Predictors of in-hospital length of stay after laparoscopic ventral hernia repair: results of multivariate logistic regression analysis

Kurian, Ashwin A.; Gallagher, Sidhbh; Cheeyandira, Abhiman; Josloff, Robert

doi:10.1007/s00464-010-1048-4

Cited by 15 publications

(14 citation statements)

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“…The morbidity and mortality rates of elderly patients were similar to those of younger age. Two studies reported longer length of stay and later return to normal activities [26,27]. The aforementioned studies have weak statistical power and short follow-up.…”

Section: Luis Sanchez Lapo Bencinimentioning

confidence: 93%

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Laparoscopic ventral/incisional hernia repair: updated guidelines from the EAES and EHS endorsed Consensus Development Conference

et al. 2015

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The availability of recent level 1 evidence (a meta-analysis of 10 RCTs) allowed to recommend that not only laparoscopic repair is an acceptable alternative to the open repair, but also it is advantageous in terms of shorter hospital stay and wound infection rate. This conclusion appears to be extremely relevant in a clinical setting. Indications about specific conditions could also be issued: laparoscopy is recommended for the treatment of recurrent ventral hernias and obese patients, while it is a potential option for compensated cirrhotic and childbearing-age female patients. Many relevant and controversial topics were thoroughly examined by this consensus conference for the first time. Among them are the issue of safety of the intraperitoneal mesh placement, traditionally considered a major drawback of the laparoscopic technique, the role for the biologic meshes, and various aspects of the laparoscopic approach for particular locations of the defect such as the abdominal border or parastomal hernias.

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Section: Luis Sanchez Lapo Bencinimentioning

confidence: 93%

“…Incarcerated hernia, together with mesh size, patient age, and complex hernia are predicting factors about longer length of stay [27]. …”

Section: Acute Presentation: Emergencymentioning

confidence: 99%

Laparoscopic ventral/incisional hernia repair: updated guidelines from the EAES and EHS endorsed Consensus Development Conference

et al. 2015

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“…[11, 14] Several previous studies have examined the effect of patient and procedural characteristics on hospital stay after LVHR. [15, 16] These studies demonstrate that more complex procedures associated with long operative duration due to lysis of adhesions or large hernia defects are associated with prolonged LOS. In our analysis, we used operative time and mesh size as markers of procedural complexity.…”

Section: Discussionmentioning

confidence: 99%

Delineation of factors associated with prolonged length of stay after laparoscopic ventral hernia repair leads to a clinical pathway and improves quality of care

et al. 2015

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Background Centers for Medicare and Medicaid Services defines laparoscopic ventral hernia repair (LVHR) as outpatient procedure. We identified our institutional length of stay (LOS) to be above the National Surgical Quality Improvement Program (NSQIP) benchmark of 1 day (interquartile range (IQR) 2 days). This study was undertaken to investigate risk factors associated with prolonged hospital stay and design an intervention to decrease median LOS. Methods This study analyzed institutional NSQIP data on patients who underwent elective LVHR from 2006–2011 to define factors associated with prolonged LOS, defined as LOS > 2 days. Modifiable factors identified in the initial analysis were included in a clinical care pathway to impact LOS. We repeated the NSQIP data analysis after implementation (4/2011–9/2012) to assess the effect of our intervention. Analysis was by univariate, ANOVA and logistic regression models. Results During the pre-implementation period, 80 patients with a median age of 54 years (31–84), stayed a median of 2 days (IQR 3). On univariate analysis, factors associated with prolonged LOS included operative time, mesh size, amount of narcotics used and female gender. In multivariate analysis, operative time and narcotics used were associated with a prolonged LOS, C-statistic=0.88. Introduction of a clinical pathway focusing on non-narcotic pain relief resulted in a decrease in mean narcotic usage from 223 to 63 mg morphine equivalents/patient (p<0.0001), decrease of median LOS to 1 day (IQR 2) (p=0.027), in line with national NSQIP benchmarks, a slight decrease in complications and a 10% decrease on hospital cost. Conclusion High narcotic use and long operative times are independent predictors of prolonged LOS in our patient population. Introduction of a standardized clinical care pathway designed to reduce perioperative narcotic use resulted in shorter LOS, improved quality and cost savings for patients undergoing LVHR.

