Efecto de la implementación de las recomendaciones del protocolo de recuperación mejorada después de cirugía (ERAS) en cirugía colorrectal en un hospital de referencia del suroccidente colombiano / Effect of the implementation of Enhanced Recovery After Surgery (ERAS) protocol recommendations in colorectal surgery at a reference hospital in Southwestern Colombia

Introducción. La implementación del protocolo de recuperación mejorada después de cirugía (ERAS) ha demostrado mejorar los desenlaces en cirugía colorrectal. En Colombia su implementación es escasa y se tiene poca evidencia de sus beneficios. Por esa razón, el objetivo de este estudio fue evaluar el efecto de la implementación del protocolo ERAS en los pacientes sometidos a cirugía colorrectal en un hospital de referencia en el suroccidente colombiano. Métodos. Estudio observacional con abordaje de emulación de experimento clínico ideal. Se incluyeron pacientes adultos sometidos a cirugía colorrectal mayor entre los años 2021 y 2023. Se midió días de estancia hospitalaria, ingreso a unidad de cuidado intensivo (UCI) y la presencia de complicaciones globales, reintervenciones o reingreso hospitalario a 30 días. Se realizó un análisis univariado y multivariado para medir el efecto de la implementación del protocolo ERAS en los desenlaces. Resultados. En total,132 pacientes cumplieron los criterios de inclusión, 79 pacientes en el período previo a la implementación de ERAS y 53 pacientes con el protocolo ERAS. En el análisis multivariado, se encontró una reducción relativa del 77 % para ingreso a UCI, del 57 % de complicaciones globales, del 67 % en el reingreso hospitalario y del 92 % para reintervenciones quirúrgicas tras el alta en los pacientes ERAS. Conclusiones. La implementación de las recomendaciones ERAS en nuestra institución demostró mejorar los resultados clínicos en pacientes sometidos a cirugía colorrectal mayor. En Colombia, se necesita de estudios multicéntricos que permitan evidenciar la plausibilidad y beneficios de estas recomendaciones en otras instituciones.

Introduction. Implementation of the Enhanced Recovery After Surgery (ERAS) protocol has been shown to improve outcomes in colorectal surgery. In Colombia, its implementation is scarce and there is limited evidence of its benefits. For this reason, the objective of this study was to evaluate the effect of ERAS protocol implementation in patients undergoing colorectal surgery in a reference hospital in Southwestern Colombia. Methods. Observational study with ideal clinical experiment emulation approach. Adult patients undergoing major colorectal surgery between 2021 and 2023 were included. Days of hospital stay, admission to the intensive care unit (ICU), and the presence of overall complications, reinterventions, or hospital readmission within 30 days were measured. A univariate and multivariate analysis was performed to measure the effect of the implementation of the ERAS protocol on the outcomes. Results. A total of 132 patients met the inclusion criteria, 79 patients in the period prior to ERAS implementation and 53 patients with the ERAS protocol. In the multivariate analysis, a relative reduction of 77% for ICU admissions, 57% for overall complications, 67% for hospital readmission, and 92% for surgical reinterventions after discharge in ERAS patients was found. Conclusions. Implementation of ERAS recommendations at our institution was shown to improve clinical outcomes in patients undergoing major colorectal surgery, In Colombia, multicenter studies are needed to demonstrate the plausibility and benefits of these recommendations in other institutions.

Hospitalizations in older adults from the Zona da Mata of Minas Gerais, Brazil: data from the Unified Health System, 2016­2018 / Hospitalizações em idosos da Zona da Mata de Minas Gerais, Brasil: dados do Sistema Único de Saúde, 2016­2018

INTRODUCTION: The growing older population increases proportionately the demand for hospital care due to the increase in health problems. OBJECTIVE: To estimate the prevalence and incidence of hospitalizations, and to investigate associated factors in older adults from the Zona da Mata of Minas Gerais, Brazil, between 2016-2018. Secondly, to provide a more comprehensive epidemiological overview of hospitalizations, the following were estimated: monthly hospitalization rate; hospital mortality rate; frequency of hospitalizations according to diagnosis, hospitalizations for conditions sensitive to primary care and in-hospital death; and hospital costs. METHODS: This is an ecological and descriptive-analytic study. Data were obtained from the Brazilian Hospital Information System (SIH/SUS). RESULTS: The prevalence of hospitalizations was 35.1% (31.2% in women and 39.7% in men). The monthly rate of hospitalizations was higher in older men when compared with older women (Rate-Ratio=1.35 [95% CI=1.27-1.43]) and adult men between 40­59 years (Rate Ratio=2.42 [95% CI=2.26-2.58]). The cumulative incidence of hospitalization was 144/1,000 older persons (125/1,000 women and 169/1,000 men). Factors significantly associated with hospitalizations were: male sex (PR=1.52 [95% CI=1.11-2.08]); hospitalization in surgical bed (PR=1.93 [95% CI=1.05-3.56]); absence of death (PR=1.94 [95% CI=1.03-3.65]); and hospital stay ≥15 days (PR=0.71 [95% CI=0.54 0.95]). The cost of hospitalizations was R$ 220,8 million (mean of R$ 201,700/day). CONCLUSÃO: The findings strengthen the need for preventive healthcare for the older population living in the Zona da Mata of Minas Gerais and alert managers to the substantial socioeconomic impact of hospitalizations.

