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Mohammad H Eslami - One of the best experts on this subject based on the ideXlab platform.
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blood transfusion is associated with increased risk of perioperative complications and prolonged hospital Duration of Stay among patients undergoing amputation
Surgery, 2015Co-Authors: Tzewoei Tan, Mohammad H Eslami, Denis Rybin, Gheorghe Doros, Wayne W Zhang, Alik FarberAbstract:Objective We evaluated the outcomes of patients undergoing major lower-extremity amputation who received packed red blood cell transfusion. Methods Using the dataset of the National Surgical Quality Improvement Program (2005–2011), we examined 5,739 above-knee and 6,725 below-knee amputations. Patients were stratified by perioperative (preoperative, intraoperative, or postoperative) blood transfusion. Outcomes included perioperative mortality, myocardial infarction (MI), thromboembolism, and Duration of Stay (DOS) at the hospital. Adjusted comparisons of outcomes between transfused and not-transfused patients were performed by matching the 2 groups for age, smoking, diabetes, renal failure, coronary artery disease, classification of the American Society of Anesthesiologists, functional status, and procedure type. Multivariable logistic and gamma regression were used to examine associations between transfusion and outcomes. Results of the 12,464 amputations in the study cohort 2,133 (17%) required transfusion. The majority of the cases were performed for critical limb ischemia (8,205 amputations; 66%) and the overall 30-days mortality was 9%. In both crude and matched cohorts, although perioperative mortality and cardiac complication rates were similar, transfusion was associated with a greater incidence of pneumonia (crude: 6.1% vs 3%, P Conclusion Among patients who had major lower-extremity amputation, perioperative transfusion independently predicted greater risks for perioperative pneumonia, thromboembolism, and prolonged hospital DOS.
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reply blood transfusion is associated with increased risk of perioperative complications and prolonged hospital Duration of Stay among patients undergoing amputation
Surgery, 2015Co-Authors: Tzewoei Tan, Mohammad H EslamiAbstract:Objective We evaluated the outcomes of patients undergoing major lower-extremity amputation who received packed red blood cell transfusion. Methods Using the dataset of the National Surgical Quality Improvement Program (2005–2011), we examined 5,739 above-knee and 6,725 below-knee amputations. Patients were stratified by perioperative (preoperative, intraoperative, or postoperative) blood transfusion. Outcomes included perioperative mortality, myocardial infarction (MI), thromboembolism, and Duration of Stay (DOS) at the hospital. Adjusted comparisons of outcomes between transfused and not-transfused patients were performed by matching the 2 groups for age, smoking, diabetes, renal failure, coronary artery disease, classification of the American Society of Anesthesiologists, functional status, and procedure type. Multivariable logistic and gamma regression were used to examine associations between transfusion and outcomes. Results of the 12,464 amputations in the study cohort 2,133 (17%) required transfusion. The majority of the cases were performed for critical limb ischemia (8,205 amputations; 66%) and the overall 30-days mortality was 9%. In both crude and matched cohorts, although perioperative mortality and cardiac complication rates were similar, transfusion was associated with a greater incidence of pneumonia (crude: 6.1% vs 3%, P Conclusion Among patients who had major lower-extremity amputation, perioperative transfusion independently predicted greater risks for perioperative pneumonia, thromboembolism, and prolonged hospital DOS.
Jon C Gould - One of the best experts on this subject based on the ideXlab platform.
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the relationship between Duration of Stay and readmissions in patients undergoing bariatric surgery
Surgery, 2015Co-Authors: Alex W Lois, Matthew J Frelich, Natasha Sahr, Samuel F Hohmann, Tao Wang, Jon C GouldAbstract:Background Hospital readmissions are a quality indicator in bariatric surgery. In recent years, Duration of Stay after bariatric surgery has trended down greatly. We hypothesized that a shorter postoperative hospitalization does not increase the likelihood of readmission. Methods The University HealthSystem Consortium (UHC) is an alliance of academic medical centers and affiliated hospitals. The UHC's clinical database contains information on inpatient Stay and returns (readmissions) up to 30 days after discharge. A multicenter analysis of outcomes was performed by the use of data from the January 2009 to December 2013 for patients 18 years and older. Patients were identified by bariatric procedure International Classification of Diseases, Ninth Revision, codes and restricted by diagnosis codes for morbid obesity. Results A total of 95,294 patients met inclusion criteria. The mean patient age was 45.4 (±0.11) years, and 73,941 (77.6%) subjects were female. There were 5,423 (5.7%) readmissions within the study period. Patients with hospitalizations of 3 days and more than 3 days were twice and four times as likely to be readmitted than those with hospitalizations of one day, respectively ( P Conclusion Patients with longer postoperative hospitalizations were more likely to be readmitted after bariatric surgery. Early discharge does not appear to be associated with increased readmission rates.
