Rol de los cuidados perioperatorios guiados por protocolo para mejorar la recuperación tras la cirugía de cáncer de cabeza y cuello: experiencia institucional / Role of protocol-guided perioperative care to enhance recovery after head and neck neoplasm surgery: An institutional experience

Antecedentes: Enhanced recovery after surgery (ERAS) mejora la recuperación tras la cirugía. El objetivo de este estudio fue determinar si ERAS causa una reducción de la estancia hospitalaria y mejora la recuperación funcional global tras la cirugía de cáncer de cabeza y cuello. Métodos Realizamos un estudio prospectivo de control de casos histórico tras la aplicación de ERAS. La base de datos del hospital seleccionó 50 pacientes elegibles confirmados para el grupo control no ERAS, incluyéndose prospectivamente 54 pacientes en el grupo ERAS. El resultado primario fue el tiempo transcurrido hasta la disposición al alta (TRD), siendo los resultados secundarios la duración de la estancia hospitalaria (DEH), la tasa de reingreso de hasta 30 días y la puntuación QoR-15 (Quality of recovery). Los datos fueron comparados mediante pruebas paramétricas y no paramétricas adecuadas. Resultados Los datos demográficos basales de los pacientes fueron comparables entre ambos grupos. Los pacientes del grupo ERAS reflejaron un TRD significativamente más breve, en comparación con el grupo no ERAS: 8 (6-10) frente a 11 (8-16); p=0,002. La DEH fue también significativamente más corta en el grupo ERAS en comparación con el grupo no ERAS (8 [7-11] frente a 12 [9-17]; valor p=0,002). El reingreso en el plazo de 30 días no fue diferente, con una cifra de 6 pacientes en cada grupo. La puntuación QoR-15 fue estadísticamente mejor en el grupo ERAS (94,88±12,50) en comparación con el grupo no ERAS (85,44±12,68; p <0,001). Conclusión La implementación del programa ERAS redujo el TRD y la DEH, mejorando la puntuación QoR-15 sobre el resultado de la recuperación reportado por el paciente en las cirugías de cáncer de cabeza y cuello. (AU)

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) versus 11 (8-16); P=.002. LOS was also significantly shorter in the ERAS group compared to the non-ERAS group (8 [7-11] versus 12 [9-17]; P=.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±12.50) compared to non-ERAS group (85.44±12.68; P<.001). Conclusion Implementing the ERAS programme decreased TRD and LOS and improved patient-reported recovery outcome QoR-15 in head and neck neoplasms surgery. (AU)

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.

Mini nutritional assessment-short form test: criterion and predictive validity in older adults from a long-term care unity / Versión corta del test de valoración nutricional: validez de criterio y predictiva en adultos mayores de una unidad de cuidados de larga duración

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.(AU)

Introducción: la versión corta del test de valoración nutricional (MNA-SF) es válida para la evaluación del riesgo nutricional y de la desnutriciónde los adultos mayores, pero pocos estudios han evaluado si predice la duración de la estancia hospitalaria (LOS) y se realizaron en unidadesde 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 aplicaronel formulario largo del MNA (MNA-LF) y el MNA-SF al ingreso y al alta. Se determinó el porcentaje de concordancia, kappa y coeficientes decorrelación interclase (CCI). Se calcularon la sensibilidad y la especificidad del MNA-SF. Se evaluó la asociación independiente del MNA-SFcon la LOS (ajustada por: índice de Charlson, sexo, edad y educación) mediante análisis de regresión de Cox (resultados: hazard ratio [HR] eintervalos 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 MNASFfueron 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 deser 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. Seencontró una asociación independiente entre la desnutrición o el riesgo nutricional por MNA-SF y la LOS...(AU)

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.