INTRODUÇÃO: O crescente aumento da população idosa faz aumentar proporcionalmente a demanda por cuidados hospitalares devido ao aumento dos problemas de saúde. OBJETIVO: Estimar a prevalência e incidência de hospitalizações, e investigar fatores associados, em idosos da Zona da Mata Mineira, Brasil, entre 2016-2018. Secundariamente, com intuito de fornecer um panorama epidemiológico mais abrangente acerca das hospitalizações, foram estimadas: taxa mensal de hospitalização; taxa de mortalidade hospitalar; frequência de hospitalizações conforme o diagnóstico, internações por condições sensíveis à atenção primária (ICSAP) e óbito hospitalar; e custos hospitalares. MÉTODO: Trata-se de um estudo ecológico e descritivo-analítico. Os dados foram obtidos do Sistema de Informação Hospitalar brasileiro (SIH/SUS). RESULTADOS: A prevalência de hospitalizações em idosos foi de 35,1% (31,2% em mulheres e 39,7% em homens). A taxa mensal de hospitalização foi maior em homens idosos quando comparados com mulheres idosas (Razão-de-Taxas=1,35 [IC 95%=1,27-1,43]) e homens adultos entre 40­59 anos (Razão-de-Taxas=2,42 [IC 95%=2,26-2,58]). A incidência acumulada de hospitalização foi de 144/1.000 idosos (125/1.000 mulheres e 169/1.000 homens). Os fatores significativamente associados com as hospitalizações foram: sexo masculino (RP=1,52 [IC 95%=1,11­2,08]), internação em leito cirúrgico (RP=1,93 [IC 95%=1,05­3,56]), ausência de óbito (RP=1,94 [IC 95%=1,03-3,65]) e permanência hospitalizado ≥15 dias (RP=0,71 [IC 95%=0,54-0,95]). O custo das hospitalizações foi de R$ 220,8 milhões (média de R$ 201,7 mil/dia). CONCLUSÃO: Os resultados reforçam a necessidade de cuidados preventivos à saúde da população idosa da Zona da Mata Mineira e alertam gestores para o substancial impacto socioeconômico gerado pelas hospitalizações.

Protocolo de recuperación mejorada después de cirugía (ERAS) atenúa el estrés y acelera la recuperación en pacientes después de resección radical por cáncer colorrectal: Experiencia en la Clínica Universitaria Colombia / Enhanced Recovery After Surgery (ERAS) protocol attenuates stress and accelerates recovery in patients after radical resection for colorectal cancer: Experience at Clínica Universitaria Colombia

Introducción. El conjunto de estrategias de recuperación mejorada después de la cirugía (ERAS, por sus siglas en inglés) constituye un enfoque de atención multimodal y multidisciplinario, cuyo propósito es reducir el estrés perioperatorio de la cirugía, disminuir la morbilidad y acortar la estancia hospitalaria. Este estudio tuvo como objetivo describir los resultados clínicos de pacientes sometidos a cirugía por cáncer colorrectal, identificando las complicaciones principales y los factores perioperatorios relacionados con el alta temprana. Métodos. Se analizaron los pacientes consecutivos sometidos a cirugía colorrectal entre los años 2020 y 2023, todos los cuales siguieron el protocolo ERAS institucional. Se evaluaron las características clínicas, los factores perioperatorios, los desenlaces postoperatorios y la tasa global de adherencia al protocolo. Resultados. Un total de 456 pacientes fueron sometidos a cirugía colorrectal, 51% de sexo masculino, con edad media de 60 años. La mayoría de las intervenciones se realizaron por laparoscopia (78 %), con una tasa de conversión del 14,5 %. Las complicaciones postoperatorias incluyeron fuga anastomótica (4,6 %), sangrado, infección intraabdominal y obstrucción intestinal. La estancia hospitalaria promedio fue de 4 días y la mortalidad del 2,8 %. La tasa global de adherencia al protocolo ERAS fue del 84,7 %. Conclusiones. El enfoque combinado de cirugía laparoscópica y protocolo ERAS es factible, seguro y se asocia con una estancia hospitalaria más corta. La implementación y adherencia al protocolo ERAS no solo mejora los resultados postoperatorios, sino que también resalta la importancia de acceder a datos sólidos, permitiendo mejorar la atención perioperatoria local.

Introduction. The Enhanced Recovery After Surgery (ERAS) protocol is a multimodal, multidisciplinary approach to care, the purpose of which is to reduce the perioperative stress of surgery, decrease morbidity, and shorten hospital stay. This study aimed to describe the clinical outcomes of patients undergoing surgery for colorectal cancer, identifying the main complications and perioperative factors related to early discharge. Methods. Consecutive patients undergoing colorectal surgery between 2020 and 2023 were analyzed, who followed the institutional ERAS protocol. Clinical characteristics, perioperative factors, postoperative outcomes, and overall protocol adherence rate were evaluated. Results. A total of 456 patients underwent colorectal surgery, 51% male, with a mean age of 60 years. Most interventions were performed laparoscopically (78%), with a conversion rate of 14.5%. Postoperative complications included anastomotic leak (4.6%), followed by bleeding, intra-abdominal infection, and intestinal obstruction. The average hospital stay was 4 days and mortality was 2.8%. The overall adherence rate to the ERAS protocol was 84.7%. Conclusions. The combined approach of laparoscopic surgery and ERAS protocol is feasible, safe, and associated with a shorter hospital stay. Implementation and adherence to the ERAS protocol not only improves postoperative outcomes, but also highlights the importance of accessing solid data, allowing for improved local perioperative care.

Digital medical 3D technology versus traditional 2D technology in the diagnosis and treatment of solid abdominal tumors in children / 中国基层医药

Objective:To investigate the value of digital medical 3D technology versus traditional 2D technology in the diagnosis and treatment of solid abdominal tumors in children. Methods:A total of 80 children with solid abdominal tumors who received surgical treatment guided by digital medical 3D technology at Guigang People's Hospital from January 2018 to January 2022 were included in the observation group. An additional 80 children with solid abdominal tumors who received surgical treatment guided by traditional 2D technology at the same hospital from January 2014 to December 2017 were included in the control group. Clinical efficacy was compared between the two groups.Results:The surgical time, intraoperative blood loss, postoperative exhaust time, postoperative hospital stay in the observation group were (111.8 ± 28.9) minutes, (26.8 ± 25.2) mL, (2.2 ± 1.2) days, (7.5 ± 1.4) days, respectively, which were significantly shorter or less than those in the control group [(193.1 ± 66.0) minutes, (86.2 ± 47.0) mL, (3.7 ± 0.9) days, (12.2 ± 3.5) days, t = 7.00, 6.88, 5.87, 7.53, all P < 0.05]. The complete surgical resection rate in the observation group was significantly higher than that in the control group [92.5% (74/80) vs. 81.3% (65/80), χ2 = 4.44, P < 0.05]. The incidence of complications in the observation group was significantly lower than that in the control group [6.3% (5/80) vs. 16.3% (13/80), χ2 = 4.00, P < 0.05]. Conclusion:The utilization of digital medical 3D technology in the surgical treatment of solid abdominal tumors in children can markedly decrease surgical time, reduce intraoperative blood loss, promote postoperative recovery, achieve a high surgical resection rate, and minimize postoperative complications.

