystectomy (MLC) are both increasingly being used to treat symptomatic gallstones. The present study compared SILC and MLC with respect to outcome in a prospective randomized trial. Methods: Seventy patients with symptomatic cholelithiasis were randomized to SILC or MLC (35 in each group). The primary outcome measure was postoperative pain. Secondary outcomes were duration of operation, complications, postoperative analgesic requirements, length of hospital stay, cosmetic result, wound length and time to return to work. Results: Surgical complications, postoperative pain scores, analgesic requirements and time to return to work were similar for both procedures. Statistically significant advantages of SILC were a shorter hospital stay, shorter total wound length and better cosmetic appearance. Duration of operation was significantly shorter for MLC. Conclusion: SILC is superior to MLC in terms of cosmetic outcome, but not in postoperative pain and requirement for analgesics. Copyright © 2010 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source] A protocol is not enough to implement an enhanced recovery programme for colorectal resection,BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 2 2007J. Maessen Background: Single-centre studies have suggested that enhanced recovery can be achieved with multimodal perioperative care protocols. This international observational study evaluated the implementation of an enhanced recovery programme in five European centres and examined the determinants affecting recovery and length of hospital stay. Methods: Four hundred and twenty-five consecutive patients undergoing elective open colorectal resection above the peritoneal reflection between January 2001 and January 2004 were enrolled in a protocol that defined multiple perioperative care elements. One centre had been developing multimodal perioperative care for 10 years, whereas the other four had previously undertaken traditional care. Results: The case mix was similar between centres. Protocol compliance before and during the surgical procedure was high, but it was low in the immediate postoperative phase. Patients fulfilled predetermined recovery criteria a median of 3 days after operation but were actually discharged a median of 5 days after surgery. Delay in discharge and the development of major complications prolonged length of stay. Previous experience with fast-track surgery was associated with a shorter hospital stay. Conclusion: Functional recovery in 3 days after colorectal resection could be achieved in daily practice. A protocol is not enough to enable discharge of patients on the day of functional recovery; more experience and better organization of care may be required. Copyright © 2006 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source] Changing patterns in the management of gastric volvulus over 14 yearsBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 3 2000W. J. Teague Background: Gastric volvulus is an uncommon condition, which can be difficult to diagnose and treat. This study represents a large series of patients with the condition. Methods: All patients presenting with gastric volvulus over a 14-year period were reviewed. Results: Some 36 patients (median age 75 years) were identified. Volvulus, usually secondary to a hiatus hernia, presented acutely in 29 patients. The major symptoms were abdominal pain, vomiting and upper gastrointestinal haemorrhage. The most useful investigations were barium contrast studies and upper gastrointestinal endoscopy, which were helpful in 21 of 25 and 11 of 18 patients respectively. Treatment was conservative in five patients, by open surgery in 13 and laparoscopic repair in 18 (three converted to open operation). There were no major complications and no deaths. Median hospital stay was shorter in patients treated by laparoscopic rather than open surgery (6 (range 4,36) versus 14 (7,50) days; P < 0·05). Conclusion: Acute and chronic gastric volvulus can be treated successfully by either open or laparoscopic surgery. However, laparoscopic surgery now represents a safe and acceptable approach, with minimal morbidity and a significantly shorter hospital stay. This is likely to be of considerable benefit for the treatment of a predominantly elderly population, often with significant co-morbidity. © 2000 British Journal of Surgery Society Ltd [source] Use of myocutaneous flaps for perineal closure following abdominoperineal excision of the rectum for adenocarcinomaCOLORECTAL DISEASE, Issue 6 2010S. Chan Abstract Introduction, Abdominoperineal excision (APE) following radiotherapy is associated with a high rate of perineal wound complications. The use of myocutaneous flaps may improve wound healing. We present our experience using myocutaneous flaps for immediate reconstruction. Method, Prospective data were collected on patients undergoing APE from October 2003 to December 2008. Patient demographics, operating time, wound complications and length of stay were recorded. Results, Fifty-one patients underwent APE for rectal adenocarcinoma, 21 had primary closure and 30 had myocutaneous flap closure (24 VRAM, 6 gracilis). The proportion of patients undergoing preoperative radiotherapy in each group were 62% and 93% respectively (P = 0.011). There were no major complications following primary closure of the unirradiated perineum. Major perineal wound complications requiring reoperation or debridement were