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Purpose: To investigate how functional cognition of people post-stroke is evaluated and reported by occupational therapists in Ireland. Functional cognition refers to the use and integration of cognitive skills for daily function. Methods: This study used a qualitative design. Six focus groups and one individual interview were conducted with 20 occupational therapists purposively sampled for variation across different clinical grades. Data were analysed according to the Braun and Clark thematic analysis framework. Results: Participants felt that assessment of functional cognition was an integral feature of occupational therapy assessment in stroke care but acknowledged that terminology used by occupational therapists for functional cognition was inconsistent. Non-standardised observational assessment was routinely used by participants. Challenges were reported with respect to written documentation of non-standardised observations. Participants reported that use of standardised cognitive assessments required considered clinical reasoning before administration. Standardised performance-based assessments were not widely implemented by participants. Conclusion: Occupational therapists in Ireland reported a multi-component assessment process to evaluate functional cognition post-stroke. Establishing practice guidelines for the assessment of functional cognition may be of benefit to occupational therapists working in stroke care. Further research is needed to quantify procedures in this assessment process to account for variation in practice. IMPLICATIONS FOR REHABILITATION: The assessment of functional cognition in stroke rehabilitation is integral to occupational therapy practice. Occupational therapists described the assessment of functional cognition as a multi-component assessment drawing from three main modalities: standardised cognitive assessments; non-standardised observations; and performance-based assessments. Professional education in, and practice guidelines, for the assessment and reporting of functional cognition could be beneficial for occupational therapists in stroke care to streamline their assessment and reporting of functional cognition. [ABSTRACT FROM AUTHOR]

Purpose: Mobilisation is a common intervention in Intensive Care (ICU). However, few studies have explored the relationship between mobility levels and outcomes. This study assessed the association of the level of mobility on ICU discharge with discharge destination from the hospital and hospital length of stay. Materials and methods: A retrospective analysis of data from 522 patients admitted to a single UK general ICU who were ventilated for ≥5 days was performed. The level of mobility was assessed using the Manchester Mobility Score (MMS). Multivariable regression analysed demographic and clinical variables for the independence of association with discharge destination and hospital length of stay. Results: MMS ≥5 on ICU discharge was independently associated with discharge destination and hospital LOS (p < 0.001). Patients achieving MMS ≥5 on ICU discharge were more likely to be discharged home (OR 3.86 95% CI 2.1 to 6.9, p < 0.001), and had an 11.8 day shorter hospital LOS (95% CI −17.6 to −6.1, p < 0.001). Conclusions: The ability to step transfer to a chair (MMS ≥5) before ICU discharge was independently associated with discharge to usual residence and hospital LOS, irrespective of preadmission morbidity. Increasing the level of patient mobility at ICU discharge should be a key focus of rehabilitation interventions. IMPLICATIONS FOR REHABILITATION: Mobilisation in the Intensive Care Unit (ICU) is common practice, however studies to date have not evaluated the impact on acute hospital outcomes. Achieving the ability to step to a chair on ICU discharge is an important rehabilitation milestone, and is associated with a shorter hospital length of stay and being discharged home. Rehabilitation interventions in the ICU should be targeted at progressing patients towards this milestone. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the test-retest reliability and construct validity of the LCADL scale applied via online form in individuals after hospitalization for COVID-19. Methods: Methodological study. After hospitalization for COVID-19 individuals completed the LCADL via online form at two separate times. They also answered the post-COVID-19 Functional Status Scale (PCFS), dyspnea, fatigue, and health perception scales, modified Medical Research Council (MRCm), Short Form Health Survey 36 (SF-36). Hospitalization data were collected from the individual's medical record. Results: 104 individuals participated in the study (57 men, 45.2 ± 11.9 years). The LCADL showed moderately to high test-retest reliability (ICC: 0.73–0.86; p < 0.001), there was no difference in scores between test and retest (p > 0.05), the mean difference between the applications was smaller than the standard error of measurement and the internal consistency was adequate (Cronbach's α = 0.70–0.94). In addition, it demonstrated adequate construct validity, showing correlations with PCFS, dyspnea perception, fatigue and health scales, mMRC, SF-36, and length of stay in the Intensive Care Unit (p < 0.05). The LCADL as percentage of the total score presented a significant floor effect (25%). Conclusion: The LCADL applied online was reliable and valid for assessing limitations due to dyspnea in ADL in individuals after hospitalization for COVID-19. IMPLICATIONS FOR REHABILITATION: The London Chest Activity of Daily Living Scale applied online is a method of evaluation of dyspnea-related ADL limitations that is valid and reliable after hospitalization for COVID-19 and can be used both in the telerehabilitation environment and in-person rehabilitation; The online form provides a more sustainable means of data storage, since no paper is needed, and saves time during in-person rehabilitation. [ABSTRACT FROM AUTHOR]

Background: Injuries are a major cause of health problems in low- and middle-income countries than in high-income nations. This study aimed to describe injuries and identify factors associated with the emergency department (ED) length of stay (LoS). Methods: This study was conducted at the Addis Ababa Burn, Emergency, and Trauma (AaBET) hospital in Addis Ababa, Ethiopia. All injured patients who visited the ED between April 1, 2021, and March 30, 2022, were included in the study. Data were collected through a retrospective medical record review. Descriptive statistics were used to present the data and a multivariable binary logistic regression model was used to assess factors associated with LoS in the ED. Results: A total of 6991 (86.8%) injured patients were studied out of 8055 patients who visited the ED. The majority of the patients were male, 5184 (74.2%), and aged between 18–44 years, 4368 (62.4%). The most common mechanism of injury was road traffic accidents, 2693 (38.5%), followed by falls, 1523 (21.8%). The most commonly reported injured body parts were the head (2179, 31.2%). Of the total injured patients, 101 (1.8%) died. The LoS in the ED was greater than 24 hours for 24.4% (95% CI: 23.3–25.5) of the injured patients, with a mean duration of 2.51 (SD = 5.18) days. Factors significantly associated with a prolonged LoS (>24 hours) in the ED included being residing in outside Addis Ababa in Oromia [AOR: 1.61, 95% CI (1.38–1.88)], Amhara [AOR: 1.56, 95% CI (1.14–2.14)] and other [AOR: 3.93, 95% CI (2.73–5.64)], male [AOR: 1.30, 95% CI (1.09–1.54)], aged 60 years or older [AOR: 1.38, 95% CI (1.03–1.85)]; sustaining injuries from road traffic accident [AOR: 2.43, 95% CI (1.19–4.94)], being triaged to orange [AOR: 3.03, 95% CI (2.40–3.83)] and red zones [AOR:3.37, 95% CI (2.65–4.28)]; having fracture injuries [AOR: 1.95, (1.34–2.83)]; and experiencing contusions and crushing injuries [AOR: 2.63 (1.57–4.42)]. Conclusions: Injuries are the major share of cases among ED patients at AaBET hospital. Patients were staying in the ED for longer than the recommended 24 hours by the Ethiopian health system. Intervention measures focusing on injury prevention are necessary to reduce the patient burden on the hospital and strengthen the hospital's capacity to reduce prolonged LoS. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusion To investigate the feasibility of a Virtual Trauma Clinic (VTC) for patients with minor to moderate trauma, and evaluate patient satisfaction and outcomes.One hundred VTC patients were matched 1:1 with historical patients from the hospital trauma registry who received conventional care. Matching was based on age ± 5 years, sex, mechanism of injury, Injury Severity Score ± 2, trauma team activation and day of week of presentation. VTC patients were sent surveys on experience and outcome measures.VTC was associated with reduced average hospital length of stay for admitted patients by 1.81 days (95% CI = −2.82, −0.79; P = 0.001) and reduced hospital admissions (odds ratio 0.26; 95% CI = 0.14, 0.48; P < 0.001). There was an avoidance of 199 inpatient bed days in total, with no trauma‐related readmissions within 30 days post‐hospital discharge. 92% of respondents (n = 22) rated the care they received from VTC as excellent or good. Patient‐reported outcome surveys showed overall improvement in functional domains but evidence of ongoing disability, with persistent issues of pain and psychological distress at 1 month post‐injury.Patients with minor to moderate trauma have ongoing care needs with high rates of pain, psychological distress and disability remaining prevalent long after discharge. VTC provided an innovative strategy for hospital avoidance with high levels of patient satisfaction and no adverse effects on safety. The overall quality of care for these patients was enhanced through the provision of standardised, patient‐centred and multidisciplinary follow‐up. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusion A predominantly endoscopic approach for acute admissions with choledocholithiasis with a gallbladder in situ (CGIS) resulted in prolonged hospital length of stay due to delays at investigation and treatment junctures. We initiated a quality improvement program of trans‐cystic biliary stenting to facilitate efficient patient progress to acute cholecystectomy and outpatient ERCP if required.We utilized implementation frameworks with regular re‐assessment for this quality improvement project. Patients who required both ERCP and cholecystectomy for management of CGIS were identified for comparison of total length of stay before and after implementation. The outcomes for stent insertion and ERCP were also collected for analysis.Twenty‐three trans‐cystic stents were attempted with 22 inserted successfully. The median total length of stay for all patients requiring both ERCP and cholecystectomy for management of CGIS was shorter compared to 6 months prior to implementation (5 days (range 3–18) vs. 6 days (range 5–17); P = 0.009). The median stenting time was 14 min (range 9–48). After stent insertion, more ERCPs were performed as day‐only outpatient cases (20/23 (87.0%) vs. 6/44 (13.6%) P < 0.001). The rate of pancreatic duct wire cannulation at ERCP was also lower (1/23 (4.3%) vs. 18/44 (40.9%); P = 0.002). No complications of stent insertion or ERCP were recorded in the study cohort.Implementation of trans‐cystic stents can lead to reductions in total hospital length of stay and improve ERCP processes. Our experience suggests that surgical initiatives can be successfully added to routine practice by establishing a project team and applying quality improvement principles. [ABSTRACT FROM AUTHOR]