Resección transuretral en bloque vs. resección transuretral convencional para el cáncer de vejiga primario no músculo-infiltrante: metaanálisis / En-bloc transurethral resection vs. conventional transurethral resection for primary non-muscle invasive bladder cancer: A meta-analysis

Introducción Se realizó un metaanálisis para evaluar el efecto de la resección transuretral en bloque en comparación con la resección transuretral convencional para el cáncer de vejiga primario no músculo-infltrante. Métodos Se realizó una búsqueda sistemática en la literatura hasta enero de 2022 y se incluyeron 28 estudios con 3.714 sujetos con cáncer de vejiga primario no músculo-infltrante al inicio del estudio; a 1.870 de ellos se les efectuó una resección transuretral en bloque y a 1.844 una resección transuretral convencional para el cáncer de vejiga primario no músculo-infltrante. Se calculó la odds-ratio (OR) y la diferencia de medias (DM) con intervalos de confianza (IC) del 95% para evaluar el efecto de una y otra en el cáncer primario de vejiga no invasivo por métodos dicotómicos o continuos con un modelo de efectos aleatorios o fijos. Resultados La resección transuretral en bloque obtuvo valores significativamente menores en términos de recurrencia a los 24 meses (OR: 0,63; IC 95%: 0,50-0,78; p<0,001), tiempo de sondaje (DM: –0,66; IC 95%: –1,02-[–0,29]; p<0,001); duración de la estancia hospitalaria (DM: –0,95; IC 95%: –1,55-[–0,34]; p=0,002), tiempo de irrigación vesical postoperatoria (DM: –6,06; IC 95%: –9,45-[–2,67]; p<0,001), contracción del nervio obturador (OR: 0,08; IC 95%: 0,02-0,34; p=0,03) y perforación de la vejiga (OR: 0,14; IC 95%: 0,06-0,36; p<0,001) y no hubo diferencias significativas en cuanto a la recurrencia a los 12meses (OR: 0,79; IC 95%: 0,61-1,04: p=0,09), tiempo quirúrgico (DM: 0,67; IC 95%: –1,92-3,25; p=0,61) y estenosis uretral (OR: 0,46; IC 95%: 0,14-1,47; p=0,19) en comparación con la resección transuretral convencional para sujetos con cáncer de vejiga primario no invasivo...(AU)

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: –1.92-3.25; P=0.61), and urethral stricture (OR: 0.46; 95%CI: 0.14-1.47; P=0.19) compared with conventional transurethral resection for primary non-muscle invasive bladder cancer subjects... (AU)

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.

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.

Two factors that can increase the length of hospital stay of patients with dementia / Dos factores que pueden aumentar la duración de la estancia hospitalaria de los pacientes con demencia

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. (AU)

Objetivos: Los pacientes con demencia tienen mayor riesgo de una estancia hospitalaria prolongada y esto se asocia con resultados adversos. El objetivo de esta evaluación del servicio fue identificar las variables predictivas de una mayor duración de la estancia hospitalaria de los pacientes con demencia. Métodos/diseño: Realizamos un análisis retrospectivo de un conjunto de datos hospitalarios transversales en el período enero-diciembre de 2016. Excluyendo la estancia hospitalaria inferior a 24h y los reingresos, la muestra estaba compuesta por 1133 pacientes que tenían un diagnóstico de demencia registrado. Resultados: Los pacientes con demencia con estancia más prolongada presentaban mayor tasa de incidencia de: a) alta a una residencia (TIR: 2.443, IC 95% 1.778-3.357) b) caídas sin daño (TIR: 2.486, IC 95% 2.029-3.045) Conclusiones: En base a estos resultados, concluimos que las mejoras realizadas en las estrategias de prevención de caídas en los hospitales y los procedimientos de planificación del alta pueden ayudar a reducir la duración de la estancia de los pacientes con demencia. (AU)

Predictors determining the duration of hospital stay among patients admitted with singlefractures / Predictores que determinan la duración de la estancia hospitalaria en pacientes ingresados con fracturasúnicas

