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Bašković M, Markanović M, Ivanović S, Boričević Z, Alavuk Kundović S, Pogorelić Z. Risk Factors Leading to Overnight Stays in Pediatric Surgical Outpatients. Children (Basel) 2024; 11:382. [PMID: 38671599 PMCID: PMC11049595 DOI: 10.3390/children11040382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Revised: 03/12/2024] [Accepted: 03/21/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Same-day surgery implies patient discharge on the same day after the surgery. The main aim of the research was to determine which predisposing factors lead to children treated with same-day surgery not being able to be discharged on the same day. METHODS For the purposes of this research, the electronic records of patients in the hospital information system were reviewed retrospectively. The search included patients who were surgically treated through the Day Surgery Unit at the Children's Hospital Zagreb with various diagnoses from 1 January 2021 to 31 December 2023. The target group consisted of patients who could not be discharged on the same day (n = 68), while for the purposes of the control group (n = 68), patients were randomly selected, comparable by age and gender, who were discharged from the hospital on the same day in accordance with the principles of same-day surgery. RESULTS In relation to the parameters of interest between the groups, statistically significant differences were observed in the type of general anesthesia (p = 0.027), the use of analgesics (p = 0.016), the time of entering the operating room (p = 0.000), the time of leaving the operating room (p < 0.0001) and the duration of surgery (76.81 ± 37.21 min vs. 46.51 ± 22.46 min, p < 0.0001). When explanatory variables were included in the regression model, they explained 38% of the variability in the dependent variable. Only the variable "duration of surgery" provided significant information to explain the variability in the dependent variable (p = 0.004). CONCLUSIONS Although the duration of surgery was imposed as the main predictor of hospitalization after same-day surgery, and considering the extremely small number of studies on the mentioned topic, especially in the pediatric population, further, preferably multicenter research on the mentioned topic is needed.
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Affiliation(s)
- Marko Bašković
- Department of Pediatric Surgery, Children’s Hospital Zagreb, Ulica Vjekoslava Klaića 16, 10000 Zagreb, Croatia; (M.B.)
- School of Medicine, University of Zagreb, Šalata 3, 10000 Zagreb, Croatia
- Scientific Centre of Excellence for Reproductive and Regenerative Medicine, School of Medicine, University of Zagreb, Šalata 3, 10000 Zagreb, Croatia
| | - Martina Markanović
- Department of Pediatric Surgery, Children’s Hospital Zagreb, Ulica Vjekoslava Klaića 16, 10000 Zagreb, Croatia; (M.B.)
- Day Surgery Unit, Children’s Hospital Zagreb, Ulica Vjekoslava Klaića 16, 10000 Zagreb, Croatia
| | - Sanja Ivanović
- Department of Pediatric Surgery, Children’s Hospital Zagreb, Ulica Vjekoslava Klaića 16, 10000 Zagreb, Croatia; (M.B.)
- Day Surgery Unit, Children’s Hospital Zagreb, Ulica Vjekoslava Klaića 16, 10000 Zagreb, Croatia
| | - Zrinka Boričević
- Department of Surgery, General Hospital Karlovac, Ulica Andrije Štampara 3, 47000 Karlovac, Croatia
| | - Sandra Alavuk Kundović
- School of Medicine, University of Zagreb, Šalata 3, 10000 Zagreb, Croatia
- Department of Anesthesiology, Reanimatology and Intensive Care Medicine, Children’s Hospital Zagreb, Ulica Vjekoslava Klaića 16, 10000 Zagreb, Croatia
| | - Zenon Pogorelić
- Department of Pediatric Surgery, University Hospital of Split, Spinčićeva Ulica 1, 21000 Split, Croatia
- Department of Surgery, School of Medicine, University of Split, Šoltanska Ulica 2a, 21000 Split, Croatia
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Prasitlumkum N, Cheungpasitporn W, Chokesuwattanaskul R, Kewcharoen J, Tokavanich N, Navaravong L, Jongnarangsin K. Comparison between same-day discharge and overnight stay after atrial fibrillation ablation: Systematic review and meta-analysis. Pacing Clin Electrophysiol 2021; 44:2054-2066. [PMID: 34657314 DOI: 10.1111/pace.14380] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 08/08/2021] [Accepted: 10/11/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND In the modern era, atrial fibrillation (AF) ablation trend has been shifted toward same-day discharge (SDD), from a traditional overnight stay. Yet, recent studies have not well stated the safety profiles which remained poor-understood and dispersed. We hence performed systematic review and meta-analysis to assess the adverse outcomes of SDD in comparison with an overnight stay. METHODS Databases were searched through January 2021. Effect estimates from the individual studies were extracted and combined using random-effects, generic inverse variance method of der Simonian and Laird. The primary outcomes included total cumulative complications and immediate complications following AF ablation. RESULTS Ten observational studies were met our inclusion criteria, comprising of total population of 11,660 patients, with SDD 51.3%. For total cumulative complications, there were no differences observed between SDD and overnight stay (5.2% vs. 6.2%: pooled OR 0.77: 95% CI 0.55-1.08, p = .13 with I2 = 27.1%). In addition, comparable immediate complications were also demonstrated (5.2 % vs. 4.3: pooled OR 1.08: 95% CI 0.72-1.62, p = .718, with I2 = 37.3 %). CONCLUSION Our study suggested that SDD had similar complication rates, both total cumulative and immediate outcomes, compared with overnight stay in selected patients following AF ablation. Nevertheless, randomized control trials are warranted to validate the findings.