seen in three (14%) patients following primary closure and five (17%) patients with flap closure. After radiotherapy, closure with a flap reduced the length of stay from 20 to 15 days, but this difference was not statistically significant (P = 0.36). Conclusion, The use of flap closure in irradiated patients is associated with fewer perineal complications and a shorter hospital stay. [source] Convalescence after colonic surgery with fast-track vs conventional careCOLORECTAL DISEASE, Issue 8 2006D. H. Jakobsen Abstract Objective, To compare convalescence after colonic surgery with a fast-track rehabilitation programme vs conventional care. Background, Introduction of a multimodal rehabilitation programme (fast-track) with focus on epidural anaesthesia, minimal invasive surgical techniques, optimal pain control, and early nutrition and mobilization together with detailed patient information have led to a shorter hospital stay after colonic surgery. There are not much data on convalescence after discharge. Methods, A prospective, controlled, non-randomized interview-based assessment in 160 patients undergoing an elective, uncomplicated, open colonic resection or the Hartmann reversal procedure with a fast-track or a conventional care programme in two university hospitals. A structured interview-based assessment was performed preoperatively, and day 14 and 30 postoperatively. Results, Patients undergoing colonic surgery with a fast-track programme regained functional capabilities earlier with less fatigue and need for sleep compared with patients having conventional care. Despite early discharge of the fast-track patients (mean 3.4 days vs 7.5 days), no differences were found according to the need for home care, social care and visit to general practitioners, although the fast-track group had an increased number of visits at the outpatient clinic for wound care. More patients in the fast-track group were re-admitted, but the overall mean total hospital stay was 4.2 days vs 8.3 days in the conventional group. Conclusion, A fast-track rehabillitation programme led to a shorter hospital stay, less fatigue and earlier resumption of normal activities, without the increased need for support after discharge compared with conventionally treated patients after uncomplicated colonic resection. [source] Bilateral vocal fold paresis after endoscopic stapling diverticulotomy for zenker's diverticulumHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 3 2004Marc Thorne MD Abstract Background. Zenker's diverticulum may be treated with a variety of surgical techniques. Endoscopic methods, specifically endoscopic stapling diverticulotomy, have gained increasing acceptance because of shorter operative times, decreased morbidity, with shorter hospital stays and time to resumption of oral feedings. Methods and Results. We report the occurrence of bilateral vocal fold paresis after endoscopic stapling diverticulotomy for Zenker's diverticulum, previously unreported in the literature. This complication likely resulted from traction on the recurrent laryngeal nerves secondary to unfavorable patient anatomy. Conclusions. Endoscopic stapling diverticulotomy is a safe and effective treatment method for Zenker's diverticulum and remains our procedure of choice for most patients. However, inability to safely expose the diverticulum endoscopically results in a significant abandonment rate for attempted procedures and may result in significant postoperative complications.© 2004 Wiley Periodicals, Inc. Head Neck26: 294,297, 2004 [source] Healthcare Utilization of Elderly Persons Hospitalized After a Noninjurious Fall in a Swiss Academic Medical CenterJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 6 2006Laurence Seematter-Bagnoud MD OBJECTIVES: To determine the risk of hospital readmission, nursing home admission, and death, as well as health services utilization over a 6-month follow-up, in community-dwelling elderly persons hospitalized after a noninjurious fall. DESIGN: Prospective cohort study with 6-month follow-up. SETTING: Swiss academic medical center. PARTICIPANTS: Six hundred ninety persons aged 75 and older hospitalized through the emergency department. MEASUREMENTS: Data on demographics and medical, physical, social, and mental status were collected upon admission. Follow-up data were collected from the state centralized billing system (hospital and nursing home admission) and proxies (death). RESULTS: Seventy patients (10%) were hospitalized after a noninjurious fall. Fallers had shorter hospital stays (median 4 vs 8 days, P<.001) and were more frequently discharged to rehabilitation or respite care than nonfallers. During follow-up, fallers were more likely to be institutionalized (adjusted hazard ratio=1.82, 95% confidence interval=1.03,3.19, P=.04) independent of comorbidity and functional and mental status. Overall institutional costs (averaged per day of follow-up) were similar for both groups ($138.5 vs $148.7, P=.66), but fallers had lower hospital costs and significantly higher rehabilitation and long-term care costs ($55.5 vs $24.1, P<.001), even after adjustment for comorbidity, living situation, and functional and cognitive status. CONCLUSION: Elderly patients hospitalized after a noninjurious fall were twice as likely to be institutionalized as those admitted for other medical conditions and had higher intermediate and long-term care services utilization during