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Heart, Lung & Circulation Jan 2022Proximal aortic graft infection (PAGI) is a rare but often fatal postoperative complication. Its management often relied on surgical preferences and resource... (Review)
Review
OBJECTIVE
Proximal aortic graft infection (PAGI) is a rare but often fatal postoperative complication. Its management often relied on surgical preferences and resource availability of each centre, until the recent unifying guidelines published by the European Society for Vascular Surgery (ESVS). This paper aimed to amalgamate the published experience in managing PAGI and their outcomes.
METHODS
PubMed, Scopus and Cochrane Library databases were searched systematically. All primary studies besides single-patient case reports were included. Data extracted included study and patient characteristics, type of index surgery, type of microorganisms involved, definitive treatment modality, and any outcome measures reported.
RESULTS
Of the 20 studies included, 157 of the 290 PAGI patients underwent complete graft explantation and replacement, 106 underwent graft-preservation interventions (debridement and/or irrigation), and 25 had antibiotics alone. Adjunctive interventions included graft coverage, vacuum-assisted closure, use of infection-resistant graft materials, and lifelong suppressive therapy. In-hospital mortality was 20.8% (n=60), with postoperative sepsis and multiorgan failure (n=24) being the most common cause. Recurrent infection occurred in 10 post-discharge patients. Post-discharge mortality rate was 11.4% (n=33), with cardiac complications and stroke being the most common cause in surgically-treated and medically-treated patients, respectively.
CONCLUSIONS
Given the risk of mortality, the management approach of PAGI highly depends on the fitness of the patient. We believe that early referral to specialised aortic centres is essential to plan for optimal management strategies and improve patient outcomes. Further studies are also required to parse out the most effective adjunctive interventions to maximise patient outcomes.
Topics: Aftercare; Aorta; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Humans; Patient Discharge; Prosthesis-Related Infections; Retrospective Studies; Treatment Outcome
PubMed: 34602347
DOI: 10.1016/j.hlc.2021.07.026 -
Endocrine Practice : Official Journal... Apr 2021The transition of diabetes care from home to hospital, within the hospital, and upon discharge is fraught with gaps that can adversely affect patient safety and length... (Review)
Review
OBJECTIVE
The transition of diabetes care from home to hospital, within the hospital, and upon discharge is fraught with gaps that can adversely affect patient safety and length of stay. We aimed to highlight the variability in care during these transitions and point out areas where research is needed.
METHODS
A PubMed search was performed with a combination of search terms that pertained to diabetes, hyperglycemia, hospitalization, locations in the hospital, discharge to home or a nursing facility, and diabetes medications. Studies with at least 50 patients that were written in the English language were included.
RESULTS
With the exception of transitioning from intravenous insulin infusion to subcutaneous insulin and perhaps admission to the regular floors, few studies pointedly focused on transitions of care, leading us to extrapolate recommendations based on data from disparate areas of care in the hospital. There is evidence at every stage of care, starting from the entry into the hospital and ending with discharge home or to a facility, that patients benefit from having protocols in place guiding overall care.
CONCLUSION
Pockets of care exist in hospitals where methods of effective diabetes management have been studied and implemented. However, there is no sustained continuum of care. Protocols and care teams that follow patients from one physical location to the other may result in improved clinical outcomes during and following a hospital stay.
Topics: Hospitalization; Humans; Hyperglycemia; Inpatients; Insulin; Patient Discharge
PubMed: 33529732
DOI: 10.1016/j.eprac.2021.01.016 -
International Journal of Environmental... Oct 2021Hospital readmissions pose a threat to the constrained health resources, especially in resource-poor low-and middle-income countries. In such scenarios, appropriate... (Review)
Review
Hospital readmissions pose a threat to the constrained health resources, especially in resource-poor low-and middle-income countries. In such scenarios, appropriate technologies to reduce avoidable readmissions in hospitals require innovative interventions. mHealth and teach-back communication are robust interventions, utilized for the reduction in preventable hospital readmissions. This review was conducted to highlight the effectiveness of mHealth and teach-back communication in hospital readmission reduction with a view to provide the best available evidence on such interventions. Two authors independently searched for appropriate MeSH terms in three databases (PubMed, Wiley, and Google Scholar). After screening the titles and abstracts, shortlisted manuscripts were subjected to quality assessment and analysis. Two authors checked the manuscripts for quality assessment and assigned scores utilizing the QualSyst tool. The average of the scores assigned by the reviewers was calculated to assign a summary quality score (SQS) to each study. Higher scores showed methodological vigor and robustness. Search strategies retrieved a total of 1932 articles after the removal of duplicates. After screening titles and abstracts, 54 articles were shortlisted. The complete reading resulted in the selection of 17 papers published between 2002 and 2019. Most of the studies were interventional and all the studies focused on hospital readmission reduction as the primary or secondary outcome. mHealth and teach-back communication were the two most common interventions that catered for the hospital readmissions. Among mHealth studies (11 out of 17), seven studies showed a significant reduction in hospital readmissions while four did not exhibit any significant reduction. Among the teach-back communication group (6 out of 17), the majority of the studies (5 out of 6) showed a significant reduction in hospital readmissions while one publication did not elicit a significant hospital readmission reduction. mHealth and teach-back communication methods showed positive effects on hospital readmission reduction. These interventions can be utilized in resource-constrained settings, especially low- and middle-income countries, to reduce preventable readmissions.