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“…O tempo de internação hospitalar, após uma determinada cirurgia, também deve ser considerado na logística de pacientes, segundo Kurian et al (2010). Renata Pereira Oliveira, Augusto da Cunha Reis, Alexandre de Carvalho Castro como benchmarking, pesquisa operacional, gestão lean e six sigma, poderiam ser adotados para melhorar a logística do paciente em saúde.…”

Section: Análise De Conteúdounclassified

Logística Hospitalar: Uma Síntese Do Estado Da Arte

Reis

Oliveira

Castro

2018

RGD

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Os sistemas de saúde visam a prevenção de doenças, promoção, assistência e recuperação da saúde da população. As preocupações gerais de saúde em um país são usualmente relevantes por se tratar de um direito do cidadão e pela necessidade de eficiência e qualidade na prestação do atendimento. Diante das dificuldades enfrentadas com as restrições de verbas e má administração, ocasionado principalmente por crise política econômica de um país, aumento da taxa de envelhecimento e complexidade do setor, torna-se importante diminuir os desperdícios e melhorar os processos nesta área. Este trabalho tem como objetivo realizar uma revisão sistemática da literatura sobre operações em logística hospitalar. Para tanto, pretende-se discutir a metodologia da revisão bibliográfica e analisar os resultados obtidos por meio de quatro bases de dados on-line, Web of Science, Science Direct, Emerald Insight e Scopus. Como resultado, os pesquisadores e gestores que trabalham no segmento da saúde terão uma síntese do estado da arte da logística hospitalar, com abordagens do uso da gestão lean, modelos computacionais, teoria das restrições, contratação de serviços de terceiros, armazenamento de materiais em redes, fluxo de pacientes, utilização de rôbos móveis, armários eletrônicos, RFID e tecnologia da informação, dentre outros.Palavras-chave: Operações. Saúde. Logística.ABSTRACTHealth systems aim at disease prevention, health promotion, care and recovery of the population. General health concerns in a country are usually relevant because it is a citizen's right and the need for efficiency and quality in care delivery. Faced with the difficulties faced by budget constraints and maladministration, caused mainly by a country's economic crisis, increasing the aging rate and complexity of the sector, it is becoming increasingly important to reduce waste and improve processes in this area. This paper aims to conduct a systematic review of the literature on hospital logistics in operations. To do so, we intend to discuss the methodology of the bibliographic review and analyze the results obtained through four online data base, Web of Science, Science Direct, Emerald Insight and Scopus. As a result, researchers and managers working in the health sector will have a art state synthesis of hospital logistics, with lean management approaches, computational models, constraint theory, contracting outsourced services, materials storage in networks, patients flow, use of mobile robotics, electronic cabinets, RFID and information technology, among others.Keywords: Operations. Healthcare. Logistics.

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Predictors of in-hospital length of stay after laparoscopic ventral hernia repair: results of multivariate logistic regression analysis

Abstract: Mesh size, incarcerated hernia, patient age, and complex hernia predict longer length of stay after laparoscopic ventral hernia repair.

Cited by 15 publications

References 17 publications

Laparoscopic ventral/incisional hernia repair: updated guidelines from the EAES and EHS endorsed Consensus Development Conference

Laparoscopic ventral/incisional hernia repair: updated guidelines from the EAES and EHS endorsed Consensus Development Conference

Delineation of factors associated with prolonged length of stay after laparoscopic ventral hernia repair leads to a clinical pathway and improves quality of care

Logística Hospitalar: Uma Síntese Do Estado Da Arte

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