Laparoscopic vs open approach for acute cholecystitis in octogenarians. A prospective multicenter observational nationwide study.

BACKGROUND: The world population is aging, with octogenarians expected to reach over 400 million by 2050. Acute cholecystitis is a serious complication in the elderly. Age is not a contraindication for emergency cholecystectomy, an option that can both save lives and preserve quality of life. METHODS: The present study aimed to compare open and laparoscopic surgical approaches. Over six months, 38 emergency surgery units enrolled all consecutive octogenarians with acute cholecystitis undergoing cholecystectomy. Postoperative outcomes were compared after propensity score matching analysis. RESULTS: The study included 212 patients (84 years [81-86], 47.2% women). The open approach was used in 32.1% of patients, and the laparoscopic approach in 67.9%. After propensity score matching, a decrease in hospital stays (open, 8 days [6-13]; laparoscopic, 5 days [4-8]; P < .001), 30-day morbidity (open, 48.5%; laparoscopic, 26.5%; P = .01), and 30-day mortality (open, 13.2%, laparoscopic, 1.5%; P = .02) was found. Among the specific postoperative complications, a decrease in septicemia (open, 14.7%; laparoscopic, 0%; P = .001) was observed. CONCLUSIONS: Laparoscopic approach was used in two out of three octogenarians. After propensity score matching, octogenarians undergoing laparoscopic approach had shorter length of hospital stay, fewer 30-day postoperative complications, fewer episodes of septicemia, and less 30-day mortality than octogenarians undergoing open approach. These findings suggest that the laparoscopic approach may be the preferred choice for octogenarians with acute cholecystitis undergoing cholecystectomy.

[Translated article] Determining factors on length of stay in primary total knee arthroplasty patients using enhanced recovery protocol after surgery (ERAS) pathway.

INTRODUCTION: There is an increase in degenerative arthropathies because of the increase in the longevity of world's population, making primary knee arthroplasties a procedure to recover quality of life without pain. There are factors associated with the length of hospital stay after this procedure. OBJECTIVE: To determine the risk factors influencing the hospital stay during the postoperative period of patients undergoing primary total knee arthroplasty with an enhanced recovery after surgery protocol (ERAS). METHODS: A retrospective study is carried out on patients undergoing primary total knee arthroplasty at an University Hospital in the period 2017-2020 using the ERAS protocol, during which 957 surgeries were performed. RESULTS: Average age of 71.7±8.2years, 62.4% were women and the 77.3% were classified as ASA II. The significantly associated factors to an increased length of stay are: age (p=.001), ASA scale (p=.04), day of surgery (p<.001), blood transfusion (p<.001), postoperative haemoglobin level at 48-72h (p<.001), the time of first postoperative mobilisation to ambulate and climb stairs (p<.001), the need for analgesic rescues (p=.003), and the presence of postoperative nausea and vomiting (p=.008). CONCLUSIONS: There are statistically significant and clinically relevant factors associated with hospital stay. Determining these factors constitutes an advantage in hospital management, in the development of strategies to improve and optimise the quality of care and available health resources.

Determining factors on length of stay in primary total knee arthroplasty patients using enhanced recovery protocol after surgery (ERAS) pathway. / Factores determinantes de la duración de la estancia hospitalaria en pacientes operados de artroplastia primaria total de rodilla usando un protocolo de recuperación mejorada (ERAS).

INTRODUCTION: There is an increase in degenerative arthropathies because of the increase in the longevity of world's population, making primary knee arthroplasties a procedure to recover quality of life without pain. There are factors associated with the length of hospital stay after this procedure. OBJECTIVE: To determine the risk factors influencing the hospital stay during the postoperative period of patients undergoing primary total knee arthroplasty with an enhanced recovery after surgery protocol (ERAS). METHODS: A retrospective study is carried out on patients undergoing primary total knee arthroplasty at an University Hospital in the period 2017-2020 using the ERAS protocol, during which 957 surgeries were performed. RESULTS: Average age of 71.7±8.2years, 62.4% were women and the 77.3% were classified as ASAII. The significantly associated factors to an increased length of stay are: age (P=.001), ASA scale (P=.04), day of surgery (P<.001), blood transfusion (P<.001), postoperative hemoglobin level at 48-72h (P<.001), the time of first postoperative mobilization to ambulate and climb stairs (P<.001), the need for analgesic rescues (P=.003), and the presence of postoperative nausea and vomiting (P=.008). CONCLUSIONS: There are statistically significant and clinically relevant factors associated with hospital stay. Determining these factors constitutes an advantage in hospital management, in the development of strategies to improve and optimize the quality of care and available health resources.

Role of protocol-guided perioperative care to enhance recovery after head and neck neoplasm surgery: An institutional experience.

