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Introdução: A taxa de mortalidade em pacientes queimados diminuiu significativamente, tornando importante avaliar outros desfechos, como o tempo de internação, que aumenta a morbidade física e psicológica, o risco de infecção hospitalar e os custos financeiros. O objetivo deste estudo é analisar a relevância de vários fatores no tempo de internação na Unidade de Queimados. Método: Foram incluídos neste estudo 711 pacientes admitidos entre 2011 e 2020 na Unidade de Queimados do Hospital de São José, Centro Hospitalar Lisboa Central, Lisboa, Portugal. Os dados coletados foram analisados utilizando o PSPP para Windows. Resultados: Os pacientes eram predominantemente do sexo masculino, com idade média de 54 anos. O tempo médio de permanência hospitalar foi de 29 dias. Os fatores que prolongaram a estadia hospitalar foram relacionados à gravidade da queimadura, ao número de cirurgias e ao tempo decorrido até a primeira cirurgia, valores laboratoriais alterados tanto no perfil hematológico quanto químico durante a hospitalização, e a presença e o número de infecções documentadas. Conclusão: Existem fatores potencialmente modificáveis que infiuenciam o tempo de permanência hospitalar. Nosso estudo nos permite concluir que o tempo decorrido até a primeira intervenção cirúrgica e a presença e o número de infecções documentadas prolongam significativamente esse desfecho, e ênfase deve ser dada à implementação de medidas que favoreçam a intervenção cirúrgica precoce e o controle rigoroso de infecções.

Introduction: Burn patients' mortality rate has decreased significantly, making it important to evaluate other outcomes, such as length-of-stay, which increases physical and psychological morbidity, risk of nosocomial infection, and financial costs. The objective of this study is to analyze the relevance of several factors in the Burn Unit length-of-stay. Material and Methods: 711 patients were included in this study, admitted between 2011 and 2020 to the Burn Unit at São José Hospital, Centro Hospitalar Lisboa Central, Lisbon, Portugal. Collected data was analyzed using PSPP for Windows. Results: Patients included in the study were predominantly males, with a mean age of 54 years. The mean length of stay was 29 days. The factors that prolonged in-hospital stay were those related to the severity of the burn, the number of surgeries and the time elapsed until the first one, altered laboratory values in both hematologic and chemistry profile during the hospitalization, and the presence and number of documented infections. Conclusion: There are potentially modifiable factors that influence length-of-stay. Our study allows us to conclude that the time elapsed until the first surgical intervention and the presence and number of documented infections significantly prolong this outcome, and emphasis should be given to the implementation of measures that favor early surgical intervention and strict infection control.

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BACKGROUND & AIMS: Malnutrition in children and adolescents is prevalent at hospital admission and the incidence increases with length of stay. Malnourished patients have loss of muscle mass and strength, compromising their functionality. Handgrip strength (HGS) is a nutritional marker understudied in pediatrics although it is capable of detecting nutritional deprivation before changes in body composition are observed. Therefore, this study aimed to evaluate the association between reduced HGS at hospital admission, compromised nutritional status and worse clinical outcomes of pediatric patients. METHODS: Cohort study conducted with patients aged 6-18 years admitted to a pediatric ward. Nutritional status was assessed in the first 48 h of hospital admission using the z-score of height for age (H/A) and body mass index for age (BMI/A), percentile of mid-arm muscle circumference for age (MAMC/A) and the pediatric global subjective nutritional assessment (SGNA). HGS was measured using a digital dynamometer and considered reduced when the maximum value of three measurements was below the 5th percentile for sex and age. The clinical outcomes analyzed were length of hospital stay and frequency of readmission within 3 months after hospital discharge. RESULTS: A total of 135 patients were evaluated (median age 10.9 years, 55.6% male) and 17.8% had reduced HGS. Patients with reduced HGS had lower H/A z-score (-0.50 vs 0.22, p = 0.012) and a higher frequency of reduced MAMC when compared to those with normal HGS (8% vs 13%, p = 0.007). Reduced HGS was not associated with malnutrition (OR = 0.63; 95%CI 0.23-1.77), prolonged hospital stay (OR = 1.89; 95%CI 0.72-4.92) or readmission to hospital 3 months after hospital discharge (OR = 1.82; 95%CI 0.67-4.93), in a model adjusted for the clinical condition. CONCLUSION: Reduced HGS was not a predictor of malnutrition and clinical outcomes. However, it was associated with lower H/A Z-score and MAMC/A percentile values and can be used as a complementary measure in the nutritional status assessment of hospitalized pediatric patients.

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INTRODUCTION: This study aimed to evaluate the efficacy of respiratory muscle training during the immediate postoperative period of cardiac surgery on respiratory muscle strength, pulmonary function, functional capacity, and length of hospital stay. METHODS: This is a systematic review and meta-analysis. A comprehensive search on PubMed®, Excerpta Medica Database (or Embase), Cumulative Index of Nursing and Allied Health Literature (or CINAHL), Latin American and Caribbean Health Sciences Literature (or LILACS), Scientific Electronic Library Online (or SciELO), Physiotherapy Evidence Database (or PEDro), and Cochrane Central Register of Controlled Trials databases was performed. A combination of free-text words and indexed terms referring to cardiac surgery, coronary artery bypass grafting, respiratory muscle training, and clinical trials was used. A total of 792 studies were identified; after careful selection, six studies were evaluated. RESULTS: The studies found significant improvement after inspiratory muscle training (IMT) (n = 165, 95% confidence interval [CI] 9.68, 21.99) and expiratory muscle training (EMT) (n = 135, 95% CI 8.59, 27.07) of maximal inspiratory pressure and maximal expiratory pressure, respectively. Also, IMT increased significantly (95% CI 19.59, 349.82, n = 85) the tidal volume. However, no differences were found in the peak expiratory flow, functional capacity, and length of hospital stay after EMT and IMT. CONCLUSION: IMT and EMT demonstrated efficacy in improving respiratory muscle strength during the immediate postoperative period of cardiac surgery. There was no evidence indicating the efficacy of IMT for pulmonary function and length of hospital stay and the efficacy of EMT for functional capacity.