Risk factors and predictive model for prolonged length of stay after spinal tuberculosis lesion removal and bone graft fusion with internal fixation / 中国脊柱脊髓杂志

Objectives:To analyze the risk factors for prolonged length of stay(LOS)after lesion removal and bone graft fusion internal fixation in patients with spinal tuberculosis,and to develop and validate a predictive model.Methods:The clinical data of 152 patients with spinal tuberculosis who underwent lesion removal and bone grafting and fusion internal fixation at Honghui Hospital affiliated to Xi'an Jiaotong Univer-sity from February 2016 to December 2020 were retrospectively analyzed.The patients were divided into the prolonged LOS(PLOS)group and normal LOS(NLOS)group according to whether their postoperative LOS ex-ceeded the postoperative LOS of the 75th percentile of the overall study cohort.Univariate analyses were per-formed for gender,age,hypertension,diabetes,paraplegia,anticoagulation history,tuberculosis resistance,pre-operative anti-tuberculosis time,blood transfusion,surgical site,surgical approach,number of fused vertebrae,operative time,intraoperative blood loss(IBL),postoperative complications,blood transfusion cost,hospital cost,C-reactive protein(CRP),erythrocyte sedimentation rate(ESR),albumin(ALB),blood routine,and coagulation function in both groups.Based on Lasso regression,the risk factors significantly associated with postoperative LOS prolongation in spinal tuberculosis were selected and incorporated into a multivariate logistic regression analysis,and thereby a prediction model was established based on the results of multivariate logistic regres-sion analysis.The model was visualized by plotting a nomogram as a means of predicting the probability of risk for prolongation of LOS after spinal tuberculosis surgery.Internal validation of the model was performed using extended Bootstrap,where receiver operating characteristic(ROC)curves,calibration curves and decision curve analysis(DCA)were plotted to verify the discrimination,accuracy and clinical applicability.Results:The 152 patients enrolled in the study had a median LOS of 10d,and the 75%LOS was 14d.There were 96 patients in the PLOS group and 56 in the NLOS group.Univariate analysis showed that the differences in age,hypertension,diabetes,anticoagulation history,tuberculosis resistance,preoperative anti-tuberculosis time,surgical site,surgical approach,surgical time,IBL,postoperative complications,CRP,ESR,preoperative ALB,blood routine,and coagulation function were not statistically significant between the two groups(P＞0.05),while the differences in gender,paraplegia,blood transfusion,number of fused vertebrae,blood transfusion cost,and hospitalization cost were statistically significant(P＜0.05).The operative time,IBL,preoperative Hb,and preop-erative ALB were divided according to the Yoden index of ROC as the dividing point,and the cut-off value of operative time was 198(min),the cut-off value of IBL was 1000(mL),the cut-off value of preoperative Hb was 118(g/L),and the cut-off value of preoperative ALB was 38.8(g/L).Through Lasso regression model,the risk factors closely related to the prolongation of LOS after spinal tuberculosis were female,blood transfusion,the number of fused vertebrae≥3,operative time≥198min and IBL≥1000mL,preoperative Hb＜118g/L and preoperative ALB＜38.8g/L.Multivariate logistic regression analysis showed that female,number of fused ver-tebrae≥3,operative time≥198min and IBL≥1000mL were the risk factors for postoperative LOS prolongation in patients with spinal tuberculosis(P＜0.05).A visual nomogram model for logistic regression was constructed,and the predictors included female,number of fused vertebrae,operative time,and IBL.A Bootstrap self-sampling of 1,000 times was performed to complete the internal validation of the model,with a C-index value of 0.882 and an area under the curve(AUC)of ROC of 0.884(95%CI:0.782 to 0.985).The calibration curve showed that the apparent curve of the model fitted well with the curve after deviation correction.The DCA curve showed that the threshold range of 0.2 to 0.9 had the greatest clinical benefit.Conclusions:Female,number of fused vertebrae≥3,operative time≥198min and IBL≥1000mL are the main risk factors for pro-longed LOS after lesion removal and bone graft fusion with internal fixation in patients with spinal tuberculo-sis,and the predictive model based on the above risk factors can help physicians to make clinical decisions and optimize the perioperative management.

Risk factors for prolonged length of stay in post-anesthesia care unit and development of a prediction model in patients undergoing radical esophagectomy / 中华麻醉学杂志

Objective:To identify the risk factors for prolonged length of stay in post-anesthesia care unit (PACU-LOS) and development of a prediction model in the patients undergoing radical esophagectomy.Methods:The medical records from patients of both sexes, aged 40-80 yr, of American Society of Anesthesiologists Physical Status classificationⅠ-Ⅲ, transferred to PACU with tracheal intubation after radical esophagectomy under general anesthesia in our hospital from January 2019 to December 2020, were retrospectively collected. The patient′s age, gender, American Society of Anesthesiologists Physical Status classification, smoking history, drinking history, history of non-thoracic surgery, history of hypertension, history of diabetes mellitus, preoperative anemia, respiratory diseases, doses of anesthetics, preoperative nerve block, intraoperative consumption of opioids and dexmedetomidine, operation method (thoracotomy and endoscopic surgery), operation time, usage of vascular drugs, bradycardia, hypotension, red blood cell infusion, plasma infusion, total infusion volume, blood loss and urine volume were collected. The extubation time in PACU, visual analog scale scores at rest at 10 min after extubation, consumption of rescue analgesics in PACU, hypoxemia after extubation, and occurrence of nausea and vomiting were also collected. Patients were divided into PACU-LOS normal group (PACU-LOS≤2 h) and PACU-LOS prolonged group (PACU-LOS>2 h) according to the PACU-LOS. Logistic regression analysis was used to identity the risk factors for prolonged PACU-LOS in the patients undergoing radical esophagectomy, and the predictive model was established and verified. The receiver operating characteristic curves were used to evaluate the model discrimination and Hosmer-Lemshow goodness-of-fit test was used to evaluate the consistency of the model.Results:A total of 943 patients were included in this study, and the incidence of prolonged PACU-LOS was 15.7%. The results of logistic regression analysis showed that chronic obstructive pulmonary disease ( OR=4.900, 95% confidence interval [ CI] 2.512-9.556), increasing age ( OR=22.154, 95% CI 6.736-73.003), prolonged time of extubation ( OR=1.214, 95% CI 1.174-1.256) and hypoxemia after extubation ( OR=4.891, 95% CI 2.167-11.039) were risk factors for prolonged PACU-LOS, and the preoperative use of nerve block ( OR=0.358, 95% CI 0.190-0.672) was a protective factor for prolonged PACU-LOS in the patients undergoing radical esophagectomy ( P<0.05). The area under the receiver operating characteristic curve (95% CI) was 0.947 (0.925-0.963), the sensitivity was 0.878, and the specificity was 0.906. The internal validation of the prediction model was carried out using the receiver operating characteristic curve in the validation set, and the area under the curve (95% CI) was 0.942 (0.895-0.942, P<0.001) and the Youden index was 0.784. The line chart prediction model was developed. The prediction analysis model was verified by Hosmer-Lemshow test, P<0.001, and the C-index visualized line chart prediction model was 0.946. Conclusions:Preoperative chronic obstructive pulmonary disease, increasing age, prolonged time of extubation and hypoxemia after extubation are risk factors for prolonged PACU-LOS, and preoperative use of nerve block is a protective factor for prolonged PACU-LOS. The risk prediction model developed can effectively predict the occurrence of prolonged PACU-LOS in the patients undergoing radical esophagectomy.

