Background: Previous literature has found mixed results concerning the relationship between depression, and anxiety, and length of hospital stay among cardiac surgical patients. Given the high prevalence of these psychiatric illnesses and cardiovascular disease in Canada, a better understanding of the relationship between these variables has the potential to influence medical and psychiatric outcomes for countless individuals. Objectives: The objectives of this manuscript style thesis are to (a) describe the prevalence of mild and moderate-to-severe symptoms of depression and anxiety disorders in a sample of cardiac patients (Manuscript 1) and (b) analyze the effects of these symptoms on post-operative length of stay while controlling for potential confounding variables (Manuscript 2). Methods: This secondary analysis used data collected from a consecutive series of consenting patients attending Foothills Hospital Pre-operative Assessment Clinic (August 1998-March 2002). Patients completed the Zung Self-Rating Depression and Anxiety scales, and a questionnaire assessing potential confounders. Manuscript 1: Prevalence values and 95% intervals were calculated for mild and moderate-to-severe depression and anxiety while logistic regression was used to determine predictors of these conditions. Manuscript 2: The relationship between symptoms of depression, anxiety and length of stay was analyzed using multiple linear regression. Results: Manuscript 1: We estimated that moderate-to-severe symptoms of depression and anxiety were present in 10.66% and 3.42%, respectively. Mild depression (21.90%) and anxiety (32.89%) were also present. Common predictors of both conditions included sex, general health, and a recent myocardial infarction. Depression was further associated with co-morbid illness, as was type of surgery with anxiety. Manuscript 2: Patients with depression experienced a significant increase in length of stay compared to mentally healthy patients. Age, general health, type of surgery and education also predicted hospital stay, while anxiety did not. Conclusions: Manuscript 1: The prevalence of depression and anxiety in our sample demonstrates the need to address the burden of psychiatric illness in this population. Predictors of these disorders may assist in determining risk groups that would benefit most from psychiatric testing and interventions. Manuscript 2: The elevated length of stay observed among patients with depression supports the implementation of screening and treatment in this population. / Thesis (Master, Community Health & Epidemiology) -- Queen's University, 2010-11-03 19:01:58.445

A burn injury is a disastrous trauma and can have very wide ranging impacts, including individual, family, and social. Burns patients generally have a long period of hospital stay whose accurate prediction can not only facilitate allocations of scarce medical resources but also help clinicians to counsel patients and relatives at an early stage of care. Besides prediction accuracy, prediction timing of length of hospital stay (LOS) for burn patients is also critical. Early prediction has profound effects on more efficient and effective medical resource allocations and better patient care and management. Hence, the objective of this study is to apply a backpropagation neural network (BPNN) for predicting length of hospital stay (LOS) for burn patients at early stages of care. Specifically, we defined two early-prediction timing, including admission and initial treatment stages. Prediction timing at the admission stage is to predict a burn patient¡¦s LOS when the patient is admitted into the Burns Unit. Prediction at the initial treatment stage refers to the timing right after the first surgery for burn wound excision and skin graft is performed (typically within 72 hours of injury if the patient¡¦s condition allows). Experimentally, we evaluated the prediction accuracy of these two stages, using that achieved at the post-treatment stage (referring to the timing when all surgeries for burn wound excision and skin graft are performed) as benchmarks. The evaluation results showed that prediction LOS at the admission and the initial treatment stages could attain an accuracy of 50.37% and 57.22%, respectively. Compared to the accuracy of 62.13% achieved by the post-treatment stage, the performance reached by the initial treatment stage would consider satisfactory.

