Hyperbaric oxygen therapy in necrotising soft tissue infections: a study of patients in the United States Nationwide Inpatient Sample.

PURPOSE: Necrotising soft tissue infection (NSTI) is a deadly disease associated with a significant risk of mortality and long-term disability from limb and tissue loss. The aim of this study was to determine the effect of hyperbaric oxygen (HBO(2)) therapy on mortality, complication rate, discharge status/location, hospital length of stay and inflation-adjusted hospitalisation cost in patients with NSTI. METHODS: This was a retrospective study of 45,913 patients in the Nationwide Inpatient Sample (NIS) from 1988 to 2009. RESULTS: A total of 405 patients received HBO(2) therapy. The patients with NSTI who received HBO(2) therapy had a lower mortality (4.5 vs. 9.4 %, p = 0.001). After adjusting for predictors and confounders, patients who received HBO(2) therapy had a statistically significantly lower risk of dying (odds ratio (OR) 0.49, 95 % confidence interval (CI) 0.29-0.83), higher hospitalisation cost (US$52,205 vs. US$45,464, p = 0.02) and longer length of stay (LOS) (14.3 days vs. 10.7 days, p < 0.001). CONCLUSIONS: This retrospective analysis of HBO(2) therapy in NSTI showed that despite the higher hospitalisation cost and longer length of stay, the statistically significant reduction in mortality supports the use of HBO(2) therapy in NSTI.

Cost and outcomes after cold and mixed adenotonsillectomy in children.

OBJECTIVE/HYPOTHESIS: To compare cold and mixed (electrocautery tonsillectomy with curettage adenoidectomy) adenotonsillectomies in children in terms of hospital medications' and materials' costs, surgical time, aspirated blood volume, and postoperative pain. STUDY DESIGN: Randomized clinical trial in community hospitals. METHODS: Seventy-two patients aged 3 to 12 years, undergoing adenotonsillectomy, were randomized in two groups through sealed envelopes that were opened just prior to the procedure. Surgical time and aspirated blood volume were measured by a staff nurse. Hospital medication and material costs were supplied by the hospital's accounting department. A validated facial pain scale was used from the day of surgery to the 10th postoperative day to quantify pain. RESULTS: Bicaudal t test showed that materials' cost was lower in the mixed technique. Surgical time and aspirated blood volume were also lower with the mixed technique. The postoperative pain was more intense in the cold technique on the day of surgery, but was more intense in the mixed technique from the 4th day to the 6th day. Linear regression showed a weak association between materials' cost and aspirated blood volume. CONCLUSIONS: Mixed technique reduces the costs of materials while offering the patient and the surgeon a safer and faster method to perform adenotonsillectomy, although it is slightly more painful than the cold technique in the latter part of the postoperative period.

The impact of diabetes mellitus and renal insufficiency on the outcome of endovascular abdominal aortic aneurysm repair.

The purpose of this study was to determine the effects of diabetes mellitus (DM) and renal insufficiency (RI) on outcomes following endovascular abdominal aneurysms repair (EVAR). The surgical outcomes associated with endovascular repair in 12 451 patients are reported. After adjusting for confounders, DM and RI were analyzed against the primary outcome variables of mortality, major complications, length of stay, treatment cost, and routine discharge rates. This study shows that RI has a greater negative influence on the outcome of EVAR than previously suspected and that a conservative approach to the use of EVAR in patients with RI is warranted. While DM has negative impact on outcomes following open repair of abdominal aortic aneurysms, this study shows that it may confer less of a risk than previously thought, when confounders are controlled for, and that EVAR might be a favorable treatment modality for patients with abdominal aortic aneurysm and coexisting DM.