Goal-directed therapy guided by the FloTrac sensor in major surgery: a systematic review and meta-analysis / Terapia guiada por metas utilizando o sensor FloTrac em cirurgia de grande porte: revisão sistemática e metanálise

ABSTRACT Objective To provide insights into the potential benefits of goal-directed therapy guided by FloTrac in reducing postoperative complications and improving outcomes. Methods We performed a systematic review and meta-analysis of randomized controlled trials to evaluate goal-directed therapy guided by FloTrac in major surgery, comparing goal-directed therapy with usual care or invasive monitoring in cardiac and noncardiac surgery subgroups. The quality of the articles and evidence were evaluated with a risk of bias tool and GRADE. Results We included 29 randomized controlled trials with 3,468 patients. Goal-directed therapy significantly reduced the duration of hospital stay (mean difference -1.43 days; 95%CI 2.07 to -0.79; I2 81%), intensive care unit stay (mean difference -0.77 days; 95%CI -1.18 to -0.36; I2 93%), and mechanical ventilation (mean difference -2.48 hours, 95%CI -4.10 to -0.86, I2 63%). There was no statistically significant difference in mortality, myocardial infarction, acute kidney injury or hypotension, but goal-directed therapy significantly reduced the risk of heart failure or pulmonary edema (RR 0.46; 95%CI 0.23 - 0.92; I2 0%). Conclusion Goal-directed therapy guided by the FloTrac sensor improved clinical outcomes and shortened the length of stay in the hospital and intensive care unit in patients undergoing major surgery. Further research can validate these results using specific protocols and better understand the potential benefits of FloTrac beyond these outcomes.

RESUMO Objetivo Fornecer informações sobre os possíveis benefícios da terapia guiada por metas utilizando o sensor FloTrac na redução de complicações pós-operatórias e na melhoria dos desfechos. Métodos Realizamos uma revisão sistemática e uma metanálise de estudos controlados e randomizados para avaliar a terapia guiada por metas utilizando o sensor FloTrac em cirurgias de grande porte, comparando a terapia guiada por metas com os cuidados habituais ou o monitoramento invasivo em subgrupos de cirurgias cardíacas e não cardíacas. A qualidade dos artigos e das evidências foi avaliada com uma ferramenta de risco de viés e o GRADE. Resultados Incluímos 29 estudos controlados e randomizados com 3.468 pacientes. A terapia guiada por metas reduziu significativamente a duração da internação hospitalar (diferença média de -1,43 dia; IC95% 2,07 - -0,79; I2 81%), a internação na unidade de terapia intensiva (diferença média de -0,77 dia; IC95% -1,18 - -0,36; I2 93%) e a ventilação mecânica (diferença média de -2,48 horas, IC95% -4,10 - -0,86; I2 63%). Não houve diferença estatisticamente significativa na mortalidade, no infarto do miocárdio, na lesão renal aguda e nem na hipotensão, mas a terapia guiada por metas reduziu significativamente o risco de insuficiência cardíaca ou edema pulmonar (risco relativo de 0,46; IC95% 0,23 - 0,92; I2 0%). Conclusão A terapia guiada por metas utilizando o sensor FloTrac melhorou os desfechos clínicos e reduziu o tempo de internação no hospital e na unidade de terapia intensiva em pacientes submetidos a cirurgias de grande porte. Outras pesquisas podem validar esses resultados usando protocolos específicos e entender melhor os possíveis benefícios do FloTrac além desses desfechos.

Outcomes of Minimally Invasive Aortic Valve Replacement in Obese Patients: A Propensity-Matched Study

ABSTRACT Introduction: Obese patients are at risk of complications after cardiac surgery. The aim of this study is to investigate safety and efficacy of a minimally invasive approach via upper sternotomy in this setting. Methods: We retrospectively reviewed 203 obese patients who underwent isolated, elective aortic valve replacement between January 2014 and January 2023 - 106 with minimally invasive aortic valve replacement (MIAVR) and 97 with conventional aortic valve replacement (CAVR). To account for baseline differences, a propensity-matching analysis was performed obtaining two balanced groups of 91 patients each. Results: The 30-day mortality rate was comparable between groups (1.1% MIAVR vs. 0% CAVR, P=0.99). MIAVR patients had faster extubation than CAVR patients (6 ± 2 vs. 9 ± 2 hours, P<0.01). Continuous positive airway pressure therapy was less common in the MIAVR than in the CAVR group (3.3% vs. 13.2%, P=0.03). Other postoperative complications did not differ significantly. Intensive care unit stay (1.8 ± 1.2 vs. 3.2 ± 1.4 days, P<0.01), but not hospital stay (6.7 ± 2.1 vs. 7.2 ± 1.9 days, P=0.09), was shorter for MIAVR than for CAVR patients. Follow-up survival was comparable (logrank P-value = 0.58). Conclusion: MIAVR via upper sternotomy has been shown to be a safe and effective option for obese patients. Respiratory outcome was promising with shorter mechanical ventilation time and reduced need for post-extubation support. The length of stay in the intensive care unit was reduced. These advantages might be important for the obese patient to whom minimally invasive surgery should not be denied.

