Association between preoperative hemoglobin with length of hospital stay among non-cardiac and non-obstetric surgery patients: a secondary analysis of a retrospective cohort study
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SUBMITTER: Wang Z
PROVIDER: S-EPMC10870523 | biostudies-literature | 2024 Jan
REPOSITORIES: biostudies-literature
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Project description:BackgroundEven though the importance of preparing patients for a surgical event is recognized, there are still gaps about the benefit of improving functional capacity by walking during the waiting time among patients scheduled for non-cardiac surgery. The aim of this study was to evaluate the impact of pre-surgical walking in-hospital length of stay, early ambulation, and the appearance of complications after surgery among patients scheduled for non-cardiac surgery.MethodsA two-arm, single- blinded randomized controlled trial was developed from May 2016 to August 2017. Eligible outpatients scheduled for non-cardiac surgery, capable of walking, were randomized (2:1 ratio) to receive a prescription of walking 150 min/week during the whole pre-surgical waiting time (n = 249) or conventional care (n = 119). The primary outcome was the difference in hospital length of stay, and secondary results were time to first ambulation during hospitalization, description of ischemic events during hospitalization and after six months of hospital discharge, and the walking continuation. We performed an intention to treat analysis and compared length of stay between both groups by Kaplan-Meier estimator (log-rank test).ResultsThere were no significant differences in the length of hospital stay between both groups (log-rank test p = 0.367) and no differences in the first ambulation time during hospitalization (log-rank test p = 0.299). Similar rates of postoperative complications were observed in both groups, but patients in the intervention group continued to practice walking six months after discharge (p < 0.001).ConclusionOur study is the first clinical trial evaluating the impact of walking before non-cardiac surgery in the length of stay, early ambulation, and complications after surgery. Prescription of walking for patients before non-cardiac surgery had no significant effect in reducing the length of stay, and early ambulation. The results become a crucial element for further investigation.Trial registrationPAMP-Phase2 was registered in ClinicalTrials.gov NCT03213496 on July 11, 2017.
| S-EPMC8320206 | biostudies-literature
Project description:Background: Endoscopic transsphenoidal surgery is the most common technique for the resection of pituitary adenoma. Data on factors associated with extended hospital stay after this surgery are limited. We aimed to characterize the relationship between preoperative medications and the risk of prolonged postoperative length of stay after this procedure. Methods: This single-center, retrospective cohort study included all adult patients scheduled for transsphenoidal pituitary surgery from 1 July 2016 to 31 December 2019. Anatomical Therapeutic Chemical codes were used to identify patients’ preoperative medications. The primary outcome was a prolonged postoperative hospital length of stay. Secondary outcomes included unplanned admission to the Intensive Care Unit, and in-hospital and one-year mortality. We developed a descriptive logistic model that included preoperative medications, obesity and age. Results: Median postoperative length of stay was 3 days for the 704 analyzed patients. Patients taking ATC-H drugs were at an increased risk of prolonged length of stay (OR 1.56, 95% CI 1.26−1.95, p < 0.001). No association was found between preoperative ATC-H medication and unplanned ICU admission or in-hospital mortality. Patients with multiple preoperative ATC-H medications had a significantly higher mean LOS (5.4 ± 7.6 days) and one-year mortality (p < 0.02). Conclusions: Clinicians should be aware of the possible vulnerability of patients taking systemic hormones preoperatively. Future studies should test this medication-based approach on endoscopic transsphenoidal pituitary surgery populations from different hospitals and countries.
