BackgroundElderly patients are potentially more vulnerable to prolonged hospital stay as they frequently require additional resources to facilitate their discharge. In an acute hospital setting, we aimed to quantify and compare length of stay (LOS) for all patients over and under the age of 65, and identify the number and cause of days lost under the care of a single surgical unit.MethodsOver a 4 month period from January to April 2010, data on the management and source of potential delay was collected daily on consecutive patients admitted and discharged under the care of one consultant surgeon at a district general hospital. Statistical analysis was then performed with particular focus on actual delays affecting elderly patients.ResultsA total of 99 complete inpatients episodes were recorded. There were 30 elective and 69 acute admissions. 10 (33%) elective vs. 42 (61%) acute patients encountered delays, losing 39 and 232 days respectively (χ2 [1, N = 99] = 6.36, p = .012). 23 of a total 39 elderly patients admitted acutely required specialist care of the elderly opinion and placement in community hospitals resulting in delays of 188 days. vs. 36 days for the 16 discharged home and 8 days for 30 patients under 65 (χ2 (2, N = 69) = 26.54, p = <.001).ConclusionsElderly patients experiencing acute surgical admission and discharge to community hospitals had prolonged LOS due to significant delays associated with care of the elderly provision. The financial considerations behind bed capacity in primary and secondary care and the provision of care of elderly services need to be balanced against unnecessary occupancy of acute hospital beds with its associated health and economic implications.
Background Transarterial chemoembolization (TACE) and bland embolization (TAE), performed for hepatocellular carcinoma (HCC), are often complicated by post-embolization syndrome (PES). There are limited data regarding the incidence of PES after TAE and the role of steroids in PES. We report the incidence of PES post TACE and TAE, identify predictors, and evaluate the role of steroids in PES. Methods Demographic and clinical variables of patients who underwent embolization were collected and PES was identified. Risk factors for PES, TACE and TAE were derived by logistic regression. We compared patients who received dexamethasone to those who did not, regarding baseline characteristics, occurrence of PES, and hospital stay. Results A total of 171 patients, average age 60.5 years, underwent the procedure, 77.8% were male, and 87.7% had cirrhosis. Of these 171, 107 underwent TACE and 64 TAE. Dexamethasone was given to 106 (61.9%) patients, of whom 85 had TACE and 21 TAE. One hundred twenty-four patients (72.5%) developed PES. PES occurred in more patients who underwent TACE, 80 (74.7%) vs. 44 (68.7%), and resulted in a longer hospital stay (1.47 vs. 1.12 days, P=0.034). Predictive factors for PES included female sex (odds ratio [OR] 2.76, 95% confidence interval [CI] 1.04-7.34; P=0.041), and alcohol-related HCC (OR 3.14, 95%CI 1.42-6.95; P=0.005). Dexamethasone did not affect the length of hospital stay (1.43 vs. 1.29 days, P=0.422) or the rate of prolonged hospitalization (18.8% vs. 15.4%, P=0.561). Conclusion There was no difference in the incidence of PES following TACE or TAE and the use of dexamethasone did not reduce the incidence of PES or the duration of hospital stay.
group included seroma/hematoma in 4% (4 of 93) and infection in 2% (2 of 93). Mean follow-up time for patients was 22 months. For the botulinum toxin treatment group, improvement of symptoms was achieved in 81% of patients (13 of 16 limbs). Patients treated with botulinum toxin did not have imaging in follow-up. No complications were reported. The average follow-up time was 53 days for the botulinum group.Conclusions: This review suggests FAPES may be treated successfully with surgical myotomy plus adjunctive vascular reconstruction if necessary (Fig) . Botulinum toxin A injection may improve symptoms shortterm, potentially delaying or eliminating the need for surgery in select patients. It may also have value as a diagnostic procedure.
Thoracic aortic aneurysms represent a major health problem. Untreated thoracic aortic aneurysms may rupture, which has a dismal outcome. The standard treatment for thoracic aneurysms is open surgical repair, but it is associated with high mortality and morbidity. Endovascular repair provides a less invasive and safer alternative. A systematic review was performed of all published literature on the above subject. Our primary objective was to measure 30-day mortality for nonruptured thoracic aortic aneurysms. Studies describing other pathologies, such as aortic dissection, mycotic aneurysms, penetrating ulcers, traumatic transactions, and pseudoaneurysms, and studies from which independent data for thoracic aortic aneurysm could not be separately extracted were excluded. Case series describing less than 10 patients and all case series describing ruptures or concealed ruptures were excluded as well. Twenty-six case series and one comparative study were identified. This formed a cohort of 1,038 patients. Technical success was possible in more than 97% of patients. The 30-day mortality was calculated to be 5.1% even though the group under study was mostly those who were refused surgery by a surgeon or had a higher surgical risk. The incidence of paraplegia and stroke was 3.1% and 4.7%, respectively. Early endoleak was seen in 16.7% of patients, whereas 11.7% of patients developed late endoleak, but most did not require any additional procedure. The rate of reintervention was 14.9%. The 12-month mortality rate was 14.2%. Endovascular repair shows encouraging short-term results. It is associated with significantly less mortality and morbidity, but long-term results need to be further investigated.
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