Yes / IMPORTANCE Patients undergoing emergency laparotomy have high mortality, but few studies exist to improve outcomes for these patients. OBJECTIVE To assess whether a collaborative approach to implement a 6-point care bundle is associated with reduction in mortality and length of stay and improvement in the delivery of standards of care across a group of hospitals. DESIGN, SETTING, AND PARTICIPANTS The Emergency Laparotomy Collaborative (ELC) was a UK-based prospective quality improvement study of the implementation of a care bundle provided to patients requiring emergency laparotomy between October 1, 2015, and September 30, 2017. Participants were 28 National Health Service hospitals and emergency surgical patients who were treated at these hospitals and whose data were entered into the National Emergency Laparotomy Audit (NELA) database. Post-ELC implementation outcomes were compared with baseline data from July 1, 2014, to September 30, 2015. Data entry and collection were performed through the NELA. INTERVENTIONS A 6-point, evidence-based care bundle was used. The bundle included prompt measurement of blood lactate levels, early review and treatment for sepsis, transfer to the operating room within defined time goals after the decision to operate, use of goal-directed fluid therapy, postoperative admission to an intensive care unit, and multidisciplinary involvement of senior clinicians in the decision and delivery of perioperative care. Change management and leadership coaching were provided to ELC leadership teams. MAIN OUTCOME AND MEASURES Primary outcomes were in-hospital mortality, both crude and Portsmouth Physiological and Operative Severity Score for the enumeration of Mortality and morbidity (P-POSSUM) risk-adjusted, and length of stay. Secondary outcomes were the changes after implementation of the separate metrics in the care bundle. RESULTS A total of 28 hospitals participated in the ELC and completed the project. The baseline group included 5562 patients (2937 female [52.8%] and a mean [range] age of 65.3 [18.0-114.0] years), whereas the post-ELC group had 9247 patients (4911 female [53.1%] and a mean [range] age of 65.0 [18.0-99.0] years). Unadjusted mortality rate decreased from 9.8% at baseline to 8.3% in year 2 of the project, and so did risk-adjusted mortality from a baseline of 5.3% to 4.5% post-ELC. Mean length of stay decreased from 20.1 days during year 1 to 18.9 days during year 2. Significant changes in 5 of the 6 metrics in the care bundle were achieved. CONCLUSIONS AND RELEVANCE A collaborative approach using a quality improvement methodology and a care bundle appeared to be effective in reducing mortality and length of stay in emergency laparotomy, suggesting that hospitals should adopt such an approach to see better patient outcomes and care delivery performance. / This study was funded by The Health Foundation, United Kingdom, as part of a Scaling Up Award.

OBJETIVOS: Avaliar o tempo de internação hospitalar e fatores preditores de internação prolongada após PRR realizada em instituição de ensino de alto volume cirúrgico. Objetivos secundários incluíram avaliar taxa de visitas não planejadas ao ambulatório e ao pronto-atendimento, readmissões hospitalares e taxa de complicações perioperatórias utilizando método de classificação padronizado. MÉTODOS: Foi realizada análise retrospectiva de dados prospectivamente coletados em base de dados padronizada para doentes portadores de câncer de próstata localizado submetidos a PRR no ICESP. Os procedimentos foram realizados por residentes do último ano de Urologia sob supervisão de um médico assistente (com experiência superior a 300 PRRs). Internação prolongada foi definida com internação > 2 dias (quartil superior). Um modelo de regressão logística incluindo apenas variáveis pré-operatórias foi inicialmente construído para determinar os fatores que predizem internação prolongada antes do ato cirúrgico; subsequentemente um segundo modelo incluindo tanto variáveis pré como intra e pós-operatórias foi analisado. As variáveis pré-operatórias incluídas no modelo foram: Idade, raça, IMC, PSA, índice de comorbidade de Charlson ajustado e não ajustado por idade, escore de ASA, cirurgias abdominais prévias, estádio clínico, volume prostático, Gleason da biópsia e porcentagem de fragmentos positivos, estratificação de risco NCCN. Os fatores intra e pós-operatórios incluídos na análise foram: tipo de anestesia, tempo operatório, sangramento estimado, transfusão sanguínea, preservação do feixe neurovascular, dissecção linfonodal, peso da próstata, volume tumoral, escore de Gleason do espécime, status da margem cirúrgica, estádio patológico e, finalmente, presença de complicações pós-operatórias (de acordo com o sistema de Clavien). RESULTADOS: Entre janeiro de 2010 e janeiro de 2012, 1011 pacientes foram submetidos a PRR em nossa instituição. A mediana de tempo de internação foi de 2 dias, sendo que 217 (21,5%) pacientes apresentaram internação prolongada. Os fatores preditores de internação prolongada dentre as variáveis pré-operatórias foram ICCa (OR. 1,317, IC95% 1,106-1,568, p=0,002) ou ICC não ajustado e idade separadamente (OR. 1,401, IC95% 1,118-1,756, p=0,003 e OR 1,050, IC95% 1,023-1,078, p < 0,001, respectivamente), escore de ASA 3 (OR. 3,260, IC95% 1,646-6,455, p < 0,001), volume prostático no USG-TR (OR, 1,005, IC95% 1,001-1,011, p=0,038) e raça negra (OR. 2,235, IC95% 1291-3,869, p=0,004); considerando-se também fatores intra e pós-operatórios na regressão, o tempo operatório (OR 1,007, IC95% 1,001-1,013, p=0,022) e presença de complicações de qualquer grau (OR 2,013, IC95% 1,192-3,399, p=0,009) ou complicações maiores (OR 2,357, IC95% 1,228-4,521, p=0,01) também foram correlacionados de maneira independente com internação prolongada. A taxa de readmissão hospitalar nesta série foi de 2,7%; visitas não programadas ao pronto atendimento ocorreram em 7,3% dos casos. A taxa global de complicações (intra e pós-operatórias) foi de 14,5%; a incidência de complicações