The article discusses a study on nutritional assessment tools as predictors of hospitalization in patients undergoing maintenance hemodialysis. The study found that hospitalization is a major cost factor for end-stage kidney disease patients on maintenance hemodialysis and is linked to increased post-discharge mortality. Nutritional indicators like the seven-point subjective global assessment, malnutrition inflammation score, and body composition measurement were evaluated to determine their predictive value for hospitalization in these patients. The study concluded that the fat tissue index (FTI) was the best predictor of hospitalization, with a cutoff value of ≥ 11.45 kg/m2 for primary-cause hospitalization. The study also highlighted the importance of addressing malnutrition and activities of daily living to reduce hospital stays in these patients. [Extracted from the article]

ABSTRACT Objective Methods Results Conclusion The impact of preoperative consultations on mortality and morbidity rates, and their association with delays and hospital stays for surgery, remains a topic of discussion. This study aims to elucidate the necessity of consultations for those undergoing femoral neck fracture surgery, examining their influence on delays, hospital durations, and their correlation with mortality rates.The study examined data from 320 emergency department patients with femoral neck fractures undergoing hip arthroplasty surgery at our hospital between 2011 and 2021, using digital medical records. Patients were consulted in relevant departments for risk optimization. They were categorized into two groups based on the time of surgery: Group 1 (operated within 48 h) and Group 2 (delayed surgery). The analysis included days from admission to surgery, total hospital stay, and time from surgery to discharge. Mortality rates, with a minimum 2‐year follow‐up, were assessed using digital records, patient contact, or a death notification system. Statistical analyses involved Mann–Whitney U, Kruskal–Wallis, post hoc analysis, Pearson's chi‐squared, and Fisher–Freeman–Halton tests (α = 0.05). SPSS v25.0 software was used.Patients with consultation requests experience significantly delayed surgery compared to those without (p < 0.001). Statistically significant differences were observed between consulted and nonconsulted groups in time until surgery (p < 0.001), time from surgery to discharge (p < 0.001), and overall length of hospital stay (p < 0.001). However, there is no statistically significant difference in 30‐day and 1‐year mortality between consulted and nonconsulted patients, both departmentally and overall.This study found that advanced age and high ASA scores were the main factors causing surgical delays in hip fracture patients. While modifiable comorbidities could reduce hospital stays, they did not significantly affect postoperative mortality. Streamlining elective consultations and reducing organizational delays could help prevent delayed surgeries and improve outcomes. [ABSTRACT FROM AUTHOR]

Background: The obesity epidemic has led to an increased number of adolescents requiring metabolic and bariatric surgery (MBS), but there is paucity of data on the impact of implementing all aspects of Enhanced Recovery After Surgery (ERAS) protocols to improve outcomes in this population. Methods: We implemented a comprehensive ERAS pathway for adolescents undergoing laparoscopic sleeve gastrectomy (LSG). Key elements included pre-operative fasting with carbohydrate loading in the morning of surgery, comprehensive anti-emetic and analgesic regimens including intra-operative lidocaine infusion (initiated before formal ERAS launch), regional anesthesia, and early goal-directed ambulation. We tracked opioid utilization, rescue anti-emetic use, time to oral intake, and hospital length of stay (HLOS) as outcome measures, and post-operative pain and returns to the system as balancing measures. Results: Eighty-six patients (52 patients pre-ERAS and 34 patients post-ERAS) underwent LSG with no differences in demographics. The post-ERAS group had earlier time to oral intake (3.0 vs. 5.5 h, p = 0.003), used less rescue anti-emetics, (8.0 vs. 16.0 mg, p < 0.001), and had shorter HLOS (33 vs. 54 h, p < 0.001) but no difference in opioid use (0.370 vs. 0.435 MME/kg, p = 0.17), post-operative pain scores or return to the system. Conclusions: Our novel use of bariatric-specific ERAS protocol with intra-operative lidocaine infusion accelerates the time to goal-directed oral intake and decreases HLOS without increasing the rate of returns to the system. This study highlights the feasibility and effectiveness of adapting adult ERAS protocols to the pediatric MBS population. Level of evidence: Level III. [ABSTRACT FROM AUTHOR]

Background: The outcomes of recent advancements in pediatric tracheostomy remain unclear. This study was conducted to identify the trends in pediatric tracheostomy in Taiwan. Methods: This population-based survey was conducted using data from Taiwan's National Health Insurance Research Database. We identified inpatients younger than 18 years who had undergone tracheostomy in Taiwan between 2000 and 2019. The study period was divided into subperiods (2000-2004, 2005-2009, 2010-2014, and 2015-2019). We analyzed patient characteristics and trends related to age, gender, hospital level, surgical indications, hospital stay duration, and mortality rates. The trends were analyzed for all pediatric patients (age <18 years) and infants (age <1 year). Results: This study included 2465 pediatric patients (mean age: 8.7 ± 6.9 years; boys: 64%). The incidence of pediatric tracheostomy decreased from 3.3 events per 100,000 individuals in 2000 to 2.1 events per 100,000 individuals in 2019 (P for trend <.001). The proportion of infants who received tracheostomy increased from 22.8% in 2000-2004 to 32.5% in 2015-2019 (P for trend =.06). The proportion of pediatric patients who received tracheostomy at medical centers increased and those at regional hospitals or district hospitals decreased (74.7%-81.0% vs 25.3%-19.0%, P for trend =.003). The proportion of pediatric patients with trauma or brain injury as a surgical indication decreased from 36.6% to 28.7% (P for trend =.001). The duration of intensive care unit (ICU) stays increased from 30 days in 2000-2004 to 50 days in 2015-2019 (P for trend <.001), and that of hospital stay increased from 58 days in 2000-2004 to 71 days in 2015-2019 (P for trend =.001). The 5-year mortality rate slightly decreased from 38.0% in 2000-2004 to 33.3% in 2005-2009 and 31.0% in 2010-2014 (P for trend =.006). Conclusions: Our findings revealed that during the study period, the number of pediatric patients receiving tracheostomy decreased, but the proportion of infants receiving tracheostomy increased. The trends in pediatric tracheostomy indicated extended ICU stay, prolonged hospital stay, and reduced 5-year mortality rates. [ABSTRACT FROM AUTHOR]

Introduction: COVID-19 provides an opportunity to examine biological phenotypes (observable morphological, functional and biological characteristics) in individuals who experience the same acute condition, potentially revealing differences in response to acute external stressors. The aim our study was to investigate biological phenotypes in older patients hospitalized for COVID-19, exploiting a panel of aging biomarkers. Methods: Data were gathered from the FRACOVID Project, an observational multicenter study, aimed to evaluate the impact of frailty on health-related outcomes in patients 60 + with COVID-19 in Northern Italy. A hierarchical cluster analysis was run using log-transformed and scaled values of TNF-a, IL-1 beta, IL-6, PAI-1, GDF-15, NT-proBNP, and Cystatin C evaluated at admission. Results: Eighty-one participants (mean age 75.3 years; 60.5% male) were evaluated. Frailty was identified in 42% of the sample and 27.2% were unable to ambulate outdoors. The mean hospital stay was 24.7 days, with an in-hospital mortality rate of 18.5%. Three biological phenotypes were found: (1) 'inflammatory', with high inflammatory biomarkers; (2) 'organ dysfunction', characterized by elevated cystatin C and NT-proBNP, and lower inflammatory markers; and (3) 'unspecific', with lower NT-proBNP and GDF-15 levels, and intermediate concentrations of other biomarkers. The 'organ dysfunction' phenotype showed the highest mean age and prevalence of frailty, disability, and chronic diseases. The 'inflammatory' phenotype showed the highest burden of respiratory and systemic signs and symptoms of infection. Conclusion: Biological phenotypes might be used to identify different clinical and functional phenotypes in individuals affected by COVID-19. [ABSTRACT FROM AUTHOR]

Background: With an aging population, knee arthroplasty is increasingly common; however, chronic postsurgical pain (CPSP) affects up to 30% of patients. This study aims to evaluate the efficacy of 5% lidocaine-medicated plaster (LP5) in preventing CPSP among patients undergoing knee arthroplasty. Methods: This is a dual-center, randomized, double-blind, placebo-controlled trial involving 128 adult patients scheduled for knee arthroplasty. Participants will be randomly assigned, stratified by center, to either the LP5 group or the placebo group (n = 64 per group). The LP5 or placebo group will apply the patch 1 day before surgery and on postoperative days 1–3, with multimodal analgesia administered postoperatively. Multimodal analgesia will include intraoperative flurbiprofen axetil and postoperative patient-controlled sufentanil. The primary outcome is the pain subscale of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at 3 months postoperatively. Secondary outcomes will include WOMAC stiffness, function, and total scales; Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) Pain Scale; 36-Item Short Form Health Survey (SF-36); postoperative pain scores; Visual Analog Scale (VAS) sleep scores; postoperative sufentanil consumption; need for rescue analgesia; length of Post-Anesthesia Care Unit (PACU) stay; length of hospital stay; and 90-day mortality. Safety outcomes will include assessments of hypotension, hypertension, bradycardia, tachycardia, arrhythmia, interventions for haemodynamic events, headache, dizziness, nausea, vomiting, local skin allergy, wound infection, and toxic reaction. Data will be analyzed following a modified intention-to-treat approach. Discussion: This study aims to provide high-quality evidence for the efficacy and safety of LP5 in preventing CPSP in patients undergoing knee arthroplasty. [ABSTRACT FROM AUTHOR]