Idade, Insuficiência Renal e Transfusão são Preditores de Risco de Longa Permanência Hospitalar após Cirurgia de Revascularização do Miocárdio / Age, Renal Failure and Transfusion are Risk Predictors of Prolonged Hospital Stay after Coronary Artery Bypass Grafting Surgery

Resumo Fundamento: A identificação de fatores de riscos na cirurgia cardiovascular auxilia na previsibilidade resultando na otimização de desfechos e redução de custos. Objetivo: Identificação dos preditores de risco pré e intraoperatórios para internação prolongada após cirurgia de revascularização do miocárdio (CRM) no Estado de São Paulo. Métodos: Análise transversal no banco de dados REPLICCAR II, registro prospectivo, consecutivo, multicêntrico que incluiu cirurgias de revascularização miocárdica realizadas entre agosto de 2017 e julho de 2019. O desfecho principal foi o tempo de internação prolongado, definida como período de pós-operatório superior a 14 (quatorze) dias. Para a identificação dos preditores foram realizadas análises de regressão logística uni- e multivariada. Os valores de p menores de 0,05 foram considerados significativos. Resultados: A mediana de idade foi de 63 (57-70) anos e 26,55% eram do sexo feminino. Dos 3703 pacientes analisados, 228 (6,16%) apresentaram longa permanência hospitalar (LPH) após a CRM e a mediana da internação foi de 17 (16-20) dias. Foram preditores da LPH após a CRM: idade >60 anos (OR 2,05; IC95% 1,43 - 2,87; p<0,001); insuficiência renal (OR 1,73; IC95% 1,29 - 2,32; p<0,001) e transfusão de hemácias no intraoperatório (OR 1,32; IC 1,07 - 2,06; p=0,01). Conclusão: Nesta análise, a idade > 60 anos, insuficiência renal e a transfusão de hemácias no intraoperatório foram preditores independentes de LPH após a CRM. A identificação destas variáveis pode ajudar no planejamento estratégico multiprofissional visando melhoria de resultados e otimização de recursos no estado de São Paulo.

Abstract Background: Identifying risk factors in cardiovascular surgery assists in predictability, resulting in optimization of outcomes and cost reduction. Objective: This study aimed to identify preoperative and intraoperative risk predictors for prolonged hospitalization after coronary artery bypass grafting (CABG) surgery in the state of São Paulo, Brazil. Methods: A cross-sectional analysis using data from the REPLICCAR II database, a prospective, consecutive, multicenter registry that included CABG surgeries performed between August 2017 and July 2019. The primary outcome was a prolonged hospital stay (PHS), defined as a postoperative period exceeding 14 days. Univariate and multivariate logistic regression analyses were performed to identify the predictors with significance set at p <0.05. Results: The median age was 63 (57-70) years and 26.55% of patients were female. Among the 3703 patients analyzed, 228 (6.16%) had a PHS after CABG, with a median hospital stay of 17 (16-20) days. Predictors of PHS after CABG included age >60 years (OR 2.05; 95% CI 1.43-2.87; p<0.001); renal failure (OR 1.73; 95% CI 1.29-2.32; p <0.001) and intraoperative red blood cell transfusion (OR 1.32; 95% CI 1.07-2.06; p=0.01). Conclusion: Age >60 years, renal failure, and intraoperative red blood cell transfusion were independent predictors of PHS after CABG. The identification of these variables can help in multiprofessional strategic planning aimed to enhance results and resource utilization in the state of São Paulo.

Cost and time of hospitalization for elderly people with bone fractures in a reference hospital

ABSTRACT Objective To describe and analyze the aspects regarding the cost and length of stay for elderly patients with bone fractures in a tertiary reference hospital. Methods A cross-sectional retrospective study using data obtained from medical records between January and December 2020. For statistical analysis, exploratory analyses, Shapiro-Wilk test, χ2 test, and Spearman correlation were used. Results During the study period, 156 elderly patients (62.2% women) with bone fractures were treated. The main trauma mechanism was a fall from a standing height (76.9%). The most common type of fracture in this sample was a transtrochanteric fracture of the femur, accounting for 40.4% of cases. The mean length of stay was 5.25 days. The total cost varied between R$2,006.53 and R$106,912.74 (average of R$15,695.76) (updated values). The mean daily cost of hospitalization was R$4,478.64. A positive correlation was found between the length of stay and total cost. No significant difference in cost was observed between the two main types of treated fractures. Conclusion Fractures in the elderly are frequent, resulting in significant costs. The longer the hospital stay for treatment, the higher the total cost. No correlation was found between total cost and number of comorbidities, number of medications used, and the comparison between the treatment of transtrochanteric and femoral neck fractures.

El riesgo nutricional como predictor de gravedad en pacientes críticos con COVID-19 / Nutritional risk as a predictor of severity in critically ill patients with COVID-19

Resumen Introducción : El riesgo nutricional es un parámetro que sirve para diagnosticar el nivel de riesgo que tiene el paciente de desarrollar efectos adversos que impacten en su estado nutricional. Existen estudios que asocian el riesgo nutricional con la evolución clínica. Objetivo : Evaluar la asociación del riesgo nutricional con variables clínicas relacionadas a la gravedad de pacientes críticos con COVID-19. Métodos : Se incluyeron pacientes adultos de UCI con COVID-19, se analizó la relación del riesgo nutricional (score NUTRICm) con las variables: estadía en UCI, asis tencia respiratoria mecánica (ARM), insuficiencia renal aguda, infección secundaria y mortalidad. Se utilizaron pruebas Mann-Whitney, chi cuadrado y V de Cramér para análisis de asociación y regresión logística para identi ficar variables predictoras de mortalidad. El intervalo de confianza fue 95% y se consideraron significativos valores < 0.05. Resultados : Se estudiaron 100 pacientes, edad pro medio 56,5 ± 14,5 años, 69% menores de 65 años, 53% sexo masculino, presencia de comorbilidad 79%, alto riesgo nutricional 51%, estadía promedio en UCI 11 días, ARM promedio 10 días y mortalidad 52%. Se hallaron asociaciones del alto riesgo nutricional con prolonga ción de estadía en UCI, duración de ARM, insuficiencia renal aguda, infecciones secundarias y mortalidad. En la regresión logística se obtuvo que la variable riesgo nutricional es predictora de mortalidad. Conclusión : Debido a la asociación del alto riesgo nu tricional con la gravedad de pacientes críticos se sugiere que el riesgo nutricional sea diagnosticado rutinariamen te en UCI y que el score NUTRICm sea tenido en cuenta como herramienta para valorar el pronóstico clínico.