BACKGROUND: Enhanced recovery after surgery (ERAS) improve recovery after surgery. This study aimed to determine whether ERAS leads to a decrease in stay in the hospital and improves global and functional recovery after head and neck neoplasms surgery. METHODS: We performed a prospective case and historical control study after the ERAS application. The hospital database selected 50 confirmed eligible patients in control non-ERAS group. Prospectively 54 patients were included in the ERAS group. The primary outcome was time to readiness for discharge (TRD); secondary outcomes were the length of stay (LOS), readmission rate of up to 30 days and Quality of recovery score QoR-15. Data were compared with appropriate parametric and nonparametric tests. RESULTS: Baseline demographic data of patients were comparable between the two groups. Patients in ERAS group had significantly shorter TRD compared to the non-ERAS group 8 (6-10) vs 11 (8-16); p-value = 0.002. LOS was also significantly shorter in the ERAS group compared to the non-ERAS group [8 (7-11) vs 12 (9-17); p-value = 0.002]. Readmission at 30-days was no different, with six patients in each group. QoR-15 score was statistically better in ERAS group (94.88 ±â€¯12.50) compared to non-ERAS group (85.44 ±â€¯12.68) [p value < 0.001]. CONCLUSION: Implementing the ERAS programme decreased TRD and LOS and improved patient-reported recovery outcome QoR-15 in head and neck neoplasms surgery.

Aspectos clínico-epidemiológicos en pacientes con abscesos odontogénicos cervicofaciales y factores asociados para estancia hospitalaria corta / Clinical-epidemiological aspects in patients with cervicofacial odontogenic abscesses and associated factors for short hospital stay

Introducción: en todo paciente hospitalizado con absceso odontogénico cervicofacial se busca resolución pronta del absceso, pero es necesario conocer cuáles son los factores que favorecen la resolución en hospitalizaciones cortas (1-3 días). Objetivo: determinar factores clínico-epidemiológicos de pacientes con abscesos odontogénicos para identificar factores que correlacionan con hospitalización corta. Material y métodos: estudio transversal, retrospectivo, observacional y analítico de 100 pacientes con abscesos odontogénicos en un Hospital General de Zona del Instituto Mexicano del Seguro Social de los años 2012-2013. Variables de estudio: días de hospitalización, sexo, edad, comorbilidades, conteo leucocitario, trismus, diente causal, región afectada y tratamientos realizados. Tamaño de muestra obtenido con fórmula para estudios observaciones con manejo de prevalencias para poblaciones infinitas, se empleó χ2 para identificar factores que correlacionan con hospitalización corta. Resultados: mujeres 56%, rango de edad 12-89 años y de hospitalización de 1-23 días; con comorbilidades 56%, leucocitosis 39% y trismus 21%. La caries causó 64% de abscesos, molares inferiores 70% y región submandibular afectada 73%. Variables estadísticamente significativas; conteo leucocitario, diente causal y región afectada. Conclusión: factores correlacionados con hospitalización corta: conteo leucocitario menor a 10,500 leucocitos, que el molar inferior no sea el diente causal y que la región submandibular no esté afectada (AU)

Introduction: prompt resolution of the abscess is sought in all patients hospitalized with cervicofacial odontogenic abscess, but which factors favor this resolution in short hospitalizations (1-3 days). Objective: determine clinical-epidemiological factors of patients with odontogenic abscesses to identify factors that correlate with short hospitalization. Material and methods: crosssectional, retrospective, observational and analytical study of 100 patients with odontogenic abscesses in a General Hospital of the Zone of the Mexican Social Security Institute from 2012-2013. Study variables; days of hospitalization, sex, age, comorbidities, leukocyte count, trismus, causative tooth, affected region and treatments performed. Sample size obtained with the formula for observational studies with prevalence management for infinite populations, χ2 was used to identify factors that correlate with short hospitalization. Results: women 56%, age range 12-89 years and hospitalization of 1-23 days, with comorbidities 56%, leukocytosis 39% and trismus 21%. Caries caused 64% of abscesses, lower molars 70% and affected submandibular region 73%. Statistically significant variables; leukocyte count, causative tooth and affected region. Conclusion: factors correlated with short hospitalization; leukocyte count less than 10,500 leukocytes, that the lower molar is not the causal tooth and that the submandibular region is not affected.

Malnutrition risk prevalence in hospitalised patients in Castilla-La Mancha: Ten years after the PREDyCES® study.

INTRODUCTION: The PREDyCESR study showed ten years ago that malnutrition is a highly prevalent problem at the hospital level. In the present study we investigate the prevalence of malnutrition in hospitals of Castilla La Mancha and its relationship with complications, mortality and length of hospital stay. METHODS: 433 patients (236 men and 197 women), from 4 hospitals were included and randomised within the first 48 h of admission. Nutritional risk was assessed using the NRS-2002 screening test. RESULTS: The mean age of the patients was 71.3 ±â€¯0.9 years (alpha-trimmed mean ±â€¯insorized standard deviation). Their mean weight was 72.3 ±â€¯0.8 kg and BMI 26.8 ±â€¯0.3 kg/m2. The mean length of hospital stay was 7.2 ±â€¯0.3 days. Of the 433 study patients, 19.4% were defined as 'at-risk' by NRS-2002 > 3. Of the patients at risk, 39.3% received nutritional support. Patients at nutritional risk had an increased length of hospital stay (9.6 vs 6.8 days; p = 0.012) and had more complications and/or higher mortality (40.5% of complications and/or mortality vs 16.4%; p < 0.005). The OR of having a complication and/or death was 3.93 (95% CI: 2.36-6.5); p < 0.005. Regarding the results obtained in the PREDyCES® study, no significant differences were found in the prevalence of nutritional risk at patients' admission (19.4% vs 23%; p = 0.12). CONCLUSIONS: The nutritional risk at hospital admission continues to be high. Patients at nutritional risk have more complications, higher mortality and an increased length of hospital stay.

