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Objectives: To report the prevalence of invasive bacterial infection (IBI) in febrile infants ≤90 days presenting to hospital within 72 h of meningococcal B (MenB) immunisation. Methods: A secondary analysis of data from two previous multicentre studies of febrile infants conducted at UK and Irish hospitals. The first study was a retrospective study, conducted at six sites between 31 August 2018 and 1 September 2019. The second study was a prospective study conducted at 35 sites between 6 July 2022 and 31 August 2023. Febrile infants ≤90 days who had received the MenB vaccine within 72 h preceding presentation were included. Results: A total of 102 infants met the inclusion criteria, with a median age of 61 days and a male predominance of 65.7%. The most reported clinical features were an abnormal cry, decreased feeding and coryzal symptoms. In total, 68/102 (66.7%) were admitted to hospital; the median length of stay was 1 day. Median C-reactive protein (CRP) was 20.5 mg/L, mean white cell count was 13.7 × 109/L, mean neutrophil count was 7.3 × 109/L and mean lymphocyte count was 4.7 × 109/L. In total, 38/102 (37.3%) had blood cultures performed, 26/102 (25.5%) had respiratory viral testing performed, 55/102 (53.9%) had urine culture performed and 14/102 (13.7%) had lumbar puncture performed. Additionally, 26/102 (25.5%) received parenteral antibiotics. There were no cases of IBI, and 3/102 (2.9%) cases of urinary tract infection. Conclusions: The rate of IBI is negligible in febrile infants following MenB immunisations. Current blood tests such as CRP are unreliable in this cohort, as many exhibit a moderate CRP rise above suggested international cut-offs for this age range. [ABSTRACT FROM AUTHOR]

Introduction: In this single-center retrospective analysis, we present case data and insights gathered over the past eight years. Additionally, we computed postnatal, pre-therapy lesion-to-lung ratios of Congenital Pulmonary Airway Malformations (CPAMs) to retrospectively assess potential outcome prediction using lesion-to-lung ratios. Methods: Data were collected between 2015 and 2022. Information such as chosen therapy, surgical duration, postoperative hospital stay, and follow-up was obtained from electronic case records. Pre-therapy pulmonary lesion volumes [mm3], lesion-to-ipsilateral-lung ratio, and lesion-to-both-lungs ratio of CPAMs were retrospectively calculated from computed tomography images using specialized software. Results: Of the 40 identified cases, 27 had CPAM, 7 had pulmonary sequestration, 4 had bronchogenic cysts, and 2 had congenital lobar emphysema. Histological examinations of resected specimens revealed no malignancy. For CPAMs, the median surgery age was 7 months (interquartile range (IQR): 0.45–11), averaging 9.54 ± 15.01 months. The CPAM surgery lasted on average 126 ± 53 min (median 124 min (IQR 108–172)). The mean length of hospital stay was 6 ± 1.41 days for thoracoscopic surgery and 17 ± 18.23 days for open surgery. No clear link was found between the lesion ratio and management choice or surgical length. Notably, larger lesions tended to result in longer postoperative stays. CPAMs with a lesion-to-ipsilateral-lung ratio of ≤0.11 were asymptomatic. Discussion and Conclusions: If patients present no symptoms, mild symptoms, or smaller CPAM lesions, "wait and watch" and a CT scan of the thorax up to approximately six months of age remain a reasonable approach. The true risk of malignancy remains ambiguous, especially since there was no evidence of malignancy in our biopsies. On the other hand, prophylactic surgery before symptoms arose led to earlier discharge and overall low intraoperative complications compared to symptomatic counterparts. Ultimately, the adopted therapy pathway remains a parental choice. For CPAMs, an increased lesion-to-lung ratio correlated with extended hospital stay and symptomatic presentation. However, there was no cut-off value for conservative or surgical treatment. [ABSTRACT FROM AUTHOR]

Introduction: Cytomegalovirus (CMV) DNAemia has been described in critically ill patients, including patients with severe acute respiratory syndrome-coronavirus2 (SARS-CoV-2) infection. Our objective is to evaluate the prevalence and clinical impact of CMV DNAemia among patients undergoing invasive mechanical ventilation (IMV) for severe SARS-CoV-2 infection and to explore the association between CMV DNAemia levels and clinical outcomes. Methods: In this retrospective monocentric study, we included patients admitted in a tertiary ICU for severe COVID-19 and who required IMV. We aimed to compare clinical and demographic variables between patients with and without CMV DNAemia. Univariate and Cox regression analyses were performed to identify factors associated with CMV DNAemia. Results: During the study period, CMV blood DNAemia occurred in 30/135 patients (22%). Patients with CMV blood DNAemia had longer ICU and hospital length of stay, as well as longer duration of IMV, and were more likely to have received dexamethasone. However, there was no significant difference in ICU mortality between patients with and without CMV DNAemia (64.8% vs. 56.7%, p = 0.42). The Cox regression analysis showed that dexamethasone was the only factor independently associated with CMV blood DNAemia (HR 4.23 [1.006–17.792], p = 0.049). Conclusions: In patients with severe SARS-CoV-2 pneumonia requiring IMV, CMV DNAemia is common and associated with prolonged ventilation and increased LOS but not with increased mortality. [ABSTRACT FROM AUTHOR]

Telemedicine brings several benefits to patients, healthcare providers, and the wider society, including reductions in the need for hospitalizations or readmissions, as well as in overall healthcare costs and the length of inpatient stay. In addition, these services may provide psychological benefits to patients, including excellent satisfaction and medication adherence. The present study aimed to investigate an in-house-developed otorhinolaryngologic remote diagnostic system (mobile app). The basis of the comparison was the incidence between the diagnoses and therapies made by remote diagnosticians and on-site specialists based on static images and videos captured by a smartphone otoscope device. In the study, 103 patients were involved. After registering demographic data, the telemedicine software was evaluated by comparing the matching of physically established diagnoses and/or therapies with remotely established diagnoses and/or therapies. The most remarkable result was in concordance with the diagnoses, with 79 matches identified of the 103 cases examined; the rate of the matching cases was 76.7% (95% CI: 68.5–84.9%). These results support that telemedicine-based otorhinolaryngological remote diagnostics could play a significant role in future healthcare. [ABSTRACT FROM AUTHOR]

Background/Objectives: Isolated cecum necrosis (ICN) is a rare disease and there are few reports on it in the literature. We retrospectively analyzed the patients with acute abdomen who had ICN, in terms of etiology, demographic findings, surgery, and prognosis to determine the best treatment approach. Methods: Seven patients with per-operative diagnosis of isolated cecal necrosis were included in the study. Age, gender, comorbidities, symptoms, laboratory data, imaging modalities, time from symptoms to surgery, surgical procedure, hospital stay, morbidity, and mortality were retrospectively analyzed. Results: The median age of the patients and the F/M ratio were 61 years and 2/5, respectively. The most common comorbidity was chronic renal failure, followed by hypertension, diabetes mellitus, and coronary artery disease. The median time from symptom onset to surgery was 1 day. The ileocolic anastomosis was performed in 4 patients and terminal ileostomy in three patients. The morbidity and mortality rates were 28.5% and 14.3%, respectively. The median length of hospital stay was 12 days. Conclusions: ICN should be suspected in elderly patients with comorbidities presenting to the emergency department with an acute abdomen. Computed tomography is an important diagnostic tool. Diagnostic laparoscopy is a good option for definitive diagnosis and end ileostomy is better than anastomosis in patients with bleeding tendency or hypotensive patients with chronic renal failure on dialysis, coronary artery disease, and in the presence of purulent peritonitis to reduce morbidity and mortality. [ABSTRACT FROM AUTHOR]

Background/Objectives: Robotic breast reconstruction is an innovative surgical technique that integrates robotic technology into breast reconstruction procedures, offering several advantages over conventional approaches. These benefits include enhanced visualization, increased surgical dexterity, and superior cosmetic outcomes. This study aims to comprehensively compare robotic-assisted and conventional breast reconstruction approaches in terms of complication profiles and operation-related measurements. Methods: A comprehensive search was conducted in PubMed, Embase, Scopus, Web of Science, Google Scholar, CENTRAL, and VHL from inception to October 2024 to identify relevant studies. Risk ratios for the following complications were calculated between the groups: donor site seroma, hematoma, infection, and unplanned reoperation. Mean differences were also calculated for the duration of surgery, length of postoperative hospital stays, and opioid use. Results: A meta-analysis was performed on 9 studies including a total of 1094 patients. No significant differences were found between the groups in the risk ratios for reoperation, seroma formation, delayed healing, infections, and hematomas. Similarly, there were no significant differences in postoperative opioid use. The duration of surgery was longer in the robot-assisted reconstruction group, whereas the duration of hospital stay was shorter compared to the conventional group. Meta-regression analysis for the duration of surgery model showed that none of the moderators had a statistically significant effect on this outcome. ROBINS-I assessment indicated that all the included studies had a serious risk of bias. Conclusions: Our results suggest that using a robot-assisted approach is associated with a shorter duration of hospital stay and a longer duration of surgery. [ABSTRACT FROM AUTHOR]

Background/Objectives: Hospital length of stay (LOS) is widely analyzed and serves as a benchmark for assessing changes during hospitalization. This study introduced a method to estimate patients' LOS and highlighted the variations in LOS among individuals with or without multiple chronic conditions (MCCs) and across different levels of disease severity, using data from the 2016 National Inpatient Sample in the United States. Methods: To analyze the factors influencing LOS, a multinomial logistic regression model was employed, demonstrating its effectiveness in estimating and predicting expected LOS. Factors such as demographic characteristics, MCCs, and disease severity were strongly linked to LOS. Results: The overall prevalence of MCCs exceeded 66%, rising to over 90% among elderly patients and more than 88% among those with severe diseases. LOS distribution was primarily concentrated within the first month following admission: over 13% of patients were discharged within a day, over 85% within a week, and more than 99% within a month. Multinomial logistic regression analysis showed that LOS was significantly influenced by age, disease severity, and the presence of MCCs. Older patients, especially those with MCCs, had significantly longer LOSs compared to younger patients without MCCs. Conclusions: LOS tended to increase with age and higher disease severity, particularly in patients with MCCs. Multinomial logistic regression revealed that patients over 65 and those with high disease severity (severity score 4) had significantly longer LOS. Shorter LOS was more frequent among patients under 65 years old, those without MCC, and those with low disease severity, whereas longer LOS was commonly observed in patients with MCCs or high disease severity. [ABSTRACT FROM AUTHOR]