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ABSTRACT Introduction: This study aimed to evaluate the efficacy of respiratory muscle training during the immediate postoperative period of cardiac surgery on respiratory muscle strength, pulmonary function, functional capacity, and length of hospital stay. Methods: This is a systematic review and meta-analysis. A comprehensive search on PubMed®, Excerpta Medica Database (or Embase), Cumulative Index of Nursing and Allied Health Literature (or CINAHL), Latin American and Caribbean Health Sciences Literature (or LILACS), Scientific Electronic Library Online (or SciELO), Physiotherapy Evidence Database (or PEDro), and Cochrane Central Register of Controlled Trials databases was performed. A combination of free-text words and indexed terms referring to cardiac surgery, coronary artery bypass grafting, respiratory muscle training, and clinical trials was used. A total of 792 studies were identified; after careful selection, six studies were evaluated. Results: The studies found significant improvement after inspiratory muscle training (IMT) (n = 165, 95% confidence interval [CI] 9.68, 21.99) and expiratory muscle training (EMT) (n = 135, 95% CI 8.59, 27.07) of maximal inspiratory pressure and maximal expiratory pressure, respectively. Also, IMT increased significantly (95% CI 19.59, 349.82, n = 85) the tidal volume. However, no differences were found in the peak expiratory flow, functional capacity, and length of hospital stay after EMT and IMT. Conclusion: IMT and EMT demonstrated efficacy in improving respiratory muscle strength during the immediate postoperative period of cardiac surgery. There was no evidence indicating the efficacy of IMT for pulmonary function and length of hospital stay and the efficacy of EMT for functional capacity.

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OBJECTIVE: To determine the factors associated with prolonged hospital-stay after appendectomy in SARS-CoV-2 pandemic. MATERIAL AND METHODS: A retrospective observational cohort study included 420 patients after surgery for acute appendicitis between March 2019 and March 2020, April 2020 and April 2021. There were 336 patients before the SARS-COV-2 pandemic, and 84 ones underwent surgery during the pandemic. RESULTS: Incidence of prolonged hospital stay was 15% and 26%, respectively (RR 1.76). RR is more than 1 and assumes SARS-CoV-2 infection as a risk factor. CONCLUSION: There is an association between SARS-CoV-2 infection and prolonged hospital-stay after surgery for acute appendicitis (RR 1.76).

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Introducción: en todo paciente hospitalizado con absceso odontogénico cervicofacial se busca resolución pronta del absceso, pero es necesario conocer cuáles son los factores que favorecen la resolución en hospitalizaciones cortas (1-3 días). Objetivo: determinar factores clínico-epidemiológicos de pacientes con abscesos odontogénicos para identificar factores que correlacionan con hospitalización corta. Material y métodos: estudio transversal, retrospectivo, observacional y analítico de 100 pacientes con abscesos odontogénicos en un Hospital General de Zona del Instituto Mexicano del Seguro Social de los años 2012-2013. Variables de estudio: días de hospitalización, sexo, edad, comorbilidades, conteo leucocitario, trismus, diente causal, región afectada y tratamientos realizados. Tamaño de muestra obtenido con fórmula para estudios observaciones con manejo de prevalencias para poblaciones infinitas, se empleó χ2 para identificar factores que correlacionan con hospitalización corta. Resultados: mujeres 56%, rango de edad 12-89 años y de hospitalización de 1-23 días; con comorbilidades 56%, leucocitosis 39% y trismus 21%. La caries causó 64% de abscesos, molares inferiores 70% y región submandibular afectada 73%. Variables estadísticamente significativas; conteo leucocitario, diente causal y región afectada. Conclusión: factores correlacionados con hospitalización corta: conteo leucocitario menor a 10,500 leucocitos, que el molar inferior no sea el diente causal y que la región submandibular no esté afectada (AU)

Introduction: prompt resolution of the abscess is sought in all patients hospitalized with cervicofacial odontogenic abscess, but which factors favor this resolution in short hospitalizations (1-3 days). Objective: determine clinical-epidemiological factors of patients with odontogenic abscesses to identify factors that correlate with short hospitalization. Material and methods: crosssectional, retrospective, observational and analytical study of 100 patients with odontogenic abscesses in a General Hospital of the Zone of the Mexican Social Security Institute from 2012-2013. Study variables; days of hospitalization, sex, age, comorbidities, leukocyte count, trismus, causative tooth, affected region and treatments performed. Sample size obtained with the formula for observational studies with prevalence management for infinite populations, χ2 was used to identify factors that correlate with short hospitalization. Results: women 56%, age range 12-89 years and hospitalization of 1-23 days, with comorbidities 56%, leukocytosis 39% and trismus 21%. Caries caused 64% of abscesses, lower molars 70% and affected submandibular region 73%. Statistically significant variables; leukocyte count, causative tooth and affected region. Conclusion: factors correlated with short hospitalization; leukocyte count less than 10,500 leukocytes, that the lower molar is not the causal tooth and that the submandibular region is not affected.