Mini nutritional assessment-short form test: criterion and predictive validity in older adults from a long-term care unity.

Introduction: Introduction: the Mini Nutritional Assessment Short-Form test (MNA-SF) is valid for malnutrition screening and diagnosis of older adults, but few studies evaluated if it predicts hospital length of stay (LOS) and were conducted in long-term care units. Objective: this study aims to evaluate the criterion and predictive validity of MNA-SF. Methods: a prospective observational study was conducted in older adults from a long-term care unity. MNA Long Form test (MNA-LF) and MNA-SF were applied, at admission and at discharge. Percentage of agreement, kappa and intra-class correlation coefficients (ICC) were determined. Sensitivity and specificity of MNA-SF were calculated. The independent association of MNA-SF with LOS (adjustment for Charlson index, sex, age, education) was assessed by Cox regression analysis [results presented as hazard ratio (HR) and 95 % confidence intervals (CI)]. Results: this sample is composed of 109 older adults (62.4 % women), aged 66-102 years. According to MNA-SF at admission, 7.3 % of participants presented normal nutrition status, 55.1 % were at risk of malnutrition and 37.6 % were malnourished. Agreement, kappa and ICC were 83.5 %, 0.692 and 0.768 at admission, and 80.9 %, 0.649 and 0.752 at discharge. MNA-SF sensitivities were 96.7 % at admission and 92.9 % at discharge; specificities were 88.9 % and 89.5 %, at admission and at discharge. According to MNA-SF at discharge, being at risk of malnutrition (HR = 0.170, 95 % CI: 0.055-0.528) or malnourished (HR = 0.059, 95 % CI: 0.016-0.223) lowered the odds of being discharged to home or to usual residence. Conclusions: a high agreement was found between MNA-LF and MNA-SF. MNA-SF revealed high sensitivities and specificities. An independent association was found between risk of malnutrition or malnutrition by MNA-SF and LOS. The use of MNA-SF instead of MNA-LF should be considered in long-term care units given its criterion and predictive validity.

Introducción: Introducción: la versión corta del test de valoración nutricional (MNA-SF) es válida para la evaluación del riesgo nutricional y de la desnutrición de los adultos mayores, pero pocos estudios han evaluado si predice la duración de la estancia hospitalaria (LOS) y se realizaron en unidades de cuidados de larga duración. Objetivo: evaluar la validez predictiva y de criterio del MNA-SF. Métodos: se realizó un estudio observacional prospectivo en adultos mayores de una unidad de cuidados de larga duración. Se aplicaron el formulario largo del MNA (MNA-LF) y el MNA-SF al ingreso y al alta. Se determinó el porcentaje de concordancia, kappa y coeficientes de correlación interclase (CCI). Se calcularon la sensibilidad y la especificidad del MNA-SF. Se evaluó la asociación independiente del MNA-SF con la LOS (ajustada por: índice de Charlson, sexo, edad y educación) mediante análisis de regresión de Cox (resultados: hazard ratio [HR] e intervalos de confianza [IC] del 95 %). Resultados: esta muestra está compuesta por 109 adultos mayores (62,4 % mujeres), con edades de 66-102 años. Según el MNA-SF al ingreso, el 7,3 % de los participantes estaban bien nutridos, el 55,1 % estaban en riesgo nutricional y el 37,6 % estaban desnutridos. La concordancia, kappa y CCI fueron del 83,5 %, del 0,692 y del 0,768 al ingreso y del 80,9 %, del 0,649 y del 0,752 al alta. Las sensibilidades del MNA-SF fueron de 96,7 % al ingreso y de 92,9 % al alta; las especificidades fueron de 88,9 % y de 89,5 %, al ingreso y al alta. Según el MNA-SF al alta, estar en riesgo nutricional (HR = 0,170, IC 95 %: 0,055-0,528) o desnutrido (HR = 0,059, IC 95 %: 0,016-0,223) redujo las probabilidades de ser dado de alta al domicilio o la residencia habitual. Conclusiones: se encontró una gran concordancia entre el MNA-LF y el MNA-SF. El MNA-SF reveló grandes sensibilidad y especificidad. Se encontró una asociación independiente entre la desnutrición o el riesgo nutricional por MNA-SF y la LOS. El uso de MNA-SF en lugar de MNA-LF debe considerarse en unidades de cuidados de larga duración dada su validez predictiva y de criterio.

Factores de riesgo asociados a estancia hospitalaria prolongada en cuidados intensivos neonatales: Un estudio de casos y controles