Simple Summary: In this study, whether preoperative diaphragm dysfunction increases the risk of postoperative lung complications (PPCs) after lung cancer surgery was examined. The results showed that patients with diaphragm atrophy had a higher risk of PPCs and longer hospital stays compared to those with normal diaphragm thickness. There was also a moderate link between diaphragm thickness during expiration and the number of complications. These findings suggest that diaphragm atrophy is an important, modifiable risk factor for PPCs, highlighting the potential benefit of early therapeutic interventions to improve outcomes after lung cancer surgery. Background/Objectives: Various conditions contribute to the development of postoperative pulmonary complications (PPCs) following thoracic surgery. In this study, the aim was to investigate whether preoperative diaphragm dysfunction is associated with an increased risk of PPCs after lung cancer resection. Methods: We prospectively examined 45 patients scheduled for video-assisted thoracoscopic surgery (VATS) lobectomy or open thoracotomy. Relevant clinical data were retrieved from hospital database records, while diaphragm muscles were assessed using ultrasound. Results: Our results demonstrated that preoperative diaphragm muscle atrophy was significantly associated with a higher risk of developing PPCs compared to patients with normal diaphragm thickness. Diaphragm atrophy was also linked to prolonged hospital stays. Additionally, we observed a moderate correlation between expiratory diaphragm thickness and the number of PPCs. Conclusions: Low diaphragm expiratory thickness is associated with postoperative pulmonary complications after lobectomy for lung cancer. Importantly, unlike other predictive factors such as age, COPD, or smoking, diaphragmatic atrophy is a modifiable risk factor that can potentially be addressed through early therapeutic intervention. [ABSTRACT FROM AUTHOR]

Objectives: To analyze the clinical characteristics, trends in hospitalization, and healthcare resource utilization of pediatric patients with fecal impaction. Methods: We utilized the Healthcare Cost and Utilization Project (HCUP) databases, including the National Inpatient Sample (NIS) and the Kids Inpatient Database (KID) datasets from 2011 to 2019, to include all hospitalizations of patients up to 18 years of age with a primary diagnosis of (1) fecal impaction or (2) a primary diagnosis of abdominal pain or constipation with a secondary diagnosis of fecal impaction. The study analyzed various comorbid factors and clinical characteristics of these patients. For healthcare resource utilization, we analyzed the length of hospital stays and total hospital charges, adjusted for inflation. Results: A total of 23,570 admissions due to fecal impactions in children between the years 2011 and 2019 were analyzed, contributing to 0.18% of the total pediatric admissions. Hospitalization rates nearly doubled from 2011 (0.15%) to 2019 (0.29%). The mean hospitalization charges also trended upwards from 15,234 USD in 2011 to 22,487 USD in 2019. The inflation-adjusted annual rate of increase in hospital charges during this period was 5.9% per year. Aggressive fecal disimpaction procedures (either manual or surgical) were performed in approximately 3% of these admissions. Multivariate regression showed that older children (13–18 years of age) were more likely to require aggressive disimpaction. Female children, those with Hispanic ethnicity, and those with obesity were less likely to be associated with the need for disimpaction. Conclusions: Hospitalizations for fecal impaction have increased significantly over the past decade, creating a substantial burden on healthcare resources. Our study highlights the importance of aggressive outpatient management strategies with close follow-up for fecal impactions, which will potentially minimize these hospitalizations. [ABSTRACT FROM AUTHOR]

Background: The lactate dehydrogenase to albumin ratio (LAR) is a novel inflammatory marker and a potential predictor of mortality in various conditions. No research has yet examined LAR's impact on mortality in cardiac surgery patients. This study evaluated LAR's role in predicting mortality and complications in isolated coronary artery bypass grafting (CABG) patients. Methods: A retrospective analysis of 377 CABG patients (93 women, 24.7%; 284 men, 75.3%; mean age 65.9 years) from 2020 to 2024 was conducted. Data included demographics, preoperative characteristics, surgical details, and postoperative outcomes, along with ICU and hospital length of stay (LOS). Results: In-hospital mortality was 6.1% (n = 23). Independent predictors were low preoperative ejection fraction (EF) (OR: 0.96, p = 0.024), baseline LAR (OR: 1.08, p = 0.000), LOS-ICU (OR: 1.1, p = 0.000), postoperative ventricular tachycardia (OR: 37.9, p = 0.006), and acute renal failure (OR: 12.1, p = 0.000). Mortality cases had a higher median LAR than survivors (8.6 vs. 5.2, p = 0.000). Elevated LAR correlated with lower preoperative EF (r = −0.227, p = 0.000), longer LOS-ICU (r = 0.17, p = 0.001), and longer LOS-hospital (r = 0.208, p = 0.000). A LAR cut-off of 7.097 predicted mortality (AUC: 0.823, sensitivity 78.3%, specificity 77.1%). Elevated LAR values were observed in all groups with postoperative complications (p < 0.05), indicating its consistent association with negative outcomes. Conclusions: LAR is a valuable predictor of in-hospital mortality and postoperative complications in CABG patients. Elevated LAR is associated with longer ICU/hospital stays and poorer outcomes. Preoperative LAR assessment can guide risk stratification, forecast mortality, and inform surgical planning and treatment strategies. [ABSTRACT FROM AUTHOR]

Background/Objectives: Enhanced recovery after surgery (ERAS) protocols aim to improve clinical outcomes, shorten hospital length of stay (LOS), and reduce costs through a multidisciplinary perioperative approach. Although introduced in colorectal surgery, they are less established in cardiac surgery, especially in combination with on-table extubation (OTE). This study evaluates the impact of a novel ERAS concept with OTE (RERACS) in elective aortic-valve-replacement and coronary bypass surgery. Methods: In a monocentric study, we compared a prospective RERACS-group (n = 114) to a retrospective control group (n = 119) (TRIAL Registration (DRKS00031402). The RERACS concept contained multiple perioperative treatment measures such as respiratory training, short fasting, and OTE. The control group received standard care. Results: Primary endpoint: postoperative LOS. Secondary measurements: length of postoperative vasoactive drug support, duration of mechanical ventilation, complication rate, and patient satisfaction on the second postoperative day. RERACS patients showed significantly shorter postoperative length of stay (ICU: 40 ± 34 h vs. 56 ± 51 h, p = 0.005; hospital: 9 ± 4 d vs. 11 ± 6 d, p = 0.028), lower nosocomial infection rates (24% vs. 40%), fewer cases of postoperative cognitive dysfunction ((subsyndromal) delirium 40% vs. 57%), reduced nausea and vomiting (14.9% vs. 32.8%), and faster weaning from catecholamines (22 ± 30 h vs. 42 ± 48 h, p < 0.001), as well as high patient satisfaction. Conclusions: Our study indicated that an ERAS concept with OTE is safe and associated with faster and improved recovery, including lower catecholamine requirements, reduced LOS, and high patient satisfaction in low-risk cardiac surgery. [ABSTRACT FROM AUTHOR]

Background: CABG is a commonly performed procedure to improve survival and quality of life in patients with coronary artery disease. Despite advances in surgical techniques and perioperative care, postoperative pneumonia remains a serious complication contributing to increased morbidity, mortality and healthcare costs. This study aims to evaluate the incidence of postoperative pneumonia (POP) and identify its risk factors in patients undergoing isolated CABG. Methods: This retrospective study analyzed 430 patients who underwent CABG between 2019 and 2024. Patient demographics, clinical characteristics, surgical details and laboratory data were collected. Statistical analysis included univariate and multivariate logistic regression to identify significant predictors of pneumonia. Results: The incidence of POP after CABG was 10% (43/430). In patients with POP, diabetes mellitus (p = 0.03) and chronic kidney disease (p = 0.048) prevalence was higher, cardiopulmonary bypass (CPB) (p = 0.01) and cross-clamp time (p = 0.003) was longer, LDH levels (p = 0.017) were higher, hemoglobin (p = 0.012) and albumin (p = 0.015) levels were lower, and lymphocyte % (p = 0.04) was lower; prevalence of COPD and length of stay (LOS) in hospital tended to be higher (both p < 0.06). Multivariate binary logistic regression identified COPD (OR 4.383, 95% CI: 1.106–17.363, p = 0.035), CPB time (OR 1.013, 95% CI: 1.001–1.025, p = 0.030) and LOS (OR 1.052, 95% CI: 1.004–1.103, p = 0.035) as independent predictors of POP. Conclusions: Postoperative pneumonia is a common complication after CABG and is strongly associated with preoperative COPD, CPB time and length of stay in hospital. These findings underline the importance of preoperative risk assessment and optimization. Early identification of high-risk patients may allow targeted strategies such as enhanced respiratory support and prophylactic antibiotics to reduce the incidence of pneumonia and improve clinical outcomes. [ABSTRACT FROM AUTHOR]

Simple Summary: Kidney cancers can sometimes form a tumor thrombus capable of growing into the renal vein and inferior vena cava, and these tumor thrombi can even extend above the diaphragm and into the right atrium and right ventricle. Surgical removal of these tumor thrombi, along with the kidney tumor, is necessary to cure patients, but can require cardiac bypass and circulatory arrest, which adds significant risk for patients undergoing surgery. Here, we describe a novel technique of endovascular tumor thrombus removal prior to surgery. We demonstrate that this technique can eliminate the need for cardiac bypass and its associated risks, thereby making surgery safer and more accessible for patients with advanced kidney cancers with a venous tumor thrombus extending into the inferior vena cava and above the diaphragm, as these patients would otherwise need to undergo cardiac bypass with circulatory arrest for curative surgery. Background: Renal cell carcinoma tends to invade venous structures, frequently extending beyond the inferior vena cava and into the heart itself, such as into the right atrium or right ventricle. Resection of tumor burden, particularly tumor thrombus, often requires cardiopulmonary bypass (CPB) and deep hypothermic circulatory arrest (DHCA), which is not feasible for all patients. Methods: Described in this study is a novel, minimally invasive endovascular approach involving endovascular thrombectomy as a viable approach in these select patients. Results: There were no surgical complications, shorter operating times, less blood loss and an average length of stay of 5.5 days in the four patients undergoing this procedure. Conclusions: We demonstrate that this technique can eliminate the need for cardiac bypass and deep hypothermic cardiac arrest and its associated risks, thereby making surgery safer and more accessible for patients with advanced kidney cancers with an inferior vena cava tumor thrombus. Furthermore, it allows for this life-saving surgery to be carried out in medical centers or hospitals where cardiac surgery is unavailable, or when cardiopulmonary bypass is medically contraindicated. [ABSTRACT FROM AUTHOR]