Introduction: Fractures pose a tremendous burden on the health care systems due to the prolonged duration of admission. Addressing various determinants that prolong hospital stay will help minimize the cost of treatment. Objective: To study the determinants associated with the duration of hospital stay among patients admitted with fractures. Methods: This was a retrospective observational study conducted at a private tertiary care hospital in Mangalore. A semi-structured proforma was used for collecting data from the medical records. Results: The mean age of the 124 patients were 48.3±21.4 years. The majority were males [69(55.6 por ciento)] and were from urban areas [86(69.3 por ciento)]. Co-morbidities were present among 69(55.6 por ciento) patients. Out of the total patients, 8(6.4 por ciento) were alcoholics, and 10(8.1 por ciento) were tobacco smokers. The majority [50(40.3 por ciento)] had fracture of the femur. Five (4 por ciento) patients developed complications during the post-operative period. Seventy-eight (62.9 por ciento) patients had medical insurance facilities. The mean duration of hospital stay was 9.6±3.2 days among the patients. The mean duration of hospital stay among patients (n=115) before surgery was 2.4±1.6 days. Increased pre-operative stay, increasing age, rural residential status, open type of fracture, and being given general anaesthesia for the operative procedure were significant predictors determining the period of stay among patients in the hospitals. Alcoholic status independently influenced the period of stay in the pre-operative period. Conclusion: Both patient and treatment characteristics were important determinants associated with the duration of hospital stay. Targeting these predictors will help to manage in-patients better and shorten their duration of hospital stay(AU)

Introducción: Las fracturas suponen una enorme carga para los sistemas sanitarios debido a la duración prolongada del ingreso. Abordar varios determinantes que prolongan la estadía en el hospital ayudará a minimizar el costo del tratamiento. Objetivo: Estudiar los determinantes asociados a la duración de la estancia hospitalaria en pacientes ingresados con fracturas. Métodos: Este es un estudio observacional retrospectivo realizado en un hospital privado de atención terciaria en Mangalore. Se utilizó una proforma semiestructurada para la recolección de datos de las historias clínicas. Resultados: La edad media de los 124 pacientes fue de 48,3±21,4 años. La mayoría eran hombres [69 (55,6 percent)] y de áreas urbanas [86 (69,3 percent)]. Las comorbilidades estuvieron presentes en 69 (55,6 percent) pacientes. Del total de pacientes, 8 (6,4 percent) eran alcohólicos y 10 (8,1 percent) fumadores. La mayoría [50 (40,3 percent)] tenía fractura de fémur. Cinco (4 percent) pacientes desarrollaron complicaciones durante el postoperatorio. Setenta y ocho (62,9 percent) pacientes tenían seguro médico. La duración media de la estancia hospitalaria fue de 9,6±3,2 días entre los pacientes. La duración media de la estancia hospitalaria de los pacientes (n=115) antes de la cirugía fue de 2,4±1,6 días. El aumento de la estancia preoperatoria, el aumento de la edad, el estado residencial rural, el tipo de fractura abierta y la anestesia general para el procedimiento quirúrgico fueron predictores significativos que determinaron el período de estancia entre los pacientes en los hospitales. El estado alcohólico influyó de forma independiente en el tiempo de estancia en el preoperatorio. Conclusión: Tanto las características del paciente como las del tratamiento fueron determinantes importantes asociadas con la duración de la estancia hospitalaria. Abordar estos predictores ayudará a manejar mejor a los pacientes hospitalizados y acortar la duración de su estadía en el hospital(AU)

Relação entre pneumonia associada à ventilação mecânica e a permanência em unidade de terapia intensiva / Relación entre neumonía asociada a ventilación mecánica y permanencia en una unidad de cuidados intensivos / Relationship between ventilator-associated pneumonia and permanence in an intensive care unit

