Probiotics supplementation and length of hospital stay in neonates with gastrointestinal surgery.
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ABSTRACT:
SUBMITTER: Mugarab-Samedi V
PROVIDER: S-EPMC6913565 | biostudies-literature | 2017
REPOSITORIES: biostudies-literature
Publications
Probiotics supplementation and length of hospital stay in neonates with gastrointestinal surgery.
Mugarab-Samedi Veronica V Howlett Alixe A Hicks Mattew M Arrieta Marie-Claire MC Beaudry Paul P Dersch-Mills Deonne D Alshaikh Belal B
International journal of surgery protocols 20171018
Any manipulation on open bowel causes interventional impact on gut microbiome, and surgical stress triggers bacterial translocation; thus, it will be fundamental to determine gut microbiome after surgery. Monitoring dynamic changes in microbiome of post-surgical infants who received probiotics and placebo could provide with important information about gut colonization and potential bacterial overgrowth. The purpose of this study is to assess the effect of probiotics supplementation on length of ...[more]
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Project description:ObjectiveWe examined the consequences of perioperative respiratory event (PRE) in terms of hospitalization and hospital cost in children who underwent ambulatory surgery.MethodsThis subgroup analysis of a prospective cohort study (ClinicalTrials.gov: NCT02036021) was conducted in children aged between 1 month and 14 years who underwent ambulatory surgery between November 2012 and December 2013. Exposure was the presence of PRE either intraoperatively or in the postanesthetic care unit or both. The primary outcome was length of stay after surgery. The secondary outcome was excess hospital cost excluding surgical cost. Financial information was also compared between PRE and non-PRE. Directed acyclic graphs were used to select the covariates to be included in the multivariate regression models. The predictors of length of stay and excess hospital cost between PRE and non-PRE children are presented as adjusted odds ratio (OR) and cost ratio (CR), respectively with 95% confidence interval (CI).ResultsSixty-three PRE and 249 non-PRE patients were recruited. In the univariate analysis, PRE was associated with length of stay (p = 0.004), postoperative oxygen requirement (p <0.001), and increased hospital charge (p = 0.006). After adjustments for age, history of snoring, American Society of Anesthesiologists physical status, type of surgery and type of payment, preoperative planned admission had an effect modification with PRE (p <0.001). The occurrence of PRE in the preoperative unplanned admission was associated with 24-fold increased odds of prolonged hospital stay (p <0.001). PRE was associated with higher excess hospital cost (CR = 1.35, p = 0.001). The mean differences in contribution margin for total procedure (per patient) (PRE vs non-PRE) differed significantly (mean = 1,523; 95% CI: 387, 2,658 baht).ConclusionPRE with unplanned admission was significantly associated with prolonged length of stay whereas PRE regardless of unplanned admission increased hospital cost by 35% in pediatric ambulatory surgery.Trial registrationClinicalTrials.gov registration number NCT02036021.
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Project description:Length-of-hospital stay (LOS) after lumbar spine surgery (LSS) can be affected by many factors. However, few studies have evaluated predictors of LOS, and all have used limited number of variables as predictors.The purpose of the study was to identify presurgical, surgical, and postsurgical predictors of LOS after LSS.Retrospective review of consecutive patients who had LSS at the University of Kansas Hospital from October 2008 to April, 2012.Five hundred ninety-three patients underwent LSS consisting of laminotomy, laminectomy, or arthrodesis.LOS. Multiple presurgical, surgical, and postsurgical variables were extracted from the patients' medical records and considered as possible predictors (independent variables) of LOS.Potential predictors that were significantly correlated with LOS were used as indicators to construct three latent factors presurgical, surgical, and postsurgical, which were in turn used to predict LOS in a structural equation model.The average LOS was 4.01±2.73 days. The presurgical factor was indicated by age (61.97±14.49 years), previous level of function (60.5% were totally independent), previous hemoglobin level (13.70±1.36 mg/dL), and use of assistive devices (60% were assistive device users). The surgical factor was indicated by severity of illness (50.2% had minor disease severity), presence of complications (1.9%), and stay in an intensive care unit (4.0%). The postsurgical factor was indicated by postsurgical walking distance (166.43±175.75 ft), level of assistance during walking (5.18±0.81 out of 7 points), balance scores (6.18±1.82 out of 10 points), and bed mobility and transfer dependency scores (9.81±1.99 out of 14 points). These three latent factors explained 47% of variation in LOS.Postsurgical factors predicted the highest variation in LOS in comparison with presurgical and surgical factors and should be taken into consideration for discharge planning. Postsurgical factors are related to the patient's function, modifiable with rehabilitation, and can be improved to shorten LOS. Inclusion of more reliable and standardized presurgical variables could improve the predictability of the model.
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Project description:Interventions: Preoperative Phase
•Fasting at midnight
•Taking mechanical bowel preparation with polyethylene glycol 2 liters or sodium phosphate 90 milliliters
•Prophylaxis antibiotic 30 min before surgery: cefoxitin or ceftriaxone and/or methonidazole. In penicillin allergy, ciprofloxacin was used instead.
Intraoperative Phase
•General anesthesia
•In patients suspected bowel obstruction or ileus surgeon may be inserted nasogastric tube
Postoperative Phase
•Fasting 5-7 days postoperative
•Control pain with strong opioid
,Preoperative Phase
•Fasting at 3 AM
•No mechanical bowel preparation
•Prophylaxis antibiotic 30 min before surgery: cefoxitin or ceftriaxone and/or methonidazole. In penicillin allergy, ciprofloxacin was used instead.
Intraoperative Phase
•Combined general and epidural at T7-8 level anesthesia
In patients suspected bowel obstruction or ileus surgeon may be inserted nasogastric tube
Postoperative Phase
•Started with liquid diet within twenty-four hour
•Patients were encouraged to ambulate within six hour after surgery
•Control pain with epidural block and paracetamol. Adding weak opioid when pain score greater than or equal to four.
;Active Comparator Procedure/Surgery,Experimental Procedure/Surgery;Traditional Program,ERAS Program
Primary outcome(s): length of hospital stay 30 day after surgery number of the day in hospital
Study Design: Randomized
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