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OBJECTIVES: The aim of this analysis was to compare the effect of extubating in the operating room (OR) versus and the intensive care unit (ICU) among patients undergoing coronary artery bypass grafting (CABG). DESIGN: A retrospective cohort analysis. SETTING: Ten cardiac referral hospitals in Latin America; participants of the São Paulo Registry of Cardiovascular Surgery II (REPLICCAR II). PARTICIPANTS: The database included a total of 4,015 patients who underwent primary and isolated CABG surgery and were ≥18 years old, of whom 205 patients were extubated in the OR. INTERVENTIONS: The analysis was made after a propensity score matching (PSM) adjustment in the population sample of patients extubated in the OR and ICU by the following variables: sex, age, body mass index, smoking, type of surgery, chronic obstructive pulmonary disease, preoperative atrial fibrillation, cardiopulmonary bypass time, preoperative creatinine, and preoperative left ventricular ejection fraction. MEASUREMENTS AND MAIN RESULTS: This study focused on the analysis of the ICU and hospital length of stay, need for reintubation, morbidity, and mortality. After PSM, 402 patients were analyzed. Both groups had similar baseline characteristics, such as age (p = 0.132), sex (p = 1.00), and estimated risk of prolonged ventilation (>24 hours, p = 0.168); however, the median ventilation time was significantly shorter in the group extubated in the OR compared to the ICU group (5.67 hours v 17.55 hours, p < 0.001). The group of patients extubated in the ICU had a longer postoperative stay (7.54 ± 3.40 days v 6.41 ± 2.91 days, p < 0.001) and longer total hospitalization time (11.49 ± 5.70 days v 10.36 ± 5.72, p = 0.013) compared to those extubated in the OR. The authors did not observe a significant difference in the need for reintubation, morbidity, or mortality rates among the evaluated groups. CONCLUSIONS: In the REPLICCAR II database, extubation performed in the OR was associated with a reduced length of postoperative and total hospital stays compared to extubation in the ICU.

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Introducción: La infección de herida quirúrgica causa altas tasas de morbilidad y repercute sobre los índices de mortalidad. Constituye la primera infección intrahospitalaria entre pacientes quirúrgicos del total de infecciones nosocomiales y la primera entre los pacientes quirúrgicos. Existen factores de riesgo como la clasificación ASA, la diabetes mellitus, la hipertensión arterial y los días de estancia hospitalaria, los cuales influyen en su desarrollo. Objetivo: Determinar la prevalencia de infecciones de sitio quirúrgico por cirugías realizadas en el Hospital Dr. Carlos Canseco de Tampico, ciudad del estado mexicano de Tamaulipas. Métodos: Diseño observacional, analítico, transversal y retrospectivo de 54 pacientes con diagnóstico de infección de sitio quirúrgico. Las variables de estudio se clasificaron como dependientes (género, edad, lugar de origen, días de estancia hospitalaria, peso, índice de masa corporal) e independientes (diagnóstico, procedimiento quirúrgico realizado y clasificación ASA otorgada). Resultados: La población de 40 a 50 años fue la más afectada, con mayor predominancia sobre el género femenino. La Clasificación ASA II y III presentaron mayor prevalencia de infección de sitio quirúrgico, sobre todo en cirugías electivas (28 por ciento). Mientras mayor fue la estancia hospitalaria, mayor fue la probabilidad de desarrollar infección de sitio quirúrgico. Conclusiones: La prevalencia de infección en el sitio quirúrgico en pacientes operados por los distintos servicios quirúrgicos no es similar a la reportada por otros autores. La Clasificación ASA II y III presentaron infección del sitio quirúrgico con más frecuencia, mientras que la comorbilidad más llamativa de este estudio fue el índice de masa corporal como factor de riesgo que no debe pasar desapercibido(AU)

Introduction: Surgical wound infection causes high morbidity rates and impacts mortality rates. It is the first in-hospital infection among surgical patients of all nosocomial infections and the first among surgical patients. There are risk factors that influence its development, such as the ASA classification, diabetes mellitus, arterial hypertension and days of hospital stay. Objective: To determine the prevalence of surgical site infections from surgeries performed at Hospital Dr. Carlos Canseco, of Tampico, a city in the Mexican state of Tamaulipas. Methods: An observational, analytical, cross-sectional and retrospective study was carried out with 54 patients with a diagnosis of surgical site infection. The study variables were classified as dependent variables (gender, age, place of origin, days of hospital stay, weight and body mass index) and independent variables (diagnosis, surgical procedure performed, and given ASA classification). Results: The population aged 40 to 50 years was the most affected, with a greater predominance of the female gender. ASA classification II and III had a higher prevalence of surgical site infection, above all in elective surgeries (28 %). The longer the hospital stay, the higher the probability of developing surgical site infection. Conclusions: The prevalence of surgical site infection in patients operated on by the different surgical services is not similar to that reported by other authors. ASA Classification II and III presented surgical site infection more frequently, while the most remarkable comorbidity in this study was body mass index as a risk factor that should not go unnoticed(AU)

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INTRODUCTION AND AIM: Acute pancreatitis (AP) is the most common cause of pancreatic disease in children. Previous studies have described factors related to days of hospital length of stay (LOS) in children. Our aim was to identify factors associated with LOS in AP. MATERIALS AND METHODS: A retrospective study was conducted at the Hospital Infantil de México Federico Gómez in Mexico City, encompassing the time frame of January 1, 2017 and March 31, 2019. AP was confirmed by medical chart review, according to the INSPPIRE criteria at the time of hospital admission, in patients below 18 years of age. AP grade was classified, following the NASPGHAN guidelines. Demographic, clinical, biochemical, nutritional, and treatment data were collected. Prolonged hospital LOS was considered that which lasted 7 days or longer. RESULTS: Fifty-one events (32 patients) were registered. Median LOS was 8 days (IQR 4-14 days). Antibiotic use was significantly associated with longer LOS (OR 31.71; 95% CI: 2.71-370.65; p = 0.006) and early feeding (EF) (within 72 h of admission) was associated with shorter LOS (OR 0.05; 95% CI: 0.001-0.63; p = 0.02). There was no association between LOS and the variables of age, recurrence, grade, etiology, comorbidities, complications, fluid resuscitation, parenteral nutrition, or biochemical characteristics upon admission. CONCLUSION: Our study, like others, corroborated the fact that EF in the management of AP was associated with fewer days of hospital LOS.