Simple Summary: Colorectal cancer is the third most common cancer worldwide, with colon cancer accounting for approximately 60% of all cases. Robotic-assisted surgery has emerged as a promising minimally invasive technique for resection. This study evaluates and compares the outcomes of robotic-assisted surgery and laparoscopic-assisted surgery for stage I to III colon cancer, using data collected between 2018 and 2024. By analyzing matched patient groups, the findings demonstrate that robotic-assisted surgery leads to faster recovery, fewer cases of bowel obstruction in left-sided colectomies, greater lymph node retrieval in right-sided colectomies, and reduced postoperative pain compared to laparoscopic-assisted surgery. These results underscore the potential of robotic-assisted surgery to enhance recovery and improve surgical precision. The study provides valuable evidence that may influence surgical practices and promote the broader adoption of robotic technology, particularly in the treatment of colon cancer. Background and Objective: Colorectal cancer (CRC) is the third most common cancer worldwide, with colon cancer accounting for approximately 60% of all CRC cases. Surgery remains the primary and most effective treatment. Robotic-assisted surgery (RAS) has emerged as a promising approach for colon cancer resection. This retrospective study compares RAS and laparoscopic-assisted surgery (LSS) for stage I–III colon cancer resections at a single medical center in East Asia. Methods: Between 1 January 2018, and 29 February 2024, patients undergoing colectomy were classified into right-side and left-side colectomies. Propensity score matching was conducted based on age group, gender, ASA score, and BMI to ensure comparability between groups. After matching, there were 50 RAS and 200 LSS cases for right colectomy (RC), and 129 RAS and 258 LSS cases for left colectomy (LC). Perioperative outcomes were compared between the two surgical approaches. The primary outcomes were recovery milestones, while secondary outcomes included complications and postoperative pain scores. Results: RAS demonstrated faster recovery milestones compared to LSS (hospital stay: 6.5 vs. 10.2 days, p = 0.005 for RC; 5.5 vs. 8.2 days, p < 0.001 for LC). RAS also resulted in lower rates of ileus (14% vs. 26%, p = 0.064 for RC; 6.2% vs. 15.9%, p = 0.007 for LC) and higher lymph node yields (31.4 vs. 26.8, p = 0.028 for RC; 25.8 vs. 23.9, p = 0.066 for LC). Major complication rates showed no significant difference between RAS and LSS (4.0% vs. 7.0%, p = 0.746 for RC; 4.7% vs. 3.1%, p = 0.563 for LC). Patients in the RAS group experienced earlier diuretic phases and reported significantly lower postoperative pain scores (3.0 vs. 4.1, p = 0.011 for RC; 2.9 vs. 4.1, p < 0.001 for LC). Conclusions: Robotic-assisted surgery is associated with faster recovery, lower rates of ileus (LC), higher lymph node yield (RC) and reduced postoperative pain compared to laparoscopic-assisted surgery for colon cancer resection. [ABSTRACT FROM AUTHOR]

Background: Emerging evidence highlights the critical role of discharge planning teams in enhancing patient care. However, there is lack of data regarding how the implementation of a discharge planning system influences the length of stay (LOS) in hospital and readmission rates among patients with neurological diseases. We conducted a retrospective analysis to examine the effects of discharge planning application on the LOS and readmission rates for patients admitted under the neurology service in Saudi Arabia. Methods: This is a retrospective study conducted at King Abdulaziz Medical City—Western region of Saudi Arabia. We included all patients admitted and discharged under the neurology service between January 2018 and December 2019. The included patients who were divided into the 2018 group (not exposed to discharge planner) and the 2019 group (exposed to discharge planner). The primary endpoints were the LOS and readmission rates. Results: The study included 856 patients (436 allocated to the 2019 group and 420 allocated to the 2018 group). There was no difference between the two groups in the LOS after adjusting confounding factors (β = −0.58, 95% CI [−2.79, 1.61], p = 0.60). However, the 2019 group were more likely to be discharged within three days compared to the 2018 group (41% vs. 26%, p < 0.005). Our analysis showed that patients in the 2019 group were less likely to be readmitted compared to the 2018 group (adjusted odds ratio = 0.70, 95% CI [0.49–0.99], p = 0.0442). Conclusions: Implementation of a discharge planning team was associated with higher early discharge rates and lower hospital readmissions, suggesting potential benefits for healthcare resource utilization in neurological services. [ABSTRACT FROM AUTHOR]

Background/Objectives: Early-onset sepsis in neonates is a potentially catastrophic condition that demands prompt management. However, laboratory diagnosis via cerebral spinal fluid and blood tests is often inconclusive, so diagnosis on the basis of clinical symptoms and risk factors is frequently required, and the majority of neonates treated with antibiotics for presumed early-onset sepsis (PEOS) do not have culture-proven sepsis. The management of such PEOS is mainly achieved via antibiotic therapy, which itself has adverse effects, creating a dilemma for clinicians in optimising healthcare. This study aimed to assess the impact of PEOS management on the common neonatal concerns of feeding tolerance, hyperbilirubinaemia, weight gain, and length of stay (LoS) in moderate to late preterm infants. Methods: A single-site, matched-cohort, retrospective study was performed on infants born between 32+3 and 36+6 weeks (2016 to 2019) admitted to the Neonatal Unit. PEOS infants on antibiotics (PEOS) were strictly matched by gestational age (±1 day) and birthweight (±5%) against a non-PEOS reference group (NPEOS). The key outcomes included the following: enteral feeding commencement and achievement; feeding intolerance (FI); phototherapy commencement and duration; antibiotic therapy duration; maximum bilirubin (MaxBili); LoS; and net postbirth weight gain. Results: There were no cases of culture-proven early-onset sepsis. PEOS (n = 185): NPEOS (n = 185) via multivariable analysis showed delayed enteral feed commencement (adjusted Odds Ratio [aOR]: 2.75; 95% confidence interval [CI]: 2.32, 3.27); there was no difference in FI, delayed onset of peak jaundice (aOR: 1.24; 95%CI: 1.12, 1.37), increased duration of phototherapy (aOR: 1.24; 95%CI: 1.10, 1.41), and increased LoS (aOR: 1.31; 95%CI; 1.02, 1.67). A univariate analysis also showed the following results (PEOS: NPEOS): no significant difference in MaxBili and delayed full enteral feed achievement (p = 0.010). Univariant or multivariable analysis showed no difference in irradiance levels. However, for NPEOS infants undergoing 0 or 1 phototherapy light treatment, there was an increased irradiance for PEOS (<0.001, 0.037, respectively). Conclusions: In moderate to late preterm infants, while PEOS diagnosis and management resolve the negative health impacts of potential sepsis, they are associated with negative healthcare outcomes on feeding, jaundice, and hospital length of stay. [ABSTRACT FROM AUTHOR]

Objective: This study aims to evaluate and identify the main preoperative risk factors affecting the timely discharge of day surgery patients, offering evidence to enhance preoperative assessments and minimize delayed discharge. Background: With the widespread adoption of day surgery in global healthcare systems, ensuring timely discharge of patients post-surgery has become a critical challenge. Numerous studies have explored various preoperative risk factors influencing delayed discharge. This meta-analysis integrates existing evidence to clarify the primary preoperative risk factors. Methods: A systematic search was conducted across the PubMed, CINAHL, Scopus, Web of Science, Embase, Cochrane Library, and CNKI databases, including all clinical studies on preoperative risk factors for day surgery published until 15 October 2024. A systematic review and random effects model were employed to aggregate data and estimate the main preoperative risk factors for day surgery. Results: A total of nine studies involving 41,458 patients were included. The analysis revealed statistically significant differences in the following preoperative risk factors: age (MD = 1.33, 95% CI: 0.73–1.93, p < 0.0001), body mass index (BMI) (MD = 0.69, 95% CI: 0.18–1.20, p = 0.008), the presence of chronic comorbidities (OR = 3.62, 95% CI: 2.93–4.46, p < 0.00001), the type of anesthesia (OR = 15.89, 95% CI: 7.07–35.69, p < 0.00001), a history of cardiac disease (OR = 2.46, 95% CI: 1.71–3.53, p < 0.00001), gender (OR = 3.18, 95% CI: 2.03–4.99, p < 0.00001), the expected duration of surgery (MD = 0.18, 95% CI: 0.15–0.20, p < 0.00001), complex procedures (OR = 1.78, 95% CI: 1.47–2.16, p < 0.00001), a lack of social family support (OR = 2.42, 95% CI: 1.60–3.67, p < 0.0001), and inadequate preoperative assessment (OR = 3.64, 95% CI: 2.06–6.41, p < 0.00001). There were no statistically significant differences between the delayed discharge group and the non-delayed discharge group in terms of the American Society of Anesthesiologists (ASA) classification (p = 1.00) and preoperative anxiety (p = 0.08). Conclusion: This study identifies the primary preoperative risk factors for delayed discharge in day surgery, including age, high BMI, the presence of chronic comorbidities, the type of anesthesia, a history of cardiac disease, gender, the duration of surgery, the complexity of the procedure, a lack of social family support, and inadequate preoperative assessment. These findings provide a reference for preoperative assessment, highlighting the need for clinical attention to these high-risk groups during preoperative screening and management to reduce the likelihood of delayed discharge and enhance surgical safety and success rates. [ABSTRACT FROM AUTHOR]

Background/Objectives: Globally, healthcare systems face challenges in optimizing performance, particularly in the wake of the COVID-19 pandemic. This study focuses on the analysis and forecasting of key performance indicators (KPIs) for the County Emergency Clinical Hospital in Craiova, Romania. The study evaluates indicators such as average length of stay (ALoS), bed occupancy rate (BOR), number of cases (NC), case mix index (CMI), and average cost per hospitalization (ACH), providing insight into their dynamics and future trends. Methods: We performed statistical analyses on quarterly data from 2010 to 2023, employing descriptive statistics and stationarity tests (e.g., Dickey–Fuller), using ARIMA models to forecast each KPI, ensuring model validation through tests for autocorrelation, heteroscedasticity, and stationarity. The model selection prioritized Akaike and Schwarz criteria for robustness. Results: The findings reveal that ALoS and BOR demonstrate seasonality and are influenced by colder months, and it is expected that the ALoS will stabilize to around five days by 2025. Moreover, we predict that the BOR will range between 46 and 52%, reflecting these seasonal variations. The NC forecasts indicate a post-pandemic recovery but to below pre-pandemic levels, and we project the CMI to stabilize at around 1.54, suggesting a return to consistent case complexity. The ACH showed significant growth, particularly in the fourth quarter, driven by inflation and seasonal costs, and it is projected to reach more than RON 3000 by 2025. Conclusions: This study highlights the utility of ARIMA models in forecasting healthcare KPIs, enabling proactive resource planning and decision-making. The findings underscore the impact of seasonality and economic factors on hospital operations, offering valuable insights for improving efficiency and adapting to post-pandemic challenges. [ABSTRACT FROM AUTHOR]