Objetivo: Identificar las patologías o condiciones neonatales que influyen en la prolongación de la estancia hospitalaria en una Unidad de Cuidados Intensivos Neonatales (UCIN). Materiales y métodos: Se realizó un estudio observacional, retrospectivo, de casos y controles; en neonatos hospitalizados de la UCIN, durante el periodo 2015 - 2019, considerando sus diagnósticos perinatales y posnatales como factores a evaluar, así como la estancia hospitalaria. Se dividieron dos grupos: casos (estancia prolongada) y controles (estancia no prolongada). Los datos recolectados fueron procesados en el programa SPSS v.23 obteniendo el OR y la Regresión Logística Binaria. Resultados: Se incluyeron 361 neonatos (91 casos y 270 controles), encontrándose significancia en factores perinatales (p<0.05): Peso al nacer (1000g a <1500g, ORa 8.2: IC3.1 - 21.2) y edad gestacional (28 a 31 sem., ORa 18.6: IC4.8-71.4; 32-33 sem, ORa 8.1: IC3.5 - 18.4); y factores posnatales (p<0.05): Síndrome de distrés respiratorio (ORa 10.3:IC 4.8-22.2), Hipertensión pulmonar persistente (OR 32.2:IC 1.8-559.0), sepsis (ORa 7.1: IC 3.1-16.0), Malnutrición neonatal (ORa 10.2:IC 4.7-22.1) y anemia del prematuro (ORa 8.3:IC 2.4-28.1). No alcanzaron significancia: asfixia, taquipnea transitoria del recién nacido, neumonía, neumotórax, displasia broncopulmonar, síndrome de aspiración meconial, conducto arterioso persistente, cardiopatía congénita, hiperbilirrubinemia, hipoglicemia, enterocolitis necrotizante y apnea del prematuro. Conclusiones: El peso al nacer, edad gestacional, Síndrome de distrés respiratorio, Hipertensión pulmonar persistente, sepsis, malnutrición neonatal y anemia del prematuro son factores de riesgo para estancia hospitalaria prolongada.

Objective: Identify neonatal pathologies or conditions that influence the prolongation of hospital stay in a Neonatal Intensive Care Unit (NICU). Materials and methods: An observational, retrospective, case-control study was carried out; in neonates hospitalized in the NICU, during the period 2015-2019, considering their perinatal and postnatal diagnoses as factors to be evaluated, as well as hospital stay. Two groups were divided: cases (prolonged stay) and controls (non-prolonged stay). The collected data were processed in the SPSS v.23 program, obtaining the OR and the Binary Logistic Regression. Results: 361 neonates (91 cases and 270 controls) were included, finding significance in perinatal factors (p<0.05): Birth weight (1000g to <1500g, ORa 8.2: CI3.1 - 21.2) and gestational age (28 to 31 weeks , ORa 18.6: CI4.8-71.4; 32-33 weeks, ORa 8.1: CI3.5 - 18.4); and postnatal factors (p<0.05): RDS (ORa 10.3: CI 4.8-22.2), PHT (OR 32.2: CI 1.8-559.0), sepsis (ORa 7.1: CI 3.1-16.0), Neonatal malnutrition (ORa 10.2: CI 4.7 -22.1) and anemia of prematurity (aOR 8.3: CI 2.4-28.1). The following did not reach significance: asphyxia, transient tachypnea of ​​the newborn, pneumonia, pneumothorax, bronchopulmonary dysplasia, meconium aspiration syndrome, patent ductus arteriosus, congenital heart disease, hyperbilirubinemia, hypoglycemia, necrotizing enterocolitis, and apnea of ​​prematurity. Conclusions: Birth weight, gestational age, RDS, PHPT, sepsis, neonatal malnutrition and anemia of prematurity are risk factors for prolonged hospital stay.

Strategies to improve the flow of admissions and hospital stays: a Delphi study of an adaptation of the Appropriateness Evaluation Protocol (AEP).

INTRODUCTION AND AIM: The Appropriateness Evaluation Protocol (AEP) tool analyzes inappropriate hospital stays and admissions. This study aimed to adapt the AEP questionnaire in order to analyse the appropriateness of hospital admissions and stays in our healthcare reality. METHODS: A study was conducted using the Delphi method in which 15 experts in clinical management and hospital care participated. The initial questionnaire items were taken from the first version of the AEP. In the first round, the participants contributed new items that they considered relevant in our current reality. In rounds 2 and 3, they evaluated 80 items according to their relevance using a Likert scale from 1 to 4 (maximum usefulness). Pursuant to the study's design, AEP items were considered adequate if the mean score according to the experts' evaluation was greater than or equal to 3. RESULTS: The participants defined a total of 19 new items. In the end, 47 items earned a mean score greater than or equal to 3. The resulting modified questionnaire include 17 items in "Reasons for Appropriate Admissions," 5 in "Reasons for Inappropriate Admissions," 15 in "Reasons for Appropriate Hospital Stays," and 10 in "Reasons for Inappropriate Hospital Stays." CONCLUSIONS: The identification according to expert opinion of priority items to determine the appropriateness of admissions and extended stays could be used in the future to help create an instrument to be used in our setting.

Evaluation of an enhanced recovery after lung surgery (ERALS) program in lung cancer lobectomy: An eight-year experience.

INTRODUCTION: Enhanced recovery after lung surgery (ERALS) protocols have proven useful in reducing postoperative stay (POS) and postoperative complications (POC). We studied the performance of an ERALS program for lung cancer lobectomy in our institution, aiming to identify which factors are associated with a reduction of POC and POS. METHODS: Analytic retrospective observational study conducted in a tertiary care teaching hospital involving patients submitted to lobectomy for lung cancer and included in an ERALS program. Univariable and multivariable analysis were employed to identify factors associated with increased risk of POC and prolonged POS. RESULTS: A total 624 patients were enrolled in the ERALS program. The median POS was 4 days (range 1-63), with 2.9% of ICU postoperative admission. A videothoracoscopic approach was used in 66.6% of cases, and 174 patients (27.9%) experienced at least one POC. Perioperative mortality rate was 0.8% (5 cases). Mobilization to chair in the first 24h after surgery was achieved in 82.5% of cases, with 46.5% of patients achieving ambulation in the first 24h. Absence of mobilization to chair and preoperative FEV1% less than 60% predicted, were identified as independent risk factors for POC, while thoracotomy approach and the presence of POC predicted prolonged POS. CONCLUSIONS: We observed a reduction in ICU admissions and POS contemporaneous with the use of an ERALS program in our institution. We demonstrated that early mobilization and videothoracoscopic approach are modifiable independent predictors of reduced POC and POS, respectively.