follow-up, independent of functional and health status. These results provide direction for interventions needed to delay or prevent institutionalization and reduce subsequent costs. [source] The patient's vulnerability, dependence and exposed situation in the discharge process: experiences of district nurses, geriatric nurses and social workersJOURNAL OF CLINICAL NURSING, Issue 10 2006IngBritt Rydeman MSc Aim., The aim of the study was to obtain a deeper understanding of the experiences of the discharge process among different professionals. Background., An optimal discharge process for hospitalized elderly to other forms of care is of crucial importance, especially since health and medical policies encourages shorter hospital stays and increased healthcare service in outpatient care. Methods., Nurses and social workers from inpatient care, outpatient care, municipal care and social services were interviewed. Eight focus-group interviews with a total of 31 persons were conducted. The subsequent analyses followed a phenomenological approach. Results., The findings revealed three themes, Framework, Basic Values and Patient Resources, which influenced the professionals' actions in the discharge process. The overall emerging structure comprised the patient's vulnerability, dependence and exposed situation in the discharge process. Conclusion., In conclusion some factors are of special importance for the co-operation and the actions of professionals involved in the discharge process. Firstly, a distinct and common framework, with conscious and organizationally based values. Secondly the need to take the patient resources into consideration. Together these factors could contribute to secure the patients involvement in the discharge process and to design an optimal, safe and good care. Relevance to clinical practice:, Collaborative approaches among a range of professionals within a variety of organizations are common, especially in the care of the elderly. The role and support of both the organizations and the educational units are decisive factors in this area. [source] Critical appraisal of the management of severe malnutrition: 1.JOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 10 2006Epidemiology, treatment guidelines Abstract: Hospital case-fatality rates for severe malnutrition in the developing world remain high, particularly in Africa where they have not changed much over recent decades. In an effort to improve case management, WHO has developed treatment guidelines. The aim of this review is to critically appraise the evidence for the guidelines and review important recent advances in the management of severe malnutrition. We conclude that not only is the evidence base deficient, but also the external generalisability of even good-quality studies is seriously compromised by the great variability in clinical practice between regions and types of health facilities in the developing world, which is much greater than between developed countries. The diagnosis of severe wasting is complicated by the dramatic change in reference standards (from CDC/WHO 1978 to CDC 2000 in EpiNut) and also by difficulties in accurate measurement of length. Although following treatment guidelines has resulted in improved outcomes, there is evidence against the statement that case-fatality rates (particularly in African hospitals) can be reduced below 5% and that higher rates are proof of poor practice, because there is wide variation in severity of illness factors. The practice of prolonged hospital treatment of severe malnutrition until wasting and/or oedema has resolved is being replaced by shorter hospital stays combined with outpatient or community follow-up because of advances in dietary management outside of hospital. [source] Skills training in telerobotic surgeryTHE INTERNATIONAL JOURNAL OF MEDICAL ROBOTICS AND COMPUTER ASSISTED SURGERY, Issue 2 2005J Hance Abstract Surgical robots have the potential to expand the repertoire of minimally invasive surgery resulting in more patients benefiting from lower operative morbidity and shorter hospital stays. However, in a similar manner to all new surgical interventions it necessary to explore the learning curves of practitioners as they adopt this new technology to enable optimisation of future training programs. Only when the standard of practice is firmly established, should the proliferation of robotic practitioners be encouraged thus ensuring patient safety is not compromised. Copyright © 2005 Robotic Publications, Ltd. [source] Laparoscopy in paediatric urology: present statusBJU INTERNATIONAL, Issue 1 2007Marc C. Smaldone The spectrum of laparoscopic surgery in children has developed dramatically; what was initially used as a diagnostic method to identify an impalpable testis is now commonly used for complex reconstructive procedures such as pyeloplasty. Laparoscopic orchidopexy and nephrectomy are well established and are used at many centres. Laparoscopic partial nephrectomy, adrenalectomy and dismembered pyeloplasty series have reported shorter hospital stays and operative times that are comparable with that of open techniques, and/or decreasing with experience. The initial experiences with laparoscopic ureteric re-implantation and laparoscopically assisted bladder reconstructive surgery are reported, with encouraging results for feasibility, hospital stay, and cosmetic outcome. [source] | ||||||||||||||||||||||||||||