Neuroinvasive West Nile Virus disease (WNND) can cause lasting cognitive and motor impairments, impacting autonomy and quality of life. Given the scarcity of research on the rehabilitative needs of patients with WNV infection, this study aims to fill a critical gap by assessing the rehabilitation needs of a real-world cohort of WNND patients. We retrospectively analyzed WNND patients who received early Physical Medicine and Rehabilitation (PMR) evaluations during the 2022 outbreak in Veneto, Italy. Data included demographics, comorbidities, length of hospital stay, days at PMR evaluation, and rehabilitation duration until discharge or death, alongside objective examination findings and Barthel Index scores. Among 29 confirmed WNND patients, the median hospital stay was 20 days, with rehabilitation starting after a median of 7 days. Motor weakness affected 48.28% of patients, swallowing issues 6.90%, and respiratory issues 24.13%. A tailored rehabilitation protocol was designed for 96.55% of patients to address functional concerns and prevent complications. Barthel Index scores showed no significant change. Discharge settings were home (58.34%), other departments (25%), and rehabilitation facilities (16.67%). This study highlights the rehabilitation needs of WNND patients, particularly regarding neuromuscular deficits, swallowing, and respiratory issues, stressing the importance of a comprehensive rehabilitation strategy for improved outcomes. [ABSTRACT FROM AUTHOR]

OBJECTIVE. The optimal surgical approach for thymoma resection is still an object of debate. The increasing experience in robotic-assisted thoracic surgery (RATS) has led to the progressive affirmation of this technique as a valid alternative to Sternotomy, Thoracotomy and Video-Assisted Thoracic Surgery (VATS) in this setting. The present study aims to compare the post-operative and short-term results of RATS Thymectomy for thymoma with those of other main surgical approaches (sternotomy, thoracotomy and VATS) from a high-volume single center. METHODS. Between May 2021 and September 2023, 40 consecutive patients underwent RATS Thymectomy for stage I to limited-stage III thymoma in our center. Three homogenous groups of patients who received thymoma resection through main alternative approaches (sternotomy, thoracotomy, VATS) over the last 5 years, were identified in order to perform a comparative analysis. Data including surgery duration, associated resections, conversion rate, overall morbidity, tumor size, radicality of resection, post-operative pain, length of hospital stay and cosmetic results were retrospectively collected and compared between the RATS and each control group. RESULTS. Mean tumor size was higher in the sternotomy group, but not significantly. The mean operative time of RATS interventions was significantly lower than that of sternotomy and VATS. It was significantly shorter compared to thoracotomy if excluding docking-undocking time. A higher rate of associated adjacent structures resection was reported in the sternotomy group (p = 0.005). Conversion rate was significantly higher in the VATS group (p = 0.026) compared to RATS. Post-operative pain at 24 and 48 h was significantly lower in the RATS group compared to the others. Improved cosmetics results were reported after RATS compared to sternotomy (p = 0.0001) and thoracotomy (p = 0.001) groups, with a trend towards better results compared to VATS (p = 0.05). Length of hospital stay was shorter in the RATS group with a significant difference vs. the sternotomy group (p < 0.001). CONCLUSIONS. These results from a single center confirm the safety and efficacy of RATS for the treatment of limited stage thymoma. An advantage in terms of operative outcomes, post-operative pain, cosmetic results and hospital stay was observed if compared to the alternative approaches. The short-term oncologic outcome was excellent based on the high complete resection rate of the tumor. [ABSTRACT FROM AUTHOR]

Continuous monitoring on the general ward leads to more and earlier interventions to prevent clinical deterioration. These clinical actions influence outcomes and may serve as an indicator of impending deterioration. This study aims to correlate clinical actions with clinical endpoints and deviating vital signs. Methods: This cohort study prospectively charted all patients undergoing continuous vital sign monitoring on a gastro-intestinal and oncological surgery, and an internal ward of an academic hospital in The Netherlands from 1 August 2018 till 31 July 2019 (METC 2018-4330, NCT04189653). Clinical actions recorded in electronic medical records were analyzed to assess correlations with patient outcomes, hospital length of stay, and alarming monitoring minutes. Results: A total of 1529 patients were included, of which 68 patients had a negative clinical endpoint. There were 2749 clinical actions recorded. Clinical actions correlated to negative clinical endpoints (ρ = 0.259; p < 0.001, OR: 3.4 to 79.5) and to the length of stay (ρ = 0.560; p < 0.001). Vital sign deviations correlated with clinical actions (ρ = 0.025–0.056; p < 0.001–p = 0.018). In the last 72 h before a clinical endpoint, for alarming minutes, this correlation with clinical actions was more pronounced (ρ = 0.340, p < 0.001). Conclusions: Predefined clinical actions performed on admitted general ward patients correlated with negative endpoints, an increased length of stay, and with deviating vital signs, especially in the period directly preceding severe deterioration. Clinical actions have potential as an intermediate measurement of deterioration. [ABSTRACT FROM AUTHOR]

Background/Objectives: Mandibular fractures are among the most common facial injuries. Bilateral fractures of the mandibular body region (BBMFs), however, are rare. The aim of this retrospective study was to analyze the characteristics, surgical management, and outcomes of BBMFs in a third-level trauma center in northern Italy. Methods: Between 1 January 2001 and 31 December 2023, the following data were collected about patients hospitalized for BBMFs: age, sex, cause of fracture, dental status, degree of mandibular atrophy, surgical approach, number and thickness of plates used, concomitant maxillofacial fractures, length of hospital stay, and outcomes. Statistical analysis was performed using SPSS software. Results: During the study period, 26 patients (11 males and 15 females) presented with BBMFs, of which five were dentate (median age, 19 years) and 21 edentulous (median age, 80 years). The primary cause of trauma was road traffic accidents (RTAs) in dentate patients and falls in edentulous patients. In most dentate patients, fractures were treated using an intraoral approach with rigid or mixed fixation, using ≤1.4 mm thick plates. Edentulous patients were primarily treated using an extraoral approach and rigid fixation with ≥1.5 mm plates. The use of plates ≥ 1.5 mm was statistically associated with edentulous patients (p = 0.042) and with increasing degrees of atrophy (p = 0.020). Conclusions: This study shows that BBMFs are uncommon injuries, associated with high-impact trauma in dentate patients and medium- or low-impact trauma, such as falls, in edentulous patients. Internal fixation was predominantly rigid, with thicker plates used as the degree of mandibular atrophy increased. [ABSTRACT FROM AUTHOR]

Background: Reduction mammaplasty is a common, elective, and safe operation, usually executed in healthy patients. Nonetheless, postoperative complications like bleeding and seroma formation can occur and significantly complicate the postoperative course. Tranexamic acid (TXA), a commonly used antifibrinolytic drug, offers a novel approach to reduce these complications. This study aims to evaluate its effect on the rate of postoperative bleeding, drainage volume, length of hospital stay, and other postoperative complications in patients undergoing reduction mammaplasty. Method: A retrospective study on all patients undergoing reduction mammaplasty at the Department of Plastic, Reconstructive, and Aesthetic Surgery EOC between 2015 and 2022 was conducted. Patients were divided into the TXA group receiving systemic TXA for 48 h and the control group not receiving any TXA. All data were analyzed using nonparametric formulas. Results: A total of 209 breasts were included in the study, with 138 cases in the control group and 71 in the TXA group. Three cases requiring revision surgery due to bleeding were observed in the control group, whereas none were observed in the TXA group. Total drainage volume was significantly reduced in the TXA group compared to the control group (TXA: 41.6 mL vs. control: 53.8 mL; p = 0.012), resulting in a significant reduction in length of hospital stay (TXA: 1.6 days vs. control: 2.2 days; p = 0.0001). Conclusions: TXA is a well-tolerated drug that significantly reduces postoperative bleeding and drainage volume, resulting in earlier drain removal and reduced length of hospital stay. TXA should, therefore, be widely used in plastic surgery, especially as trends in healthcare systems necessitate more outpatient procedures and quicker postoperative recovery. [ABSTRACT FROM AUTHOR]

Background: Postoperative physiotherapy is a cornerstone of Enhanced Recovery After Surgery (ERAS) programs, especially following lung resection. Despite its importance, the literature lacks clear recommendations and guidelines, particularly regarding the role of incentive spirometry (IS). This study aims to determine whether incentive spirometry offers additional benefits over early ambulation alone in patients undergoing lung resection for primary lung cancer. Methods: We conducted a retrospective case–control study at the European Institute of Oncology (IEO) involving patients who underwent lung resection from June 2020 to June 2022. Patients were divided into two cohorts: early ambulation alone (control group) and early ambulation with IS (IS group). The primary endpoint was the rate of postoperative pulmonary complications. Secondary endpoints included length of hospital stay and time to chest drain removal. A propensity score-matched analysis was performed based on age, sex, and BMI. Data were compared using Chi-squared and Student's t-tests as appropriate. Results: A total of 304 patients were included, with 153 in the intervention group and 151 in the control group. After propensity-score matching, 52 patients from each cohort were compared. No significant differences were found between the groups regarding postoperative oxygen requirement, fever, atelectasis, residual pleural space, need for bronchoscopy toilette, and re-hospitalization rate. IS group showed trends toward shorter hospital stays and lower time to chest drain removal, though without reaching statistical significance. Conclusions: IS did not significantly improve postoperative outcomes compared to early ambulation alone in patients undergoing lung resection for primary lung cancer. More extensive, prospective, randomized trials are needed to confirm these findings. [ABSTRACT FROM AUTHOR]

Background/Objectives: Hypercapnic respiratory failure (HRF) is a primary cause of admittance to the intensive care unit (ICU). This study aimed to investigate the factors that affect the length of hospital stay in HRF patients. Methods: This study was designed as a retrospective, cross-sectional analysis of patients who were admitted to the ICU because of HRF between 2022 and 2024. The demographic and clinical characteristics of the patients and laboratory results were recorded. The Charlson Comorbidity Index (CCI) was calculated. The relationship between these parameters and the length of hospital stay was assessed. Results: A total of 138 patients were included in the study. The average length of hospital stay was 11.45 days, and 37% of the patients were included in the long-term hospitalization group. The degree of hypercapnia was not associated with the length of hospital stay. It was determined that the patients' albumin levels and CCI were significant determinants of the length of hospital stay. The combined assessment of these two parameters was found to be superior compared to their separate evaluations. Conclusions: In our study, hypoalbuminemia and a higher CCI were identified as predictors of a prolonged ICU stay in HRF patients. Albumin levels of <3.25 g/dL and CCI scores of ≥5 were linked to longer stays, with this combined evaluation offering greater predictive value. These factors can guide patient management. [ABSTRACT FROM AUTHOR]