Background: The introduction of Emergency Medicine in Rwanda in 2015 has been associated with a mortality reduction in patients presenting to Kigali University Teaching Hospital (KUTH). In the context of increasing numbers of critically ill patients presenting to Emergency Departments (ED) globally, the aim of this study was to describe the characteristics of critically ill patients, the critical care interventions performed, and the outcomes of critically ill patients presenting to the KUTH ED with the goal of informing future research into the root causes of mortality of critically ill ED patients and of identifying high yield topics for didactic and procedural training. Methods: A descriptive observational prospective cohort pilot study analyzed all patients ≥15 years who presented to KUTH between April and June 2022 with modified South African Triage Scores of Red with alarm, Red without alarm, and Orange. Results: Of 320 patients, 66.9% were male and median age was 40 years. Patients were triaged as Orange (65.3%), Red without alarm (22.8%), and Red with alarm (11.9%). Presentations were categorized as: medical emergencies (48.0%), traumatic injury (44.5%), and surgical emergencies (7.6%). Median length of stay was 31 h (IQR 28, 56) and boarding was 23 h (IQR 8, 48). Overall mortality was 12.2% and highest among medical emergencies (16.5%, p = 0.048) and increased significantly with triage color: Red with alarm (47.4%), Red without alarm (16.4%), and Orange (4.3%, p < 0.0001). Cardiopulmonary resuscitation (CPR) (10.3%), endotracheal intubation (8.8%), and vasopressor administration (3.1%) were the most frequent critical interventions performed. Survival after cardiac arrest was 9.1% and 32.1% after intubation. Mortality was associated with the following interventions: CPR, intubation, and use of vasopressors (p < 0.05). Conclusions: This pilot study identified the most common critical care interventions performed and a high mortality among patients who required these interventions in the ED of a tertiary teaching hospital in Rwanda. These findings will inform didactics and procedural training for emergency care providers. Future research should focus on the root causes of mortality in these specific patient populations and identify areas of system strengthening to reduce mortality. [ABSTRACT FROM AUTHOR]

Purpose: Hospital length of stay (LOS) following admission for appendicitis is difficult to predict. Shock index, pediatric age adjusted (SIPA) accurately identifies severely injured trauma patients and predicts mortality among children admitted to the ICU. Our aim was to determine if elevated SIPA at presentation, and time to normalization of SIPA, can identify children with perforated appendicitis and predict hospital LOS. Methods: This was a retrospective cohort study of children 1–17 years admitted to a quaternary care referral center with appendicitis after appendectomy in 2021. The primary outcomes were presence of perforated appendicitis and hospital LOS. Generalized linear regressions were performed. Covariates included in all models were age, sex, fecalith, initial temperature, and time from diagnosis to OR. Results: We included 169 patients; 53 (31.4%) had perforated appendicitis. After adjustment, elevated SIPA was associated with presence of perforated appendicitis (p = 0.0002) and longer LOS (p < 0.0001). A patient presenting with appendicitis and elevated SIPA had 5.447 times higher odds of having perforated appendicitis (95% CI: 2.262, 13.826), a mean hospital LOS 2.047 times longer (95% CI: 1.564, 2.683), a mean time to toleration of regular diet 4.995 times longer (95% CI: 2.914, 8.918), and a mean duration of antibiotics that is 1.761 times longer (95% CI: 1.383, 2.243) than a patient with normal SIPA. Conclusion: In children with appendicitis, elevated SIPA at presentation is associated with higher risk of perforation. These findings support the incorporation of SIPA during triage of patients with appendicitis and counseling families after surgery. Level of evidence: Level 3. [ABSTRACT FROM AUTHOR]

Background: The initiation time and formula for supplemental parenteral nutrition after surgery require optimization, especially in older patients undergoing major gastrointestinal surgery. This study aimed to assess the effect of early supplementation with a branched-chain amino acid (BCAA)-enriched formula (BAF) on short-term postoperative outcomes in older patients undergoing gastric surgery. Methods: This single-center, prospective, double-blinded, randomized clinical trial was conducted from March 10, 2020, to September 15, 2022. Patients aged 65–80 years with gastric cancer scheduled for curative resection were assessed for eligibility and randomly allocated to a high-proportion BCAA (HBCAA) (early supplementation with the BAF) or control (routine nutrition) group. The primary outcome was the standardized length of hospital stay (LOS). Results: A total of 150 patients were randomized. Thirteen patients were excluded due to the resection of other organs, presence of metastasis, or withdrawal of consent. Finally, we included 70 and 67 patients in the HBCAA and control groups, respectively (mean age: 70.5 ± 4.2 years; 96 men [70.1%]). The standardized LOS was significantly shorter in the treatment group than in the control group (median [interquartile range]: 8.0 [7.8, 8.0] vs. 8.5 [8.0, 9.0] days; mean difference, 0.38; 95% confidence interval [CI], 0.02–0.74 days; P <.001). Patients in the HBCAA group showed better gastrointestinal function with faster defecation (4.0 [3.6, 5.0] vs. 5.0 [4.0, 5.5] days; mean difference, 0.6 days; 95% CI, 0.26–0.94 days; P <.001) and semi-liquid diet initiation (8.0 [7.5, 8.0] vs. 8.0 [8.0, 8.8] days; mean difference, 0.36 days; 95% CI, 0.03–0.7 days; P <.001) and had lesser weight loss at postoperative day 5 than those in the control group did (3.5 [2.7, 6.5] vs. 4.9 [3.3, 7.6]%; mean difference, 1.23%; 95% CI, 0.27–2.19%; P =.011). Conclusions: In this randomized clinical trial, compared with routine nutrition, early supplementation with a BAF was associated with a shorter standardized LOS in older patients undergoing gastric surgery, suggesting that it may be a favorable strategy for patients with a poor tolerance to external nutrition who are undergoing major surgery. Trial registration: ClinicalTrials.gov; Identifier: ChiCTR2000029635. [ABSTRACT FROM AUTHOR]

Standard chest tubes (CTs) used to drain retained blood can become occluded from blood clots, leading to ineffective drainage and postoperative complications such as cardiac tamponade. Chest tube clearance strategies (CTCSs) were developed to improve CT patency. Our meta‐analysis compared the safety and efficacy of CTCS versus CT following cardiac surgery. The PubMed/MEDLINE, Embase, Web of Science, and Scopus databases were searched from 1946 to 2023 for studies that compared CTCS to CT. Two investigators independently reviewed, screened, extracted, and assessed the data prior to performing a random effects meta‐analysis using R. The primary outcome was re‐exploration and the secondary outcomes were retained blood syndrome, mortality, blood products, stroke, cardiac arrest, atrial fibrillation, ventilation time, intensive care unit (ICU) time, hospital length of stay, and chest drainage. Five studies (2288 patients) were included. There were two clinical trials (n = 620) and three observational studies (1668 patients). Compared to CT, CTCS had a significant reduction of postoperative atrial fibrillation (risk ratio (RR) 0.80, 95% CI 0.70 to 0.92, I2 = 17%, p < 0.01). There was no significant difference in re‐exploration, retained blood syndrome, hospital length of stay, and ICU length of stay. However, with the addition of four unmatched studies (n = 2583), CTCS was associated with a significant reduction in re‐exploration (RR 0.52, 95% CI 0.37 to 0.73, I2 = 34%, p < 0.01), retained blood syndrome (RR 0.71, 95% CI 0.53 to 0.95, I2 = 72%, p = 0.02), hospital length of stay (mean difference (MD) −0.40, 95% CI −0.78 to −0.01, I2 = 49%, p = 0.04), and chest drainage (MD 0.80, 95% CI 0.70 to 0.92, I2 = 17%, p < 0.01). Drawing from results including the unmatched studies, CTCSs are associated with fewer postoperative complications compared to CT. This was achieved without major differences in chest drainage, supporting the important role of preventing even small accumulations of blood in the pericardial space. [ABSTRACT FROM AUTHOR]

Objectives Study Setting and Design Data Sources and Analytic Sample Principal Findings Conclusions To examine heterogeneity in physician batch ordering practices and measure the associations between a physician's tendency to batch order imaging tests on patient outcomes and resource utilization.In this retrospective study, we used comprehensive EMR data from patients who visited the Mayo Clinic of Arizona Emergency Department (ED) between October 6, 2018 and December 31, 2019. Primary outcomes are patient length of stay (LOS) in the ED, number of diagnostic imaging tests ordered during a patient encounter, and patients' return with admission to the ED within 72 h. The association between outcomes and physician batch tendency was measured using a multivariable linear regression controlling for various covariates.The Mayo Clinic of Arizona Emergency Department recorded approximately 50,836 visits, all randomly assigned to physicians during the study period. After excluding rare complaints, we were left with an analytical sample of 43,299 patient encounters.Findings show that having a physician with a batch tendency 1 standard deviation (SD) greater than the average physician was associated with a 4.5% increase in ED LOS (p < 0.001). It was also associated with a 14.8% (0.2 percentage points) decrease in the probability of a 72‐h return with admission (p < 0.001), implying that batching may lead to more comprehensive evaluations, reducing the need for short‐term revisits. A batch tendency 1SD greater than that of the average physician was also associated with an additional 8 imaging tests ordered per 100 patient encounters (p < 0.001), suggesting that batch ordering may be leading to tests that would not have been otherwise ordered had the physician waited for the results from one test before placing their next order.This study highlights the considerable impact of physicians' diagnostic test ordering strategies on ED efficiency and patient care. The results also highlight the need to develop guidelines to optimize ED test ordering practices. [ABSTRACT FROM AUTHOR]

Background Aims Methods Results Conclusion Extended stays in specialist secure hospital units raise ethical concerns. While this topic has been investigated in various countries, there has been little research on it in France.We aimed to study the length of stay of patients in the Henri Colin unit, a secure hospital unit in the Paris area and test relationships between length of stay and sociodemographic, clinical and legal features.In this records‐based retrospective study, we included all 60 inpatients on a census day just prior to the pandemic. We chose a 2‐year threshold to define long stay status.Mean length of stay was just in the long‐stay range (756.7 days, SD 1071.2). Over a quarter (17, 28%) of the patients had been hospitalised for more than 2 years and 5 (8%) patients for more than 5 years. In multivariate analysis, legal status and need for seclusion during stay were significantly associated with long‐stay status. These results are consistent with international literature, especially as they show the significant interplay between legal and medical aspects in the patients' care pathway.As the first such study in a specialist medium security hospital unit in France, this study adds to the international evidence on the complexities surrounding extended stays in secure units and underscores the importance of addressing both clinical and legal aspects in the treatment of patients with mental disorders in these settings. [ABSTRACT FROM AUTHOR]