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Affiliation(s)
- Narut Prasitlumkum
- Division of Cardiology, University of California Riverside, Riverside, California, USA
| | | | - Ronpichai Chokesuwattanaskul
- Division of Cardiovascular Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.,Cardiac Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.,Center of Excellence in Arrhythmia Research Chulalongkorn University, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Jakrin Kewcharoen
- Department of Cardiology, Loma Linda University, Loma Linda, California
| | - Nithi Tokavanich
- Division of Cardiovascular Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.,Center of Excellence in Arrhythmia Research Chulalongkorn University, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Leenhapong Navaravong
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Krit Jongnarangsin
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
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Bovonratwet P, Chen AZ, Shen TS, Ondeck NT, Islam W, Ast MP, Su EP. What Are the Reasons and Risk Factors for 30-Day Readmission After Outpatient Total Hip Arthroplasty? J Arthroplasty 2021; 36:S258-S263.e1. [PMID: 33162278 DOI: 10.1016/j.arth.2020.10.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 10/04/2020] [Accepted: 10/09/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND A higher volume of primary total hip arthroplasty (THA) is starting to be performed as an outpatient procedure. However, data on appropriate patient selection for this surgical protocol is scarce. METHODS Patients who underwent primary THA were identified in the 2012-2018 National Surgical Quality Improvement Program database. Outpatient procedure was defined as having a hospital length of stay of 0 days. The primary outcome was a readmission within the 30-day postoperative period. Risk factors for and effect of overnight hospital stay on 30-day readmission after outpatient THA were identified through multivariable models. Reasons for and timing of readmission were also identified. RESULTS A total of 5245 outpatient THA patients and 44,171 patients who stayed 1 night were identified. The incidence of 30-day readmission after outpatient THA was 1.60% (95% confidence interval [CI] 1.26-1.94). Risk factors for 30-day readmission after outpatient THA include the following: older age relative to 18-60 years old (most notably 71-75 years old, relative risk [RR] = 2.3, 95% CI = 1.15-4.62; 76-80 years old, RR = 6.6, 95% CI = 3.55-12.43; and >80 years old, RR = 5.6, 95% CI = 2.43-12.89, P < .001) and bleeding disorders (RR = 4.5, 95% CI = 1.45-14.31, P = .010). For patients who had some of these risk factors, their risk of medically related 30-day readmission was reduced if they had stayed 1 night at the hospital (P < .05). The majority of readmissions were surgically related (62%), including wound complications (27%) and periprosthetic fractures (25%). CONCLUSION The rate of 30-day readmission after outpatient THA was low. Patients who are at high risk for 30-day readmission after outpatient THA include those with older age and bleeding disorders. Some of these patients may benefit from an inpatient hospital stay.