Prevalencia y análisis de factores de infección de sitio quirúrgico en clínica de heridas / Prevalence and Analysis of Surgical Site Infection Factors in Wound Clinic

Introducción: La infección de herida quirúrgica causa altas tasas de morbilidad y repercute sobre los índices de mortalidad. Constituye la primera infección intrahospitalaria entre pacientes quirúrgicos del total de infecciones nosocomiales y la primera entre los pacientes quirúrgicos. Existen factores de riesgo como la clasificación ASA, la diabetes mellitus, la hipertensión arterial y los días de estancia hospitalaria, los cuales influyen en su desarrollo. Objetivo: Determinar la prevalencia de infecciones de sitio quirúrgico por cirugías realizadas en el Hospital Dr. Carlos Canseco de Tampico, ciudad del estado mexicano de Tamaulipas. Métodos: Diseño observacional, analítico, transversal y retrospectivo de 54 pacientes con diagnóstico de infección de sitio quirúrgico. Las variables de estudio se clasificaron como dependientes (género, edad, lugar de origen, días de estancia hospitalaria, peso, índice de masa corporal) e independientes (diagnóstico, procedimiento quirúrgico realizado y clasificación ASA otorgada). Resultados: La población de 40 a 50 años fue la más afectada, con mayor predominancia sobre el género femenino. La Clasificación ASA II y III presentaron mayor prevalencia de infección de sitio quirúrgico, sobre todo en cirugías electivas (28 por ciento). Mientras mayor fue la estancia hospitalaria, mayor fue la probabilidad de desarrollar infección de sitio quirúrgico. Conclusiones: La prevalencia de infección en el sitio quirúrgico en pacientes operados por los distintos servicios quirúrgicos no es similar a la reportada por otros autores. La Clasificación ASA II y III presentaron infección del sitio quirúrgico con más frecuencia, mientras que la comorbilidad más llamativa de este estudio fue el índice de masa corporal como factor de riesgo que no debe pasar desapercibido(AU)

Introduction: Surgical wound infection causes high morbidity rates and impacts mortality rates. It is the first in-hospital infection among surgical patients of all nosocomial infections and the first among surgical patients. There are risk factors that influence its development, such as the ASA classification, diabetes mellitus, arterial hypertension and days of hospital stay. Objective: To determine the prevalence of surgical site infections from surgeries performed at Hospital Dr. Carlos Canseco, of Tampico, a city in the Mexican state of Tamaulipas. Methods: An observational, analytical, cross-sectional and retrospective study was carried out with 54 patients with a diagnosis of surgical site infection. The study variables were classified as dependent variables (gender, age, place of origin, days of hospital stay, weight and body mass index) and independent variables (diagnosis, surgical procedure performed, and given ASA classification). Results: The population aged 40 to 50 years was the most affected, with a greater predominance of the female gender. ASA classification II and III had a higher prevalence of surgical site infection, above all in elective surgeries (28 %). The longer the hospital stay, the higher the probability of developing surgical site infection. Conclusions: The prevalence of surgical site infection in patients operated on by the different surgical services is not similar to that reported by other authors. ASA Classification II and III presented surgical site infection more frequently, while the most remarkable comorbidity in this study was body mass index as a risk factor that should not go unnoticed(AU)

Factors associated with hospital length of stay in children with acute pancreatitis.

INTRODUCTION AND AIM: Acute pancreatitis (AP) is the most common cause of pancreatic disease in children. Previous studies have described factors related to days of hospital length of stay (LOS) in children. Our aim was to identify factors associated with LOS in AP. MATERIALS AND METHODS: A retrospective study was conducted at the Hospital Infantil de México Federico Gómez in Mexico City, encompassing the time frame of January 1, 2017 and March 31, 2019. AP was confirmed by medical chart review, according to the INSPPIRE criteria at the time of hospital admission, in patients below 18 years of age. AP grade was classified, following the NASPGHAN guidelines. Demographic, clinical, biochemical, nutritional, and treatment data were collected. Prolonged hospital LOS was considered that which lasted 7 days or longer. RESULTS: Fifty-one events (32 patients) were registered. Median LOS was 8 days (IQR 4-14 days). Antibiotic use was significantly associated with longer LOS (OR 31.71; 95% CI: 2.71-370.65; p = 0.006) and early feeding (EF) (within 72 h of admission) was associated with shorter LOS (OR 0.05; 95% CI: 0.001-0.63; p = 0.02). There was no association between LOS and the variables of age, recurrence, grade, etiology, comorbidities, complications, fluid resuscitation, parenteral nutrition, or biochemical characteristics upon admission. CONCLUSION: Our study, like others, corroborated the fact that EF in the management of AP was associated with fewer days of hospital LOS.