The study evaluated the accuracy and clinical impact of rapid diagnostics (RD) with or without antibiotic decision support (ADS) for hospitalized patients with urinary tract infections. A two‐centre prospective intervention was conducted with 230 patients divided into three groups: RD‐only (n = 59), RD plus ADS (n = 56) and a control group (n = 115). Mean laboratory turnaround time for RD was 10 h and 50 min. Of 115 microorganisms, 108 were correctly identified. The error rate for rapid susceptibility determination was 0.85%. Total antibiotic consumption, measured in defined daily doses (DDD), was lower in the intervention groups compared to the control group (ADS: 10.3 DDD, p = 0.01; RD: 10.9 DDD, p = 0.06; control: 13.0 DDD). No significant differences were observed in the use of broad‐spectrum antibiotics (p = 0.816). Adherence to antibiotic guidelines was significantly better in the ADS group compared to the control group (p = 0.015) (RD vs control; p = 0.261). The ADS group also received fewer doses of ineffective antibiotics (ADS: 1.8 doses, p = 0.012; RD: 2.4 doses, p = 0.195; control: 3.4 doses). Length of hospital and ICU stays or 30‐day readmission rates did not differ across groups. No in‐hospital mortality was observed in any group. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusion Left ventricular (LV) unloading is a crucial intervention to decrease the harmful consequences of extracorporeal membrane oxygenation (ECMO) on hemodynamic status in cardiogenic shock (CS) patients. However, a lingering question preoccupies experts: Should we intervene early or wait until clinical deterioration caused by increasing afterload is detected?A systematic review and meta‐analysis synthesizing studies, which were retrieved by systematically searching PubMed, Web of Science, SCOPUS, and Cochrane through December 2023. We used R V. 4.3 to pool dichotomous data using risk ratio (RR) and continuous data using mean difference (MD) with a 95% confidence interval (CI). PROSPERO ID: CRD42024501643.Eight studies with 2.117 patients were included. Early/prophylactic LV unloading was associated with a lower incidence of all‐cause mortality [RR: 0.87 with 95% CI (0.79, 0.95), p < 0.01]. However, there was no significant difference between the two groups regarding cardiac mortality [RR: 1.01 with 95% CI (0.68, 1.48), p = 0.98], non‐cardiac mortality [RR: 0.86 with 95% CI (0.46, 1.62), p = 0.64], and in‐hospital mortality [RR: 0.95 with 95% CI (0.86, 1.05), p = 0.30]. There was no significant difference between the two groups regarding ECMO weaning, myocardial recovery, ECMO duration, and length of hospitalization.Early/prophylactic LV unloading during ECMO for CS patients was associated with a decreased incidence of all‐cause mortality and sepsis or infection, with no effect on ECMO weaning, myocardial recovery, ECMO duration, and hospital length of stay. [ABSTRACT FROM AUTHOR]

Background: The U.S.-Mexico "border wall" between El Paso, Texas and Ciudad Juárez, Mexico was raised and extended beginning in 2018 in accordance with Presidential Executive Order 13,767. We hypothesized that these changes resulted in increased incidence and severity of injuries of individuals attempting to cross the border wall in the El Paso region. Methods: A retrospective cohort review was conducted of University Medical Center of El Paso Trauma Registry charts from 2001 to 2022. Year of injury, gender, age, Injury Severity Score, hospital length-of-stay, ICU length-of-stay, ventilator days, and survival were analyzed by Chi-square analysis with Fisher's exact test for categorical variables and Independent Samples T-test for continuous variables. An independent samples Mann Whitney U Test was used to compare border wall fall injuries before and after 2018. Results: Of the 842 patients reviewed, 69 patients presented before 2018 and 773 presented from 2018 to 2022. Statistically significant differences were identified in the mean Injury Severity Score which increased from 6.3 (SD ± 3.8) to 8.3 (SD ± 5.5, p <.001) and the mean hospital length-of-stay which increased from 6.7 days (SD ± 5.5) to 9.5 days (SD ± 8.0, p <.005). Conclusion: The incidence, severity, and hospital length-of-stay related to injuries crossing the U.S.-Mexico border have increased with changes in height of the border wall since 2018. Additional resources should be allocated to Emergency Departments and Trauma Centers along the Southwest Border to serve this unique patient population. Additional consideration should be given to the cost of the border wall. [ABSTRACT FROM AUTHOR]

Objectives: Coronary artery bypass grafting (CABG) is essential for treating coronary artery disease, with postoperative aspirin crucial to prevent graft restenosis. However, its gastrointestinal side effects may limit tolerability in some patients. Indobufen presents a potential alternative, but its safety and efficacy need further validation. This study aimed to compare the efficacy and safety of indobufen versus aspirin in patients' post-CABG. Methods: This retrospective observational study included 39 patients who underwent CABG at two centers from January to December 2023. Patients were retrospectively assigned to two groups based on the antiplatelet therapy they received: the indobufen group (n = 19) and the aspirin group (n = 20). The primary endpoint was a composite of non-fatal myocardial infarction, stroke, and revascularization due to acute coronary syndrome in the intention-to-treat population. Postoperative data on platelet count, hemoglobin, D-dimer, activated partial thromboplastin time (APTT), and hospital stay length were collected. Transfusion rate, bleeding, thrombotic events, and gastrointestinal adverse reactions were compared between the two groups. Results: Over the 8-to-18-month follow-up period, 5 patients (25%) in the aspirin group reached the primary endpoint, while none in the indobufen group did, a difference that was statistically significant (p = 0.02). Although the rates of non-fatal myocardial infarction, revascularization, stroke, and thrombotic events were higher in the aspirin group, these differences did not reach statistical significance. Importantly, the total bleeding events were markedly lower in the indobufen group (15.79% vs. 55%, p = 0.011), with major bleeding events also significantly reduced in the indobufen group (0% vs. 20%, p = 0.04). Both groups showed no significant differences were observed in postoperative hospital stay, hemoglobin, and D-dimer levels between the groups. However, the indobufen group demonstrated significantly lower platelet count and APTT. The average daily cost of indobufen was 27.8 times higher than that of aspirin. Conclusion: Indobufen demonstrates a comparable antiplatelet effect to aspirin and offers significant advantages in reducing gastrointestinal adverse reactions and bleeding risk. It can be considered a preferable alternative for patients who cannot tolerate or have contraindications to aspirin. Further large-scale clinical trials are needed to confirm its potential as the first-choice antiplatelet therapy post-CABG. [ABSTRACT FROM AUTHOR]

Background: Patients transitioning between different care contexts are at increased risk of experiencing adverse events. In particular, being discharged to home after inpatient treatment involves significant risks. However, there is a lack of valid and internationally comparable assessment tools on patients' experiences of difficulties following hospital discharge. Therefore, this study aimed to adapt and validate the German version of the post-discharge coping difficulty scale (PDCDS-G). Methods: Patients were recruited at a German university hospital. 815 adult patients participated in a self-report survey following an inpatient stay of at least three days. Factorial validity of the PDCDS-G was evaluated via factor analyses. Further, examination of measurement invariance was performed. To establish criterion validity, associations with patients' self-reported health status and occurrence of patient safety were determined. Further, group differences regarding patient characteristics, hospitalization factors, and survey-related variables were examined. Results: Factorial validity of the PDCDS-G was confirmed by a two-factorial model with good model fit. Both factors showed good to excellent reliability. The two-factor model achieved measurement invariance across all patient characteristics, hospitalization factors, and survey-related variables. Significant relationships with patients' health status and the occurrence of patient safety incidents corroborate criterion validity of the PDCDS-G. Differential associations of the two PDCDS-G factors regarding patient characteristics, hospitalization, and survey-related variables were found. Discussion: Construct and criterion validity, as well as the reliability of the PDCDS-G, were verified. Further, instrument's measurement invariance was confirmed allowing use of the scale for the interpretation of group differences and comparisons between studies. Conclusions: The PDCDS-G provides a validated and comparable patient-reported outcomes measure for patient experiences after hospital discharge to home. The PDCDS-G can be used for patient surveys in quality or patient safety improvement in care transition processes. [ABSTRACT FROM AUTHOR]

Background: This study aims to evaluate the impact of Quebec's first hospital-at-home-inspired mobile Seniors' Clinic, the "Clinique des Ainés (CDA)", on frail older adults' returns to the Emergency Department (ED), mortality, and hospital Length Of Stay (LOS) and rehospitalizations. Methods: Design: Quasi-experimental pre-post implementation cohort study. Population: Patients aged ≥ 75 years admitted to the short-term geriatric unit after an ED consultation (control) or included by the CDA (intervention). Outcomes: return to ED (RtoED), mortality, ED & hospital LOS, and rehospitalizations. Statistical analyses: Multivariable regression modelling. Results: Overall, 891 patients were included. At the intervention site (CDA) (n = 437), RtoED were similar at 30 (17.5% & 19.5%, p = 0.58), 90 (34.4% & 37.3%, p = 0.46) and 180 days (47.2% & 54.0%, p = 0.07) in the pre and post-implementation phases. No mortality differences were found. The hospitalization LOS was significantly shorter (28.26 and 14.22 days, p < 0.01). At 90 days, rehospitalization LOS was decreased by 8.51 days (p = 0.02) and by 6.48 days at 180 days (p = 0.03). Compared to the control site (n = 454) in the post-implementation phase, RtoED was 54% at the intervention site compared to 44.1% (p = 0.02) at 180 days. The CDA had a lower adjusted probability of mortality at 90 days compared to the control site (4.8% VS 11.7%, p = 0.03). No rehospitalization LOS differences were noted. Conclusions: The Clinique des Ainés showed effectiveness in caring for frail older patients in their homes by decreasing their hospital LOS by half and 90 days mortality risk. It was a safe care trajectory without a clinically significant increase in ED returns or mortality. [ABSTRACT FROM AUTHOR]

Objective: Limited evidence exists regarding the impact of the COVID‐19 pandemic on the onset and trajectory of eating disorders (EDs) among young in Spain. This study aims to analyze the characteristics and recent trends in hospital admissions for EDs within the pediatric population. Methods: A retrospective analysis was conducted on hospital admissions for EDs among patients aged 10–19 years between 2016 and 2022. The main outcomes examined included hospital rates (overall, stratified by ED type and age group), psychiatric comorbidities, and length of stay. Results: A total of 8275 hospitalizations due to EDs were identified, constituting 1 in 6 hospital admissions for mental illness and behavioral disorders. Predominant characteristics of this population included female sex (93%), aged 15–19 years (58.3%), admission primarily for anorexia nervosa (71.6%), and psychiatric comorbidity (35.6%). Hospital admissions for EDs in the pediatric population showed an increasing trend, with an annual average increase of 11.1% (95% CI: 2.6, 22.6). This rise was led by children aged 10–14 years, with a yearly increase in EDs hospitalization rates of 28.4% (95% CI: 13.5, 56.3) since 2019. Each discharge related to EDs was associated with a median stay of 24 days (IQR: 10, 40). Discussion: Efforts in community healthcare should prioritize early detection and intervention for symptoms indicative of EDs in the pediatric population, aiming to mitigate the severity of cases requiring hospitalization. These findings underscore the necessity for targeted health planning policies to address the growing burden of EDs among Spanish youth. [ABSTRACT FROM AUTHOR]