| S-EPMC9572419 | biostudies-literature
Project description:BackgroundAnaemia is frequently recorded during preoperative screening and has been suggested to affect outcomes after surgery negatively.ObjectivesThe objectives were to assess the frequency of moderate to severe anaemia and its association with length of hospital stay.DesignPost hoc analysis of the international observational prospective 'Local ASsessment of VEntilatory management during General Anaesthesia for Surgery' (LAS VEGAS) study.Patients and settingThe current analysis included adult patients requiring general anaesthesia for non-cardiac surgery. Preoperative anaemia was defined as a haemoglobin concentration of 11 g dl-1 or lower, thus including moderate and severe anaemia according to World Health Organisation criteria.Main outcome measuresThe primary outcome was length of hospital stay. Secondary outcomes included hospital mortality, intra-operative adverse events and postoperative pulmonary complications (PPCs).ResultsHaemoglobin concentrations were available for 8264 of 9864 patients. Preoperative moderate to severe anaemia was present in 7.7% of patients. Multivariable analysis showed that preoperative moderate to severe anaemia was associated with an increased length of hospital stay with a mean difference of 1.3 ((95% CI 0.8 to 1.8) days; P < .001). In the propensity-matched analysis, this association remained present, median 4.0 [IQR 1.0 to 5.0] vs. 2.0 [IQR 0.0 to 5.0] days, P = .001. Multivariable analysis showed an increased in-hospital mortality (OR 2.9 (95% CI 1.1 to 7.5); P = .029), and higher incidences of intra-operative hypotension (36.3 vs. 25.3%; P < .001) and PPCs (17.1 vs. 10.5%; P = .001) in moderately to severely anaemic patients. However, this was not confirmed in the propensity score-matched analysis.ConclusionsIn this international cohort of non-cardiac surgical patients, preoperative moderate to severe anaemia was associated with a longer duration of hospital stay but not increased intra-operative complications, PPCs or in-hospital mortality.Trial registrationThe LAS VEGAS study was registered at Clinicaltrials.gov, NCT01601223.
| S-EPMC9867571 | biostudies-literature
Project description:BackgroundThe remarkable advancements in surgical techniques over recent years have shifted the clinical focus from merely reducing mortality to enhancing the quality of postoperative recovery. The duration of a patient's hospital stay serves as a crucial indicator in evaluating postoperative recovery and surgical outcomes. This study aims to identify predictors of the length of hospital stay for children who have undergone corrective surgery for Ebstein Anomaly (EA).MethodsWe conducted a retrospective cohort study on children (under 18 years of age) diagnosed with EA who were admitted for corrective surgery between January 2009 and November 2021 at Fuwai Hospital. The primary outcome was the Time to Hospital Discharge (THD). Cox proportional hazard models were utilized to identify predictors of THD. In the context of time-to-event analysis, discharge was considered an event. In cases where death occurred before discharge, it was defined as an extended THD, input as 100 days (exceeding the longest observed THD), and considered as a non-event.ResultsA total of 270 children were included in this study, out of which three died in the hospital. Following the Cox proportional hazard analysis, six predictors of THD were identified. The hazard ratios and corresponding 95% confidence intervals were as follows: age, 1.030(1.005,1.055); C/R > 0.65, 0.507(0.364,0.707); Carpentier type C or D, 0.578(0.429,0.779); CPB time, 0.995(0.991,0.998); dexamethasone, 1.373(1.051,1.795); and transfusion, 0.680(0.529,0.875). The children were categorized into three groups based on the quartile of THD. Compared to children in the ≤ 6 days group, those in the ≥ 11 days group were associated with a higher incidence of adverse outcomes. Additionally, the duration of mechanical ventilation and ICU stay, as well as hospital costs, were significantly higher in this group.ConclusionWe identified six predictors of THD for children undergoing corrective surgery for EA. Clinicians can utilize these variables to optimize perioperative management strategies, reduce adverse complications, improve postoperative recovery, and reduce unnecessary medical expenses.