Objetivo: Analisar a relação de incidência de Pneumonia associada à ventilação mecânica (PAV) com o aumento da média de permanência em pacientes de terapia intensiva. Método: Pesquisa quantitativa, retrospectiva, descritiva e documental. Realizada em duas UTIs de um Hospital Universitário no Estado do Paraná. A amostra foi composta por 2503 pacientes, no período de janeiro de 2017 a junho de 2019. Resultados: A maioria dos pacientes era do sexo masculino 58,7% (n=1471). Verificou-se forte poder estatístico, p valor de 0,0001, evidenciando que a PAV aumentou o tempo de internação, ou seja, o desenvolvimento de PAV gera uma permanência maior na UTI. O desfecho, 74,19% receberam alta e 25,81% evoluíram para óbito. Conclusão: Os dados apontaram para uma relação estatisticamente comprovada entre a PAV e o acréscimo do tempo de internação nas UTIs, o que acarreta o aumento dos riscos de morbimortalidade e altos custos na hospitalização.(AU)

Objective: To analyze the relationship between the incidence of Ventilator-associated pneumonia (VAP) and the increase in the average length of stay in intensive care patients. Method: Quantitative, retrospective, descriptive and documentary research. Carried out in two ICUs of a University Hospital in the State of Paraná. The sample consisted of 2503 patients, from January 2017 to June 2019. Results: Most patients were male 58.7% (n=1471). There was a strong statistical power, p value of 0.0001, showing that the VAP increased the length of stay, that is, the development of VAP generates a longer stay in the ICU. The outcome, 74.19% were discharged and 25.81% evolved to death. Conclusion: The data pointed to a statistically proven relationship between VAP and increased length of stay in the ICUs, which leads to increased risks of morbidity and mortality and high hospitalization costs.(AU)

Objetivo: Analizar la relación entre la incidencia de neumonía asociada a ventilador (NAV) y el aumento de la estancia media en pacientes de cuidados intensivos. Método: Investigación cuantitativa, retrospectiva, descriptiva y documental. Realizado en dos UCI de un Hospital Universitario del Estado de Paraná. La muestra estuvo constituida por 2503 pacientes, de enero de 2017 a junio de 2019. Resultados: La mayoría de los pacientes fueron hombres 58,7% (n = 1471). Hubo un fuerte poder estadístico, valor de p de 0,0001, mostrando que la NAV aumentó la estancia, es decir, el desarrollo de NAV genera una estancia más prolongada en la UCI. El resultado, 74,19% fueron dados de alta y 25,81% evolucionaron a muerte. Conclusión: Los datos apuntan a una relación estadísticamente probada entre NAV y mayor tiempo de estancia en UCI, lo que conduce a mayores riesgos de morbilidad y mortalidad y altos costos de hospitalización.(AU)

Perme ICU Mobility Score (Perme Score) and the ICU Mobility Scale (IMS): translation and cultural adaptation for the Spanish language / Escalas Perme ICU Mobility Score (Perme Score) e ICU Mobility Scale (IMS): traducción y adaptación cultural para el idioma español

Abstract Introduction: The scales to measure functional mobility in critically ill patients were developed and validated in English, there is a need for these tools in Spanish speaking countries. Objective: To perform translation, cultural adaptation and inter-rater reliability of the Spanish versions of the Perme Intensive Care Unit Mobility Score and IMS tools in ICU patients. Methods: Translation and validation study between November 2016 and July 2017, following the COSMIN Protocol's recommendations. Two couples of physiotherapists with the role of observer/rater applied both scales in 150 patients upon admission and discharge of a medical-surgical ICU from a private hospital in Colombia. The sample size was defined taking into account the lowest proportion of reported agreement (68.57%), a Kappa index of 0.2784 or higher to ensure that the calculated n was adequate, and a confidence level of 95% Results: Translation and cultural adaptation were performed, the final version of both scales in Spanish was approved by the authors. The sample was 150 patients, 52% were men, the average age was 58 ± 17 years, invasive mechanical ventilation was present in 63 (42%) of the cases. Inter-rater reliability of the ICU Mobility Scale was between 0.97 and 1.00, and for the Perme Intensive Care Unit the Mobility Score it was between 0.99 and 1 in the two moments of the measurements. Conclusions: Both scales were translated and culturally adapted and presented excellent inter-rater reliability in the two pairs of raters (rater/observer).