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INTRODUCTION: intravenous (IV) tranexamic acid (TXA) has shown its usefulness to prevent postsurgical anemia, but few studies have analyzed its topical administration. Seven years ago, we implemented a new topical administration (moistening three gauzes with 1.5 g of TXA) in our primary total hip arthroplasties (THA). The objective of this study was to compare blood loss, hospital stay and complications without the use of TXA, topical use or 10 mg/kg IV plus topical. MATERIAL AND METHODS: consecutive retrospective series of 274 patients undergoing CTA (mean 70 years [59-76], 59% women) operated from 2014 to 2019. Loss of hemoglobin and hematocrit, blood transfusions, hospital stay, thromboembolic complications were compared and 30-day mortality among three groups: non-tranexamic (44.2%), topical (45.6%), topical + IV (9.9%). RESULTS: after 24 and 48 hours, hemoglobin and hematocrit decreased less (p < 0.05) in patients treated with TXA (topical and/or IV). Blood transfusion was required in 32% of patients without TXA, 12% of those treated with topical TXA only (RR = 3.24 [95% CI: 1.69-6.20]), and 0% of patients who received IV TXA (p = 0.005) (RR = 4.07 [95% CI: 2.14-7.48]). Hospital stay was reduced three days with TXA (p < 0.001). We have not observed any adverse effects related to TXA. CONCLUSIONS: the use of TXA in CTA significantly reduces anemia, transfusions and hospital stay without increasing complications. Isolated topical TXA (hemostatic pads) is less effective than topical IV + topical use, but both significantly improve anemia, transfusions, and hospital stay compared to no use.

INTRODUCCIÓN: el ácido tranexámico (ATX) intravenoso (IV) ha demostrado su utilidad para evitar la anemia postquirúrgica, pero pocos estudios han analizado su administración tópica. Hace siete años implementamos una nueva administración tópica (humedeciendo tres compresas con 1.5 g de ATX) en nuestras artroplastías totales de cadera (ATC) primarias. El objetivo de este estudio ha sido comparar la pérdida de sangre, estancia hospitalaria y complicaciones sin uso de ATX, uso tópico o 10 mg/kg IV más tópico. MATERIAL Y MÉTODOS: serie retrospectiva consecutiva de 274 pacientes intervenidos de ATC (promedio 70 años [59-76], 59% mujeres) operados de 2014 a 2019. Se compararon pérdida de hemoglobina y hematocrito, transfusiones de sangre, estancia hospitalaria, complicaciones tromboembólicas y mortalidad a 30 días entre tres grupos: no tranexámico (44.2%), tópico (45.6%), tópico + IV (9.9%). RESULTADOS: después de 24 y 48 horas, la hemoglobina y el hematocrito disminuyeron menos (p < 0.05) en los pacientes tratados con ATX (tópico y/o IV). Se requirió transfusión de sangre en 32% de los pacientes sin ATX, 12% de los tratados sólo con ATX tópico (RR = 3.24 [IC de 95%: 1.69-6.20]) y 0% de los pacientes que recibieron ATX IV (p = 0.005) (RR = 4.07 [IC de 95%: 2.14-7.48]). La estancia hospitalaria se redujo en tres días con ATX (p < 0.001). No hemos observado efectos adversos relacionados con ATX. CONCLUSIONES: el uso del ATX en ATC reduce significativamente la anemia, las transfusiones y la estancia hospitalaria sin aumentar las complicaciones. El ATX tópico aislado (compresas hemostáticas) es menos eficaz que el uso tópico IV + tópico, pero ambos mejoran significativamente la anemia, las transfusiones y la estancia hospitalaria en comparación con su no utilización.

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Objetivo: Evaluar la asociación entre glucemia de ingreso y desenlaces adversos en pacientes hospitalizados con COVID-19 en un hospital nacional peruano. Métodos: Estudio observacional tipo cohorte retrospectiva. Se revisaron historias clínicas electrónicas de pacientes hospitalizados por COVID-19 en un servicio de especialidades. Los pacientes se clasificaron según niveles de glucemia al ingreso: ≤ y >140mg/dL; el desenlace primario fue mortalidad y el secundario un compuesto que incluyó mortalidad, shock séptico, ventilación mecánica o traslado a UCI. Se evaluó la estancia hospitalaria y se realizó un subanálisis de regresión logística multivariada en pacientes diabéticos. Resultados: Se evaluaron 169 pacientes, media de edad 61 años, 64.5% varones. 71% presentaban alguna comorbilidad, siendo las más frecuentes: hipertensión arterial (34%), obesidad (30%), diabetes (26%). El 70% presentó gravedad tomográfica. La mediana de glucemia de ingreso fue 126.5mg/dL (RIC: 109-157mg/dL), uno de cada 3 presentó glucemia >140mg/dL. La tasa de mortalidad fue 9700 muertes por cada 100 000 personas-semana, con frecuencia de 21.3%. No se encontró diferencia significativa entre hiperglucemia y normoglucemia, tanto en mortalidad como desenlace compuesto. Los pacientes con hiperglucemia de ingreso presentaron mayor estancia hospitalaria que los normoglucémicos (19 días vs 13 días, p180mg/dL presentó OR de 6.42 (IC95%: 1.07-38.6), ajustado a edad y a gravedad clínica de ingreso. Conclusiones: La hiperglucemia al ingreso se asoció a mayor estancia hospitalaria, y los pacientes diabéticos con hiperglucemia >180mg/dL presentaron un riesgo 6 veces mayor de presentar desenlace adverso.