| S-EPMC11316292 | biostudies-literature
Project description:The number of available hospital beds is decreasing in many countries. Reducing the length of hospital stay (LOS) and increasing bed turnover could improve patient flow. We evaluated whether robot-assisted surgery (RAS) had a beneficial impact on the LOS in a French hospital trust with a long-established robotic program (Assistance Publique-Hôpitaux de Paris, AP-HP). We extracted data from "Programme de Médicalisation des Systèmes d'Information" to determine the median LOS for adults in our trust after RAS versus laparoscopy and open surgery in 2021-2022 for eight target procedures, and compared data nationally and at similar academic centres (same database). We also calculated the number of hospitalisation days 'saved' using RAS. Overall, 9326 target procedures were performed at AP-HP: 3864 (41.4%) RAS, 2978 (31.9%) laparoscopies, and 2484 (26.6%) open surgeries. The median LOS for RAS was lower than laparoscopy and open surgery for all procedures, apart from hysterectomy and colectomy (equivalent to laparoscopy). Results for urological procedures at AP-HP reflected national values. The equivalent of 5390 hospitalisation days was saved in 2021-2022 using RAS instead of open surgery or laparoscopy at AP-HP; of these, 86% represented hospitalisation days saved using RAS in urological procedures. Using RAS instead of open surgery or laparoscopy (particularly in urological procedures) reduced the median LOS and may save thousands of hospitalisation days every year. This should help to increase patient turnover and facilitate patient flow.
| S-EPMC11374824 | biostudies-literature
Project description:Preoperative sarcopenic status can affect length of hospital stay and patient outcomes after surgery. The aim of this study was to investigate the impacts of preoperative handgrip strength (HGS) on length of stay (LOS) and outcomes after lumbar fusion surgery. HGS was measured preoperatively, and the cut-off value for low HGS was <28 kg for men and <18 kg for women. Perioperative patient outcomes were compared between patients with low and normal HGS. A total of 225 patients, consisting of 86 and 139 patients in the low and normal HGS groups, respectively, fully satisfied the study criteria for analysis. A longer LOS (median 10 vs. 8 days, p = 0.013) and a higher incidence of serious postoperative complications (15.1 vs. 3.6%, p = 0.002) were observed in the low HGS group. In the multivariate analysis, a low HGS (odds ratio (OR) = 1.917, 95% confidence interval (CI) = 1.046-3.513, p = 0.035) was significantly associated with a longer LOS after surgery. Preoperative HGS below the reference values by sex appeared to be an independent factor associated with longer LOS after lumbar fusion surgery.
| S-EPMC9323344 | biostudies-literature
Project description:ObjectivesOur aim was to identify which patients are likely to stay in hospital longer following total hip replacement surgery.DesignLongitudinal, observational study used routinely collected data.SettingData were collected from an NHS Trust in South-West England between 2016 and 2019.Participants2352 hip replacement patients had complete data and were included in analysis.Primary and secondary outcome measuresThree measures of length of stay were used: a count measure of number of days spent in hospital, a binary measure of ≤7 days/>7 days in hospital and a binary measure of remaining in hospital when medically fit for discharge.ResultsThe mean length of stay was 5.4 days following surgery, with 18% in hospital for more than 7 days, and 11% staying in hospital when medically fit for discharge. Longer hospital stay was associated with older age (OR=1.06, 95% CI 1.05 to 1.08), being female (OR=1.42, 95% CI 1.12 to 1.81) and more comorbidities (OR=3.52, 95% CI 1.45 to 8.55) and shorter length of stay with not having had a recent hospital admission (OR=0.44, 95% CI 0.32 to 0.60). Results were similar for remaining in hospital when medically fit for discharge, with the addition of an association with highest socioeconomic deprivation (OR=2.08, 95% CI 1.37 to 3.16).ConclusionsOlder, female patients with more comorbidities and from more socioeconomically deprived areas are likely to remain in hospital for longer following surgery. This study produced regression models demonstrating consistent results across three measures of prolonged hospital stay following hip replacement surgery. These findings could be used to inform surgery planning and when supporting patient discharge following surgery.