Resumen Introducción: Las escalas para medir la movilidad funcional en el paciente crítico han sido desarrolladas y validadas en lengua inglesa, existe una necesidad de contar con estas escalas en nuestros países hispanoparlantes. Objetivo: Realizar traducción, adaptación cultural y determinar confiabilidad inter evaluador de la versión en español del Perme Intensive Care Unit Mobility Score y del ICU Mobility Scale (IMS). Métodos: Estudio de traducción y validación entre noviembre de 2016 y Julio de 2017 siguiendo las recomendaciones del Protocolo COSMIN. Dos parejas de fisioterapeutas con el rol de observador/evaluador aplicaron ambas escalas en 150 pacientes al ingreso y egreso de una UCI médico-quirúrgica de una clínica privada en Colombia. Se definió el tamaño de muestra teniendo en cuenta la menor proporción de concordancia reportada (68.6%), un índice Kappa 0.2784 o superior para garantizar que el n calculado fuera adecuado, y un nivel de confianza de 95% Resultados: Se realizó la traducción y adaptación cultural, la versión final de ambas escalas en idioma español fue aprobada por los autores. La muestra fue de 150 pacientes, 52% fueron hombres, la edad promedio fue de 58 ±17 años, la ventilación mecánica invasiva estuvo presente en 63 (42.0%) de los casos. Se encontró confiabilidad inter-evaluador del ICU Mobility Scale entre 0.97 y 1 y para Perme Intensive Care Unit Mobility Score estuvo entre 0.99 y 1.00 en los dos momentos de mediciones. Conclusiones Ambas escalas fueron traducidas y adaptadas culturalmente y presentaron excelente confiabilidad inter-evaluador en las dos parejas de evaluadores (evaluador/observador).

High-flow nasal cannula therapy versus non-invasive ventilation in children with severe acute asthma exacerbation: An observational cohort study.

INTRODUCTION: The present study describes our experience with the high-flow humidified nasal cannula (HFNC) versus non-invasive ventilation (NIV) in children with severe acute asthma exacerbation (SA). METHODS: An observational study of a retrospective cohort of 42 children with SA admitted to a Pediatric Intensive Care Unit (PICU) for non-invasive respiratory support was made. The primary outcome measure was failure of initial respiratory support (need to escalate from HFNC to NIV or from NIV to invasive ventilation). Secondary outcome measures were the duration of respiratory support and PICU length of stay (LOS). RESULTS: Forty-two children met the inclusion criteria. Twenty (47.6%) received HFNC and 22 (52.3%) NIV as initial respiratory support. There were no treatment failures in the NIV group. However, 8 children (40%) in the HFNC group required escalation to NIV. The PICU LOS was similar in both the NIV and HFNC groups. However, on considering the HFNC failure subgroup, the median length of respiratory support was 3-fold longer (63h) and the PICU LOS was also longer compared with the rest of subjects exhibiting treatment success. CONCLUSIONS: Despite its obvious limitations, this observational study could suggest that HFNC in some subjects with SA may delay NIV support and potentially cause longer respiratory support, and longer PICU LOS.