BACKGROUND: After decades of experience supporting surgical quality and safety by the American College of Surgeons (ACS), the ACS Quality Verification Program (ACS QVP) was developed to help hospitals improve surgical quality and safety. This review is the final installment of a 3-part review aimed to synthesize evidence supporting the main principles of the ACS QVP. STUDY DESIGN: Evidence was systematically reviewed for 3 principles: standardized team-based care across 5 phases of surgical care, disease-based management, and external regulatory review. MEDLINE was searched for articles published from inception to January 2019 and 2 reviewers independently screened studies for inclusion in a hierarchical manner, extracted data, and summarized results in a narrative fashion. A total of 5,237 studies across these 3 topics were identified. Studies were included if they evaluated the relationship between the standard of interest and patient-level or organization measures within the last 20 years. RESULTS: After applying inclusion criteria, a total of 150 studies in systematic reviews and primary studies were included for assessment. Despite institutional variation in standardized clinical pathways, evidence demonstrated improved outcomes such as reduced length of stay, costs, and complications. Evidence for multidisciplinary disease-based care protocols was mixed, though trended toward improving patient outcomes such as reduced length of stay and readmissions. Similarly, the evidence for accreditation and adherence to external process measures was also mixed, though several studies demonstrated the benefit of accreditation programs on patient outcomes. CONCLUSIONS: The identified literature supports the importance of standardized multidisciplinary and disease-based processes and external regulatory systems to improve quality of care. [ABSTRACT FROM AUTHOR]

BACKGROUND: Same-day mastectomy (SDM) protocols have been shown to be safe, and their use increased up to 4-fold compared with prepandemic rates. We sought to identify factors that predict overnight patient admission and evaluate the associated cost of care. STUDY DESIGN: Patients undergoing mastectomy from March 2020 to April 2022 were analyzed. Patient demographics, tumor characteristics, operative details, perioperative factors, 30-day complication, fixed and variable cost, and contribution margin were compared between those who underwent SDM vs those who required overnight admission after mastectomy (OAM). RESULTS: Of a total of 183 patients with planned SDM, 104 (57%) had SDM and 79 (43%) had OAM. Both groups had similar demographic, tumor, and operative characteristics. Patients who required OAM were more likely to be preoperative opioid users (p = 0.002), have higher American Society of Anesthesiology class (p = 0.028), and more likely to have procedure start time (PST) after 12:00 pm (49% vs 33%, p = 0.033). The rates of 30-day unplanned postoperative events were similar between SDM and OAM. Preoperative opioid user (odds ratio [OR] 3.62, 95% CI 1.56 to 8.40), postanesthesia care unit length of stay greater than 1 hour (OR 1.17, 95% CI 1.01 to 1.37), and PST after 12:00 pm (OR 2.56, 95% CI 1.19 to 5.51) were independent predictors of OAM on multivariate analysis. Both fixed ($5,545 vs $4,909, p = 0.03) and variable costs ($6,426 vs $4,909, p = 0.03) were higher for OAM compared with SDM. Contribution margin was not significantly different between the 2 groups (-$431 SDM vs -$734 OAM, p = 0.46). CONCLUSIONS: Preoperative opioid use, American Society of Anesthesiology class, longer postanesthesia care unit length of stay, and PST after noon predict a higher likelihood of admission after planned SDM. OAM translated to higher cost but not to decreased profit for the hospital. [ABSTRACT FROM AUTHOR]

BACKGROUND: Traumatic hemothorax (HTX) is often managed with tube thoracostomy (TT); however, TT carries a high complication rate. In 2017, a guideline was implemented at our Level I trauma center to observe traumatic HTX 300 mL or less in patients who are hemodynamically stable. We hypothesized that this guideline would decrease TT placement without increasing observation failure rates. STUDY DESIGN: This was a single-center retrospective review of all adult patients admitted with an HTX on CT before (2015 to 2016) and after (2018 to 2019) the guideline implementation. Exclusion criteria were TT placement before CT scan, absence of CT scan, death within 5 days of admission, and a concurrent pneumothorax more than 20 mm. HTX volume was calculated using CT scan images and Mergo's formula: V = d2 x L (where V is the volume, d is the depth, and L is the length). The primary outcome was observation failure, defined as the need for TT, video-assisted thoracoscopic surgery, thoracotomy after repeat imaging or worsening of symptoms, and pulmonary morbidity. RESULTS: A total of 357 patients met inclusion criteria, of whom 210 were admitted after guideline implementation. No significant differences in baseline demographics, comorbidities, or injury characteristics across both cohorts were observed. The postimplementation cohort had a significant increase in observation rate (75% vs 59%) and a decrease in TT placement (42% vs 57%). The postimplementation group had a statistically significant shorter hospital (6 vs 8 days) and ICU (2 vs 3 days) length of stay. No significant differences in observation failure, pulmonary complications, 30-day readmission, or 30-day mortality were observed across both cohorts. CONCLUSIONS: The implementation of the 300-mL guideline led to a decrease in TT placement without increasing observation failure or complication rates. [ABSTRACT FROM AUTHOR]

Objectives: During the course of the Coronavirus disease 2019 (COVID-19) pandemic, numerous comorbidities were identified as risk factors for increased morbidity and mortality. Few studies have examined human immunodeficiency virus (HIV) and COVID-19 co-infection and the impact of HIV on COVID-19 outcomes. In this study, we compared outcomes of people living with HIV with COVID-19 with a control group to examine outcomes. Methods: We identified 45 people living with HIV admitted with COVID-19 to one of three large healthcare systems in Memphis, Tennessee, between March 1 and October 31, 2020. We matched the people living with HIV in a 1:1 fashion to a control group of COVID-19-positive patients without a recorded history of HIV and compared clinical outcomes. Nine pairs were not able to be optimally matched, so a sensitivity analysis was completed by repeating the same analyses in the primary analysis while excluding the nine mismatched pairs. Results: Patients did not differ significantly in demographic variables due to the matching algorithm, and there was no significant difference in measured outcomes between people living with HIV and controls. A CD4 count of <200 cells per microliter was not significantly associated with increased morbidity or mortality. Controlling for HIV status, an elevated Charlson Comorbidity Index score of >3 was associated with increased intubation (P = 0.02), vasopressor use (odds ratio [OR] 4.81, P = 0.04), intensive care unit level of care (OR 4.37, P = 0.007), mortality (OR 7.14, P = 0.02), and length of overall hospital stay in days (P = 0.004). Conclusions: We found no difference in outcomes of people living with HIV in comparison to matched controls based on HIV status but found that an increased Charlson Comorbidity Index score led to increased morbidity and mortality regardless of HIV status. [ABSTRACT FROM AUTHOR]

Background: Hyperuricemia has been linked to various adverse clinical outcomes. Data on the clinical outcomes and the relationship between hyperuricemia and sepsis remain limited. The aim of this study was to evaluate the impact of hyperuricemia on clinical outcomes in sepsis patients and to identify whether it can predict the mortality in this patient population. Methods: This was a retrospective cohort study of adult patients with sepsis admitted to the intensive care unit (ICU) from 1 January 2021 to 31 December 2023. The patients were divided into hyperuricemia and non-hyperuricemia groups. Hyperuricemia was defined as a serum uric acid level > 416.4 µmol/L (7.0 mg/dL) in males or >357.0 µmol/L (6.0 mg/dL) in females based on the first serum uric acid reading within 24 h of ICU admission. The primary outcome of this study was ICU mortality. Secondary outcomes included in-hospital mortality, progression to septic shock, and ICU and hospital lengths of stay (LOSs). Results: A total of 599 patients were included in the study. Among these, 303 were in hyperuricemia group, while 296 were in the non-hyperuricemia group. The incidence of ICU and in-hospital mortality was higher in the hyperuricemia group compared to the non-hyperuricemia group (26.7% vs. 18.9% (p < 0.001) and 34.7% vs. 19.3% (p < 0.001), respectively). After adjusting for cofounders, hyperuricemia was not a predictor of ICU mortality (OR 1.52, 95% CI 0.95–2.43, p = 0.083). Most secondary outcomes were similar between the groups. However, the hyperuricemia group had a higher incidence of progression to septic shock (67.3% vs. 50.7%, p < 0.001), and hospital LOS was significantly longer in the hyperuricemia group (384 vs. 264 h, p = 0.004). Conclusions: Our findings demonstrated that hyperuricemia in sepsis patients was associated with worse clinical outcomes such as higher ICU and hospital mortality. Moreover, there was a higher incidence of septic shock progression and longer hospital LOS. The other outcomes were not statistically significantly different. Further prospective research is warranted to confirm these findings. [ABSTRACT FROM AUTHOR]

Background: Skin- (SSM) and nipple-sparing (NSM) mastectomies are frequently performed surgeries with a considerable risk for post-operative hematoma or seroma. Tranexamic acid (TXA) is a potent antifibrinolytic drug commonly used in many surgical fields but rather novel in plastic and, specifically, breast surgery. This study investigates the influence of TXA in patients undergoing SSM or NSM with expander-based reconstruction (EbR) on post-operative outcomes. Methodology: A retrospective study was conducted on 132 patients undergoing uni- or bilateral SSM or NSM with EbR between May 2015 and March 2022. Patients receiving systemic TXA treatment for 48 h following a standardized protocol were compared to those who received no treatment. Multivariable linear regression was performed to identify influencing factors and quantify their effect on drainage volume, duration of drain placement, length of hospital stay, post-operative bleeding, and seroma formation. Results: The 132 patients underwent a total of 155 mastectomies (72 in the TXA group, 83 in the control group). TXA significantly reduced drainage volume (−22.3 mL, p = 0.011). Duration of drain placement and length of hospital stay were significantly shorter in the TXA group (p < 0.001 and p = 0.001). No significant side effects were reported. Conclusion: TXA is a safe drug if administered respecting the well-defined contraindications. Systemic TXA administration significantly reduces drainage volume in patients undergoing SSM or NSM and should encourage surgeons to reconsider using drains in post-operative protocols. Duration of drain placement and length of hospital stay were significantly reduced in the TXA group but other factors like resection weight might have a more substantial impact. [ABSTRACT FROM AUTHOR]