Safety and feasibility of transradial access for percutaneous coronary intervention in chronic total occlusions.

INTRODUCTION AND OBJECTIVES: Transfemoral access is the most frequently used vascular approach in chronic total occlusion percutaneous coronary interventions (CTO-PCI). The aim of this study was to evaluate the safety and feasibility of a transradial access CTO-PCI program and its impact on angiographic and clinical results and length of hospital stay. METHODS: Retrospective multicenter cohort study including 2550 consecutive CTO-PCI procedures included in a multicenter registry with accurate information on vascular access. A total of 896 procedures were performed as radial-only access while 1654 were performed through at least 1 femoral puncture. Clinical and angiographic data were collected. RESULTS: The mean age was 66.3± 11.4 years. The mean Japan-chronic total occlusion score (2.7±0.3) was similar in the 2 groups. Successful revascularization was achieved in 2009 (79.6%) cases, 78.2% and 82.1% in the femoral and radial access cohorts, respectively (P=.002). Periprocedural in-hospital complications were observed in 5.1% and 2.3% (P=.02), with fewer access site-dependant vascular complications in the transradial cohort (2.3% vs 0.2%; P=.009). The mean length of hospital stay was significantly shorter in the transradial access group (0.89±1.4 vs 2.2±3.2 days, P<.001). CONCLUSIONS: A transradial program for CTO-PCI is safe and effective in most CTO lesions. The transradial strategy has fewer vascular complications and shorter length of hospital stay without compromising the success rate.

Predictive factors of prolonged postoperative length of stay after anatomic pulmonary resection.

INTRODUCTION: The objective of this study is to create a predictive model of prolonged postoperative length of stay (PLOS) in patients undergoing anatomic lung resection, to validate it in an external series and to evaluate the influence of PLOS on readmission and 90-day mortality. METHODS: All patients registered in the GEVATS database discharged after the intervention were included. We define PLOS as the postoperative stay in days above the 75th percentile of stay for all patients in the series. A univariate and multivariate analysis was performed using logistic regression and the model was validated in an external cohort. The possible association between PLOS and readmission and mortality at 90 days was analyzed. RESULTS: 3473 patients were included in the study. The median postoperative stay was 5 days (IQR: 4-7). 815 patients had PLOS (≥8 days), of which 79.9% had postoperative complications. The final model included as variables: age, BMI, male sex, ppoFEV1%, ppoDLCO% and thoracotomy; the AUC in the referral series was 0.684 (95% CI: 0.661-0.706) and in the validation series was 0.73 (95% CI: 0.681-0.78). A significant association was found between PLOS and readmission (p < .000) and 90-day mortality (p < .000). CONCLUSIONS: The variables age, BMI, male sex, ppoFEV1%, ppoDLCO% and thoracotomy affect PLOS. PLOS is associated with an increased risk of readmission and 90-day mortality. 20% of PLOS are not related to the occurrence of postoperative complications.

En-bloc transurethral resection vs. conventional transurethral resection for primary non-muscle invasive bladder cancer: A meta-analysis.

INTRODUCTION: We performed a meta-analysis to evaluate the effect of en-bloc transurethral resection vs. conventional transurethral resection for primary non-muscle invasive bladder cancer. METHODS: A systematic literature search up to January 2022 was done and 28 studies included 3714 primary non-muscle invasive bladder cancer subjects at the start of the study; 1870 of them were en-bloc transurethral resection, and 1844 were conventional transurethral resection for primary non-muscle invasive bladder cancer. We calculated the odds-ratio (OR) and mean-difference (MD) with 95% confidence-intervals (CIs) to evaluate the effect of en-bloc transurethral resection compared with conventional transurethral resection for primary non-muscle invasive bladder cancer by the dichotomous or continuous methods with random or fixed-effects models. RESULTS: En-bloc transurethral resection had significantly lower twenty-four-month recurrence (OR: 0.63; 95%CI: 0.50-0.78; p < 0.001), catheterization-time (MD: -0.66; 95%CI: -1.02-[-0.29]; p < 0.001), length of hospital stay (MD: -0.95; 95%CI: -1.55-[-0.34]; p = 0.002), postoperative bladder irrigation duration (MD: -6.06; 95%CI: -9.45-[-2.67]; p < 0.001), obturator nerve reflex (OR: 0.08; 95%CI: 0.02-0.34; p = 0.03), and bladder perforation (OR: 0.14; 95%CI: 0.06-0.36: p < 0.001) and no significant difference in the 12-month-recurrence (OR: 0.79; 95%CI: 0.61-1.04; p = 0.09), the operation time (MD: 0.67; 95%CI: -1.92 to 3.25; p = 0.61), and urethral stricture (OR: 0.46; 95%CI: 0.14-1.47; p = 0.0.19) compared with conventional transurethral resection for primary non-muscle invasive bladder cancer subjects. CONCLUSIONS: En-bloc transurethral resection had a significantly lower twenty-four-month recurrence, catheterization time, length of hospital stay, postoperative bladder irrigation duration, obturator nerve reflex, bladder perforation, and no significant difference in the twelve-month recurrence, operation time, and urethral stricture compared with conventional transurethral resection for primary non-muscle invasive bladder cancer subjects. Further studies are required.