Objective: Evaluate the association between glycemia on admission and adverse outcomes in hospitalized patients with COVID19 in a Peruvian national hospital. Methods: Retrospective, observational cohort study. We collected data from electronic medical records of COVID19 patients in a medical specialties service. Patients were classified according to blood glucose levels on admission: ≤ and >140mg/dL. Primary outcome was mortality, and the secondary a composite that included mortality, septic shock, mechanical ventilation, or transfer to ICU. We also evaluated hospital stay and a multivariate logistic regression sub analysis was performed in diabetic patients. Results: 169 patients were evaluated. The mean age was 61 years, 64.5% were male. 71% had at least one comorbidity, the most frequent: arterial hypertension (34%), obesity (30%) and diabetes (26%). 70% presented tomographic gravity. Median blood glucose at admission was 126.5mg/dL (IQR: 109-157mg/dL), one of every 3 had blood glucose levels >140mg/dL. Mortality rate was 9700 deaths per 100000 person-weeks, with a frequency of 21.3%. No significant difference was found between hyperglycemia and normoglycemia, mortality and in composite outcome. Patients with hyperglycemia on admission had longer hospital stay than normoglycemic patients (19 vs 13 days, p180mg/dL presented OR of 6.42 (95% CI: 1.07-38.6) for composite outcome, adjusted for age and clinical severity at admission. Conclusions: Hyperglycemia at admission was associated with a longer hospital stay and diabetic patients with hyperglycemia >180mg/dL had a 6-fold increased risk of presenting an adverse outcome.

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OBJECTIVE: The objective of the study was to compare the use of neonatal conventional brain magnetic resonance imaging (MRI) with that of clinical factors and socioeconomic status (SES) to predict long-term neurodevelopment in children with severe congenital heart disease (CHD). STUDY DESIGN: In this prospective cohort study, perioperative MRIs were acquired in 57 term-born infants with CHD undergoing cardiopulmonary bypass surgery during their first year of life. Total brain volume (TBV) was measured using an automated method. Brain injury severity (BIS) was assessed by an established scoring system. The neurodevelopmental outcome was assessed at 6 years using standardized test batteries. A multiple linear regression model was used for cognitive and motor outcomes with postoperative TBV, perioperative BIS, CHD complexity, length of hospital stay, and SES as covariates. RESULTS: CHD diagnoses included univentricular heart defect (n = 15), transposition of the great arteries (n = 33), and acyanotic CHD (n = 9). Perioperative moderate-to-severe brain injury was detected in 15 (26%) patients. The total IQ was similar to test norms (P = .11), whereas the total motor score (P < .001) was lower. Neither postoperative TBV nor perioperative BIS predicted the total IQ, but SES (P < .001) and longer hospital stay (P = .004) did. No factor predicted the motor outcome. CONCLUSION: Although the predictive value of neonatal conventional MRIs for long-term neurodevelopment is low, duration of hospital stay and SES better predict the outcome in this CHD sample. These findings should be considered in initiating early therapeutic support.

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BACKGROUND: Resident involvement in the operating room is a vital component of their medical education. Laparoscopic cholecystectomy (LC) represents the paradigmatic minimally invasive training procedure, both due to its prevalence and its different forms of complexity. We aim to evaluate whether the supervised participation of residents as operative surgeons in LC of different degrees of complexity affects postoperative outcomes in a university hospital. METHODS: This is a retrospective, single-center study that included all consecutive adult (> 18 years old) patients operated for a LC between January 1, 2012 and December 31, 2017. Each surgical procedure was recorded according to the level of complexity that we established in three types of categorization (level 1: elective surgery; level 2: cholecystitis; level 3: biliary instrumentation). Patients were clinically monitored at an outpatient clinic 7 and 30-day postoperative. Postoperative outcomes of patients operated by supervised residents (SR) and trained surgeons (TS) were compared. Postoperative complications were graded according to the Clavien-Dindo classification of surgical complications. RESULTS: A total of 2331 patients underwent LC during the study period, of whom 1573 patients (67.5%) were operated by SR and 758 patients (32.5%) by TS. There were no significant differences among age, sex, and BMI between patients operated in both groups, with the exception of ASA (P = 0.0001). Intraoperative cholangiography was performed in 100% of the patients, without bile duct injuries. There were no deaths in the 30 postoperative days. The overall complication rate was 5.70% (133 patients), with no significant differences when comparing LC performed by SR and TS (5.09 vs. 6.99%; P = 0.063). The severity rates of complications were similar in both groups (P = 0.379). Patient readmission showed a statistical difference comparing SR vs TS (0.76% vs. 2.2%; P = 0.010). The postoperative complications rate according to the complexity level of LC was not significant in level 1 and 2 for both groups. However in complexity level 3 the TS group experienced a greater rate of complications compared to the SR group (18.12% vs. 9.38%; P = 0.058). In the multivariate analysis, the participation of the residents as operating surgeons was not independently associated with an increased risk of complications (OR 1.22, 95% CI 0.84-1.77; P = 0.275), neither other risk factors like age ≥ 65 years, BMI, complexity level 2-3, or ASA ≥ 3-4. The association of another surgical procedure with the LC was an independent factor of morbidity (OR 3.85, 95% CI 2.54-5.85; P = 0.000). CONCLUSION: Resident involvement in LC with different degrees of complexity did not affect postoperative outcomes. The participation of a resident as operating surgeon is not an independent risk factor and may be considered ethical, safe, and reliable whenever implemented in the background of a residency-training program with continuous supervision and national accreditation. The sum of other procedures not related to a LC should be taken as a risk factor of morbidity.