Background/Objectives: In March 2018, a tertiary teaching hospital launched a medical hospitalist team. This study presents the clinical characteristics and outcomes of medical hospitalist care and reveals the relationship between them. Methods: This study included 4003 patients first admitted to the hospitalist team via emergency room and then discharged from the hospitalist team between March 2018 and November 2022. The patients were admitted either to the teaching admitter hospitalist team or the hospitalist-led acute medical unit (AMU). Afterward, the patients were either discharged, if possible, within a few days or transferred to ward hospitalists if assigned wards for hospitalist care were available. Results: The patients' mean Charlson Comorbidity Index score was 3.5 and the mean National Early Warning Score was 3.4. Of the admissions, 44.2% of the patients were admitted to the AMU, and 26.8% received an early consultation with a subspecialist. Each hospitalist managed 12.8 patients per month on average. The patients' mean LOS was 14.52 days, 10.5% of patients died during hospitalization, and 13.0% of patients had unscheduled readmission within 1 month. The patients' mean total cost per hospital stay was 572,836 won per day. Admission to the AMU was associated with a lower total cost per hospital stay, but the relationships with mortality, readmission, and LOS were not significant. Conclusions: The study reports on the outcomes of implementing a medical hospitalist care system that combines short-term admission wards with integrated care models to manage complex cases. These findings provide insights into optimizing hospitalist systems for improved patient outcomes. [ABSTRACT FROM AUTHOR]

Objectives: The choice of the best Video-Assisted Thoracic Surgery (VATS) surgical approach is still debated. Surgeons are often faced with the choice between innovation and self-confidence. The present study reports the experience of a high-volume single institute, comparing data of uni-portal, bi-portal and tri-portal VATS, to find out the safest and most effective mini-invasive approach, leading surgeon's choice. Methods: Between 2015 and 2022, a total of 210 matched patients underwent VATS lobectomy for early-stage cancer, using uni-portal (fifth intercostal space), bi-portal (seventh space for optic and the fifth), and tri-portal (seventh and the fifth/four) access. Patients were matched for age, BPCO, smoke, comorbidities, lesions (size and staging) to obtain three homogenous groups (A: uni-portal; B: bi-portal; C: tri-portal). The surgeons had comparable expertise. Data were retrospectively collected from institutional database and analyzed. Results: No differences were detected considering time of surgery, length of hospital stay, complications, conversion rate, specific survival, and days of chest tube length of stay. Better results on chest tube removal were described in group A (mean 1.1 days) compared to B (mean 2.6 days) and C (mean 4.7 days); nevertheless, they not statistically significant (p = 0.106). Conclusions: No significant differences among the groups were described, except for the reduction in chest tube permanence in group A. This allows to hypothesize an enhanced recovery after surgery in this group but the different approaches in this series seem to guarantee comparable safety and effectiveness. Considering no superiority of one method above the others, the best suggested approach should be the one for which the surgeon feels more confident. [ABSTRACT FROM AUTHOR]

Background: This study investigated the effect of mannitol administration on postoperative renal function during robot-assisted partial nephrectomy (RAPN) in patients with renal cell carcinoma (RCC). Methods: Patients with RCC who underwent RAPN at eight Japanese facilities between March 2016 and November 2023 were enrolled. In this study, patients were categorized into two groups according to those who received mannitol during RAPN (Group I) and those who did not receive mannitol (Group II). Differences in covariates between the two groups were adjusted using propensity score matching (PSM). Results: The study included 1530 patients with RCC who underwent RAPN. PSM was performed on 531 participants in each group. No difference was observed in perioperative outcomes between the two groups in terms of length of hospital stay, surgical outcomes, achievement ratio of Trifecta, and estimated glomerular filtration rate at 28 days, 90 days, and 1 year postoperatively. Conclusions: Intraoperative mannitol administration during RAPN for improving renal function may be unnecessary. [ABSTRACT FROM AUTHOR]

Objective: This study offered an updated meta-analysis of randomized controlled trials (RCTs) that assessed preoperative misoprostol compared to control (matched placebos or no treatment) during abdominal myomectomies. Methods: Six databases underwent screening until 7 April 2024. The risk of bias was assessed using the Cochrane Collaboration tool. The results were presented as mean differences (MDs) or risk ratios (RRs) along with 95% confidence intervals (CIs) using the random-effects model. Results: Sixteen RCTs were analyzed, involving 975 women. The overall quality of the studies was rated as "low" or had "some concerns" of bias in seven and eight RCTs, respectively; one RCT had an overall "high" risk of bias. For primary endpoints, the misoprostol intervention had significantly lower mean intraoperative blood loss (n = 15, MD = −180.2 mL, 95% CI [−224.04, −136.35], p < 0.001), mean hemoglobin drop (n = 13, MD = −0.58 g/dl, 95% CI [−0.82, −0.35], p < 0.001), and rate of perioperative blood transfusion (n = 13, RR = 0.43, 95% CI [0.29, 0.63], p < 0.001) compared to the control intervention. For secondary endpoints, the misoprostol intervention had significantly lower mean hematocrit drop (MD = 2.15, 95% CI −3.34, −0.96], p < 0.001), mean operative time (MD = −12.95 min, 95% CI [−19.89, −6.01], p < 0.001), and mean hospital stay (MD = −0.14 days, 95% CI [−0.25, −0.02], p = 0.02) compared to the control intervention. Nonetheless, no significant change was indicated between both interventions regarding the rate of postoperative fever. Conclusions: During abdominal myomectomy, the administration of preoperative misoprostol was generally safe and yielded statistically significant reductions in intraoperative blood loss, hemoglobin drop, and perioperative blood transfusion. [ABSTRACT FROM AUTHOR]

Background: Older adults with severe aortic stenosis (AS) may receive care in a nursing home (NH) prior to undergoing transcatheter aortic valve replacement (TAVR). NH level of care can be used to stabilize medical conditions, to provide rehabilitation services, or for long‐term care services. Our primary objective is to determine whether NH utilization pre‐TAVR can be used to stratify patients at risk for higher mortality and poor disposition outcomes at 30 and 365 days post‐TAVR. Methods: We conducted a retrospective cohort study among Medicare beneficiaries who spent ≥1 day in an NH 6 months before TAVR (2011–2019). The intensity of NH utilization was categorized as low users (1–30 days), medium users (31–89 days), long‐stay NH residents (≥ 100 days, with no more than a 10‐day gap in care), and high post‐acute rehabilitation patients (≥90 days, with more than a 10‐day gap in care). The probabilities of death and disposition were estimated using multinomial logistic regression, adjusting for age, sex, and race. Results: Among 15,581 patients, 9908 (63.6%) were low users, 4312 (27.7%) were medium users, 663 (4.3%) were high post‐acute care rehab users, and 698 (4.4%) were long‐stay NH residents before TAVR. High post‐acute care rehabilitation patients were more likely to have dementia, weight loss, falls, and extensive dependence of activities of daily living (ADLs) as compared with low NH users. Mortality was the greatest in high post‐acute care rehab users: 5.5% at 30 days, and 36.4% at 365 days. In contrast, low NH users had similar mortality rates compared with long‐stay NH residents: 4.8% versus 4.8% at 30 days, and 24.9% versus 27.0% at 365 days. Conclusion: Frequent bouts of post‐acute rehabilitation before TAVR were associated with adverse outcomes, yet this metric may be helpful to determine which patients with severe AS could benefit from palliative and geriatric services. [ABSTRACT FROM AUTHOR]

Background: Whether cognitive and functional recovery in skilled nursing facilities (SNF) following hospitalization differs by delirium and Alzheimer's disease related dementias (ADRD) has not been examined. Objective: To compare change in cognition and function among short‐stay SNF patients with delirium, ADRD, or both. Design: Retrospective cohort study using claims data from 2011 to 2013. Setting: Centers for Medicare and Medicaid certified SNFs. Participants: A total of 740,838 older adults newly admitted to a short‐stay SNF without prevalent ADRD who had at least two assessments of cognition and function. Measurements: Incident delirium was measured by the Minimum Data Set (MDS) Confusion Assessment Method and ICD‐9 codes, and incident ADRD by ICD‐9 codes and MDS diagnoses. Cognitive improvement was a better or maximum score on the MDS Brief Interview for Mental Status, and functional recovery was a better or maximum score on the MDS Activities of Daily Living Scale. Results: Within 30 days of SNF admission, the rate of cognitive improvement in patients with both delirium/ADRD was half that of patients with neither delirium/ADRD (HR = 0.45, 95% CI:0.43, 0.46). The ADRD‐only and delirium‐only groups also were 43% less likely to have improved cognition or function compared to those with neither delirium/ADRD (HR = 0.57, 95% CI:0.56, 0.58 and HR = 0.57, 95% CI:0.55, 0.60, respectively). Functional improvement was less likely in patients with both delirium/ADRD, as well (HR = 0.85, 95% CI:0.83, 0.87). The ADRD only and delirium only groups were also less likely to improve in function (HR = 0.93, 95% CI:0.92, 0.94 and HR = 0.92, 95% CI:0.90, 0.93, respectively) compared to those with neither delirium/ADRD. Conclusions: Among older adults without dementia admitted to SNF for post‐acute care following hospitalization, a positive screen for delirium and a new diagnosis of ADRD, within 7 days of SNF admission, were both significantly associated with worse cognitive and functional recovery. Patients with both delirium and new ADRD had the worst cognitive and functional recovery. [ABSTRACT FROM AUTHOR]