Outcomes of hybrid procedures for peripheral arterial disease: 5-year single center experience.

OBJECTIVE: The objective of the study was to present patients with peripheral vascular disease (PVD) who underwent hybrid procedures at our institution, the results of these interventions for a 5-year period and determine patency, mortality, failure, and amputation rates compared to the literature. MATERIAL AND METHODS: Observational, single center, retrospective, and cross-sectional study which analyzed data gathered from the vascular quality initiative from patients who had hybrid revascularization procedures from January 2010 to December 2015. RESULTS: 87 patients were identified: 51 (58%) male, 36 (41%) female, 9 (10%) had critical limb ischemia (CLI), and 78 (90%) claudication. We analyzed results of hybrid interventions in their variations. Technical success rate was 100%, patency at 2 years 88.5% (primary 65%, primary-assisted 18.3%, and secondary 4.5%) and 11.49% failure rate (lost patency < 1 year, conversion to open or/and amputation). Predictors of failure were: Female, previous chronic heart failure, longer length of stay, and previously transferred from another hospital. Amputation rate was 12.6% (10.3% major and 2.2% minor amputation), the only significant predictor was age (p = 0.035, odds ratio = 0.89) (0.806-99). CONCLUSIONS: Hybrid procedures are effective to treat patients with either CLI or claudication. Our study had outcomes comparable to the literature, with similar patency, amputation, and complication rates. We conclude it is a safe and effective option for PVD with multi-level disease.

OBJETIVO: Presentar pacientes con EAP que requirieron procedimientos híbridos en nuestra institución, resultados en 1 periodo de 5 años y determinar permeabilidad, mortalidad, falla y rangos de amputación comparado con la literatura. MATERIAL Y MÉTODOS: Estudio observacional un céntrico, retrospectivo y transversal que analizó datos obtenidos del VQI de pacientes post-revascularización híbrida de Enero 2010 a Diciembre 2015. RESULTADOS: Se identificaron 87 pacientes: 51 masculinos (58%) y 34 femeninos (41%). 9 (10%) presentaron isquemia crítica, 78 (90%) claudicación. Se analizaron resultados de dichas intervenciones en sus variaciones, con éxito técnico 100%, permeabilidad a 2 años 88.5% (primaria 65%, primaria asistida 18.3%, secundaria 4.5%) y 11.49% de falla (pérdida de permeabilidad < 1 año, conversión a cirugía abierta y/o amputación). Predictores de falla: femenino, IC, larga EIH, traslado de hospital previo). El rango de amputación fue 12.6% (10.3% mayor, 2-2% amputación menor) y el único predictor significativo fue edad (p = 0.035, OR = 0.89) (0.806-99). CONCLUSIONES: Los procedimientos híbridos son efectivos para tratar pacientes con isquemia crítica o claudicación. Nuestro estudio tuvo resultados similares a la literatura,permeabilidad, riesgo de amputación y complicaciones comparables con lo descrito. Concluimos que es una opción segura y efectiva para tratar pacientes con EAP multinivel.

Two factors that can increase the length of hospital stay of patients with dementia.

OBJECTIVES: Patients with dementia are at greater risk of a long hospital stay and this is associated with adverse outcomes. The aim of this service evaluation was to identify variables most predictive of increased length of hospital stay amongst patients with dementia. METHODS/DESIGN: We conducted a retrospective analysis on a cross-sectional hospital dataset for the period January-December 2016. Excluding length of stay less than 24h and readmissions, the sample comprised of 1133 patients who had a dementia diagnosis on record. RESULTS: The highest incidence rate ratio for length of stay in the dementia sample was: (a) discharge to a care home (IRR: 2.443, 95% CI 1.778-3.357), (b) falls without harm (IRR: 2.486, 95% CI 2.029-3.045). CONCLUSIONS: Based on this dataset, we conclude that improvements made to falls prevention strategies in hospitals and discharge planning procedures can help to reduce the length of stay for patients with dementia.

Glucemia de ingreso asociada a mortalidad y estancia hospitalaria en un servicio multidisciplinario de un hospital nacional peruano

Objetivo: Evaluar la asociación entre glucemia de ingreso y desenlaces adversos en pacientes hospitalizados con COVID-19 en un hospital nacional peruano. Métodos: Estudio observacional tipo cohorte retrospectiva. Se revisaron historias clínicas electrónicas de pacientes hospitalizados por COVID-19 en un servicio de especialidades. Los pacientes se clasificaron según niveles de glucemia al ingreso: ≤ y >140mg/dL; el desenlace primario fue mortalidad y el secundario un compuesto que incluyó mortalidad, shock séptico, ventilación mecánica o traslado a UCI. Se evaluó la estancia hospitalaria y se realizó un subanálisis de regresión logística multivariada en pacientes diabéticos. Resultados: Se evaluaron 169 pacientes, media de edad 61 años, 64.5% varones. 71% presentaban alguna comorbilidad, siendo las más frecuentes: hipertensión arterial (34%), obesidad (30%), diabetes (26%). El 70% presentó gravedad tomográfica. La mediana de glucemia de ingreso fue 126.5mg/dL (RIC: 109-157mg/dL), uno de cada 3 presentó glucemia >140mg/dL. La tasa de mortalidad fue 9700 muertes por cada 100 000 personas-semana, con frecuencia de 21.3%. No se encontró diferencia significativa entre hiperglucemia y normoglucemia, tanto en mortalidad como desenlace compuesto. Los pacientes con hiperglucemia de ingreso presentaron mayor estancia hospitalaria que los normoglucémicos (19 días vs 13 días, p180mg/dL presentó OR de 6.42 (IC95%: 1.07-38.6), ajustado a edad y a gravedad clínica de ingreso. Conclusiones: La hiperglucemia al ingreso se asoció a mayor estancia hospitalaria, y los pacientes diabéticos con hiperglucemia >180mg/dL presentaron un riesgo 6 veces mayor de presentar desenlace adverso.