pós-operatórias menores (graus 1 e 2) e maiores (Grau 3 ou 4) foi de 8,5% e 5,4%, respectivamente. CONCLUSÃO: Os fatores preditores independentes de internação prolongada dentre as variáveis pré-operatórias foram ICCa (ou ICC não ajustado e idade separadamente), escore de ASA 3, volume prostático no USG-TR e raça negra; considerando-se também fatores intra e pós-operatórios, o tempo operatório e presença de complicações de qualquer grau e complicações maiores foram correlacionados de maneira independente com internação prolongada. A identificação destes fatores permite não só auxiliar no planejamento de gastos e aconselhamento de pacientes, mas potencialmente promover modificações de variáveis que possam reduzir o tempo de admissão dos pacientes após PRR / OBJECTIVES: To evaluate the length hospital stay and predictors of prolonged hospitalization after RRP performed in a high-surgical volume teaching institution. Secondary objectives were to analyze the rate of unplanned visits to the office and emergency care, hospital readmissions and perioperative complications rates using a standardized classification system. METHODS: Retrospective analysis of prospectively collected data in a standardized database for patients with localized prostate cancer undergoing RRP in our institution. The procedures were performed by senior residents under the supervision of a staff surgeon (with prior experience larger than 300 RRPs). Prolonged hospitalization was defined as hospital stay longer than 2 days (upper quartile). A logistic regression model including only preoperative variables was initially built to determine the factors that predict prolonged hospital stay before the surgical procedure; subsequently, a second model including both pre and intraoperative variables was analyzed. Preoperative variables included in the model were age, race, BMI, PSA, Charlson comorbidity index (adjusted and not adjusted for age), ASA score, previous abdominal surgery, clinical stage, prostate volume, biopsy Gleason and percentage of positive cores, NCCN risk stratification. Intra and postoperative factors included in the analysis were: type of anesthesia, operative time, estimated bleeding loss, transfusion, nerve-sparing approach, lymph node dissection, prostate weight, tumor volume, Gleason score specimen, positive margin rates, pathologic stage, and, finally, the presence of postoperative complications (according to Clavien grading system). RESULTS: Between January 2010 and January 2012, 1011 patients underwent RRP at our institution. The median hospital stay was 2 days, and 217 (21.5%) patients had prolonged hospitalization. Predictors of prolonged hospital stay among the preoperative variables were ICCa (OR. 1.317, 95% CI 1.106 to 1.568, p = 0.002) or unadjusted ICC and age separately (OR. 1.401, 95% CI 1.118 to 1.756, p = 0.003 and OR 1.050, 95% CI 1.023 to 1.078, p < 0.001, respectively), ASA score of 3 (OR. 3.260, 95% CI 1.646 to 6.455, p < 0.001), prostate volume on USG-TR (OR, 1.005; 95% CI 1.001 -1.011, p = 0.038) and African-American race (OR 2.235, 95% CI 1291 to 3.869, p = 0.004).; considering also intra and postoperative factors, operative time (OR 1.007, 95% CI 1.001 to 1.013, p = 0.022) and the presence of any complications (OR 2.013, 95% CI 1.192 to 3.399, p = 0.009) or major complications (OR 2.357, 95% CI 1.228 to 4.521, p = 0.01) were also correlated independently with prolonged hospital stay. Hospital readmission rate in this series was 2.7%; unscheduled visits to emergency care occurred in 7.3% of cases. The complication rate was 14.5%; the incidence of minor (grades 1 and 2) and major complications (Grade 3 or 4) was 8.5% and 5.4%, respectively. CONCLUSION: The independent predictors of prolonged hospitalization among the preoperative variables were ICCa (or unadjusted ICC and age separately), ASA score of 3, prostate volume on USG-TR and African-American race; considering also intra and postoperative factors, operative time, presence of any complications and major complications were correlated independently with prolonged hospital stay. The identification of these factors allows not only better planning the institutional costs related to RRP but also proper counseling of patients undergoing RRP; potentially modifiable risk factors can be optimized to shorter length of hospital stay after RRP

To see if aggressive diuresis in first twenty four hours is associated with a comparable number of total days in the hospital as compared to non-aggressive diuresis. In this retrospective cohort study, we compared the length of hospital stay of consecutive patients admitted in one year based on their diuresis during the first twenty-four hours of hospitalization: aggressive diuresis (group 1) i.e. > 2400mL versus non-aggressive diuresis (group 2) i.e. ≤ 2400mL urine output. Patients were excluded if in cardiogenic shock, had creatinine level above 3 mg/dL on admission, or on dialysis. A total of 194 patients were enrolled (29 in group 1 and 165 in group 2 respectively). The Kaplan-Meier estimate of the median cumulative proportion of patients still hospitalized for the group 1 was 4 days and in group 2 was 5 days (log-rank test; P=0.67). In univariate analysis, Cox PH regression showed unadjusted hazard rate of discharge from hospital was slightly higher in group 1 than group 2 but was statistically non-significant (HR=1.08; P=0.70). In multivariate Cox model analysis, creatinine at the time of admission when greater than 1.6mg/dL (P=0.75), LVEF (P= 0.14), total twenty-four hours dose of intravenous Furosemide given (P=0.98) and interaction between Furosemide dose and Creatinine level (P=0.79) were not significant predictor of hospital discharge. Adjusted hazard rate for discharge from hospital was 12% higher in group 1 than group 2 but still statistically non-significant (HR=1.12; P=0.60). Since the length of hospital stay is similar between two groups, we suggest the goal of diuresis to be less than 2400mL in first twenty-four hours to prevent excessive dehydration.