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Introduction: Fractures pose a tremendous burden on the health care systems due to the prolonged duration of admission. Addressing various determinants that prolong hospital stay will help minimize the cost of treatment. Objective: To study the determinants associated with the duration of hospital stay among patients admitted with fractures. Methods: This was a retrospective observational study conducted at a private tertiary care hospital in Mangalore. A semi-structured proforma was used for collecting data from the medical records. Results: The mean age of the 124 patients were 48.3±21.4 years. The majority were males [69(55.6 por ciento)] and were from urban areas [86(69.3 por ciento)]. Co-morbidities were present among 69(55.6 por ciento) patients. Out of the total patients, 8(6.4 por ciento) were alcoholics, and 10(8.1 por ciento) were tobacco smokers. The majority [50(40.3 por ciento)] had fracture of the femur. Five (4 por ciento) patients developed complications during the post-operative period. Seventy-eight (62.9 por ciento) patients had medical insurance facilities. The mean duration of hospital stay was 9.6±3.2 days among the patients. The mean duration of hospital stay among patients (n=115) before surgery was 2.4±1.6 days. Increased pre-operative stay, increasing age, rural residential status, open type of fracture, and being given general anaesthesia for the operative procedure were significant predictors determining the period of stay among patients in the hospitals. Alcoholic status independently influenced the period of stay in the pre-operative period. Conclusion: Both patient and treatment characteristics were important determinants associated with the duration of hospital stay. Targeting these predictors will help to manage in-patients better and shorten their duration of hospital stay(AU)

Introducción: Las fracturas suponen una enorme carga para los sistemas sanitarios debido a la duración prolongada del ingreso. Abordar varios determinantes que prolongan la estadía en el hospital ayudará a minimizar el costo del tratamiento. Objetivo: Estudiar los determinantes asociados a la duración de la estancia hospitalaria en pacientes ingresados con fracturas. Métodos: Este es un estudio observacional retrospectivo realizado en un hospital privado de atención terciaria en Mangalore. Se utilizó una proforma semiestructurada para la recolección de datos de las historias clínicas. Resultados: La edad media de los 124 pacientes fue de 48,3±21,4 años. La mayoría eran hombres [69 (55,6 percent)] y de áreas urbanas [86 (69,3 percent)]. Las comorbilidades estuvieron presentes en 69 (55,6 percent) pacientes. Del total de pacientes, 8 (6,4 percent) eran alcohólicos y 10 (8,1 percent) fumadores. La mayoría [50 (40,3 percent)] tenía fractura de fémur. Cinco (4 percent) pacientes desarrollaron complicaciones durante el postoperatorio. Setenta y ocho (62,9 percent) pacientes tenían seguro médico. La duración media de la estancia hospitalaria fue de 9,6±3,2 días entre los pacientes. La duración media de la estancia hospitalaria de los pacientes (n=115) antes de la cirugía fue de 2,4±1,6 días. El aumento de la estancia preoperatoria, el aumento de la edad, el estado residencial rural, el tipo de fractura abierta y la anestesia general para el procedimiento quirúrgico fueron predictores significativos que determinaron el período de estancia entre los pacientes en los hospitales. El estado alcohólico influyó de forma independiente en el tiempo de estancia en el preoperatorio. Conclusión: Tanto las características del paciente como las del tratamiento fueron determinantes importantes asociadas con la duración de la estancia hospitalaria. Abordar estos predictores ayudará a manejar mejor a los pacientes hospitalizados y acortar la duración de su estadía en el hospital(AU)

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RESUMEN Introducción: La desnutrición hospitalaria es un proceso multicausal y de alta prevalencia. La intervención nutricional temprana mejora el pronóstico de los pacientes afectados y reduce los costos sanitarios. Objetivo: Estimar la diferencia de costo efectividad de la atención de rutina comparado con la intervención nutricional temprana, en pacientes en riesgo nutricional, en un Hospital Universitario de alta complejidad entre marzo y octubre de 2012. Materiales y métodos: Estudio de evaluación económica en 165 pacientes adultos hospitalizados de especialidades médicas y quirúrgicas. Se tomó como referencia la información de un estudio de intervención cuasi experimental realizado en el año 2012. Se estratificaran los pacientes de acuerdo a días de estancia hospitalaria, complicaciones y estado nutricional según grupo de intervención y se obtuvieron los costos sanitarios. Resultados: La mediana en el costo por paciente con complicaciones fue de US$ 3.950 en el grupo de intervención nutricional temprana comparado con US$ 5.301 por la atención de rutina; para la estancia hospitalaria fue de US$ 2.462 vs US$ 4.201 y para los recursos derivados de optimización del peso fue de US$ 3.627 vs US$ 5.132 respectivamente. Conclusión: La intervención nutricional temprana en los pacientes en riesgo nutricional, disminuyó los costos derivados de complicaciones, estancia hospitalaria y optimización del estado nutricional.