Simple Summary: Individuals with cancer, including multiple myeloma, often have significant nursing needs. The specific nature of their condition and the functional difficulties from treatment impact their overall quality of life. Therefore, it is crucial to provide the highest quality care, addressing needs such as pain relief, health status monitoring post-therapy, and proper nursing activities. Considering patients' perspectives and tailoring care to their needs is also important. In our study, we checked the opinions of multiple myeloma patients from Poland about the quality of nursing care. The results obtained give a picture of the situation and may be helpful in formulating areas requiring improvement. Background/Objectives: Patient satisfaction is one of the indicators of the quality of nursing care. The purpose of this study is to find out the level of satisfaction of patients with multiple myeloma with the quality of nursing care in oncology units. Methods: Data were obtained by a diagnostic survey method, using the Newcastle Nursing Satisfaction Scale. The survey was conducted among patients from four oncology departments in Poland on the day the patient was discharged or transferred to another unit. Participation in the study was voluntary and required patient consent. Patients were assured of the anonymity of their responses. Results: The study included 65 men and 75 women treated with chemotherapy and autologous hematopoietic stem cell transplant. Experiences and satisfaction with nursing care presented a level of 71.80 points and 74.46 points, respectively. The analysis showed no statistically significant differences between the groups in terms of treatment and gender. A statistically significant negative association was shown between age and nursing care experience score (r = −0.19; p = 0.024). Positive associations were shown between length of stay on the unit and rating of experience of nursing care (r = 0.23; p = 0.006) and satisfaction with nursing care (r = 0.26; p = 0.002). Conclusions: The experience and satisfaction with nursing care among patients treated for multiple myeloma in Polish oncology units is moderate. Efforts should be made to improve the quality of nursing care, especially taking into account the needs of the elderly. [ABSTRACT FROM AUTHOR]

Simple Summary: Robot-assisted radical prostatectomy (RARP) has been standardized for prostate cancer (PCa) over the last 20 years. Using the Sapienza residency program 3+2 trocar configuration with a second laparoscopic port replacing the fourth robotic arm, the bedside assistant is more involved during the surgical procedure and requires higher laparoscopic skills. In this study, we examine perioperative, functional, and oncological results of RARP using the Sapienza 3+2 trocar configuration in cases where the bedside assistant was either an attending surgeon or a urology resident. We identified that the level of expertise of the bedside assistant did not influence oncological and functional results. With this premise, the Sapienza 3+2 trocar configuration could be employed in residency programs to allow laparoscopic training of surgical residents without compromising the current request for robotic-assisted surgeries. Background/Objectives: Robot-assisted radical prostatectomy (RARP) for the treatment of prostate cancer (PCa) has been standardized over the last 20 years. At our institution, only n = 3 rob arms are used for RARP. In addition, n = 2, 12 mm lap trocars are placed for the bedside assistant symmetrically at the midclavicular lines, which allows for direct pelvic triangulation and greater involvement of the assisting surgeon. The aim of our study was to compare surgical and perioperative outcomes of RARP performed using our alternative trocar placement with no fourth robotic arm in the subgroups of experienced attending surgeons and post-graduate residents as bedside assistants. Residents' satisfaction was also explored. Methods: RARPs performed within the urology residency program between 2019 and 2024 were retrospectively analyzed. Only rob procedures performed using our 3+2 trocars configuration were included. Intra- and postoperative outcomes, as well as long-term functional outcomes including continence recovery and potency, were assessed, stratified by the level of expertise of the bedside assistant, i.e., an experienced attending or post-graduate Year I–III resident. Satisfaction of residents assigned to the two groups during their robotic rotation was evaluated considering three domains with a score from 1 to 10: insight into surgical procedure, confidence level, and gratification level. Results: Out of n = 281 RARP procedures, the bedside assistant was an attending in 104 cases and a resident in 177. Operative time was found to be slightly longer in cases where the second operator was a resident (attendings vs. residents: 134 ± 40 vs. 152 ± 24; p < 0.001). Postoperative hospitalization time was longer in patients in the resident group (attendings vs. residents: 3.9 ± 1.6 vs. 4.3 ± 1 days; p = 0.025). However, cases where the second operator was a resident had a lower rate of positive surgical margins, with rates of 19.7% in the resident and 43.3% in the attending surgeon cohorts (OR = 0.32; 95% CI 0.18–0.55). This difference remained significant in multivariate analysis. There was no significant difference in postoperative blood transfusion rates (attendings vs. residents: 1.9% vs. 1.2%; p = 0.6). Similarly, long-term functional outcomes in terms of erectile dysfunction and urinary incontinence rates mostly overlapped between groups. The mean score in all three domains evaluating residents' satisfaction was significantly higher when residents actively participated in the surgical procedure as bedside assistants (p = 0.02, p = 0.004, and p < 0.001, respectively, for insights into surgical procedure, confidence level, and gratification level). Conclusions: These findings provide insight into how an alternative port positioning during RARP could improve the involvement of the bedside assistant, particularly residents, without compromising perioperative outcomes or surgical safety. [ABSTRACT FROM AUTHOR]

Background/Objectives: Peri-intubation hypotension is a known complication of endotracheal intubation. In the hospital setting, peri-intubation hypotension has been shown to increase hospital mortality and length of stay. The use of prophylactic vasopressors at the time of sedation induction to prevent peri-intubation hypotension has been raised. This systematic review and meta-analysis aims to review the safety and efficacy of this practice. Methods: The study was fully registered with PROSPERO on 13 October 2022, and screening for eligibility was initiated on 20 September 2024. Randomized controlled trials, along with retrospective or prospective cohort studies, were included in the search. The terms "peri-intubation hypotension", "vasopressors", "intubation", and "anesthesia induced hypotension" were used to search the title/summary in PubMed, Cochrane Library, and Google Scholar databases. An assessment of bias for each study was conducted using the Newcastle-Ottawa Quality Assessment Scale. The primary outcome was the rate of hypotension peri-intubation. Any complications secondary to hypotension or vasopressors were the secondary outcome. Results: We identified 13 studies, which were all randomized controlled studies, to include in the final analysis. The risk ratio for preventing peri-intubation hypotension was 1.6 (95% CI, 1.2–2.14) with the use of prophylactic phenylephrine while giving propofol versus no prophylactic vasopressors and 1.28 (95% CI 1.03–1.60) with the use of ephedrine. Conclusions: These findings suggest that in patients undergoing intubation in the operating room with propofol, prophylactic vasopressors given with induction for intubation decrease the odds of hypotension. [ABSTRACT FROM AUTHOR]

Background and Objectives: Deep neck infections (DNIs) are severe diagnoses that can cause serious complications. However, there are insufficient data to predict the evolution of this pathology. This study aims to review the microbiology of DNIs and to identify the factors that influence prolonged hospitalization. Materials and Methods: The present retrospective cohort observational analytical study analyzed 138 patients with DNIs who were diagnosed and received surgical treatment over a 8-year period. Results: Reduced lymphocyte percentages and increased neutrophil-to-lymphocyte ratios (NLRs) were significantly associated with complications (p < 0.001 and p = 0.0041, respectively). Laryngotracheal infections were significantly associated with complications (25.53%) (p = 0.0004). Diabetes mellitus (DM) and immunocompromised status were strongly associated with complications (p < 0.001 and p = 0.0056, respectively), establishing these conditions as significant risk factors. Patients with complications experienced substantially longer hospitalizations, with a mean duration of 24.9 days compared to 8.32 days in patients without complications (p < 0.001). Complications were observed in 47 patients (34.06%). The most common complications were airway obstruction, which occurred in 26 patients (18.84%), and mediastinitis, which was noted in 31 patients (22.46%). Patients requiring tracheotomy due to airway obstruction had 6.51 times higher odds of long-term hospitalization compared to those without airway obstruction (OR = 6.51; p < 0.001). Mediastinitis was associated with a 4.81-fold increase in the odds of prolonged hospitalization (OR = 4.81; p < 0.001). Monomicrobial infections were observed in 35.5% of cases, with no significant difference between the short-term (<2 weeks, 37.33%) and long-term (≥2 weeks, 33.33%) hospitalization groups (p = 0.8472). Conversely, polymicrobial infections were significantly associated with prolonged hospitalization, occurring in 20.63% of the long-term cases compared to 6.66% of the short-term cases (p < 0.001). The most common aerobic bacteria observed were Staphylococcus aureus (14.28%), Streptococcus constellatus (12.69%) and Streptococcus viridans (7.93%) during long-term hospitalization. Comparative analysis of the Kaplan–Meier survival curves based on the presence of infection revealed a significantly lower survival in cases with a positive culture. Conclusions: Deep neck infection has a complex pathology, whose therapeutic management remains a challenge in order to reduce the length of hospitalization and mortality. [ABSTRACT FROM AUTHOR]

COPD is one of the leading causes of death worldwide, so it represents a significant public health challenge. Over the years, new effective therapies have been proposed. However, the burden of COPD is still conditioned by frequent acute events defined as exacerbations (exacerbation of COPD-ECOPD), which have a significant impact not only on the patient's quality of life but also on the progression of the disease, morbidity, and mortality. Related to the severity of the condition, ECOPD may require hospital admission and often repeatedly more admissions (readmission). The phenomenon of readmissions is a significant problem, contributing substantially to the utilisation of healthcare resources and the economic burden of COPD. Related contributing factors are still poorly understood, and managing the patients readmitted to the hospital with ECOPD may be challenging. Hospital readmissions should be optimally managed, including supporting and preventive strategies. Although early readmissions (30 days from discharge) are a marker of the quality of the patient's care, we need to consider COPD patients globally. It is not sufficient to address just the acute events, so multidimensional management is necessary, able to follow the patient over time to identify, by a personalised approach, the correct treatment during and post hospitalisation and intercept any factor affecting the natural history of the disease, comprising the risk of hospital readmissions. In the context of the literature concerning respiratory medicine, particularly COPD patients, our narrative review analyses recent evidence regarding the current management of COPD hospital readmissions, aiming to propose preventive strategies helpful in clinical practice. The proposed strategies can potentially improve clinical outcomes and reduce healthcare costs when effectively implemented in practice. [ABSTRACT FROM AUTHOR]