Objective: Given the apparent life-threatening nature of COVID-19, finding an effective treatment is under investigation. Materials and Methods: We assessed effect of shallomin oral syrup (co IranAmin®) as a complementary treatment to improve the clinical outcomes in COVID-19 patients. Patients in the control group received the approved treatment protocol (lopinavir/ritonavir), while those in the intervention group were treated with the oral syrup shallomin in addition to the approved treatment. Clinical status of treated patients was recorded and compared. Results: There were meaningful differences between the two groups regarding shortened length of hospital stay and the recovery time for cough, myalgia, sore throat, and shortness of breath. No side effect occurred in the intervention group compared to the control group in terms of biochemical and hematological factors. Conclusion: It seems that the treatment with shallomin syrup showed remarkable contribution to the recovery of COVID-19 induced symptoms in the patients under lopinavir/ritonavir therapy. [ABSTRACT FROM AUTHOR]

Introduction: Chronic myeloid leukemia (CML) is a hematological malignancy with an excellent prognostic outcome. After the advancements in CML treatment and the introduction of different tyrosine kinase inhibitors (TKIs), the life expectancy of CML patients has become equivalent to that of the general population. As a result, coronary artery disease is anticipated to be the leading cause of death among CML patients. Moreover, TKI use is associated with a risk of endothelial dysfunction, thrombosis, and cardiovascular events, including myocardial infarction. In this study, we compare the outcomes of percutaneous coronary intervention (PCI) in patients with CML to their matched non-CML counterparts. Method: This is a retrospective cohort study using the Nationwide Readmission Database from January 2016 to December 2020. Adults with or without CML hospitalized for acute myocardial infarction and underwent PCI were included. The patients were identified using ICD-10 codes. The primary outcomes were in-hospital mortality and 30-day readmission rates. The secondary outcomes were PCI complications rates. Results: Out of 2,727,619 patients with myocardial infarction, 2,124 CML patients were identified. A total of 888 CML patients underwent PCI. CML patients were significantly older (mean age: 68.34 ± 11.14 vs. 64.40 ± 12.61 years, p < 0.001) than non-CML patients without a difference in sex distribution. Hypertension (85.45% vs. 78.64%), diabetes (45.48% vs. 37.29), stroke (11.84% vs. 7.78) at baseline were significantly higher in the CML group. Prior myocardial infarction events (20.51% vs. 15.17%) and prior PCI procedure (24.47% vs. 16.89%) were significantly higher in the CML group. CML patients had a significantly longer hospital stay (4.66 ± 4.40 vs. 3.75 ± 4.62 days, p = 0.001). The primary outcomes did not differ between the comparison groups. The risk of post-PCI complications did not differ between the comparison groups in the propensity matched analysis except for coronary artery dissection (odds ratio [OR]: 0.10; 95% confidence interval [CI]: 0.02–0.65, p = 0.016) and ischemic stroke (OR: 0.35; 95% CI: 0.14–0.93, p = 0.034) which were lower in the CML group. Conclusion: This analysis showed no statistically significant difference in mortality, 30-day readmission, and post PCI complications rates between CML and non-CML patients. However, interestingly, CML patients may experience lower coronary artery dissection and ischemic stroke events than those without CML diagnosis. [ABSTRACT FROM AUTHOR]

Objectives: Although the guidelines clearly recommend the fasting time of children before anesthesia, it is usually difficult to control. For pediatric patients, prolonged fasting time before surgery will lead to dehydration and hypoglycemia. Adenotonsillectomy is one of the most common operations in pediatric patients, but its complications are not rare. The purpose of this study is to analyze the relationship between preoperative fasting time and postoperative complications in children undergoing adenotonsillectomy. Methods: The medical and surgical records of 480 pediatric patients who underwent adenotonsillectomy were analyzed retrospectively. They were divided into three groups, including adenoidectomy group, tonsillectomy group, and adenotonsillectomy group. Logistic regression analysis was used to analyze the effect of preoperative fasting time on postoperative complications and hospital stay in pediatric patients of the three groups. Results: The postoperative bleeding rate in the adenoidectomy group (5.16%) was lower than tonsillectomy group and adenoidectomy group (P <.001). Logistic regression analysis showed that the fasting time was positively correlated with the vomiting and pain in adenoidectomy group, tonsillectomy group, and adenotonsillectomy group. And, the postoperative hospital stay was also positively correlated with fasting time in three groups. Conclusion: The prolonged fasting time before otolaryngology surgery in children is related to the occurrence of postoperative complications like vomiting and pain, and also to the increase of postoperative hospital stay. [ABSTRACT FROM AUTHOR]

Objective: To examine associations of laboratory and imaging data with diagnostic parameters of necrotizing otitis externa (NOE) and its severity, and to compare between bacterial and fungal infections. Methods: Records of patients diagnosed with NOE during 2010–2018 at the Department of Otolaryngology, Head and Neck Surgery were reviewed retrospectively for demographics; disease characteristics; and laboratory, scintigraphy, and imaging results. Results: Of 48 patients with NOE, the mean age is 73±11.6 years; 32 (67%) were males; 83% had diabetes mellitus. Common pathogens were pseudomonas (49%) and fungi (33%). Sensitivities of the technetium-scan (SPECT ratio ≥1.5), temporal bone computed tomography (CT), and gallium-scan (SPECT ratio ≥1.3) were: 78.7%, 48.8%, and 31.4%, respectively. Gallium-scan results correlated positively with CT bone involvement (p=0.002) and hospital length of stay (p=0.0014). C-reactive protein (CRP) level correlated with hospital length of stay (p=0.028) and positive technetium-scan results (p=0.012). Fungal infection had a higher technetium SPECT ratio (2.16 vs. 1.77, p=0.04), gallium SPECT ratio (1.4 vs. 1.2, p=0.02), longer duration of systemic treatment (87.4 vs. 37.9 days, p=0.014), and longer hospital length of stay (31.6 vs. 15.2 days, p=0.004) compared to non-fungal infection. Eight (17%) patients had responded poorly to treatment. Fungal pathogens, facial nerve paresis, extra-auricular, and bilateral disease were more prevalent among the non-responders. Conclusion: The technetium scan has higher sensitivity than temporal bone CT for diagnosing NOE. The gallium scan and CRP correlated well with hospital length of stay. A high rate of fungal infection was found, with significantly higher technetium and gallium SPECT ratios and worse outcome compared to bacterial infection. Fungal NOE remains therapeutically challenging. [ABSTRACT FROM AUTHOR]

Introduction: Left atrial appendage occlusion (LAAO) can be performed using diverse anesthetic approaches ranging from moderate sedation (MS) to general anesthesia (GA), and guided by intracardiac echocardiography (ICE) or transesophageal echocardiography (TEE). Prior studies have demonstrated shorter time in lab for heart rhythm procedures performed under MS. The objective of this study was to compare laboratory times, acute procedural outcomes and complication rates for LAAO procedures performed using MS and 4‐dimensional ICE as opposed to GA. Methods and Results: This was a retrospective observational cohort study of 135 consecutive patients who were referred for LAAO to be performed with either GA or MS between June 2022 and April 2024. The primary endpoints were total laboratory time, procedure time, nonprocedure time, and fluoroscopy time. The secondary endpoints were stroke, peri‐device leak (>5 mm), device‐related left atrial thrombus, cardiovascular mortality, and all‐cause mortality at 45 days and 6 months postprocedure, where data were available. The mean age of patients in the study was 78.8 ± 7.8 years and 64.4% were male with no difference between GA and MS. In the MS group, 4D‐ICE was used for intraprocedural imaging in 95.5% of patients and 2 dimensional‐ICE (2D‐ICE) was used in 4.5% of patients. In the GA group, intra‐procedural imaging was done using TEE in 51.5%, 2D‐ICE in 32.4% and 4D‐ICE in 16.2% of cases. Total laboratory time was significantly lower in the MS group compared to the GA group (68.3 ± 23.1 vs 117.1 ± 34.3 min; p < 0.001), due to shorter nonprocedure time (15.2 ± 9.1 vs 63.7 ± 22.0 min; p < 0.001), with no significant difference in procedure time and fluoroscopy time. There was no significant difference in complications at 45 days and 6 months postprocedure. Conclusion: In this single center study, MS reduced total lab time by reducing nonprocedure time when compared to GA for LAAO, without affecting clinical outcomes. [ABSTRACT FROM AUTHOR]

Background: Complications associated with cardiovascular implantable electronic devices may necessitate device and lead removal. An open approach to removal may be electively chosen in cases with high risk of complications or those requiring additional concomitant cardiac surgery. This study aimed to investigate outcomes of patients who underwent elective open lead extractions (OLE) at two large tertiary care centers. Methods: The records of 29 patients undergoing elective OLE were analyzed through retrospective chart review. Results: 69 total leads were extracted from 29 patients (77% completely, 23% partially). The average age of the oldest leads was 13.3 ± 11.3 years. Infective endocarditis with severe valvular insufficiency requiring valvular intervention (41%)—an infectious etiology, and tricuspid valve intervention to correct RV lead‐related severe TR (38%)—a noninfectious etiology, were the most common reasons for OLE. 38% of the patients had additional co‐primary or secondary indications for open extraction, such as CABG and pericardiectomies. The rate of major complications and procedural failure was 3% each (1/29). 30‐day survival was 100%, and 1‐year survival was 92%. The average length of hospital stay was 15 days and higher among those undergoing OLE for infectious indications. Conclusion: Open lead extractions offered a similar clinical success rate (97%) to transvenous extractions in this cohort and may be a viable alternative for those necessitating valvular intervention or when the risk of complications from TLE is considered very high. [ABSTRACT FROM AUTHOR]

Background: Objective and subjective outcomes in the direct anterior approach (DAA) and posterior approach (PA) in total hip arthroplasty (THA) were assessed in this study, using the Oxford Hip Score (OHS) as primary outcome. Pain, 3 objective performance-based tests, surgical time, blood loss and length of stay were assessed as secondary outcomes. Methods: Patients with primary end-stage osteoarthritis were prospectively enrolled by shared decision making for the DAA (32 patients) or PA (26 patients). Baseline data were collected preoperatively and outcomes postoperatively at 2-, 6-, 9- and 12-month follow-up. Results: There is no significant difference (p < 0.05) between the DAA and PA on primary outcome (OHS). There was a main effect of time which indicated an increase of OHS over time independent of group (p < 0.01). Conclusions: In the current study, no significant differences in postoperative functional outcome were found between DAA and PA in all follow-up moments. [ABSTRACT FROM AUTHOR]

