Nutritional status significantly affects hospital length of stay among surgical patients in public hospitals of Northern Ethiopia: single cohort study

Intraoperative Diastolic Hypotension-Prolonged Postoperative Hospital Stay in Patients with Gastric Cancer: A Retrospective Cohort Study with Propensity Score Matching

Purpose

In patients undergoing surgical resection for gastric cancer, perioperative hemodynamic fluctuations may affect organ perfusion, increase the incidence of postoperative complications, and prolong hospital stay.

Patients and Methods

We retrospectively identified patients who underwent resection for gastric cancer at our institution from April 1, 2015 to October 30, 2018. Demographic information, perioperative data, and information on postoperative recovery were recorded. The primary outcome was length of postoperative hospital stay; the secondary outcome was incidence of postoperative complications. Propensity score matching was performed. The associations between perioperative factors and postoperative hospital stay were analyzed using multivariable logistic regression models in the full and matched cohorts.

Results

In total, 933 patients were included; of these, 676 had diastolic hypotension (defined as diastolic blood pressure <60 mmHg for >10 min). In both cohorts, patients with diastolic hypotension had statistically significantly longer postoperative hospital stay (full: mean 14.5 ± standard deviation 10.2 vs 11.6 ± 6.5 days, P < 0.001; matched: 13.7 ± 9.9 vs 11.7 ± 6.6 days, P = 0.009) and a higher incidence of postoperative complications (full: 170 [25.1%] vs 27 [10.5%] cases, P < 0.001; matched: 60 [24.4%] vs 33 [13.4%] cases, P = 0.003), compared with patients without diastolic hypotension. After correction for confounding factors, intraoperative diastolic hypotension was associated with longer postoperative hospital stay in both the full and the matched cohort (full: HR, 1.535 [95% CI, 1.115-2.114], P = 0.009; matched: HR, 1.532 [95% CI, 1.032-2.273], P = 0.034).

Conclusion

For patients with gastric cancer, intraoperative diastolic hypotension may increase the incidence of postoperative complications and prolong postoperative hospital stay.

Incidence and predictors of attrition rate after children started inpatient treatments for complicated severe acute malnutrition in North West Ethiopia

BACKGROUND

Retaining children for inpatient treatment of complicated severe acute malnutrition (SAM) is a growing challenge until achieved the reference weight of a child. In Ethiopia, there is limited information regarding the time to be lost from the stabilizing centers after initiation of treatment. Thus, this study aimed to identify incidence and predictors of attrition for children suffering from SAM after started inpatient treatment in North West Ethiopia.

METHODS

A retrospective cohort study was conducted among under-five children admitted and started inpatient treatment for complicated SAM from 2015/2016 to 2020/2021. Data were entered using Epi-data version 4.2 and then exported to STATA (SE) version R-14 software for further analysis. The analysis was computed using Cox proportional hazard regression model after checking all proportional hazard assumptions. Covariates having < 0.2 of P values in the bi-variable analysis were candidates transferred to the multivariable Cox proportional hazard regression model. Finally, a statistical significance was declared at a P value of < 0.05.

RESULT

Overall, 760 files of under-five children were analyzed with a mean (± SD) age of participants 27.8 (± 16.5) months. About 6944 child-days of treatment observation were recorded with the crude incidence of attrition rate of 9.7% (95% CI 7.9-12.6). The overall median time of attrition and half-life time S(t_1/2) of survival rates was determined as 14 (IQR =  ± 7) days and 91.6% (95% CI 88.2-93.1), respectively. The attrition rate was significantly associated with cases living in rural residents (AHR = 6.03; 95% CI 2.2; 25.2), being re-admitted SAM cases (AHR = 2.99; 95% CI 1.62; 5.5), and caregivers did not have formal education (AHR = :5.6, 95% CI 2.7; 11.7) were all independent predictors for attrition from inpatient treatment.

CONCLUSIONS

Nearly one in every ten severely acute malnourished under-five children defaulted at the end of treatment observation with a median time of 14 (IQR =  ± 7) days. Living in a rural residence, being re-admitted cases, caregivers who did not have a formal education were significantly associated with the attrition rate. Hence, it is crucial to detect and control the identified causes of defaulting from treatment observation promptly. Furthermore, serious counseling during admission and nutritional provision strategies are essential for virtuous treatment outcomes.