Topics: Aftercare; Humans; Patient Discharge; Patient Readmission; Teach-Back Communication; Telemedicine
PubMed: 34639741
DOI: 10.3390/ijerph181910442 -
Cardiovascular Revascularization... Oct 2021The passage of the Hospital Readmissions Reduction Program (HRRP) has been associated with been associated with decreased risk-standardized readmission rates for heart... (Review)
Review
BACKGROUND
The passage of the Hospital Readmissions Reduction Program (HRRP) has been associated with been associated with decreased risk-standardized readmission rates for heart failure (HF) patients. However, some quantitative analyses have shown association between HRRP and increased mortality for hospitalized HF patients. Qualitative information on what hospital programs were actually implemented can help us understand if this trend is a causal effect of the law or an unrelated trend.
PURPOSE
To perform a systematic literature review to synthesize evidence on what clinical programs American hospitals implemented in response to HRRP.
METHODS
Following PRISMA guidelines, we conducted a systematic review in April 2020 that included a search of PubMed, the Cochrane Library and Cumulative Index to Nursing and Allied Literature (CINAHL) for studies related to hospital strategies to reduce HF readmissions.
RESULTS
Of 20 included articles, 8 were qualitative (survey and interviews), 3 were systematic reviews, 5 were single site quality improvement (QI) initiatives, 2 were plans for ongoing randomized control trials (RCTs), one was a plan for a future RCT and one was an observational analysis. We found that interventions hospitals undertook in response to HRRP to reduce HF readmissions fell into four categories: inpatient care, discharge, transitional care and data collection/administration. The majority of interventions were related to transitional care, most commonly scheduling follow up appointments within 7-14 days of discharge, performing post-discharge phone calls and partnering with community physicians.
CONCLUSIONS
We did not find any published evidence of practices that could mechanistically be linked to harm to HF patients enacted by hospitals in response to HRRP. For example, no programs encouraged emergency department providers to discharge patients from emergency departments. We found QI initiatives, improved discharge planning and increased post-discharge follow up.
Topics: Benchmarking; Heart Failure; Hospitals; Humans; Patient Discharge; Patient Readmission; United States
PubMed: 33339772
DOI: 10.1016/j.carrev.2020.12.015 -
International Journal For Quality in... Jul 2020Hospital bed utility and length of stay affect the healthcare budget and quality of patient care. Prior studies already show admission and operation on weekends have... (Meta-Analysis)
Meta-Analysis
PURPOSE
Hospital bed utility and length of stay affect the healthcare budget and quality of patient care. Prior studies already show admission and operation on weekends have higher mortality rates compared with weekdays, which has been identified as the 'weekend effect.' However, discharges on weekends are also linked with quality of care, and have been evaluated in the recent decade with different dimensions. This meta-analysis aims to discuss weekend discharges associated with 30-day readmission, 30-day mortality, 30-day emergency department visits and 14-day follow-up visits compared with weekday discharges.
DATA SOURCES
PubMed, EMBASE, Cochrane Library and ClinicalTrials.gov were searched from January 2000 to November 2019.
STUDY SELECTION
Preferred reporting items for systematic reviews and meta-analyses guidelines were followed. Only studies published in English were reviewed. The random-effects model was applied to assess the effects of heterogeneity among the selected studies.
