Objective To systematically review the effects of enteral immunonutrition (EIN) on postoperative infection and the length of hospital stay in patients with gastrointestinal cancer after surgery, in order to provide high quality evidence for the rational perioperation nutrition plan for patients with malignant gastrointestinal tumor. Methods Randomized controlled trials (RCTs) published in English about application of EIN vs. general treatment for gastrointestinal surgery published from Jan. 1st, 1997 to Oct. 31st 2012 were retrieved in the following databases: PubMed, Ovid, and EMbase. References of the included studies were also retrieved. According to the inclusion and exclusion criteria, two reviewers independently screened studies, extracted data, and evaluated the methodological quality. Then, meta-analysis was conducted using RevMan 5.2 software. Results 19 RCTs involving 2 298 patients were included. The results of meta-analysis showed that: there was no significant difference between the postoperative EIN group and the control group in reducing the risk of postoperative infection (OR=0.91, 95%CI 0.56 to 1.47, P=0.70); But postoperative and perioperative EIN had reduced the risk of postoperative infection with a significant difference (OR=0.57, 95%CI 0.39 to 0.82, P=0.002; OR=0.52, 95%CI 0.35 to 0.76, P=0.000 9). Additionally, the results of sensitivity analysis revealed that: no matter when EIN was used (during preoperative, postoperative, or perioperative periods), it reduced the length of postoperative hospital stay with significant differences, compared to the standard nutrition group (OR= −2.39, 95%CI −3.28 to −1.49, Plt;0.000 01; OR= −2.42, 95%CI −4.07 to −0.78, P=0.004; OR= −2.76, 95%CI −3.46 to −2.06, Plt;0.000 01). Conclusion Current evidence shows that perioperative EIN can decrease postoperative infection and reduce the length of hospital stay of patients with malignant gastrointestinal tumor. Due to the limited quantity and quality of the included studies, high quality RCTs are needed to verify the above conclusion.
Objective To explore the distribution characteristics and prognostic risk factors of critically ill patients who has long-term hospitalization in intensive care unit ( ICU) . Methods A retrospective study was carried out to evaluate 119 critically ill patients from January 2003 to July 2009 by extracting data from computerized hospital information system. The patients were divided into a survival group and a non-survival group based on discharging outcomes. A binary logistic regression analysis wasintroduced to investigate potential risk factors of prognosis. Results Age, type of payment, entity of disease,and length of ICU stay were significantly different between the two groups ( P lt; 0. 05) in independent-Samples T test. Logistic regressions indicated that age, length of ICU stay and plasma infusion were independent predictors for worse outcome. Conclusions Age, length of ICU stay and plasma infusion may directly influence the prognosis of patients with prolonged stay in ICU. Intensive therapies should be emphasized for those patients at high risk.
Objective To examine the length of hospital stay and expenses associated with hysterectomy in China and to compare the results with those from developed counties, so as to provide comparative information about hysterectomy in China. Methods Hospital discharge data on hysterectomies performed in Peking Union Medical College Hospital from 2002 to 2006 were retrieved. The cases were classified into 3 groups, namely abdominal, laparoscopic and vaginal hysterectomy. The length of hospital stay and expenses associated with hysterectomy were analyzed retrospectively. Results Records of 5975 women who underwent hysterectomies were analyzed, including 3295 cases (65.7%) of abdominal hysterectomy, 1543 (25.8%) cases of laparoscopic hysterectomy (25.8%) and 507 (8.5%) cases of vaginal hysterectomy. The median (mean) postoperative length of stay were 6 (6.4) days, 4 (4.8) days and 5 (5.6) days in the abdominal, laparoscopic and vaginal hysterectomy groups, respectively. These were approximately 2 days longer than those in developed countries. The median total expenses were 6109.0, 7296.3 and 5265.2 RMB in the abdominal, laparoscopic and vaginal hysterectomy groups, respectively. After adjustment for the differences in Gross National Income (GNI) per capita between China and developed countries, the expenses associated with hysterectomy in China were 8.7 and 1.8-4.9 times higher than those in UK and USA, respectively. Conclusion Compared with abdominal and vaginal hysterectomies, laparoscopic hysterectomy is associated with a shorter postoperative length of stay, but with higher hospital cost. Compared with developed countries, hysterectomy is actually more expensive and associated with a longer hospital stay in China.