Objective: Evaluate the association between glycemia on admission and adverse outcomes in hospitalized patients with COVID19 in a Peruvian national hospital. Methods: Retrospective, observational cohort study. We collected data from electronic medical records of COVID19 patients in a medical specialties service. Patients were classified according to blood glucose levels on admission: ≤ and >140mg/dL. Primary outcome was mortality, and the secondary a composite that included mortality, septic shock, mechanical ventilation, or transfer to ICU. We also evaluated hospital stay and a multivariate logistic regression sub analysis was performed in diabetic patients. Results: 169 patients were evaluated. The mean age was 61 years, 64.5% were male. 71% had at least one comorbidity, the most frequent: arterial hypertension (34%), obesity (30%) and diabetes (26%). 70% presented tomographic gravity. Median blood glucose at admission was 126.5mg/dL (IQR: 109-157mg/dL), one of every 3 had blood glucose levels >140mg/dL. Mortality rate was 9700 deaths per 100000 person-weeks, with a frequency of 21.3%. No significant difference was found between hyperglycemia and normoglycemia, mortality and in composite outcome. Patients with hyperglycemia on admission had longer hospital stay than normoglycemic patients (19 vs 13 days, p180mg/dL presented OR of 6.42 (95% CI: 1.07-38.6) for composite outcome, adjusted for age and clinical severity at admission. Conclusions: Hyperglycemia at admission was associated with a longer hospital stay and diabetic patients with hyperglycemia >180mg/dL had a 6-fold increased risk of presenting an adverse outcome.

Analysis of the effectiveness and safety of short-stay units in the hospitalization of patients with acute heart failure. Propensity Score SSU-EAHFE.

OBJECTIVES: This work aims to analyze if hospitalization in short-stay units (SSU) of patients diagnosed in the emergency department with acute heart failure (AHF) is effective in terms of the length of hospital stay and if it is associated with differences in short-term progress. METHOD: Patients from the EAHFE registry diagnosed with AHF who were admitted to the SSU (SSU group) were included and compared to those hospitalized in other departments (non-SSU group) from all hospitals (comparison A) and, separately, those from hospitals with an SSU (comparison B) and without an SSU (comparison C). For each comparison, patients in the SSU/non-SSU groups were matched by propensity score. The length of hospital stay (efficacy), 30-day mortality, and post-discharge adverse events at 30 days (safety) were compared. RESULTS: A total of 2,003 SSU patients and 12,193 non-SSU patients were identified. Of them, 674 pairs of patients were matched for comparison A, 634 for comparison B, and 588 for comparison C. The hospital stay was significantly shorter in the SSU group in all comparisons (A: median 4 days (IQR = 2-5) versus 8 (5-12) days, p < 0.001; B: 4 (2-5) versus 8 (5-12), p < 0.001; C: 4 (2-5) versus 8 (6-12), p < 0.001). Admission to the SSU was not associated with differences in mortality (A: HR = 1.027, 95%CI = 0.681-1.549; B: 0.976, 0.647-1.472; C: 0.818, 0.662-1.010) or post-discharge adverse events (A: HR = 1.002, 95%CI = 0.816-1.232; B: 0.983, 0.796-1.215; C: 1.135, 0.905-1.424). CONCLUSION: The hospitalization of patients with AHF in the SSU is associated with shorter hospital stays but there were no differences in short-term progress.

[Influence of medical outliers in patients with femoral neck fracture]. / Influencia del ingreso hospitalario ectópico en pacientes con fractura del cuello femoral.

OBJECTIVES: The objective is to describe and analyze how outlier admission influences hospital stay and the appearance of complications in patients with a femoral neck fracture treated with arthroplasty. MATERIAL AND METHOD: A historical cohort study was carried out in which the group of patients with a displaced fracture of the femoral neck who had an outlier admission was defined as an exposed cohort, that is, they were admitted to a hospitalization area not belonging to the Orthopedic Surgery and Traumatology department, unlike the unexposed cohort, that included patients admitted to a hospitalization area assigned to the Orthopedic Surgery and Traumatology department. RESULTS: Outlier admission was a risk factor for requiring a postoperative transfusion (RR 1.52, 95% CI 1.05-2.21; P=.035), to have a postoperative stay longer than 5 days (RR 1.35, 95% CI 1.04-1.74; P=.038) and to suffer general postoperative complications (RR 1.35, 95% CI 1.02-1.78; P=.048). CONCLUSIONS: Outlier admission is a threat to the quality and safety of health care. In patients over 80 years of age, medical outliers is a risk factor for postoperative transfusion and systemic postoperative complications.