Purpose: To identify potential predictors of prolonged length of hospital stay in patients submitted to lung resection surgery. Materials and methods: This is a cohort study, carried out in 105 patients with lung cancer, submitted to posterolateral thoracotomy pulmonary resection. Data collection included preoperative assessment of demographic, clinical, pulmonary function, respiratory muscle function, physical fitness, and behavioral habits. After surgery, length of hospital stay was documented, and the sample was divided into two groups according to the length of hospital stay (LOS): the normal hospital stay group (NLOS) until 8 days, and the prolonged hospital stay group (PLOS) with more than 8 days of hospital stay. Multiple linear regressions were performed between length of hospital stay and the studied variables, for the total sample and, specifically, for the PLOS group. Results: The multiple linear regression for the total sample, the most explanatory power variables were TLC, MIP, PEF, and BMI. When considering only the PLOS, the variables that mostly explained were the MIP%, MEP and TLC%. Conclusion: Besides the classic outcomes used to calculate surgical risk, the body mass index, respiratory muscle strength, peak expiratory flow, and total lung capacity are predictors of the variation on length of hospital stay in patients submitted to lung resection. IMPLICATIONS FOR REHABILITATION: The addition of the respiratory muscles function in the preoperative assessment, might contribute to predict prolonged hospital stay in patients submitted to lung resection surgery. Respiratory muscle strength might be included in a prehabilitation program for patients selected to lung resection surgery. The preoperative respiratory muscle strength increment might contribute to reduce economic cost related to prolonged hospital stay after pulmonary resection surgery. [ABSTRACT FROM AUTHOR]

Background: Anecdotally, patients don't seem to be more unwell than they were 10 years ago, yet they still seem more 'complex'. Aims: The aim of this study was to use an objective measure to assess the trend in complexity of general medicine patients over a 9‐year period. Methods: Complexity was pragmatically defined as a composite of comorbidity plus dependence/frailty. We selected 100 consecutive patients discharged from General Medicine at Monash Medical Centre (a tertiary hospital in Melbourne, Australia) in the month of April of each year from 2011 to 2019. For each patient, we retrospectively calculated their burden of comorbidity and their degree of dependency/frailty. Comorbidity was measured using the Charlson Comorbidity Index (CCI), and dependence/frailty was assessed using the Katz Index of Independence in Activities of Daily Living (Katz ADL) and the Braden Scale (BS). The BS is a pressure injury risk assessment tool. Additional demographic data were collected, including length of stay, admission and discharge residence, 30‐day readmission rate and inpatient mortality. Results: There was no statistically significant change in the CCI or the Katz ADL. The median BS did however significantly decrease from 19 in 2011 to 16 in 2019 (P = 0.006), reflecting an increased risk of pressure injuries. Conclusions: Despite a stable level of comorbidity, our finding of a decreasing BS score may suggest that patients are becoming more dependent. This increase in dependency rather than a change in chronic disease burden may be the cause of apparent increasing patient complexity. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Frailty is a good predictor of adverse outcomes among older patients, especially those who have undergone surgery. The prevalence of frailty among kidney transplant candidates is higher than the general population. This study aimed to explore the predictive value of frailty on post-transplant adverse outcomes among kidney recipients. METHODS: A systematic review was performed for relevant studies until May 20, 2022, using four databases (Embase, Medline, Cochrane, and PsycINFO) for prospective design studies (PROSPERP: CRD42022331022). Random-effect meta-analysis modeling was undertaken in RevMan 5.3 to estimate the predictive value of frailty on adverse outcomes after kidney transplant. RESULTS: This systematic review included 14 studies, eight of which were suitable for metaanalysis. Frailty increased the risk of mortality (pooled hazard ratio [HR] 1.98, 95% confidence interval [CI] 1.48-2.64), surgical complications (risk ratio [RR] 2.14, 95% CI 1.01-4.54), deathcensored graft failure (DCGF) (pooled HR 3.31, 95% CI 1.27-8.62), length of stay (LOS) (pooled RR 1.59, 95% CI 1.05-2.39), length of stay =2 weeks (pooled odds ratio [OR] 1.72, 95% CI 1.26-2.35), and other common adverse outcomes among kidney transplant recipients. CONCLUSIONS: Frailty is associated with adverse outcomes after kidney transplant. This systematic review suggests the importance of assessing frailty among kidney transplant candidates prior to transplantation. Further research focusing on pre-transplant assessment combined with frailty is warranted to improve kidney transplant management. [ABSTRACT FROM AUTHOR]

Background: Far lateral (extraforaminal) disc herniations comprise approximately 10% of symptomatic lumbar disc herniations. They represent operative challenges due to accessibility and surgical unfamiliarity. Surgical strategies in the past have included open discectomy and posterior lumbar interbody fusion. Tubular microdiscectomies have gained traction due to their minimally invasive advantages, including reduced morbidity, pain and length of hospital stay. Methods: We report our retrospective single institution consecutive case series of tubular far lateral microdiscectomies. One hundred and seventy-six patients were operated on over an eight-year period. Clinical outcomes were assessed after institutional ethics approval. We additionally describe our surgical technique with an illustrative video case. Results: Over a mean follow-up of 21 weeks, 77% of patients had good or excellent clinical outcomes according to the MacNab criteria. 12% of patients underwent reoperation at the index level for symptom recurrence or persistence. Mean length of hospital stay was 1.3 days. There was a 1% rate of both postoperative haematoma and infection. Mean operation duration was 86 minutes. Conclusion: This case series represents the largest currently reported in the literature. Minimally invasive microdiscectomies performed through tubes allow for precise localisation, reduced tissue disruption and favourable clinical outcomes. Our results appear consistent with a review of the literature, demonstrating the safety and efficacy of this approach. [ABSTRACT FROM AUTHOR]

Purpose: A common spine surgery procedure involves decompression of the lumbar spine. The impact of the surgeon's learning curve on relevant clinical outcomes is currently not well examined in the literature. A variety of machine learning algorithms have been investigated in this study to determine how a surgeon's learning curve and other clinical parameters will influence prolonged lengths of stay (LOS), extended operating times (OT), and complications, as well as whether these clinical parameters can be reliably predicted. Methods: A retrospective monocentric cohort study of patients with lumbar spinal stenosis treated with microsurgical (MSD) and full-endoscopic (FED) decompression was conducted. The study included 206 patients with lumbar spinal stenosis who underwent FED (63; 30.6%) and MSD (118; 57.3%). Prolonged LOS and OT were defined as those exceeding the 75th percentile of the cohort. Furthermore, complications were assessed as a dependent variable. Using unsupervised learning, clusters were identified in the data, which helped distinguish between the early learning curve (ELC) and the late learning curve (LLC). From 15 algorithms, the top five algorithms that best fit the data were selected for each prediction task. We calculated the accuracy of prediction (Acc) and the area under the curve (AUC). The most significant predictors were determined using a feature importance analysis. Results: For the FED group, the median number of surgeries with case surgery type at the time of surgery was 72 in the ELC group and 274 in the LLC group. FED patients did not significantly differ in outcome variables (LOS, OT, complication rate) between the ELC and LLC group. The random forest model demonstrated the highest mean accuracy and AUC across all folds for each classification task. For OT, it achieved an accuracy of 76.08% and an AUC of 0.89. For LOS, the model reached an accuracy of 83.83% and an AUC of 0.91. Lastly, in predicting complications, the random forest model attained the highest accuracy of 89.90% and an AUC of 0.94. Feature importance analysis indicated that LOS, OT, and complications were more significantly affected by patient characteristics than the surgical technique (FED versus MSD) or the surgeon's learning curve. Conclusions: A median of 72 cases of FED surgeries led to comparable clinical outcomes in the early learning curve phase compared to experienced surgeons. These outcomes seem to be more significantly affected by patient characteristics than the learning curve or the surgical technique. Several study variables, including the learning curve, can be used to predict whether lumbar decompression surgery will result in an increased LOS, OT, or complications. To introduce the provided prediction tools into clinics, the algorithms need to be implemented into open-source software and externally validated through large-scale randomized controlled trials. [ABSTRACT FROM AUTHOR]

The aim of this meta-analysis was to evaluate the efficacy and safety of robotic pancreaticoduodenectomy (RPD) in improving perioperative aspects and postoperative complications in patients. Methods: We searched PubMed, Embase, Web of Science, and the Cochrane Library database systems for studies that compared RPD with laparoscopic pancreaticoduodenectomy (LPD). Meta-analysis was performed for 24 relevant outcomes, including perioperative outcomes and postoperative complications. Subsequently, a subgroup analysis based on geographical regions was conducted to investigate the impact of regional differences on the perioperative outcomes of the RPD group and the LPD group. Results: This review found 19 studies with 12,731 individuals (3539 RPD and 9192 LPD). In comparison to LPD, RPD had lower rates of Conversion (OR = 0.58, P < 0.00001), Blood Transfusion (OR = 0.59, P = 0.02), Length of Stay (MD = − 0.54, P = 0.01), postoperative complications [Pneumonia (OR = 0.31, P < 0.0001), and Wound Disruption (OR = 0.26, P = 0.0007)], and more thorough lymph node harvesting (MD = 1.25, P = 0.001). Subgroup analysis showed that Blood Transfusion (I2 = 55%, P = 0.02), Conversion (I2 = 30%, P < 0.00001), Length of Stay (I2 = 71%, P = 0.01), and Lymph Node Harvested (I2 = 87%, P = 0.001) were statistically significant. Interestingly, compared to China, other countries had lower rates of Conversion and more lymph nodes harvested for RPD surgery. Conclusion: The benefits of RPD surgery over LPD surgery in terms of therapy and an optimistic short-term prognosis are clearly supported by this study. Moreover, subgroup analysis based on regional differences revealed statistically significant results for Conversion, Length of Stay (days), Number of Lymph Nodes Harvested and the rate of Blood Transfusion, indicating significant variability across regions. This study provides a solid theoretical foundation and basis for the advancement of RPD in clinical practice. [ABSTRACT FROM AUTHOR]