Objective To verify the feasibility and effectiveness of the modified fast-track surgery (FTS) in the perioperative period of open liver resection. Methods A prospective randomized controlled trial was carried out in 188 consecutive patients undergoing open liver resection between March and December 2014 in the Department of Liver Surgery of West China Hospital. The modified fast recovery procedure and standard rehabilitation procedure were compared in terms of length of hospital stay after operation, hospitalization cost, complications and readmission rate. Results A total of 188 consecutive patients were enrolled in the trial. The analysis included 87 patients in the modified fast recovery group and 89 in the standard rehabilitation group. Compared with the standard rehabilitation group, the modified fast recovery group had a shorter length of hospital stay [(5.70±1.47)vs. (7.26±1.96) days] and a lower cost [(42.7±6.7)vs. (47.3±12.5) thousand yuan], and the differences were statistically significant (P<0.05). There were 20 complication cases in the modified group and 39 in the standard group with significant difference (P=0.003). There was no significant difference in the rate of readmission between the two groups (P=1.000). Compared with the standard group, patients in the modified group had less pain 8 hours, the 1st and 2nd days after surgery, better postoperative activities of daily living, more initiative cough times and off-bed activity times, longer duration of movement, and earlier bowel recovery and exhausting, and all the above differences were significantly different (P<0.05). Stepwise regression analysis showed that postoperative complications and bowel recovery and exhausting time were independent related factors for postoperative hospital stay (P<0.001). Conclusions Multimodal analgesia-based fast recovery procedure is feasible and effective in the perioperative period of partial hepatectomy. It can shorten the time of hospitalization and reduce the cost of hospitalization.
ObjectiveTo evaluate four triage methods including START, Care-Flight, rapid emergency medicinescore (REMS) and Sacco score for the length of hospital stay, length of ICU stay and the severity of injury in Lushan earthquake victims.MethodsA retrospective analysis was performed in 41 cases of critical earthquake victims in the emergency department of West China Hospital from April 20th to April 26th, 2013 in Lushan earthquake. The length of hospital stay and length of ICU stay were compared for four triage methods. The correlation between four triage methods and length of hospital stay, length of ICU stay and injury severity score (ISS) were also analyzed.ResultsThe length of ICU stay for victims whose triage level were red by START triage method or Care-Flight triage method was longer than whose triage levels were yellow. But the length of hospital stay for victims between the two triage levels had no significant difference. In addition, there was a correlation between critical victims and the length of ICU stay in the classification of START triage method and Care-Flight triage method.ConclusionThe length of ICU stay of the victims, whose triage level are red by START triage or Care-Flight triage methods, are longer than whose triage level are yellow. The levels of START and Care-Flight triage are correlated to length of ICU stay.
Objective To analyze the risk factors associated with prolonged length of hospital stay (PLOS) after lobectomy for lung cancer patients. Methods The clinical records of 771 lung cancer patients undergoing lobectomy between May 2012 and June 2016 in the Second Affiliated Hospital of Harbin Medical University were retrospectively analyzed. According to different length of hospital stay (LOS), 771 patients were divided into two groups, a normal LOS group and a PLOS group. In the normal LOS group, there were 551 patients including 234 females and 317 males with a median age of 59 years, whose LOS was shorter than 8.0 days. In the PLOS group, there were 220 patients including 72 females and 148 males with a median age of 60 years, whose LOS was no less than 8.0 days. Then, we analyzed the independent risk factors of PLOS by multivariate logistic regression analysis. Results Univariate analysis showed that risk factors for PLOS included male, arrhythmias and atrioventricular block, smaller FVC%, unilateral pneumonectomy, operation and anesthesia duration, intraoperative blood loss and number of lymph node dissection in the operation (P<0.05). Multivariate logistic regression analysis showed that the age ≥75 years (OR=4.100, 95%CI 1.677 to 10.026), unilateral pneumonectomy (OR=2.563, 95%CI 1.473 to 4.460), FVC% < 89.05% (OR=1.500, 95%CI 1.020 to 2.206), numbers of lymph node dissection≥ 13.5 (OR=1.826, 95%CI 1.262 to 2.642), operation duration≥126.5 min (OR=1.858, 95%CI 1.200 to 2.876) and arrhythmia (OR=2.944, 95%CI 1.380 to 6.284) were independent risk factors of PLOS (all P<0.05). Conclusion LOS is influenced by age, surgical type, FVC%, numbers of lymph node dissection, arrhythmia and operation duration. Careful assessment and appropriate management of risk factors are helpful to improve postoperative recovery after lobectomy for lung cancer patients.