Oxigenoterapia de alto flujo frente a ventilación no invasiva en niños con estatus asmático: estudio observacional de cohortes / High-flow oxygen therapy versus non-invasive ventilation in children with asthmatic status: observational cohort study

Introducción El objetivo de este estudio es comparar nuestra experiencia con el uso de oxigenoterapia de alto flujo (OAF) frente a la ventilación no invasiva (NIV) en niños con estatus asmático (EA). Métodos Estudio observacional de una cohorte retrospectiva de 42 niños con EA ingresados en nuestra Unidad de Cuidados Intensivos Pediátricos (UCIP) con soporte respiratorio no invasivo. El objetivo principal del estudio fue valorar el éxito/fracaso del soporte respiratorio inicial (necesidad o no de escalar a un soporte respiratorio superior). El objetivo secundario fue comparar la duración del soporte respiratorio y del ingreso en la UCIP. Resultados Cuarenta y dos niños cumplieron con los criterios de inclusión. Veinte (47,6 por ciento) fueron tratados con OAF y 22 (52,3 por ciento) con VNI como soporte respiratorio inicial. No hubo fracaso terapéutico en el grupo VNI, si bien 8 niños (40 por ciento) del grupo OAF fueron cambiados a VNI. La duración de la estancia en la UCIP y en el hospital fue similar en ambos grupos NIV y HFNC. Sin embargo, en el subgrupo de fracaso de OAF, la duración del soporte respiratorio (el triple, 63h) y la estancia en la UCIP fueron mucho mayores en comparación con los sujetos que tuvieron éxito en el tratamiento. Conclusiones Este estudio observacional, con sus evidentes limitaciones, podría sugerir que el uso de HFNC en algunos sujetos con EA puede retrasar el inicio de la VNI y potencialmente causar un soporte respiratorio más prolongado y una mayor estancia en la UCIP.

Clinical features, mortality, hospital admission, and length of stay of a cohort of adult patients with diabetic ketoacidosis attending the emergency room of a tertiary hospital in Spain.

AIM: To assess the clinical features, length of stay, incidence rate, mortality, and hospital admissions of patients with episodes of diabetic ketoacidosis (DKA). PATIENTS: It was conducted retrospective, cross-sectional study of 164 consecutive admissions of adult patients (2008-August 2012), with type 1 or type 2 diabetes already known or new onset. RESULTS: Mortality rate was 1.2%. The DKA episodes were mild (18.9%), moderate (31.7%), or severe (49.4%). The cumulative incidence was 2.66 cases/1000 patients with diabetes (DM) in 4.5 years. The most common causes triggering DKA were infection (33.2%) and dietary transgression and/or insulin dose omission (30.7%). A total of 12.8% of patients had new onset DM, 56.7% type 1, and 26.8% type 2 DM. Patients with type 2 DM were older and had at admission higher creatinine, BUN, osmolality, sodium, and anion gap levels. Patients with new-onset of DM had higher levels of glucose and sodium, but lower potassium levels. No differences were found in pH or bicarbonate. Admission to the intensive care unit (ICU) was required in >50% of cases (p<0.001), and 86.6% of patients were finally admitted to a medical ward (p=0.005). The length of stay at the ICU (p<0.001) and hospital (p=0.013) was significantly different depending on DKA severity. CONCLUSIONS: Most DKA episodes require hospital admission, but mortality is <2%, and length of stay at the ER and medical ward depends on type of DM and initial severity of the episode.

Anesthesia for bariatric surgery: 8-year retrospective study: are our patients now easier to manage?

OBJECTIVES: To review the perioperative management of patients who had undergone bariatric surgery in our institution during an 8-year period, with the aim of identifying variables that correlated with improved clinical outcomes and changes in perioperative practice. METHODS: This was a retrospective observational study of 437 patients who had undergone bariatric surgery from January 2005 to June 2013. Of these patients, 163 had undergone open or laparoscopic biliopancreatic diversion (Group 1), and 274 had been managed according to a Tailored Laparoscopic Approach Program (TLAP) (Group 2). We analyzed major cardiocirculatory, pulmonary, and surgery-related complications, mortality rate, intensive care unit (ICU) admissions, post-anesthetic care unit (PACU) length of stay, and perioperative management standards, throughout the study period. RESULTS: Changes were observed in anesthetic patterns and perioperative care standards during the study period: 25% of patients had combined epidural anesthesia in 2005, compared with none at present; ICU admissions decreased from 28.6% in 2005 to 3.1% at present; and time in PACU declined from a median of 23 h in 2005 to 5.12h at present. Duration of postoperative opioid therapy was also significantly reduced (from 48 h to 6h). Group 2 had a significantly lower mortality rate than Group 1 (0.37% versus 4.3%, respectively, P=0.004). CONCLUSIONS: In our institution, adoption of a TLAP for bariatric surgery has led to changes in perioperative care standards that have been followed by clear improvements according to morbidity, mortality and management indicators.