ABSTRACT Introduction: Hospital malnutrition is a highly prevalent process with multiple causes. Early nutritional intervention improves the prognosis of affected patients and reduces health costs. Objective: To estimate the cost-effectiveness of routine care compared with early nutritional intervention, in patients at nutritional risk, in a high complexity university hospital between March and October 2012. Materials and methods: Economic evaluation study in 165 adult hospitalized medical and surgical specialty patients. The information from a quasi-experimental intervention study conducted in 2012 was taken as a reference. Patients were stratified by intervention group according to days of hospital stay, complications and nutritional status; health costs were also obtained. Results: For the early nutritional intervention group compared to routine care, the median cost per patient with complications was US$ 3,950 vs US$ 5,301; US$ 2,462 vs US$ 4,201 for hospital stay and US$ 3,627 vs US$ 5,132 for resources derived from weight optimization, respectively. Conclusion: The early nutritional intervention in patients at nutritional risk, decreased the costs derived from complications, hospital stay, and optimization of nutritional status.

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Resumen: Introducción: El ácido tranexámico (ATX) intravenoso (IV) ha demostrado su utilidad para evitar la anemia postquirúrgica, pero pocos estudios han analizado su administración tópica. Hace siete años implementamos una nueva administración tópica (humedeciendo tres compresas con 1.5 g de ATX) en nuestras artroplastías totales de cadera (ATC) primarias. El objetivo de este estudio ha sido comparar la pérdida de sangre, estancia hospitalaria y complicaciones sin uso de ATX, uso tópico o 10 mg/kg IV más tópico. Material y métodos: Serie retrospectiva consecutiva de 274 pacientes intervenidos de ATC (promedio 70 años [59-76], 59% mujeres) operados de 2014 a 2019. Se compararon pérdida de hemoglobina y hematocrito, transfusiones de sangre, estancia hospitalaria, complicaciones tromboembólicas y mortalidad a 30 días entre tres grupos: no tranexámico (44.2%), tópico (45.6%), tópico + IV (9.9%). Resultados: Después de 24 y 48 horas, la hemoglobina y el hematocrito disminuyeron menos (p < 0.05) en los pacientes tratados con ATX (tópico y/o IV). Se requirió transfusión de sangre en 32% de los pacientes sin ATX, 12% de los tratados sólo con ATX tópico (RR = 3.24 [IC de 95%: 1.69-6.20]) y 0% de los pacientes que recibieron ATX IV (p = 0.005) (RR = 4.07 [IC de 95%: 2.14-7.48]). La estancia hospitalaria se redujo en tres días con ATX (p < 0.001). No hemos observado efectos adversos relacionados con ATX. Conclusiones: El uso del ATX en ATC reduce significativamente la anemia, las transfusiones y la estancia hospitalaria sin aumentar las complicaciones. El ATX tópico aislado (compresas hemostáticas) es menos eficaz que el uso tópico IV + tópico, pero ambos mejoran significativamente la anemia, las transfusiones y la estancia hospitalaria en comparación con su no utilización.

Abstract: Introduction: Intravenous (IV) tranexamic acid (TXA) has shown its usefulness to prevent postsurgical anemia, but few studies have analyzed its topical administration. Seven years ago, we implemented a new topical administration (moistening three gauzes with 1.5 g of TXA) in our primary total hip arthroplasties (THA). The objective of this study was to compare blood loss, hospital stay and complications without the use of TXA, topical use or 10 mg/kg IV plus topical. Material and methods: Consecutive retrospective series of 274 patients undergoing CTA (mean 70 years [59-76], 59% women) operated from 2014 to 2019. Loss of hemoglobin and hematocrit, blood transfusions, hospital stay, thromboembolic complications were compared and 30-day mortality among three groups: non-tranexamic (44.2%), topical (45.6%), topical + IV (9.9%). Results: After 24 and 48 hours, hemoglobin and hematocrit decreased less (p < 0.05) in patients treated with TXA (topical and/or IV). Blood transfusion was required in 32% of patients without TXA, 12% of those treated with topical TXA only (RR = 3.24 [95% CI: 1.69-6.20]), and 0% of patients who received IV TXA (p = 0.005) (RR = 4.07 [95% CI: 2.14-7.48]). Hospital stay was reduced three days with TXA (p < 0.001). We have not observed any adverse effects related to TXA. Conclusions: The use of TXA in CTA significantly reduces anemia, transfusions and hospital stay without increasing complications. Isolated topical TXA (hemostatic pads) is less effective than topical IV + topical use, but both significantly improve anemia, transfusions, and hospital stay compared to no use.

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Abstract Introduction Coronavirus Disease 2019 (COVID-19) is a novel viral disease with person-to-person transmission that has spread to many countries since the end of 2019. Although many unknowns were resolved within a year and the vaccine is available, it is still a major global health problem. Objective COVID-19 infection may present with a considerably wide spectrum of severity and host factors play a significant role in determining the course of the disease. One of these factors is blood groups. Based on previous experience, it is believed that the ABO blood group type affects prognosis, treatment response and length of stay in the hospital. In this study, our aim was to evaluate whether the blood group had an effect on the length of the hospital stay. To the best of our knowledge, no previous studies have assessed the effect of ABO blood groups, as well as age, on the length of the hospital stay in these settings. Methods In this retrospective cohort study, 969 patients admitted to our hospital between March 15, 2020 and May 15, 2020 were evaluated. The patients were divided into 4 groups according to ABO blood groups. The effect of the ABO blood group by age on the course of the disease, need for intensive care, duration of hospitalization and mortality in patients with COVID-19 infection, especially in geriatric patients, was evaluated. Results Of all the patients, 9.1% required admission to the intensive care unit (ICU), of whom 83% died. The average length of ICU stay was 11 days (0 - 59). The observed mortality rates in blood groups A, B, AB and 0 were 86.4%, 93.3%, 80.0% and 70.8%, respectively, indicating similar death rates in all ABO blood types. When the Rh phenotype was taken into consideration, no significant changes in results were seen. Conclusion As a result, we could not observe a significant relationship between blood groups and clinical outcomes in this study, which included a sample of Turkish patients with COVID-19.