Abstract Introduction : Nutritional risk is a parameter used to diagnose the level of risk that the patient has of develop ing adverse effects that impact their nutritional status. There are studies that associate nutritional risk with clinical evolution. Objective : To evaluate the association of nutritional risk with clinical variables related to the severity of critically ill patients with COVID-19. Methods : Adult ICU patients with COVID-19 were included, and the relationship between nutritional risk (NUTRICm score) and the variables: ICU stay, Invasive Mechanical Ventilation (IMV), acute renal failure, sec ondary infection, and mortality were analyzed. Mann- Whitney, chi-square, and Cramér's V tests were used for association analysis and logistic regression to identify mortality predictor variables. The confidence interval was 95% and values <0.05 were considered significant. Results : 100 patients were studied, average age 56.5 ± 14.5 years, 69% under 65 years of age, 53% male, pres ence of comorbidity 79%, high nutritional risk 51%, average stay in the ICU 11 days, average IMV 10 days, and mortality 52%. Associations of high nutritional risk with prolonged stay in the ICU, duration of IMV, acute renal failure, secondary infections and mortality were found. In the logistic regression it was found that the nutritional risk variable is a predictor of mortality. Conclusion : Given the association of high nutritional risk with the severity of critical patients, it is suggested that nutritional risk be routinely diagnosed in the ICU and that the NUTRICm score be taken into account as a tool to assess clinical prognosis.

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.

Assessment of the Risk Factors Related to the Length of Hospital Stay and Postoperative Complications in Patients Undergoing Primary Total Knee Arthroplasty / Avaliação dos fatores de risco relacionados ao tempo de internação e às complicações pós-operatórias em pacientes submetidos a artroplastia total primária do joelho

Abstract Objective To assess the risk factors involving longer hospital stays and early postoperative complications (first 30 days after surgery) in patients undergoing total knee arthroplasty (TKA). Materials and Methods Across-sectional study was conducted with collection of data of patients who underwent TKA in a private hospital between 2015 and 2019. The following data were collected: age, gender, body mass index, and clinical comorbid-ities. We also collected intraoperative data such as the grade on the classification of the American Society of Anesthesiologists (ASA), the duration of the surgery, the length of stay, the postoperative complications, and readmission within 30 days. Statistical models were used to investigate the possible risk factors associated with longer hospital stays and postoperative complications. Results There was evidence of an increase in the length of hospital stay in older patients, with higher grades on the ASA classification or who suffered postoperative complications. For each increase in 1 year of age, we expect the length of stay to be multiplied by 1.008 (95% confidence interval [95%CI]: 1.004 to 1.012; p < 0,001). In patients who were ASA grade III, the time is expected to be multiplied by 1.297 (95%CI: 1.083 to 1.554; p = 0,005) when compared with grade-I patients. In patients who suffered postoperative complications, the time is expected to be multiplied by 1.505 (95%CI: 1.332 to 1.700; p < 0.001) compared with patients without complications. Conclusion The present study demonstrated that, in patients who underwent primary TKA, preoperative characteristics such as older age and ASA grade > III, as well as the development of postoperative complications, independently predict the increase in the length of hospital stay.

Resumo Objetivo Avaliar os fatores de risco relacionados a um tempo de internação mais longo e às complicações pós-operatórias precoces (primeiros 30 dias após a cirurgia) em pacientes submetidos a artroplastia total do joelho (ATJ). Materiais e Métodos Este é um estudo transversal com coleta de dados de pacientes submetidos a ATJ em um hospital privado entre 2015 e 2019. Os seguintes dados foram coletados: idade, gênero, índice de massa corporal, e comorbidades clínicas. Também coletamos dados intraoperatórios, como o grau na classificação da American Society of Anesthesiologists (ASA) e a duração da cirurgia, além do tempo de internação, as complicações pós-operatórias, e a readmissão em 30 dias. Os possíveis fatores de risco associados a um tempo de internação mais longo e às taxas de complicações pós-operatórias foram investigados por meio de modelos estatísticos. Resultados Os pacientes mais velhos, com graus mais elevados na classificação da ASA ou que sofreram complicações pós-operatórias, ficaram internados por mais tempo. Para cada aumento em um ano de idade, esperamos que o tempo de internação seja multiplicado por 1,008 (intervalo de confiança de 95% [IC95%]: 1,004 a 1,012; p < 0,001). Em pacientes de grau III na classificação da ASA, espera-se que o tempo seja multiplicado por 1,297 (IC95%: 1,083 a 1,554; p = 0,005) em comparação com pacientes de grau I. Em pacientes com complicações pós-operatórias, espera-se que o tempo seja multiplicado por 1,505 (IC95%: 1,332 a 1,700; p < 0,001) em comparação com pacientes sem complicações. Conclusão Este estudo demonstrou que, em pacientes submetidos a ATJ primária, características pré-operatórias, como idade avançada e grau ≥ III na classificação da ASA, e o desenvolvimento de complicações pós-operatórias predizem o aumento do tempo de internação hospitalar de forma independente.