Background and Objectives: A tracheostomy is a frequently performed surgical intervention in intensive care units (ICUs) for patients requiring prolonged mechanical ventilation. This procedure can offer significant benefits, including reduced sedation requirements, improved patient comfort, and enhanced airway management. However, it is also associated with various risks, and the absence of standardized clinical guidelines complicates its implementation. This study aimed to determine the prevalence of tracheostomy among ICU patients, while also evaluating patient characteristics, complication rates, and overall outcomes related to the procedure. Materials and Methods: We conducted an observational, cross-sectional, point-prevalence survey across eight ICUs in Italy. Data were collected over two 24 h periods in March and April 2024, with a focus on ICU characteristics, patient demographics, the details of tracheostomy procedures, and associated complications. Results: Among the 92 patients surveyed in the ICUs, 31 (33.7%) had undergone tracheostomy. The overall prevalence of tracheostomy was found to be 9.1%, translating to a rate of 1.8 per 1000 admission days. The mean age of patients with a tracheostomy was 59.5 years (SD = 13.8), with a notable predominance of male patients (67.7%). Neurological conditions were identified as the most common reason for ICU admission, accounting for 48.4% of cases. Tracheostomy procedures were typically performed after a mean duration of 12.9 days of mechanical ventilation, primarily due to difficulties related to prolonged weaning (64.5%). Both early and late complications were observed, and 19.35% of tracheostomized patients did not survive beyond one month following the procedure. The average length of stay in the ICU for these patients was significantly extended, averaging 43.0 days (SD = 34.3). Conclusions: These findings highlight the critical role of tracheostomy in the management of critically ill patients within Italian ICUs. The high prevalence and notable complication rates emphasize the urgent need for standardized clinical protocols aimed at optimizing patient outcomes and minimizing adverse events. Further research is essential to refine current practices and develop comprehensive guidelines for the management of tracheostomy in critically ill patients. [ABSTRACT FROM AUTHOR]

Background and Objectives: Resection of the caudate lobe of the liver is considered a highly challenging surgical procedure due to the deep anatomic location of this segment and the relationships with major vessels. There is no clear evidence about the safety and effectiveness of robotic resection of the caudate lobe. The aim of this systematic review was to report data about the safety, technical feasibility, and postoperative outcomes of robotic caudate lobectomy. Materials and Methods: A systematic review of the MEDLINE and SCOPUS databases was undertaken, including studies published until 19 December 2024. Results: A total of 5 studies including 110 patients were selected. Of these surgeries, 56.3% were performed for malignant tumors. Tumor size varied significantly between 0.9 and 7.7 cm in the largest diameter. The mean operative time was 184.5 min (range 70–522 min), and the estimated blood loss was 95.5 mL (range 10–1500 mL). The median hospital length of stay was 4.2 days (range 2–19 days) and no cases of conversion to open were reported. All the patients underwent R0 resection. In total, 24 out of 110 patients (21.8%) developed postoperative complications, with 1.8% of all patients developing a major complication (Clavien–Dindo classification ≥ III). No perioperative deaths were reported by the included studies. Conclusions: Few retrospective studies investigating the outcomes of robotic resection of the caudate lobe are currently available in the literature. From published data, it may be a safe and feasible alternative to open and laparoscopic caudate lobectomy in selected patients in referral HPB centers. Further studies with larger sample sizes are needed to confirm such preliminary findings. [ABSTRACT FROM AUTHOR]

Background and Objectives: The aim of this study was to comprehensively analyze the evolution in textbook outcome (TO) achievement after liver resection for hepatocellular carcinoma (HCC) over two decades at a single tertiary referral center. Materials and Methods: All consecutive liver resections for HCC at Seoul National University Bundang Hospital from 2003 to 2022 were analyzed. The included 1334 patients were divided into four groups by time intervals identified through change point analysis. TO was defined as no intraoperative transfusions, positive margins, major complications, 30-day readmission or mortality, and prolonged length of hospital stay (LOS). Results: Multiple change point analysis identified three change points (2006, 2012, 2017), and patients were divided into four groups. More recent time interval groups were associated with older age (59 vs. 59 vs. 61 vs. 63 years, p < 0.0001) and more comorbidities. Minimally invasive procedures were increasingly performed (open/laparoscopic/robotic 37.0%/63.0%/0%) vs. 43.8%/56.2%/0% vs. 17.1%/82.4%/0.5% vs. 22.9%/75.9%/1.2%, p < 0.0001). TO achievement improved over time (1.9% vs. 18.5% vs. 47.7% vs. 62.5%, p < 0.0001), and LOS was the greatest limiting factor. Conclusions: TO after liver resection improved with advances in minimally invasive techniques and parenchymal sparing procedures, even in older patients with more comorbidities and advanced tumors. [ABSTRACT FROM AUTHOR]

Background/Objectives: The increasing medical and nursing care complexity in hospitalized children represents a significant challenge for healthcare systems. However, the link between these two dimensions remains partially explored. This study aims to decipher the relationship between Diagnosis-Related Group (DRG) weight and nursing care complexity in hospitalized children and to identify the determinants of medical complexity. Methods: This retrospective study, conducted in an Italian university hospital, included children aged 2 to 11 years admitted to the hospital in 2022 with a minimum hospital stay of 2 days. Data were gathered from the Neonatal Pediatric Professional Assessment Instrument and the Hospital Discharge Register. DRG weight was used as an indicator of medical complexity, while the number of nursing diagnoses (NDs) documented in the first 24 h from hospital admission and the nursing actions (NAs) recorded during the patient's hospital stay were used to measure nursing care complexity. Correlation analyses were conducted to explore the associations between DRG weight, NDs, and NAs. Stepwise regression was run to identify the key determinants of medical complexity across sociodemographic, clinical, organizational, and nursing variables. Results: Among 914 patients (mean age of 6.11 ± 2.90 years), the median DRG weight was 0.6982 (IQR: 0.5522). Patients had an average of 3.89 ± 2.83 NDs and a median of 17 NAs (IQR: 8). Significant correlations were found between NDs and NAs (rs = 0.507; p < 0.001), as well as between DRG weight and the frequency of NDs (rs = 0.232; p < 0.001) and NAs (rs = 0.184; p < 0.001). Stepwise regression indicated that the number of NAs, surgical DRG, scheduled admissions, and ND frequency were significant determinants of DRG weight (R2 = 0.311; adjusted R2 = 0.308; p < 0.001). Conclusions: In children, DRG weight is also influenced by nursing care complexity, alongside clinical and organizational factors. An integrated approach is essential to enhance pediatric care and patient outcomes. [ABSTRACT FROM AUTHOR]

Background: Foreign body aspiration is a preventable occurrence that carries a high risk of mortality in the pediatric population. Clinically, foreign body aspiration manifests as cough, followed by choking, which might not be given any consideration by the caregivers of the child. An episode of sudden wheezing can also raise the suspicion of a foreign body in the lower respiratory tract. The clinical findings depend on the type, size, and localization of the foreign body and include persistent cough, localized airway resistance, localized or diffuse wheezing, and difficulty breathing. A bronchoscopy is the procedure of choice for the removal of foreign bodies. Flexible bronchoscopy is increasingly being used as the initial diagnostic procedure in children with an uncertain history of choking, in the absence of physical and radiological lung changes, and in chronic complaints requiring the exclusion of a foreign body in the airways. Thus, the aim of this study was to describe our clinical experience with lower respiratory tract foreign body extraction in children over a period of five years. Materials and Methods: Over a 5-year period, 154 patients under the age of 18 underwent a bronchoscopy due to a suspected foreign body in the lower respiratory tract. Of these patients, 92% had an incident leading to acute respiratory distress, and 8% had no definite data on such an event in the anamnesis. Results: A foreign body in the respiratory tract was found in and extracted from 50 patients, and foreign bodies were absent in 104 of the cases. Conclusions: If a foreign body enters the lower respiratory tract, immediate and adequate actions are required to solve the problem. A bronchoscopy should be conducted in every suspected case of foreign body aspiration. [ABSTRACT FROM AUTHOR]

Background/Objectives: Influenza poses significant risks in children, causing complications like febrile seizures and hospitalizations. Antiviral treatments include oseltamivir and peramivir, both FDA-approved neuraminidase inhibitors. This study aims to compare the effectiveness of intravenous peramivir and oral oseltamivir in pediatric patients presenting to an emergency department, with a primary focus on the revisit rate within 72 h post-treatment. Methods: A retrospective study analyzed 1327 children aged 1–15 years diagnosed with influenza A or B between 1 January 2019 and 29 February 2020, at a single urban hospital. Patients were divided into oseltamivir (n = 1243) and peramivir (n = 84) groups. Data included demographics, clinical symptoms, emergency department stays, and revisit rates. Fisher's exact test was used for analysis, with p-values < 0.05 considered significant. Results: A total of 1327 pediatric patients were included, with 1243 receiving oseltamivir and 84 receiving peramivir. Patients in the peramivir group were older (median age 5.88 years vs. 4.54 years, p = 0.002) and had higher rates of gastrointestinal symptoms. The emergency department length of stay was significantly longer in the peramivir group (167 min vs. 63 min, p < 0.001). The revisit rate within 3 days was 5.63% for oseltamivir and 9.52% for peramivir, with no statistically significant difference (p = 0.22). Conclusions: Peramivir presents as an effective alternative treatment for influenza in children, particularly in situations where oral administration is not feasible due to gastrointestinal intolerance, highlighting the importance of an alternative route of antiviral administration. [ABSTRACT FROM AUTHOR]

Cystic echinococcosis (CE) is a neglected tropical parasitic disease linked with significant social and economic burdens worldwide. The scientific community has minimal information on echinococcosis in Romanian people, and hospital medical records are the only sources that may be used to investigate its status. A 7-year retrospective clinical study on pediatric patients with CE from Southeast Romania was performed, and 39 children and adolescents were included, aged 2–15 years old. They were hospitalized with cystic echinococcosis in the Pediatric Department and Pediatric Surgery Department of Constanta County Clinical Emergency Hospital "St. Apostle Andrew" between 1 January 2017 and 1 October 2024. Twenty-nine (74.36%) pediatric patients came from rural zones, and 10 (25.64%) had urban residences. In total, 28 children (71.79%) had contact with four different animals (dogs, goats, pigs, and sheep); only four were from urban zones, and they had contact only with dogs. Data regarding the length of hospital stay, cyst location, and complications were collected and analyzed. According to the medical files, the diagnosis was established using imaging techniques and serological tests for CE. IgE and IgG reported appreciable variations in correlation with all parameters, and significant differences (p < 0.05) were recorded. IgE levels considerably increased in cases of no animal contact, pulmonary involvement, complications, surgical treatment, and multiple hospitalizations. Moderate IgE values were recorded in cases of urban residences, pig and sheep contact, and hepatic involvement. The IgG concentration considerably increased with sheep contact and moderately increased in cases of rural zones, hepatic involvement, complications, and surgical treatment. The results show that incidental discovery, symptoms, complications, multiple dissemination, pulmonary involvement, and dog and pig contact increase the hospitalization time. Extensive data analysis supports our results. Our findings highlight the complexity of managing E. granulosus infections in children and evidence the importance of a multidisciplinary approach, combining early diagnostic tools, tailored medical therapy, and careful surgical intervention when necessary. [ABSTRACT FROM AUTHOR]