DATA EXTRACTION
Year of publication, country, sample size, number of weekday/weekend discharges, 30-day readmission, 30-day mortality, 30-day ED visits and 14-day appointment follow-up rate.
RESULTS OF DATA SYNTHESIS
There are 20 studies from seven countries, including 13 articles from America, in the present meta-analysis. There was no significant difference in odds ratio (OR) in 30-day readmission, 30-day mortality, 30-day ED visit, and 14-day follow-up between weekday and weekend. However, the OR for 30-day readmission was significantly higher among patients in the USA, including studies with high heterogeneity.
CONCLUSION
In the USA, the 30-day readmission rate was higher in patients who had been discharged on the weekend compared with the weekday. However, interpretation should be cautious because of data limitation and high heterogeneity. Further intervention should be conducted to eliminate any healthcare inequality within the healthcare system and to improve the quality of patient care.
Topics: Aftercare; Emergency Service, Hospital; Humans; Length of Stay; Mortality; Outcome Assessment, Health Care; Patient Discharge; Patient Readmission; Quality Assurance, Health Care; Time Factors
PubMed: 32453404
DOI: 10.1093/intqhc/mzaa060 -
Resuscitation Mar 2021To evaluate the optimal timing and doses of epinephrine for Infants and children suffering in-hospital or out-of-hospital cardiac arrest. (Meta-Analysis)
Meta-Analysis Review
AIM
To evaluate the optimal timing and doses of epinephrine for Infants and children suffering in-hospital or out-of-hospital cardiac arrest.
METHODS
We searched Medline, EMBASE, and Cochrane Controlled Register of Trials (CENTRAL) for human randomized clinical trials and observational studies including comparative cohorts. Two investigators reviewed relevance of studies, extracted the data, conducted meta-analyses and assessed the risk of bias using the GRADE and CLARITY frameworks. Authors of the eligible studies were contacted to obtain additional data. Critically important outcomes included return of spontaneous circulation, survival to hospital discharge and survival with good neurological outcome.
RESULTS
We identified 7 observational studies suitable for meta-analysis and no randomized clinical trials. The overall certainty of evidence was very low. For the critically important outcomes, the earlier administration of epinephrine was favorable for both in-hospital and out-of-hospital cardiac arrest. Because of a limited number of eligible studies and the presence of severe confounding factors, we could not determine the optimal interval of epinephrine administration.
CONCLUSIONS
Earlier administration of the first epinephrine dose could be more favorable in non-shockable pediatric cardiac arrest. The optimal interval for epinephrine administration remains unclear.
Topics: Child; Epinephrine; Humans; Infant; Out-of-Hospital Cardiac Arrest; Patient Discharge
PubMed: 33529645
DOI: 10.1016/j.resuscitation.2021.01.015 -
Journal of Minimally Invasive Gynecology Jul 2022To perform a systematic review on consumption, leftover, and disposal of prescribed opioids after surgery in obstetrics and gynecology (The International Prospective... (Review)
Review
OBJECTIVE
To perform a systematic review on consumption, leftover, and disposal of prescribed opioids after surgery in obstetrics and gynecology (The International Prospective Register of Systematic Reviews ID 249856).
DATA SOURCES
Electronic database searches on PubMed, Embase, Cochrane Library, and MEDLINE and other search methods including all studies published between the years 2000 and 2021 were used.
METHODS OF STUDY SELECTION
We included all randomized trials, cohorts, case-control studies, and clinical trials. The search was limited to studies related to obstetrics and gynecology. Studies that pertained to opioid consumption, leftover, and disposal patterns were selected. We excluded review articles, meeting abstracts, case series and case reports, and abstracts without access to full texts. The search was limited to trials in humans and published in English language. Study population included women who were prescribed opioids after obstetric and/or gynecologic procedures. Information on opioid consumption, leftover, and disposal patterns were extracted and compared among different procedures. Potential risk of bias was evaluated using the Newcastle-Ottawa Scale for cohort studies and the National Heart, Lung, and Blood Institute Study Quality Assessment Tool of Controlled Interventional Studies for clinical trial.