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the impact of perioperative dexmedetomidine infusion on postoperative narcotic use and Duration of Stay after laparoscopic bariatric surgery
Journal of Gastrointestinal Surgery, 2007Co-Authors: Chirag Dholakia, Gretchen Beverstein, Michael J Garren, Christopher P Nemergut, John Boncyk, Jon C GouldAbstract:Dexmedetomidine (Precedex, Hospira, Lake Forest, IL) is an alpha-2 receptor agonist with sedative and analgesic sparing properties. This medication has not been associated with respiratory suppression, despite occasionally high levels of sedation. For 10 months, all patients undergoing a laparoscopic bariatric procedure received a dexmedetomidine infusion 30 min before the anticipated completion of the procedure (n = 34). A control group was comprised of a similar number of patients to have had laparoscopic bariatric surgery in the time period immediately before these 10 months (n = 37). All pathways and discharge criteria were identical for patients in each group. A total of 73 patients were included in this retrospective chart review. Two gastric bypass patients were excluded for complications requiring additional surgery (one bleed and one leak). Gastric bypass patients who received a dexmedetomidine infusion required fewer narcotics (66 vs 130 mg of morphine equivalents) than control patients and met discharge criteria on post-op day (POD) 1 more often (61% discharged POD 1 vs 26% discharged POD 1, p = 0.02). Vital signs and pain scores were similar in all groups. Dexmedetomidine infusion perioperatively is safe and may help to minimize narcotic requirements and decrease Duration of Stay after laparoscopic bariatric procedures. This may have important patient safety ramifications in a patient population with a high prevalence of obstructive sleep apnea. A well-organized prospective, randomized, double-blinded trial is necessary to confirm the benefits of dexmedetomidine suggested by this study.
Tzewoei Tan - One of the best experts on this subject based on the ideXlab platform.
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blood transfusion is associated with increased risk of perioperative complications and prolonged hospital Duration of Stay among patients undergoing amputation
Surgery, 2015Co-Authors: Tzewoei Tan, Mohammad H Eslami, Denis Rybin, Gheorghe Doros, Wayne W Zhang, Alik FarberAbstract:Objective We evaluated the outcomes of patients undergoing major lower-extremity amputation who received packed red blood cell transfusion. Methods Using the dataset of the National Surgical Quality Improvement Program (2005–2011), we examined 5,739 above-knee and 6,725 below-knee amputations. Patients were stratified by perioperative (preoperative, intraoperative, or postoperative) blood transfusion. Outcomes included perioperative mortality, myocardial infarction (MI), thromboembolism, and Duration of Stay (DOS) at the hospital. Adjusted comparisons of outcomes between transfused and not-transfused patients were performed by matching the 2 groups for age, smoking, diabetes, renal failure, coronary artery disease, classification of the American Society of Anesthesiologists, functional status, and procedure type. Multivariable logistic and gamma regression were used to examine associations between transfusion and outcomes. Results of the 12,464 amputations in the study cohort 2,133 (17%) required transfusion. The majority of the cases were performed for critical limb ischemia (8,205 amputations; 66%) and the overall 30-days mortality was 9%. In both crude and matched cohorts, although perioperative mortality and cardiac complication rates were similar, transfusion was associated with a greater incidence of pneumonia (crude: 6.1% vs 3%, P Conclusion Among patients who had major lower-extremity amputation, perioperative transfusion independently predicted greater risks for perioperative pneumonia, thromboembolism, and prolonged hospital DOS.
