RESUMO
OBJECTIVES: To study differences in care of patients admitted for epistaxis during the weekend compared to the weekday. STUDY DESIGN: Retrospective database review. SETTING: 2003 to 2014 National Inpatient Sample. METHODS: Patients admitted for a primary diagnosis of epistaxis were extracted from the National Inpatient Sample from 2003 to 2014. Univariate and multivariate analyses were applied to assess differences in patient demographics, clinical characteristics, treatment, and outcomes between weekend and weekday admissions. RESULTS: A total of 39,329 cases were included in our study cohort, with 28,458 weekday admissions and 10,892 weekend admissions. There was no significant difference in patient race, gender, insurance status, hospital ownership status, or location between weekend and weekday admissions (p > .05). Most weekend admissions were emergent (82.2%) and were treated with packing (51.8%). Upon performing logistic regression, the likelihood of emergent admission (odds ratio [OR] 1.41, 95% confidence interval [CI] 1.32-1.51, p < .001) and prolonged length of stay (OR 1.11, 95% CI 1.05-1.17, p < .001) was higher for weekend admissions versus weekday admissions. Moreover, odds of packing for epistaxis were significantly higher (OR 1.14, 95% CI 1.09-1.19, p < .001) on the weekend, while odds of ligation (OR 0.88, 95% CI 0.80-0.97, p = .013) and endovascular arterial embolization (OR 0.74, 95% CI 0.65-0.84, p < .001) were lower. There were no significant differences in in-hospital mortality, patient discharge disposition, and total hospital charges (p > .05). CONCLUSION: Patients primarily admitted for epistaxis over the weekend were more likely to be emergent, experienced prolonged length of stay, and be treated nonoperatively with packing, than weekday admissions. No significant differences in patient insurance or hospital ownership were identified.
Assuntos
Epistaxe , Hospitalização , Humanos , Tempo de Internação , Estudos Retrospectivos , Análise Multivariada , Mortalidade Hospitalar , Admissão do PacienteRESUMO
RESUMEN Objetivo: Reportar dos casos de embarazo ectópico abdominal avanzado, con buen resultado materno / perinatal, y revisar la literatura disponible con respecto al manejo de la placenta y el pronóstico de esta entidad. Materiales y métodos: Se describen dos casos de embarazo ectópico abdominal avanzado en los que se realizó extracción de la placenta, con feto viable y resultado perinatal favorable. Estos fueron atendidos en una institución de cuarto nivel de complejidad,ubicada en la ciudad de Cali, Colombia. Se realizó una revisión de la literatura registrada en las bases de datos Medline vía PubMed, con los términos de búsqueda: "embarazo abdominal", "embarazo esplénico", "embarazo hepático", "embarazo omental" y "embarazo peritoneal". La búsqueda se limitó a artículos publicados durante los últimos doce años en inglés y español. Resultados: Se recuperaron 228 referencias, de las cuales 42 artículos cumplieron con los criterios de inclusión que informan un total de 74 pacientes con embarazo ectópico abdominal. En cuanto al manejo de la placenta, la remoción de la misma se informó en 42 casos (58%). La mortalidad materna se presentó en 4 casos (4,1%), todos por hemorragia posparto. Un total de 60 pacientes (81%) presentaron complicaciones, la más frecuente fue hemorragia en 38 de ellas (51%). En cuanto al resultado perinatal, se encontró una mortalidad perinatal del 43%. Conclusión: El manejo de la placenta es el punto clave del que podría depender la frecuencia de complicaciones maternas. Se requieren estudios prospectivos que evalúen el manejo más seguro y efectivo de esta condición.
ABSTRACT Objective: Report two cases of advanced ectopic abdominal pregnancy with good maternal/perinatal outcomes, and to review the literature available regarding the management of the placenta and the prognosis for this condition. Materials and methods: Description of two cases of advanced ectopic abdominal pregnancies with viable fetuses and favourable perinatal outcomes, in which the placenta was removed. The cases were seen at a Level IV institution in the city of Cali, Colombia. Review of the literature registered in the Medline data base via Pubmed using the search terms "abdominal pregnancy", "splenic pregnancy", "hepatic pregnancy", "omental pregnancy" and "peritoneal pregnancy". The search was limited to articles published in English and Spanish during the past 12 years. Results: Overall, 228 references were retrieved, of which 42 articles reporting on a total of 74 patients with ectopic abdominal pregnancy met the inclusion criteria. Regarding the management of the placenta, it was removed in 42 cases (58%). There were 4 cases of maternal mortality (4,1%) all of them due to postpartum bleeding. Complications occurred in 60 patients (81%), bleeding being the most frequent in 38 of them (51%). As for perinatal outcome, perinatal mortality was 43.8%. Conclusion: Placental management is the the key determinant factor of the frequency of maternal complications. Prospective studies to assess the safest and most effective management of this condition are required.