TABULATION, INTEGRATION, AND RESULTS
Of 2343 articles, 10 were used in the analysis: 9 cohorts and 1 randomized clinical trial. We found that among patients who underwent obstetric and gynecologic procedures, a considerable number of opioids are unused. The total number of consumed opioids after discharge in patients who underwent cesarean delivery was 21.8 oral morphine equivalent (OME); vaginal hysterectomy, 55.7 OME; abdominal hysterectomy, 105.8 OME; and laparoscopic hysterectomy, 89.0 OME. The number of opioids leftover in the vaginal, abdominal, and laparoscopic hysterectomy groups was 67.6 OME, 115.5 OME, and 95.3 OME, respectively. On average, 77.5% of leftover opioids were not disposed/kept, whereas only 20% discarded their medication through a disposal program. Five studies were deemed to have fair quality, and the rest were rated as good quality.
CONCLUSION
Compared with those after cesarean delivery, patients undergoing gynecologic procedures consumed a large number of opioids, especially after abdominal hysterectomies. Abdominal hysterectomy was also associated with a high number of opioids leftover. Most patients did not use the entire prescribed opioids and were either keeping their unused opioids or unsure about what to do with them. We recommend perioperative opioid-specific counseling and education on opioid consumption, potential hazards of unused medication, and proper disposal for patients. Strategies to reduce opioids prescription by physicians should be considered.
Topics: Female; Humans; Pregnancy; Analgesics, Opioid; Pain Management; Pain, Postoperative; Patient Discharge; Practice Patterns, Physicians'; Randomized Controlled Trials as Topic
PubMed: 35513302
DOI: 10.1016/j.jmig.2022.04.017 -
Journal of Shoulder and Elbow Surgery Jul 2022Transitioning shoulder arthroplasty (SA) from an inpatient to outpatient procedure is associated with increased patient satisfaction and potentially decreased costs;... (Review)
Review
BACKGROUND AND HYPOTHESIS
Transitioning shoulder arthroplasty (SA) from an inpatient to outpatient procedure is associated with increased patient satisfaction and potentially decreased costs; however, concerns exist about complications following same-day discharge. We hypothesized that outpatient SA would be associated with low rates of failed discharges, readmissions, and complications, rendering it a safe and effective option for SA.
METHODS
A systematic review of the outpatient SA literature identified 16 of 447 studies with level III and IV evidence that met the inclusion criteria with at least 90 days of follow-up. Data on patient demographic characteristics, preoperative and postoperative protocols, surgery characteristics, failed discharges, complications, and readmissions were collected and pooled for analysis.
RESULTS
A total of 990 patients were included in our analysis. Many studies identified specific institutional protocols for determining eligibility for outpatient SA, including preoperative clearance from an anesthesiologist; identification of a perioperative caretaker; and exclusion of patients based on cardiac, pulmonary, or hematologic risk factors. Failed same-day discharge occurred in only 0.9% of patients (7 of 788), and 2.1% of patients (9 of 418) and 0.79% of patients (2 of 252) presented to an emergency department or urgent care facility for a perioperative concern. The readmission rate for periprosthetic fracture, arthrofibrosis, infection, subscapularis rupture, and anterior subluxation was 1.3% (7 of 529 patients). Complications occurred in 7.0% of patients (70 of 990), with 5.4% of patients (53 of 990) experiencing a surgical complication and 1.7% (17 of 990) having a medical complication. There were 28 total reoperations (2.9%, 28 of 955 patients).
DISCUSSION AND CONCLUSION
Outpatient SA is associated with low rates of failed discharges, readmissions, and complications. Additionally, the medical and surgical complications that occur after outpatient SA are unlikely to be prevented by the short inpatient stay characteristic of traditional SA. With careful screening measures to identify appropriate candidates for same-day discharge, outpatient SA represents a safe approach to prevent unnecessary hospitalizations and to decrease costs associated with SA.
Topics: Arthroplasty, Replacement, Shoulder; Hospitalization; Humans; Outpatients; Patient Readmission; Postoperative Complications; Reoperation; Retrospective Studies
PubMed: 35278682
DOI: 10.1016/j.jse.2022.01.154 -
Surgery For Obesity and Related... Mar 2023
Meta-Analysis
Topics: Humans; Gastric Bypass; Patient Discharge; Obesity, Morbid; Gastrectomy; Laparoscopy; Treatment Outcome
PubMed: 36379841
DOI: 10.1016/j.soard.2022.10.011 -
Surgery For Obesity and Related... Mar 2023
Meta-Analysis
Topics: Humans; Gastric Bypass; Patient Discharge; Obesity, Morbid; Gastrectomy; Laparoscopy; Treatment Outcome
PubMed: 36404227
DOI: 10.1016/j.soard.2022.10.013