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reply blood transfusion is associated with increased risk of perioperative complications and prolonged hospital Duration of Stay among patients undergoing amputation
Surgery, 2015Co-Authors: Tzewoei Tan, Mohammad H EslamiAbstract:Objective We evaluated the outcomes of patients undergoing major lower-extremity amputation who received packed red blood cell transfusion. Methods Using the dataset of the National Surgical Quality Improvement Program (2005–2011), we examined 5,739 above-knee and 6,725 below-knee amputations. Patients were stratified by perioperative (preoperative, intraoperative, or postoperative) blood transfusion. Outcomes included perioperative mortality, myocardial infarction (MI), thromboembolism, and Duration of Stay (DOS) at the hospital. Adjusted comparisons of outcomes between transfused and not-transfused patients were performed by matching the 2 groups for age, smoking, diabetes, renal failure, coronary artery disease, classification of the American Society of Anesthesiologists, functional status, and procedure type. Multivariable logistic and gamma regression were used to examine associations between transfusion and outcomes. Results of the 12,464 amputations in the study cohort 2,133 (17%) required transfusion. The majority of the cases were performed for critical limb ischemia (8,205 amputations; 66%) and the overall 30-days mortality was 9%. In both crude and matched cohorts, although perioperative mortality and cardiac complication rates were similar, transfusion was associated with a greater incidence of pneumonia (crude: 6.1% vs 3%, P Conclusion Among patients who had major lower-extremity amputation, perioperative transfusion independently predicted greater risks for perioperative pneumonia, thromboembolism, and prolonged hospital DOS.
Folke Sjoberg - One of the best experts on this subject based on the ideXlab platform.
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division of overall Duration of Stay into operative Stay and postoperative Stay improves the overall estimate as a measure of quality of outcome in burn care
PLOS ONE, 2017Co-Authors: Islam Abdelrahman, Moustafa Elmasry, Pia Olofsson, Ingrid Steinvall, Mats Fredrikson, Folke SjobergAbstract:Surgically managed burn patients admitted between 2010-14 were included. Operative Stay was defined as the time from admission until the last operation, postoperative Stay as the time from the last operation until discharge. The difference in variation was analysed with F-test. A retrospective review of medical records was done to explore reasons for extended postoperative Stay. Multivariable regression was used to assess factors associated with operative Stay and postoperative Stay.Operative Stay/TBSA% showed less variation than total Duration/TBSA% (F test = 2.38, p<0.01). The size of the burn, and the number of operations, were the independent factors that influenced operative Stay (R2 0.65). Except for the size of the burn other factors were associated with Duration of postoperative Stay: wound related, psychological and other medical causes, advanced medical support, and accommodation arrangements before discharge, of which the two last were the most important with an increase of (mean) 12 and 17 days (p<0.001, R2 0.51).Adjusted operative Stay showed less variation than total hospital Stay and thus can be considered a more accurate outcome measure for surgically managed burns. The size of burn and number of operations are the factors affecting this outcome measure.
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division of overall Duration of Stay into operative Stay and postoperative Stay improves the overall estimate as a measure of quality of outcome in burn care
PLOS ONE, 2017Co-Authors: Islam Abdelrahman, Moustafa Elmasry, Pia Olofsson, Ingrid Steinvall, Mats Fredrikson, Folke SjobergAbstract:Patients and Methods: Surgically managed burn patients admitted between 2010-14 were included. Operative Stay was defined as the time from admission until the last operation, postoperative Stay as ...
Alik Farber - One of the best experts on this subject based on the ideXlab platform.
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blood transfusion is associated with increased risk of perioperative complications and prolonged hospital Duration of Stay among patients undergoing amputation
Surgery, 2015Co-Authors: Tzewoei Tan, Mohammad H Eslami, Denis Rybin, Gheorghe Doros, Wayne W Zhang, Alik FarberAbstract:Objective We evaluated the outcomes of patients undergoing major lower-extremity amputation who received packed red blood cell transfusion. Methods Using the dataset of the National Surgical Quality Improvement Program (2005–2011), we examined 5,739 above-knee and 6,725 below-knee amputations. Patients were stratified by perioperative (preoperative, intraoperative, or postoperative) blood transfusion. Outcomes included perioperative mortality, myocardial infarction (MI), thromboembolism, and Duration of Stay (DOS) at the hospital. Adjusted comparisons of outcomes between transfused and not-transfused patients were performed by matching the 2 groups for age, smoking, diabetes, renal failure, coronary artery disease, classification of the American Society of Anesthesiologists, functional status, and procedure type. Multivariable logistic and gamma regression were used to examine associations between transfusion and outcomes. Results of the 12,464 amputations in the study cohort 2,133 (17%) required transfusion. The majority of the cases were performed for critical limb ischemia (8,205 amputations; 66%) and the overall 30-days mortality was 9%. In both crude and matched cohorts, although perioperative mortality and cardiac complication rates were similar, transfusion was associated with a greater incidence of pneumonia (crude: 6.1% vs 3%, P Conclusion Among patients who had major lower-extremity amputation, perioperative transfusion independently predicted greater risks for perioperative pneumonia, thromboembolism, and prolonged hospital DOS.