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Affiliation(s)
- Patawut Bovonratwet
- Department of Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY; Department of Orthopaedic Surgery, NewYork-Presbyterian Hospital, Weill Cornell Medical Center, New York, NY
| | - Aaron Z Chen
- Department of Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY
| | - Tony S Shen
- Department of Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY; Department of Orthopaedic Surgery, NewYork-Presbyterian Hospital, Weill Cornell Medical Center, New York, NY
| | - Nathaniel T Ondeck
- Department of Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY; Department of Orthopaedic Surgery, NewYork-Presbyterian Hospital, Weill Cornell Medical Center, New York, NY
| | - Wasif Islam
- Department of Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY
| | - Michael P Ast
- Department of Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY
| | - Edwin P Su
- Department of Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY
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Sentell KT, Badani KK, Paulucci DJ, Hemal AK, Porter J, Eun DD, Bhandari A, Abaza R. A Single Overnight Stay After Robotic Partial Nephrectomy Does Not Increase Complications. J Endourol 2019; 33:1003-1008. [PMID: 31422698 DOI: 10.1089/end.2019.0218] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Objectives: To evaluate the feasibility of postoperative day 1 (POD1) discharge after robotic partial nephrectomy (RPN) and to determine whether a protocol targeting a shorter length of stay (LOS) is associated with any difference in the rate of postoperative complications. Materials and Methods: We reviewed a prospectively maintained, multi-institutional database of patients who underwent RPN from September 2013 to September 2016. Three of the six participating surgeons used a protocol that targeted discharge on POD1, whereas three surgeons did not. Patient characteristics and postoperative complication rates between the two groups were compared. Results: A total of 665 patients were included, 455 of whom were treated by surgeons utilizing a POD1 discharge protocol, whereas 210 were not. The mean LOS for those in the POD1 protocol group was 1.13 days vs 2.02 days in the non-protocol group. Between groups, there were no differences in age (p = 0.098), body mass index (p = 0.164), tumor size (p = 0.502), or R.E.N.A.L. Nephrometry score (p = 0.974), but POD1 discharge protocol patients had higher age-adjusted Charlson comorbidity score (4 vs 2, p = 0.033), were less likely to have a hilar tumor (15.9% vs 23.1%, p = 0.03), and had a larger percent decrease in discharge estimated glomerular filtration rate (-15.9% vs -7.1%, p < 0.001). There were no differences in the rates of overall (p = 0.715), major (p = 0.164), medical (p = 0.089), or surgical complications (p = 0.301) or in complications by the Clavien-Dindo category (p = 0.13). Conclusion: Discharge on POD1 after RPN is feasible, reproducible by different surgeons, and not associated with an increased risk of postoperative complications.
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Affiliation(s)
- Katherine T Sentell
- OhioHealth Robotic Urologic and Cancer Surgery, Dublin Methodist Hospital, Dublin, Ohio
| | - Ketan K Badani
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - David J Paulucci
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ashok K Hemal
- Department of Urology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - James Porter
- Department of Urology, Swedish Medical Center, Seattle, Washington
| | - Daniel D Eun
- Department of Urology, Temple University School of Medicine, Philadelphia, Pennsylvania
| | - Akshay Bhandari
- Division of Urology, Columbia University at Mount Sinai, Miami Beach, Florida
| | - Ronney Abaza
- OhioHealth Robotic Urologic and Cancer Surgery, Dublin Methodist Hospital, Dublin, Ohio
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Abstract
BACKGROUND Few studies have investigated climbing-related acute mountain sickness (AMS) on Mt Fuji. Although several studies of AMS have been conducted elsewhere, Mt Fuji is unique because there are many mountain lodges between the fifth station (a common starting point for climbers at an altitude of 2305 m) and the summit (3776 m), and many climbers commonly sleep overnight at mountain lodges during their ascents. This study surveyed the prevalence of AMS among climbers on Mt Fuji to determine which factors, if any, were related to the risk of developing AMS. METHODS This study collected data from 345 participants who climbed Mt Fuji in August 2013, including information regarding age, sex, climbing experience and whether the climber stayed at a mountain lodge (n = 239). AMS was surveyed using the Lake Louise Score (LLS) questionnaire. The item on perceived sleep quality was excluded for those who did not stay at a mountain lodge (n = 106). RESULTS The overall prevalence of AMS was 29.5% (≥ 3 LLS with headache). According to a univariate analysis, AMS was not associated with sex (male vs female), age group (20-29, 30-39, 40-49 or >50 years) or stay at a mountain lodge (single day vs overnight stay). Conversely, prior experience climbing Mt Fuji (no prior attempts vs one or more prior attempts) was related to the risk of AMS. In addition, there was a significant deviation in the number of participants reporting poor sleep, and total sleep time was significantly shorter in participants with AMS. CONCLUSIONS These preliminary findings suggest that no single factor can explain the risk for developing AMS while climbing Mt Fuji. In addition, impaired perceived sleep quality was associated with the severity of AMS in climbers who stayed overnight at a mountain lodge.
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Affiliation(s)
- Masahiro Horiuchi
- Division of Human Environmental Science, Mt Fuji Research Institute, Kami-Yoshida 5597-1, Fuji-Yoshida-City, Yamanashi, 4030005, Japan and
| | - Junko Endo
- Division of Human Environmental Science, Mt Fuji Research Institute, Kami-Yoshida 5597-1, Fuji-Yoshida-City, Yamanashi, 4030005, Japan and
| | - Shin Akatsuka
- Division of Human Environmental Science, Mt Fuji Research Institute, Kami-Yoshida 5597-1, Fuji-Yoshida-City, Yamanashi, 4030005, Japan and
| | - Tadashi Uno
- Division of Human Environmental Science, Mt Fuji Research Institute, Kami-Yoshida 5597-1, Fuji-Yoshida-City, Yamanashi, 4030005, Japan and
| | - Thomas E Jones
- Division of Human Environmental Science, Mt Fuji Research Institute, Kami-Yoshida 5597-1, Fuji-Yoshida-City, Yamanashi, 4030005, Japan and
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