ABSTRACT
BACKGROUND CONTEXT: With the goal of improving patient outcomes, the Integrated Spine Center at UT Southwestern Medical Center implemented an enhanced recovery after surgery (ERAS) protocol which includes pre- and post-surgery guidelines. Numerous studies have shown benefit of implementation of ERAS protocols to standardize perioperative care in line with best practices; however, the literature on complication rates, LOS, and readmissions shows mixed results. PURPOSE: The goal of this study was to investigate the impact of the ERAS protocol implementation on complication rates in the perioperative period, as well as hospital and ICU length of stay and hospital re-admission rates. STUDY DESIGN/SETTING: A retrospective cohort study was performed on all patients who underwent spine surgery between September 2016 and September 2021 at a single institution. Patients who met inclusion criteria were divided into non-ERAS and ERAS groups, and comparative statistics were used to evaluate ERAS protocol effectiveness. PATIENT SAMPLE: All patients who underwent spine surgery at UT Southwestern between September 2016 and September 2021 were evaluated for inclusion in the study. The patient sample was further refined to include only complex patient cases which were able to receive the full ERAS protocol (non-emergent admissions). OUTCOME MEASURES: Presence of absence of post-operative complications including surgical site infection, AKI, DVT, MI, sepsis, pneumonia, PE, stroke, shock, and other complications were compared between groups, as were hospital and ICU length of stay, and 7, 30, and 90 day readmissions. Self-reported or functional measures were not used in outcome evaluation. METHODS: A database of patient and surgery characteristics was built using an EMR query tool with spot checks performed by the authors. Control and treatment groups were matched for gender, age, BMI, ASA score, and surgery type. Total number of complication rates was compared between ERAS and non-ERAS groups, and comparative statistics were used to determine significance. RESULTS: Significant differences between ERAS versus non-ERAS groups were found in rates of UTI (6.8% vs. 3.1%, respectively; p=.031), constipation (20.6% vs. 11.4%, respectively; p=.001), and any complications (31.4% vs. 19.4%, respectively; p<.001). There was no significant difference in the rates of other complications, in length of hospital or ICU stay, or readmissions at 7, 30, and 90 days. CONCLUSIONS: Implementation of the ERAS protocol did not decrease complication rates or length of stay, and ERAS patients had significantly higher rates of UTI, constipation, and any complications. There may have been confounding factors due to the impact of COVID-19 on delivery of care, as well as misalignment between ERAS goals and outcome measures.
ABSTRACT
Spontaneous rupture of the renal pelvis is a relatively rare urologic finding. It is associated with obstructing ureteral calculi and can occur with or without urinary instrumentation. Spontaneous rupture is typically diagnosed through imaging modalities such as computed tomography (CT) scans or retrograde pyelography. In this case report, we detail a case regarding spontaneous rupture of the renal pelvis (SRRP) of a 33-year-old male with idiopathic extravasation of contrast from the renal pelvis discovered on delayed phase CT scan of the abdomen and pelvis. This is a unique case of SRRP as the etiology remains idiopathic.
ABSTRACT
Maryland's Green Infrastructure (GI) is a network of large, intact natural areas (hubs), interconnected by linear swaths of riparian or upland vegetation (corridors). The GI serves significant ecological functions and provides the bulk of the state's natural support system. This study examined whether the GI as mapped does, in fact, identify Maryland's most ecologically valuable forested lands, using forest interior dwelling birds (hereafter called "forest birds") as bio-indicators. We conducted bird point counts within forest both inside and outside of hubs on Maryland's Eastern Shore. We also collected a wide variety of habitat data. We found that both the condition of a forest and its surrounding landscape influenced the bird communities. On average, forest bird richness was significantly higher within hubs; furthermore, almost all sites with at least five forest bird species present were in hubs. Forest bird richness and abundance were highest in undisturbed, mature broadleaf forest with wetlands and streams nearby. We detected a significant relationship between forest bird richness and the ecological score of a finer-scale landscape assessment, focused on "cells" of about 0.1 ha in size. This field study also validated the Rapid Field Assessment (RFA) protocol developed in 2001 to assess, on the ground, the relative condition of individual sites or properties within the GI. Forest bird richness and abundance were positively correlated with the RFA community scores. Our results underscore the importance of maintaining regional biological diversity by retaining large blocks of forest, especially mature forest containing streams and wetlands.