ObjectiveTo investigate the effects of antimicrobial management program on inpatients outcomes and antimicrobial resistance among clinical isolates in a large-scaled university hospital.MethodsThe antibiotics use density (AUD) and antimicrobial resistance rate of multi-drug resistant bacteria before (from January 2009 to December 2010) and after (from January 2012 to December 2016) the intervention of antimicrobial management program in a large-scaled university hospital (4 300 beds) were calculated and compared, and the correlations of AUD with average length of hospital stay and mortality rate were analyzed.ResultsThe AUD was significantly decreased after intervention (P<0.001). The resistance rate of Staphylococcus aureus to oxacillin decreased (P<0.001). Among Gram-negative bacteria, the resistance rates to carbapenems in Acinetobacter baumannii (P<0.001) and Klebsiella pneumoniae increased (P=0.011). AUD was not correlated with the average length of hospital stay (P=0.644), while positively correlated with the in-hospital mortality rate (r=0.932, P=0.001).ConclusionsThe implementation of antimicrobial management program can significantly reduce the antimicrobial use and do not worsen patient outcomes in the hospital. The impact of the program on resistance varies significantly depending on both the bacterium and the agent, and carbapenem-non-susceptible Gram-negative bacilli emerges as a major threat. It is still necessary to combine other infection control measures.
Objective To analyze the risk factors for postoperative length of stay (PLOS) after mediastinal tumor resection by robot-assisted non-endotracheal intubation and to optimize the perioperative process. MethodsThe clinical data of patients who underwent Da Vinci robot-assisted mediastinal tumor resection with non-endotracheal intubation at the Department of Thoracic Surgery, General Hospital of Northern Theater Command from 2016 to 2019 were retrospectively analyzed. According to the median PLOS, the patients were divided into two groups. The univariate analysis and multivariate logistic regression were used to analyze risk factors for prolonged PLOS (longer than median PLOS). ResultsA total of 190 patients were enrolled, including 92 males and 98 females with a median age of 51.5 (41.0, 59.0) years. The median PLOS of all patients was 3.0 (2.0, 4.0) d. There were 71 patients in the PLOS>3 d group and 119 patients in the PLOS≤3 d group. Multivariate logistic regression showed that indwelled thoracic catheter [OR=11.852, 95%CI (2.384, 58.912), P=0.003], preoperative symptoms of muscle weakness [OR=4.814, 95%CI (1.337, 17.337), P=0.016] and postoperative visual analogue scale>5 points [OR=6.696, 95%CI (3.033, 14.783), P<0.001] were independent factors for prolonged PLOS. Totally no tube (TNT) allowed patients to be discharged on the first day after surgery. ConclusionRobot-assisted mediastinal tumor resection with non-endotracheal intubation can promote rapid recovery. The methods of optimizing perioperative process are TNT, controlling muscle weakness symptoms and postoperative pain relief.
ObjectiveTo analyze the association between the cultural level and hospitalization management process and length of hospitalization of the colorectal patients served by West China Hospital of Sichuan University as a regional center in the current version of the Database from Colorectal Cancer (DACCA). MethodAccording to the established screening criteria, eligible colorectal cancer patients were collected from the updated version of DACCA on June 29, 2022. The analyzed data items included gender, age, BMI, blood type, marriage, waiting time before admission, preoperative hospitalization time, postoperative hospitalization time, total hospitalization time, and management process, and patients were divided into illiterate group, primary education group, medium education group, and higher education group according to their educational level, then compared the hospitalization management process and length of hospitalization of each group. ResultsA total of 4 765 eligible data were screened, with secondary education being the most prevalent (2 792, 58.6%), followed by primary (1 337, 28.1%) and higher education (417, 8.7%), and illiteracy being the least prevalent (219, 4.6%). In the classification of management processes, “regular” account for the majority (4 219, 88.5%), followed by “enhanced”(274, 5.8%), “individual” was third (231, 4.8%), and “rapid” was the least (41, 0.9%). There was no statistically significant difference in the comparison of waiting time before admission, preoperative hospitalisation time and postoperative hospitalisation time among patients with different literacy levels (P=0.371, P=0.095, P=0.352), but there was a statistically significant difference in total hospitalisation time (P=0.021), with a significant difference in total hospitalisation length between illiterate patients and patients with medium education (P=0.041). There was no statistically significant difference in the comparison of inpatient management processes of patients in different literacy groups (χ2=15.2, P=0.085). ConclusionsAnalysis of the DACCA data revealed a statistically significant difference in total hospitalisation time between patients with illiteracy and those with medium education. However, the choice of hospitalisation management process was similar for patients with different literacy levels, which needs to be further analysed for the reasons.