Abscess-forming cervical bacterial infections are rare and serious infections. Methods: We retrospectively examined the trends in abscess-forming cervical bacterial infections in children who required inpatient treatment in three periods before (January 2016 to June 2020), during (July 2020 to December 2022) and after the COVID-19 pandemic (January 2023 to June 2024). Results: The study included 96 patients with superficial cervical abscesses and 111 patients with deep cervical abscesses (34 with retropharyngeal abscesses, 51 with peritonsillar abscesses, and 26 with deep neck abscesses). Both decreased during the COVID-19 pandemic and increased significantly after the COVID-19 pandemic compared to before the COVID-19 pandemic (0.94 ± 0.92 vs. 0.50 ± 0.72 vs. 1.67 ± 1.11/month, 0.93 ± 0.96 vs. 0.60 ± 0.84 vs. 2.39 ± 1.70/month), which was related with the trends of respiratory viral infections. Bacteria were identified in 79 of the 97 cases in which punctures were performed; however, there were no significant differences between the three periods. No significant changes were found in the pharyngeal streptococcal antigen positivity rate, rate of oral antibiotic use before hospitalization, length of hospital stay, or duration of antibiotic administration before and after the COVID-19 pandemic. Conclusions: The COVID-19 pandemic has affected the epidemiology of cervical abscess-forming bacterial infections in children. Although the reemergence of respiratory viral infections after the COVID-19 pandemic may be a factor, the cause of the doubling in the number of neck abscesses after the COVID-19 pandemic remains unclear and requires further investigation. [ABSTRACT FROM AUTHOR]

Background/Objectives: Pelvic kidney is a congenital anomaly characterized by the kidney's failure to ascend to its normal anatomical location during early embryonic development. This anomaly complicates traditional surgical approaches for renal calculi due to the kidney's atypical positioning and associated anatomical challenges. We sought to summarize our experience with robotic-assisted pyelolithotomy (RPPK) for pelvic kidney stones. Methods: A retrospective review of patients who underwent RPPK was conducted between 2014 and 2023. Demographic data on stone characteristics, operative details, and postoperative outcomes were analyzed. Results: Four patients (three male; mean age—51.2 years with a range of 45–54; mean BMI—26.6 with a range of 22.3–32.2) underwent RPPK. All had a right-sided pelvic kidney; two had prior failed ureteroscopy. The mean stone diameter was 27.7 mm (range: 17–35); the mean density was 1207.5 HU (range: 905–1500). The mean operative time was 265 min (range: 200–323); the time from incision to closure was 142.2 min (range: 95–225). No ureteral stents or drains were used. Blood loss was negligible. The mean hospital stay was 2.2 days. No immediate complications were recorded. The mean follow-up was 11.75 months (range: 3–30). Conclusions: RPPK is safe and effective for managing pelvic kidney stones. Challenging renal anatomy stone size and density are not obstacles to the robotic approach unlike other fragmentation methods [ABSTRACT FROM AUTHOR]

Background: Venous thromboembolisms constitute a major cause of morbidity and mortality with 60,000 to 100,000 deaths attributed to pulmonary embolism in the US annually. Both clinical presentations and treatment strategies can vary greatly, and the selection of an appropriate therapeutic strategy is often provider specific. A pulmonary embolism response team (PERT) offers a multidisciplinary approach to clinical decision making and the management of high-risk pulmonary emboli. There is insufficient data on the effect of PERT programs on clinical outcomes. Methods: We searched PubMed, Scopus, Web of Science, and Cochrane to identify PERT studies through March 2024. The primary outcome was all-cause mortality, and the secondary outcomes included the rates of surgical thrombectomy, catheter directed thrombolysis, hospital length of stay (HLOS), and ICU length of stay (ICULOS). We used the Newcastle−Ottawa Scale tool to assess studies' quality. We used random-effects models to compare outcomes between the pooled populations and moderator analysis to identify sources of heterogeneity and perform subgroup analysis. Results: We included 13 observational studies, which comprised a total of 12,586 patients, 7512 (60%) patients were from the pre-PERT period and 5065 (40%) patients were from the PERT period. Twelve studies reported the rate of all-cause mortality for their patient population. Patients in the PERT period were associated with similar odds of all-cause mortality as patients in the pre-PERT period (OR: 1.52; 95% CI: 0.80–2.89; p = 0.20). In the random-effects meta-analysis, there was no significant difference in ICULOS between PERT and pre-PERT patients (difference in means: 0.08; 95% CI: −0.32 to 0.49; p = 0.68). There was no statistically significant difference in HLOS between the two groups (difference in means: −0.82; 95% CI: −2.86 to 1.23; p = 0.43). Conclusions: This meta-analysis demonstrates no significant difference in all studied measures in the pre- and post-PERT time periods, which notably included patient mortality and length of stay. Further study into the details of the PERT system at institutions reporting mortality benefits may reveal practice differences that explain the outcome discrepancy and could help optimize PERT implementation at other institutions. [ABSTRACT FROM AUTHOR]

Background/Objectives: Proximal femoral fractures (PFFs) among individuals aged ≥90 years are becoming more common with an aging population and are associated with high morbidity and mortality. This study analyzed the prognostic factors influencing survival in nonagenarian patients undergoing surgery for PFFs. Methods: We enrolled 285 patients who underwent surgery between 2016 and 2022. Patients were classified into two groups: those with postoperative survival >1 year (L) and those with postoperative survival ≤1 year (D). Factors assessed included age, sex, body mass index (BMI), cognitive impairment, fracture type, surgical timing, length of hospital stay, implant type, preoperative hemoglobin/albumin/white blood cell levels, and Geriatric Nutritional Risk Index (GNRI). Results: The mean age at surgery was 93.2 ± 2.8 years (mean follow-up = 18.9 months). The 12-month mortality rate was 28.8%. Intertrochanteric fractures were observed in 136/47 patients, and femoral neck fractures were observed in 67/35 patients in the L/D group, respectively (p = 0.13). Days from admission to surgery were not significantly associated with mortality (p = 0.56). The mean hospital stay was 17/22 days in the L/D group, respectively. Univariate analysis identified age, BMI, cognitive impairment, albumin level, and GNRI as statistically significant predictors. Multivariate analysis revealed length of hospital stay (odds ratio [OR] = 1.048 [95% confidence interval (CI): 1.019–1.078]; p = 0.001), cognitive impairment (OR = 3.082 [95% CI: 1.367–6.945]; p = 0.007), and GNRI (OR = 0.929 [95% CI: 0.901–0.958]; p < 0.001) as independent predictors of mortality. Conclusions: This study identified cognitive impairment, a low GNRI, and prolonged hospital stay as independent prognostic factors for 1-year mortality in nonagenarian patients with PFFs. These findings highlight the importance of addressing malnutrition and cognitive decline through tailored interventions, alongside optimizing surgical timing and hospital care. A multidisciplinary approach remains essential for improving survival outcomes in this vulnerable population. [ABSTRACT FROM AUTHOR]

Introduction: The treatment of infective endocarditis (IE) is based on long intravenous administration of antibiotics. This is still a hard-to-die dogma. Throughout the years, different researchers have attempted to demonstrate the safety and efficacy of an oral switch of the antibiotic regimen, with only scarce success. Nevertheless, in recent years, different reports have evaluated the efficacy of oral switch therapy in selected patients. Due to the lack of large trials, a meta-analysis could be useful to evaluate the potential benefits of early oral switch therapy not only in terms of microbiological cure but also in terms of relapse, mortality, and length of hospital stay (LOS). Methods: We conducted a Medline search, from which we were able to extrapolate 29 papers on IE treatment; the inclusion criteria were met by six papers only. Three trials were not randomized studies; therefore, we conducted the analysis both including and excluding the mentioned papers. Results: Overall, we conducted our analysis on 840 patients who received intravenous treatment and 677 who received oral treatment. Our results confirmed that oral switch therapy represents an option in selected patients, with a reduction in the relapse rate (OR: 0.54, 95% CI: 0.31–0.92). No statistically significant differences were observed for treatment failure (OR: 0.74, 95% CI: 0.48–1.14), length of hospitalization (OR: −0.42, 95% CI: −1.55–0.71), complication rate (OR: 0.38, 95% CI: 0.1–1.54), and mortality (OR: 0.52, 95% CI: 0.22–1.22). Discussion: Our results allow us to conclude that oral switch therapy is a feasible option in clinically stable patients with infective endocarditis. Moreover, oral switch therapy seems to perform significantly better than intravenous treatment in terms of relapse of infection. The data further support the implementation of oral switch therapy in infective endocarditis. [ABSTRACT FROM AUTHOR]

Simple Summary: Esophageal cancer surgery is associated with a high risk of postoperative complications such as anastomotic leakage (AL). Preoperative malnutrition is a potential risk factor but the best way to diagnose its status remains unclear. The use of preoperative CT scans to detect deficits in body composition such as a reduced skeletal muscle index (SMI) can help to identify high-risk patients for postoperative complications. This study aimed to analyze clinical data of 111 patients after esophagectomy by correlating their preoperative CT scans with postoperative outcomes. These data showed reduced SMI in patients with postoperative (AL) and a prolonged postoperative length of stay in hospital in this group. Background: Surgery for esophageal cancer has an associated high rate of postoperative complications such as anastomotic leakage (AL) and fistulas. Pre-operative sarcopenia as a loss of skeletal muscle mass and function is identified as a potential prognostic factor in determining the outcomes of oncological surgical resections for esophageal cancers. In this study, we evaluated the impact of body composition on postoperative complications in esophageal cancer surgery. Methods: In this cohort study, we analyzed patients' body composition at the level of the third lumbar vertebra on CT scans before Ivor Lewis resections for esophageal cancers between January 2015 and December 2022. Patients with a skeletal muscle index (SMI) ≤ 38.5 cm2/m2 in women and ≤52.4 cm2/m2 in men were classified as sarcopenic. Postoperative complications were categorized following the Dindo–Clavien classification and included AL, postoperative pneumonia, length of hospital stay, and failure-to-rescue which were compared between the sarcopenic and non-sarcopenic patients. Results: From a group of 111 patients with Ivor Lewis esophagectomy, 70 patients (63.1%) were classified as sarcopenic based on the SMI and the previously published gender-specific cut-off values. AL occurred at 12.6% (5.6% in adenocarcinoma). Within the whole cohort, patients with AL had a significantly low SMI of 43.487 ± 8.088 vs. 48.668 ± 7.514; p = 0.012. Additionally, the SMI showed a negative correlation to the length of postoperative hospital stay (r = −0.204; p = 0.032; N = 111). The failure-to-rescue rate was higher in the group of sarcopenic patients (12.8% vs. 8%). Conclusions: Our data showed a correlation between SMI and AL. This effect could not be seen in gender-specific SMI. This study showed a lower failure-to-rescue rate in non-sarcopenic patients after Ivor Lewis esophagectomy. These findings underscore the crucial role of determining the preoperative nutritional and body composition status as measured by the preoperative CT scans. [ABSTRACT FROM AUTHOR]