Optimization of an early discharge program after laparoscopic radical prostatectomy.

OBJECTIVE: To assess the safety of hospital discharge 24 hours after laparoscopic radical prostatectomy and to identify possible factors associated with longer hospital stays. MATERIAL AND METHODS: Retrospective study of patients diagnosed with localized prostate cancer underwent to laparoscopic radical prostatectomy consecutively between May of 2007 and December of 2010. Those patients who met the following requirements were discharged in less than 24 hours: absence of complications, drainage debit minor than 50 cc, normal oral tolerance, no significant bladder haematuria and good functional recovery. Logistic regression analysis was conducted in order to assess the possible associated variables with longer hospital stays. RESULTS: A total of 266 patients were analysed. The follow-up median was 34 months. Eighty patients (30.1%) were discharged in less than 24 hours. Average stay (SD) of all series was 2.9 days (3.08). Solely HTA, neurovascular bundles sparing and the development of lymphadenectomy were statistically significant between both groups in univariate analysis (discharge<24 hours vs. discharge>24 hours). In multivariate analysis, only HTA (OR=1.98 [CI 95%:1.13-3.47], P=.016) and lymphadenectomy performance (OR=2.56 [CI 95%:1.18-5.56] P=.017) were independent predictive variables of hospital stays longer than 24 hours. CONCLUSIONS: Early hospital discharge of patients underwent to LRP is feasible and safe. In our series, the lymphadenectomy performance and the HTA were associated factors to longer hospital stay.

Prevalence of overweight among hospitalized patients regardless of length of hospital / Predominância de excesso de peso entre pacientes hospitalizados independente do tempo de internação / La prevalencia de sobrepeso entre los pacientes hospitalizados, independientemente de la duración del ingreso

Introduction: Obesity is considered a major public health problem in developed countries and a global epidemic by the World Health Organisation. Objective: To describe the nutritional status and its relationship to diagnosis and length of hospital patients in a private hospital. Method: cross sectional study, Nutrition Department, College of Health Sciences, Methodist University of Piracicaba (Unimep), Piracicaba, São Paulo, Brazil. Cross-sectional study with 1.012 patients 55.6% were female and 44.4% male, mean age 58.5 + - 17.2 and 59.2 + - 17.1 years, respectively. The variables were diagnosis, body mass index and hospitalization time. Data were processed using Excel, and expressed by means of descriptive statistics. The difference between the percentage distributions of nominal variables was analyzed by chi-square test, adopting a significance level of 5%. Results: neoplasms (25%), cardiovascular diseases and diabetes (16%), diseases of the digestive tract (14%) and orthopedic disorders (12%) were the most frequent. Malnutrition was found in 7% of the population, while eutrophic patients accounted for 46% and 47% met with pre-obesity. Regarding the time of admission, it was found that the majority (71%) was hospitalized for a period of up to seven days. It was found that there was prevalence of obesity and obesity in pre all diseases with exception of patients with cancer, including nutritional status was prevalent malnutrition (p <0.05). Conclusion: The high prevalence of obesity among hospitalized patients reinforces the evidence of increased use of public services resulting from comorbidezes associated with excess weight, in addition, the study draws attention to the in-hospital malnutrition in the obese individual.

