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1.
Am Surg ; 89(6): 2350-2356, 2023 Jun.
Article in English | MEDLINE | ID: mdl-35491837

ABSTRACT

BACKGROUND: Enhanced recovery after surgery (ERAS) pathways have been shown to improve pancreatic surgery outcomes, though feasibility in a community hospital remain unclear. We hypothesized that an ERAS protocol would reduce hospital length of stay (LOS) without increased morbidity. METHODS: An ERAS pathway was initiated for patients undergoing pancreatic surgery at a community cancer center and compared to a historical cohort. The primary outcome was hospital LOS. Secondary outcomes included 30-day readmission rates, comprehensive complication index (CCI®), textbook outcomes (TO), and mortality. RESULTS: A total of 144 patients were included, with 63 patients in the ERAS group and 81 in the control group. The mean LOS decreased significantly in the ERAS group (6.85 [± 4.8]) vs 9.96 [±6.8] days, P = .001), without an increase in 30-day admission rates or CCI. CONCLUSIONS: Implementation of an ERAS protocol in a community setting reduced LOS without a corresponding increase in readmission rates or morbidity.


Subject(s)
Digestive System Surgical Procedures , Enhanced Recovery After Surgery , Humans , Cohort Studies , Hospitals, Community , Postoperative Complications/epidemiology , Length of Stay , Retrospective Studies
2.
Ann Otol Rhinol Laryngol ; 129(2): 191-194, 2020 Feb.
Article in English | MEDLINE | ID: mdl-31561707

ABSTRACT

INTRODUCTION: Horner syndrome is described as the clinical triad of miosis, ptosis, and anhidrosis. In pediatric patients the condition may be congenital or acquired from neoplastic, infectious or traumatic conditions, including birth trauma. Most cases of pediatric Horner syndrome present first to a pediatric ophthalmologist however since the neural pathways involve the cervical sympathetic chain otolaryngologists should understand the pathophysiology to avoid delay in management of potentially malignant cases. OBJECTIVES: To aid otolaryngologists in recognizing and managing pediatric Horner syndrome by describing 3 unique cases from malignant, traumatic and/or congenital causes. METHODS: Case report of 3 pediatric patients with Horner syndrome presenting to our pediatric otolaryngology department. RESULTS: Case #1 is 5-month-old female with ptosis and a left level II 1.5 cm neck mass. Magnetic resonance imaging showed the mass displacing the common carotid artery and excisional biopsy revealed a poorly differentiated neuroblastoma. Case #2 is a 9-year-old female with anisocoria appearing after suffering a severe playground injury. Case #3 is a 3-year-old-male who developed ptosis and anisocoria following re-excision of a recurrent cervical lymphatic malformation. CONCLUSION: Pediatric Horner syndrome may be a benign finding that is easily overlooked but may reflect a serious underlying condition. Otolaryngologists should be aware of the pathophysiology and differential diagnosis, including malignant causes, to appropriately manage patients.


Subject(s)
Horner Syndrome/diagnosis , Child , Child, Preschool , Female , Humans , Infant , Male , Otolaryngology , Pediatrics
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