Prolonged Stay in Intensive Care Unit and Its Predictors in a Tertiary Care Centre of West Bengal, India

Background : Intensive Care Unit (ICU) is considered as one of the most expensive and complex medical resources of any hospital. Research on ICUs may provide valuable inputs in developing an improved model of patient-care and hospital management and a better utilisation of the scarce resources especially in this ongoing pandemic crisis. ICU Length of Stay has long been used as a surrogate marker for resource utilisation. The following study was conducted in a Tertiary Care Hospital of West Bengal to find out the prevalence of prolonged ICU stay and their related factors. Methodology : This was an Observational, descriptive type study conducted in an intensive care unit of a teaching hospital of West Bengal during April-September 2021. Potential predictors were analysed along with various clinicodemographic profiles of the study subjects for possible association with prolonged ICU-Length of Stay (LOS >14days). Results and Discussion : Out of total 287 patients almost 19% patients had a Length of Stay (LOS) of more than 14 days. The patients admitted in the ICU due to surgical trauma, respiratory or neurological cases were more likely to have a prolonged LOS. Patient who had Coagulopathy, Infection, Oliguria or needed Mechanical ventilation or Vasopressor therapy in the first 24-hour following admission had higher ICU stay. The patients having LOS of >14 days had a higher mean APACHE II score. Conclusion : The predictors identified in this study can be used in targeting this particular group to improve resource utilization and efficiency of ICU

The impact of emergence delirium on hospital length of stay for children who underwent tonsillectomy/adenotonsillectomy: an observational retrospective study

Abstract Background Emergence Delirium (ED) is a combination of disturbance of perception and psychomotor agitation that is common in pediatric patients after general anesthesia, especially at preschool age. Since the effect of ED on the length of stay has been studied in adults but infrequently in children, the aim of this study was to investigate the relationship between ED and length of stay in this population. Methods A single center, retrospective, observational study was carried out in children who underwent tonsillectomy or adenotonsillectomy. The Pediatric Anesthesia Emergence Delirium (PAED) scale was used to assess ED. In addition to the time to hospital discharge (time frame 24 hours), drugs used, comorbidities, early postoperative complications, and pain were investigated if potentially associated with the complication. Results Four hundred sixteen children aged from 1.5 to 10 years (183 female, 233 male) were included. ED occurred in 25.5% of patients (n = 106). Patients were divided into the ED group and the No-ED group. The discharge time was similar in both groups. No significant differences were observed in the frequency of postoperative complications. The use of fentanyl or dexmedetomidine did not affect ED occurrence. The frequency of pain was greater in the ED group, both in the recovery room and in the ward (p= 0.01). Conclusions The occurrence of ED in children after tonsillectomy/adenotonsillectomy did not extend the length of stay.

Cardiac Myxomas: A Single?Center Case Series of 145 Patients Over a 32?Year Period Study

Background:Myxomas are the most common primary cardiac tumors that develop mostly at the atrial chambers of the heart and represent 0,25% of all cardiac diseases. Methods: This is a retrospective study aiming to analyze epidemiological and intraoperative data from cardiac myxoma cases in the hospital of the last 32 years. The study population was 145 cardiac surgical patients and was divided into 4 certain 8?year periods. 87,6% of cases had the myxoma located at left atrium and 97,2% of all patients fully recovered. 4,1% of patients relapsed and underwent a redo operation. Results: Mean CPB time and mean ICU length of stay increased during the 8?year periods (p < 0,001, P < 0,001, P = 0,002 and P = 0,003 respectively). In-hospital length of stay decreased to 5 days in the most recent period (p < 0,001). Cases significantly increased to 54 in the last 8?year period (p = 0,009). Conclusion: Improvement on cardiac imaging and a better accessibility may drive patients to earlier and safer diagnosis of myxomas preventing any deterioration of their condition. Improvement on postoperative care can also reduce in-hospital length of stay. Surgical excision is the treatment of choice and guaranteed survival at 97,2% of patients.

Estudio de los desenlaces perioperatorios de la apendicitis aguda durante la pandemia por COVID-19: un estudio observacional analítico de cohorte / Study of perioperative outcomes of acute appendicitis during the COVID-19 pandemic: An analytical observational cohort study

Introducción. La condición de pandemia por COVID-19 impactó a la sociedad y los sistemas de salud a nivel mundial. Las adaptaciones institucionales procuraron mantener la calidad de la atención a pesar de un contexto organizacional desfavorable. La apendicitis aguda requirió ser manejada en un nuevo escenario institucional. El objetivo de este estudio fue evaluar la efectividad del tratamiento quirúrgico de la apendicitis durante la pandemia. Métodos. Estudio observacional analítico, retrospectivo, en el que se incluyeron pacientes sometidos a apendicectomía, antes y durante la pandemia por COVID-19. Se evaluaron las complicaciones, infección del sitio operatorio, reingresos y estancia hospitalaria. Adicionalmente, se analizaron los desenlaces en los 3 picos epidemiológicos de la pandemia. Se efectuaron estadísticas descriptivas y analíticas entre los grupos a comparar. Resultados. Se incluyeron 1521 pacientes con apendicitis, 48,3 % operados antes y 51,7 % durante la pandemia. No hubo diferencias entre los grupos en complicaciones (p=0,352), infección del sitio operatorio (p=0,191), reingreso en los primeros 30 días (p=0,605) y estancia hospitalaria (p=0,514). El manejo de la apendicitis durante el tercer pico fue similar a las prácticas habituales. El tiempo de evolución fue mayor durante la pandemia (p=0,04) y los pacientes fueron llevados a cirugía más pronto que previo a la pandemia (p<0,001). Conclusiones. No se evidenció un incremento de complicaciones quirúrgicas, reingresos, estancia hospitalaria ni infección del sitio operatorio en los pacientes operados durante la pandemia. Hubo un efecto favorable para los pacientes como consecuencia de la adaptación institucional en la pandemia por COVID-19

Introduction. COVID-19 pandemic impacted society and health systems worldwide. The institutional adaptations sought to maintain the quality of care in an unfavorable organizational context. Acute appendicitis was required to be managed in a new institutional setting. The effectiveness of surgical treatment of appendicitis during the pandemic was evaluated. Methods. Retrospective analytical observational study, in patients with appendectomy, before and during COVID-19 pandemic. Complications, surgical site infections, readmissions, and hospital stay were evaluated. Additionally, the outcomes in the 3 epidemiological peaks of the pandemic were analyzed. Descriptive and analytical statistics were performed between the groups to be compared. Results. A total of 1521 patients with appendicitis were included, 48.3% before and 51.7% during the pandemic. There were no differences in complications (p=0.352), operative site infection (p=0.191), readmission at 30 days (p=0.605), and hospital stay (p=0.514) between the groups. Management of appendicitis during the 3rd peak was like usual practices. There was a long evolution time during the pandemic (p=0.04) and the patients were taken to surgery sooner than before the pandemic (p<0.001). Conclusions. There was no evidence of an increase in surgical complications, readmissions, hospital stay, and surgical site infections during patients who underwent surgery. There was a favorable effect for patients because of institutional adaptation in the COVID-19 pandemic