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INTRODUCTION: Coronavirus Disease 2019 (COVID-19) is a novel viral disease with person-to-person transmission that has spread to many countries since the end of 2019. Although many unknowns were resolved within a year and the vaccine is available, it is still a major global health problem. OBJECTIVE: COVID-19 infection may present with a considerably wide spectrum of severity and host factors play a significant role in determining the course of the disease. One of these factors is blood groups. Based on previous experience, it is believed that the ABO blood group type affects prognosis, treatment response and length of stay in the hospital. In this study, our aim was to evaluate whether the blood group had an effect on the length of the hospital stay. To the best of our knowledge, no previous studies have assessed the effect of ABO blood groups, as well as age, on the length of the hospital stay in these settings. METHODS: In this retrospective cohort study, 969 patients admitted to our hospital between March 15, 2020 and May 15, 2020 were evaluated. The patients were divided into 4 groups according to ABO blood groups. The effect of the ABO blood group by age on the course of the disease, need for intensive care, duration of hospitalization and mortality in patients with COVID-19 infection, especially in geriatric patients, was evaluated. RESULTS: Of all the patients, 9.1% required admission to the intensive care unit (ICU), of whom 83% died. The average length of ICU stay was 11 days (0 - 59). The observed mortality rates in blood groups A, B, AB and 0 were 86.4%, 93.3%, 80.0% and 70.8%, respectively, indicating similar death rates in all ABO blood types. When the Rh phenotype was taken into consideration, no significant changes in results were seen. CONCLUSION: As a result, we could not observe a significant relationship between blood groups and clinical outcomes in this study, which included a sample of Turkish patients with COVID-19.

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BACKGROUND: Approximately 5-7 % of pregnant women have hypertension during pregnancy, requiring antihypertensive drug treatment. There have been a lack of studies evaluating how drug-related problems (DRPs) affect morbidity or mortality in the postpartum period among women with a history of preeclampsia. OBJECTIVE: To determine the influence of drug-related problems on length of hospital stay of postpartum women with a history of preeclampsia. METHODS: This cross-sectional study included postpartum women diagnosed with preeclampsia, from June to November 2016, in two teaching maternity hospitals in Brazil. The outcomes assessed were, length of hospital stay of postpartum women. The DRPs were classified through the Pharmaceutical Care Network Europe Foundation (PCNE) v 8.01. RESULTS: 600 women were included, and 354 (59%) were exposed to at least one DRP. The most frequent DRPs were no administration of the prescribed medication, lack of prescription of a medication, although the indication was clear, and ineffectiveness (unknown reason). In patients exposed to DRP, the average length of hospital stay after labour was 5.4 (S.D. 3.6) days versus 4.4 (S.D. 3.3) days in patients non-exposed to DRP (p = 0.0001). The period (in days) to achieve blood pressure control after labour was 4.5 (S.D. 3.5) 3.5 (S.D. 3.2), respectively (p = 0.0001). There were no deaths during the study. CONCLUSION AND RELEVANCE: Drug-related problems significantly increased the length of hospital stay in postpartum women with a history of preeclampsia.

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Resumen Introducción: la desnutrición hospitalaria, vinculada principalmente a la enfermedad o injuria, tiene una alta prevalencia a nivel mundial. Está asociada negativamente con resultados clínicos y económicos. Objetivo: Determinar si existe asociación entre el estado nutricional al ingreso hospitalario y el tiempo de internación. Materiales y método: se realizó un estudio observacional, descriptivo y retrospectivo, en pacientes adultos ingresados al Hospital Interzonal General de Agudos "San Roque" durante el año 2019. Para el tamizaje nutricional se utilizó el Malnutrition Screening Tool (MST) y para la evaluación nutricional la Valoración Global Subjetiva. Se calculó la estancia hospitalaria como la diferencia entre la fecha de ingreso y egreso. Resultados: se evaluaron 2296 pacientes. La prevalencia global de desnutrición fue del 25,4%. Se encontraron diferencias estadísticamente significativas entre estancia hospitalaria prolongada y estado nutricional; tanto en pacientes con desnutrición moderada [OR crudo 2,75 (IC 95% 2,1-3,4; p < 0,0001)] como en pacientes con desnutrición severa [OR crudo 5 (IC 95% 3,5 - 7,0; p < 0,0001)]. Conclusión: este estudio refleja la alta prevalencia de desnutrición que padecen los pacientes al ingreso hospitalario, como así también el mayor riesgo de tener estancias más prolongadas cuando existe desnutrición.

Abstract Introduction: hospital malnutrition, mainly linked to illness or injury, has a high prevalence worldwide. It is negatively associated with clinical and economic outcomes. Objective: to determine if there is an association between nutritional status and length of hospital stay. Materials and method: observational, descriptive and retrospective study was carried out in adult patients admitted to the Hospital Interzonal General de Agudos "San Roque" during 2019. For nutritional screening, the Malnutrition Screening Tool was used and for nutritional assessment, the Subjective Global Assessment. Length of hospital stay was calculated as the difference between the date of admission and discharge. Results: 2296 patients were assessed. The global prevalence of malnutrition was 25,4%. Statistically significant differences were found between prolonged hospital stay and nutritional status; both in patients with moderate malnutrition [crude OR 2,75 (95% CI 2,1-3,4; p<0.0001)] and in patients with severe malnutrition [crude OR 5 (95% CI 3,5 - 7,0; p<0,0001)]. Conclusion: this study reflects the high prevalence of malnutrition suffered by patients at hospital admission, as well as the increased risk of having longer stays when malnutrition exists.

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