| S-EPMC11340698 | biostudies-literature
Project description:Any manipulation on open bowel causes interventional impact on gut microbiome, and surgical stress triggers bacterial translocation; thus, it will be fundamental to determine gut microbiome after surgery. Monitoring dynamic changes in microbiome of post-surgical infants who received probiotics and placebo could provide with important information about gut colonization and potential bacterial overgrowth. The purpose of this study is to assess the effect of probiotics supplementation on length of hospital stay, duration of parenteral nutrition, and feed tolerance in neonates after gastrointestinal surgery.
| S-EPMC6913565 | biostudies-literature
Project description:Study Design Retrospective case series. Objective Recent studies suggest that baseline hematocrit (Hct) levels may affect the surgical outcomes after orthopedic procedures. The authors examined whether preoperative Hct values had a significant effect on the hospital length of stay (LoS) after lumbar spinal procedures. Methods We retrospectively reviewed patients who underwent routine lumbar spine procedures from November 2012 through September 2013. Patients were included if they had both a baseline Hct and hospital LoS recorded. Patients were divided into two groups: those with an Hct ≥ 40% (nonanemic) and those with an Hct < 40% (anemic). LoS after surgery was evaluated for each group. Results One hundred seventeen patients underwent lumbar spine procedures for lumbar stenosis (n = 34), symptomatic lumbar disk herniation (n = 39), lumbar spondylolisthesis (n = 26), lumbar adjacent segment disease (n = 8), or symptomatic recurrent lumbar disk herniation (n = 10). Mean LoS was 3.3 and 2.4 days in anemic (27 patients) and nonanemic groups (90 patients), respectively (p = 0.02). The linear regression analysis demonstrated that a decrease in Hct was associated with a longer stay. A decrease from preoperative to postoperative day 1 Hct of 3.5 points resulted in an increased LoS of 1 day (R (2) = 0.145; p = 0.002). The correlation of Hct decrease with longer LoS remained (β = 0.167, p = 0.006) after adjusting for other variables with multivariate regression analysis. Conclusions Lower preoperative Hct or a substantial decrease in Hct may contribute to longer hospitalization after lumbar spine surgery. These findings should prompt an investigation into the strategies for optimizing Hct levels in patients with preoperative anemia prior to lumbar spine procedures.
| S-EPMC4577325 | biostudies-other
Project description:BackgroundSugammadex is a newer medication used for rapid and reliable reversal of neuromuscular blockade. This study evaluated whether sugammadex could reduce the length of postoperative hospital stay in patients undergoing abdominal surgery.MethodsThis single center retrospective cohort study included patients who underwent major abdominal surgery between January 2015 and October 2019. Patients were randomized according to reversal with sugammadex or spontaneous recovery. The primary outcome was length of postoperative hospital stay. The secondary outcomes were length of post-anesthetic care unit (PACU) stay, postoperative ambulation time, time-to-first-defecation, and incidence of pulmonary complications. After 1:1 propensity score matching, univariate and multiple linear regression analyses estimated the differences in outcomes.ResultsOf the 1614 patients, 517 received sugammadex and 645 spontaneously recovered. After adjusting for potential confounders, non-linear relationship was detected between administration of sugammadex and the length of postoperative hospital stay (β = 0.29 95% confidence interval {CI}: [- 1.13, - 0.54], P = 0.4912). However, it was associated with shorter PACU stay (β = - 20.30 95% CI: [- 24.48, - 17.11], P < 0.0001), shorter time to postoperative ambulation movement (β = - 0.43 95% CI: [- 0.62, - 0.23], P < 0.0001), and reduced time-to-first-defecation (β = - 2.25 95% CI: [- 0.45, - 0.05], P = 0.0129), when compared to the spontaneously recovered group. The incidence of pneumonia in the sugammadex group was significantly lower than that in the spontaneously recovered group (18.6% [44/237] vs. 39.2% [93/237] P < 0.05).ConclusionsNeuromuscular blockade reversal with sugammadex after abdominal surgery demonstrated an excellent recovery profile and was associated with decreased risk of pneumonia, although it did not affect the length of postoperative hospital stay.
| S-EPMC9875499 | biostudies-literature