Estudo dos determinantes dos custos no atendimento dos pacientes com lesão medular decorrente de trauma raquimedular / Study of cost determinants in the care of subjects with traumatic spinal cord injury

O trauma raquimedular (TRM) é a principal etiologia relacionada à lesão medular em homens jovens. Em decorrência da complexidade ao atendimento desses pacientes e às suas complicações, os custos envolvidos nesses casos são vultosos. Objetivo: Avaliar os custos associados ao atendimento hospitalar e ambulatorial dos pacientes com lesão medular traumática num serviço universitário. Métodos: Este estudo baseou-se na revisão de informações clínicas sobre a lesão medular e suas complicações, bem como a busca de valores relacionados ao atendimento no período hospitalar e ambulatorial de indivíduos com lesão medular traumática num serviço universitário em 2009. Resultados: Foram contabilizados 51 pacientes com trauma na coluna vertebral, dos quais 14 apresentaram TRM (idade= 38,9 ± 20,8; homens: 86%). Os custos do atendimento foram R$402.908,68 na ausência de lesão medular e R$304.433,77 com lesão medular. Os custos do atendimento estiveram relacionados com o tempo de internação, o número de intercorrências clínicas e procedimentos cirúrgicos. A reabilitação correspondeu a 23% dos custos dos pacientes com TRM. Conclusão: Os custos relacionados ao atendimento do paciente com TRM são maiores que aqueles associados ao trauma de coluna sem lesão neurológica. O número de complicações clínicas correlaciona-se diretamente ao tempo de internação e os custos desse atendimento. A reabilitação corresponde a menor parte das despesas no cuidado aos pacientes com TRM

Spinal cord injury (SCI) is the main etiology related to spinal cord injury in young men. Due to the complexity of health care for these patients and their complications, the costs involved in these cases are high. Objective: To evaluate the costs associated with hospital and outpatient care for patients with traumatic spinal cord injury at a university service. Methods: This study was based on the review of clinical information about spinal cord injury and its complications, as well as the search for monetary amounts related to inpatient and outpatient care of individuals with traumatic SCI in a university service in 2009. Results: There were 51 patients with spinal trauma, of which 14 had SCI (age= 38.9 ± 20.8 years; men: 86%). Costs were R$402,908.68 in the absence of spinal cord injury and R$304,433.77 with spinal cord injury, and were statistically associated to the length of stay, the number of clinical complications and surgical procedures. Rehabilitation accounted for 23% of costs for patients with SCI. Conclusion: The costs related to the care of patients with SCI are higher than those associated with spinal trauma without neurological damage. The number of clinical complications is directly correlated with the length of hospital stay and the costs of this care. Rehabilitation corresponds to a smaller part of the expenses in the care of patients with SCI

Comparison of Outcomes After Transcatheter Versus Surgical Repeat Mitral Valve Replacement

ABSTRACT Introduction: Repeat transcatheter mitral valve replacement (rTMVR) has emerged as a new option for the management of high-risk patients unsuitable for repeat surgical mitral valve replacement (rSMVR). The aim of this study was to compare hospital outcomes, survival, and reoperations after rTMVR versus surgical mitral valve replacement. Methods: We compared patients who underwent rTMVR (n=22) from 2017 to 2019 (Group 1) to patients who underwent rSMVR (n=98) with or without tricuspid valve surgery from 2009 to 2019 (Group 2). We excluded patients who underwent a concomitant transcatheter aortic valve replacement or other concomitant surgery. Results: Patients in Group 1 were significantly older (72.5 [67-78] vs. 57 [52-64] years, P<0.001). There was no diference in EuroSCORE II between groups (6.56 [5.47-8.04] vs. 6.74 [4.28-11.84], P=0.86). Implanted valve size was 26 (26-29) mm in Group 1 and 25 (25-27) mm in Group 2 (P=0.106). There was no diference in operative mortality between groups (P=0.46). However, intensive care unit (ICU) and hospital stays were shorter in Group 1 (P=0.03 and <0.001, respectively). NYHA class improved significantly in both groups at one year (P<0.001 for both groups). There was no group effect on survival (P=0.84) or cardiac readmission (P=0.26). However, reoperations were more frequent in Group 1 (P=0.01). Conclusion: Transcatheter mitral valve-in-valve could shorten ICU and hospital stay compared to rSMVR with a comparable mortality rate. rTMVR is a safe procedure; however, it has a higher risk of reoperation. rTMVR can be an option in selected high-risk patients.

Comparative study of length of stay of COVID-19 recovered patients in government and private tertiary care setup

Background: COVID-19 pandemic placed an unprecedented strain on health-care systems. The demand for healthcare in hospitals and intensive care units increased everywhere in the world in the form of beds, staff, equipment, medicines, etc. In this process, length of stay in hospital of COVID-infected patients is a crucial point for hospital authorities to plan to provide effective healthcare to patients arriving at the hospital and also to treat non-COVID patients and other medical emergencies. Aims and Objectives: The aims of this study were to find the difference in length of stay in government and private tertiary care setup, to find the length of stay of COVID recovered patient with and without morbidities. Materials and Methods: After taking due permission from the ethical committee and respective authorities concerned in private and government tertiary care hospitals, case sheets of patient recovered from COVID were taken and analyzed in terms of patients condition while presentation to hospital, SpO2, morbidities, number of days symptoms developed, and length of stay in hospital. Results: In my study, the length of stay of COVID-infected people in private and government setup was almost the same, around 11–12 days. Patients with comorbidities had a higher length of stay in hospital in both private and government setup, but the duration of stay was higher in government setup 14 days in government setup, 11–12 days in private setup. Good SpO2 at time of admission had decreased the length of stay of hospital in both setups. There is no correlation between length of stay in hospital and period of symptoms before admission in both private and government setup. Conclusions: In my study, the length of stay of patient with COVID infection was higher in government setup by 1 day without morbidities and 2–3 days with morbidities.