Introdução: A obesidade está sendo considerada um problema importante de saúde pública em países desenvolvidos e uma epidemia global pela Organização Mundial de Saúde. Objetivo: Descrever o estado nutricional e sua relação com o diagnóstico e tempo de internação em pacientes de um hospital privado. Método: estudo transversal, Departamento de Nutrição, faculdade de Ciências da saúde, Universidade Metodista de Piracicaba (Unimep), Piracicaba, São Paulo, Brasil. Estudo transversal com 1.012 pacientes sendo 55,6% do sexo feminino e 44,4% do sexo masculino, com idade média de 58,5 +- 17,2 e 59,2 +- 17,1 anos, respectivamente. As variáveis estudadas foram diagnóstico, estado nutricional e tempo de internação. Os dados foram processados pelo programa Excel, sendo expressos por meio de estatística descritiva. A diferença entre as distribuições percentuais das variáveis nominais foi analisada pelo teste qui-quadrado, adotando-se um nível de significância de 5%. Resultados: as neoplasias (25%), as doenças cardiovasculares e diabetes (16%), doenças do trato digestório (14%) e as doenças ortopédicas (12%) foram as de maior ocorrência. A desnutrição foi encontrada em 7% da população, enquanto que os pacientes eutróficos representaram 46%, e 47% encontrava-se com pré-obesidade. Com relação ao tempo de internação, verificou-se que a maioria (71%) permaneceu internada por um período de até sete dias. Verificou-se que houve prevalência de pré obesidade e obesidade em todas as doenças com exceção apenas dos pacientes portadores de neoplasias, entre os quais o estado nutricional prevalente foi a desnutrição (p<0,05). Conclusão: A grande prevalência de obesidade entre os pacientes hospitalizados reforça as evidências do aumento da utilização dos serviços públicos decorrente das comorbidezes associadas ao excesso de peso, além disso, o estudo chama a atenção para a desnutrição intra-hospitalar no indivíduo obeso.

Introducción: La obesidad se considera un problema importante de salud pública en los países desarrollados y una epidemia mundial por la Organización Mundial de la Salud. Objetivo: Describir el estado nutricional y su relación con el diagnóstico y la duración de los pacientes hospitalizados en un hospital privado. Método: Estudio descriptivo, transversal, Departamento de Nutrición de la Facultad de Ciencias de la Salud, la Universidad Metodista de Piracicaba (UNIMEP), Piracicaba, São Paulo, Brasil. Estudio transversal com1.012 pacientes 55,6% eran mujeres y 44,4% varones, edad promedio de 58,5 + - 17,2 y 59,2 + - 17,1 años, respectivamente. Las variables fueron: diagnóstico, estado nutricional y la duración de la hospitalización. Los datos fueron procesados con Excel, y expresada por medio de estadística descriptiva. La diferencia entre las distribuciones porcentuales de las variables nominales se analizó mediante la prueba de chi-cuadrado, adoptándose un nivel de significancia del 5%. Resultados: Las neoplasias (25%), enfermedades cardiovasculares y la diabetes (16%), enfermedades del tracto digestivo (14%) y trastornos ortopédicos (12%) fueron las más frecuentes. La desnutrición se encuentra en el 7% de la población, mientras que los pacientes eutróficos representó el 46% y el 47% se reunió con el pre-obesidad. En cuanto al momento del ingreso, se encontró que la mayoría (71%) fue hospitalizado durante un período de hasta siete días. Se encontró que hubo predominio de la obesidad y la obesidad en todas las enfermedades previas, con excepción de los pacientes con cáncer, incluyendo el estado nutricional desnutrición prevalente (p <0,05). Conclusión: La alta prevalencia de la obesidad entre los pacientes hospitalizados refuerza la evidencia de un mayor uso de los servicios públicos como resultado de comorbidezes asociados con el exceso de peso, además, el estudio llama la atención sobre la desnutrición en el hospital en el individuo obeso.