Background/Objectives: Timely and appropriate outpatient care can prevent potentially avoidable hospitalizations (PAHs) for heart failure (HF). We analyzed the trends, determinants, and consequences of PAHs for HF in Switzerland over two decades.; Methods: Hospital discharge data of Switzerland from 1998 to 2018 were utilized. PAH was defined according to the Organization for Economic Cooperation and Development (OECD) criteria.; Results: Data from 206,000 PAHs for HF were included (49.1% women, 55.8% aged over 80). Admission rates for PAHs represented 54.5 per 10,000 admissions in 1999, and they increased to 117.6 per 10,000 admissions in 2018. Similarly, age-standardized admission rates were 107.8 per 100,000 inhabitants in 1999, and they increased to 220.7 per 100,000 inhabitants in 2018. Between 1999 and 2018, patients admitted with PAHs for HF became older (% of patients aged over 80: 60.4% in 2018 vs. 49.2% in 1999), presented more frequently with a Charlson index < 4 (65% vs. 35%), were admitted more frequently as an emergency (89.0% vs. 60.7%), by the patient's own initiative (31.5% vs. 13.9%), while ICU admission increased only slightly (8.6% vs. 7.6%) and length of stay decreased—median and (interquartile range) 8 (6–13) vs. 12 (8–18) days. In 2018, the costs related to PAHs for HF were estimated at over CHF 170 million, and the corresponding number of occupied beds at 407 per year; Conclusions: In Switzerland, the number of PAHs for HF has increased steadily. The medical and financial burden due to PAH for HF could still be reduced with timely and appropriate outpatient care. [ABSTRACT FROM AUTHOR]

The global demand for end-stage hip and knee osteoarthritis surgical treatment is rising, as is the need of optimal postoperative rehabilitation. Patient stratification is key to provide rehabilitation professionals and policy makers with real-life data in support of early discharge planning and continuous care provision. The aim of this retrospective, observational study was to investigate which factors can predict the burden of care at discharge (BCD) and the inpatient rehabilitation length of stay (LOS) based on a set of demographic, societal, clinical and organizational data collected from a high-volume orthopedic hospital. We included 45.306 variables from 1678 patients. All variables were initially tested individually using a linear regression model for inpatient rehabilitation LOS and a logistic regression model for BCD. Variables that resulted significant (p < 0.05) were subsequently considered in a single, comprehensive linear regression model, or a single, logistic regression model, respectively. Age, living with a family, occupational status, baseline Barthel Index and duration of surgery were predictors of inpatient rehabilitation LOS and BCD. Sex, primary or secondary osteoarthritis, American Society of Anesthesiologists score, body mass index, transfusion, biological risk, type of anesthesia, day of surgery, numeric pain rating scale and baseline cognitive function at baseline were not. Including specific patient comorbidities, surgical access technique and chronic use of pharmacological therapy can improve the predictive power of the model. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has significantly impacted healthcare systems worldwide, including dental care. This study aimed to investigate the effects of the pandemic on the management of medication-related osteonecrosis of the jaw (MRONJ). Abnormal blood glucose levels may contribute to the development of MRONJ and act as an important risk factor. This retrospective study included 217 patients with MRONJ. The patients were divided into two groups: the pre-COVID-19 group (16 March 2018 to 16 March 2020; 75 patients; 46 females and 29 males; average age, 74.5 years) and the post-COVID-19 group (1 June 2022 to 1 June 2024; 142 patients; 91 females and 51 males; average age, 69.6 years). Data pertaining to demographic characteristics, length of hospital stay, glucose levels, location of lesions, and underlying diseases were collected. The average length of hospital stays was 4 and 5 days in the pre- and post-COVID-19 groups, respectively. The average fasting glucose levels were 5.5 and 5.9 mmol/L in the pre- and post-COVID-19 groups, respectively. Localization patterns shifted, with a higher incidence in the maxilla in the post-COVID-19 group. These findings suggest a significant increase in MRONJ cases and changes in clinical outcomes due to the pandemic. The increase in the number of patients treated after the pandemic highlights the importance of ongoing vigilance and adaptation in preventing MRONJ, with a particular focus on risk factors. [ABSTRACT FROM AUTHOR]

Background/Objectives: Orthostatic hypotension (OH) is highly prevalent in hospitalized patients and can lead to major consequences. The prevalence of OH among patients with stroke has also been reported to be high in in-patient cohorts. However, no previous analysis has focused exclusively on patients with hemorrhagic stroke, a group that may have a different disease profile, including a greater need for blood pressure control and surgical intervention. This study aims to examine the prevalence of OH, its risk factors, and potential impact in patients who were hospitalized due to hemorrhagic stroke. Methods: A retrospective analysis of in-patient records between 1 January 2021 and 30 April 2023 was conducted for patients with stroke due to intracerebral hemorrhage (ICH) or subarachnoid hemorrhage (SAH) who were referred to rehabilitation at a tertiary hospital in Singapore. OH was defined as a drop in systolic blood pressure of ≥20 mmHg or diastolic blood pressure of ≥10 mmHg during the sit-up test as part of the rehabilitation assessment. Additional data collected included demographic information, length of stay, antihypertensive medications used at the time of assessment, comorbidities, and discharge functional outcomes as measured by a modified Rankin Scale. Results: A total of 77 patients (65 [84.4%] with ICH and 12 [15.6%] with SAH) were included in the analysis. The prevalence of OH was 37.7%. A history of surgical intervention was identified as the major risk factor for the development of OH (odds ratio 4.28, 95% confidence interval 1.37 to 13.35, p = 0.009). There was no difference in hospital length of stay or discharge modified Rankin Scale scores between the two groups. Conclusions: OH was frequently observed among patients with hemorrhagic stroke during the acute/subacute stage and should be monitored, especially in patients who require surgical intervention. [ABSTRACT FROM AUTHOR]

Objective: Carotid artery stenting (CAS) has traditionally been performed using the transfemoral approach (TFA). Recently, the transradial approach (TRA) has gained attention for its lower invasiveness and reduced complication risk. This study compares outcomes between two access strategy timeframes, TFA-first and TRA-first, to evaluate how this shift influences outcomes in a real-world setting. Methods: A retrospective analysis of 85 CAS procedures was conducted at our institution from October 2018 to September 2024, categorizing them into TFA-first (n = 42) and TRA-first (n = 43) periods. The primary endpoint was access-related complications and 30-day perioperative events, including stroke, myocardial infarction, and mortality. The secondary endpoints included target lesion access success rate, frequency of access route conversions, procedural time, and hospital length of stay. Results: Baseline characteristics, including age, sex, symptomatic status, stenosis severity, plaque characteristics, and anatomical considerations, were comparable between groups. In the TFA-first period, 88% of procedures utilized TFA, and TRA was not used at all, while the remaining 12% employed the transbrachial approach (TBA). In the TRA-first period, 23% of procedures employed TFA, 60% utilized TRA, and 16% relied on TBA (p < 0.01). Both groups achieved a similar rate of target lesion access success (98% each) with only one conversion per group. The primary endpoint was significantly lower in the TRA-first group (0%) compared to the TFA-first group (10%, p = 0.04), primarily due to reduced access-site complications. Additionally, the median hospital stay was shorter in the TRA-first group at 6 days compared to 10 days (p = 0.02). Conclusions: Adopting a TRA-first strategy over TFA in CAS leads to better outcomes by improving access-site safety and reducing hospital stays. Developing TRA-specific devices could further expand the applicability of TRA in CAS. [ABSTRACT FROM AUTHOR]

Background/Objectives: Heart failure (HF) is a significant public health issue with high morbidity and mortality rates. This study aims to investigate the interrelationships between frailty, cognitive impairment, and depression in older adults with HF, specifically focusing on how the physical and neuropsychiatric dimensions of frailty contribute to cognitive decline. Methods: This study included 250 patients aged 60 years or older, diagnosed with HF and hospitalized for acute decompensated HF. The patients were assessed using standardized protocols for frailty, cognitive function, and depression. The frailty was evaluated using Fried's phenotype criteria, cognitive function with MMSE and MoCA, and depression and anxiety with HADS and PHQ-9. Statistical analyses included univariable and multivariable linear regression to identify the predictors of frailty. Results: Of the 250 patients, 151 (60.4%) were identified as frail. The frail patients were older (mean age 73.58 ± 6.80 years) compared to the non-frail patients (mean age 70.39 ± 6.16 years, p = 0.0002). Significant differences were observed in the NYHA class, length of the hospital stay, and prevalence of diabetes mellitus. The frail patients had worse cognitive (MMSE: 27.39 ± 2.12 vs. 28.13 ± 1.72, p = 0.004; MoCA: 24.68 ± 3.65 vs. 25.64 ± 3.98, p = 0.050) and psychological outcomes (higher prevalence of marked depression based on HADS categories: 8.61% vs. 1.01%, p = 0.021; and PHQ-9 categories: severe depression: 2.65% vs. 1.01%, p < 0.001). Conclusions: Age, C-reactive protein (CRP) levels, and anxiety were identified as independent predictors of frailty in the patients with heart failure. Depression, cognitive dysfunction, and the length of the hospital stay showed significant differences between the frail and non-frail patients in the group comparisons but were not independent predictors. [ABSTRACT FROM AUTHOR]

Background/Objectives: Acute cholecystitis (AC) presents a significant burden in emergency surgical settings. Early laparoscopic cholecystectomy (ELC) is the standard of care for AC, yet its implementation varies. This study aims to assess the impact of preoperative waiting time (WT) on postoperative length of stay (LOS) in patients undergoing urgent cholecystectomy. Methods: From June 2021 to September 2022, data on patients undergoing urgent cholecystectomy for AC or pancreatitis were collected from two university hospitals. Patients were categorized into early (ELC) or delayed (DLC) cholecystectomy groups based on WT. The primary outcome was the assessment of the variables influencing LOS via univariate and multivariate analyses. Results: This study included 170 patients, predominantly female, with a median age of 64.50 years. ELC was performed in 58.2% of cases, with a median WT of 0 days, while DLC was performed in 41.8%, with a median WT of 3 days. Postoperative complications occurred in 21.8% of cases, with LOS being significantly shorter in the ELC group (median 5 days vs. 9 days; p = 0.001). Multivariate analysis confirmed that WT (OR 8.08 (1.65–77.18; p = 0.033)) was the most important predictor of LOS. Conclusions: ELC is associated with a shorter LOS and with DLC, aligning with the WSES recommendations. Earlier surgery reduces the risk of complications and overall hospital costs. An extended WT contributes to a prolonged LOS, underscoring the importance of timely access to operating theaters for acute biliary pathologies. [ABSTRACT FROM AUTHOR]