Orientador: Paula Schimidt Azevedo Gaiolla / Resumo: A partir da década de 90, muito se discute sobre estratégias para melhorar a recuperação do paciente após a realização da cirurgia. Dentre elas está a redução do tempo de jejum no pré-operatório, com a administração de líquidos claros e a diminuição da infusão de fluidos no intra e pósoperatório. Essas medidas têm sido aplicadas em vários trabalhos e protocolos mostrando-se segura e influenciando no tempo de internação do paciente e em outras complicações. Portanto, os objetivos desse trabalho foram avaliar se o tempo de jejum e o volume infundido no perioperatório influenciam no tempo de internação e no aparecimento de lesão por pressão(LPP) de pacientes cirúrgicos.Para tanto, foram estudados pacientes submetidos a cirurgias do aparelho digestivo, vascular, ortopédica, uroló- gica e ginecológica. Foram avaliados dados demográficos, clínicos e laboratoriais, escalas de risco cirúrgico, de risco para LPP e risco nutricional. Após a cirurgia o paciente foi avaliado quanto ao aparecimento de LPP pela escala de Avaliação e Classificação da LPP e o tempo de internação. A comparação univariada entre os indivíduos que apresentaram ou não LPP ou que ficaram ou não internados por mais de 5 dias, foi realizada pelo teste t de student, Mann Whitnney para as variáveis numéricas, a depender da normalidade de distribuição. A comparação univariada entre as variáveis categóricas foram realizadas pelo teste de qui-quadrado. A regressão logística múltipla foi utilizada para pesquisar variáveis... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Since the 90’s, a lot has been discussed about strategies to improve the recovery of patients after surgery. One of them is the reduction of preoperative fasting time, with the administration of clear liquids and with the decrease of intra and postoperative fluid infusion. As a matter of fact, those measures have been applied in several studies and protocols proving to be safe and influencing hospitalization time and in other complications. Therefore, the objectives of this work were to evaluate if the fasting time and the volume infused in the perioperative, influencing in the hospitalization time and the appearance of pressure injury in surgical patients. Therefore, were studied patients submitted to the following surgeries: digestive, vascular, orthopedic, urological and gynecological. Demographic, clinical and laboratorial data were analyzed, surgical risk scale, risk for pressure injury and nutritional risk. After the surgery, the patient was evaluated for the appearance of pressure injury by the Evaluate Scale and Classification of Pressure injury and hospitalization time. The univariate comparison between the individuals who presented or not the pressure injury time of hospitalization lower than five days or higher than five days was performed by the tstudent test and Mann Whitnney for the numerical variables, depending on the normality of the distribution. The univariate comparison between the categorical variables were made through the qui-square test. The multiple l... (Complete abstract click electronic access below) / Mestre

<p>Många patienter upplever en känsla av oro och frustration under vårdvistelsen. Obehandlad oro kan leda till ökade komplikationer. Oro och ångest är vanligt förekommande hos patienter, men går ofta sjuksköterskan obemärkt förbi. Det är av betydelse att sjuksköterskan kan identifiera och kommunicera om känslor med patienten, samt känna trygghet i sitt sätt att kommunicera. Syftet var att belysa hur sjuksköterskan genom kommunikation kan hjälpa patienten att reducera oro och ångest under vårdvistelsen. Studien genomfördes som en litteraturstudie baserad på 16 vetenskapliga artiklar. Resultatet visade att identifiering är en förutsättning för att kunna reducera oro hos patienten. Faktorer som ökar oro är rädsla, tid och bristande kommunikationsfärdigheter hos sjuksköterskan. Patientcentrerad vård, samt interpersonell förmåga är av stor betydelse för att minska oro. Effektiv reducering av oro sker när sjuksköterskan tillämpar interaktionsprocesser. Betydelsen ligger i att finna kommunikativa tekniker som sjuksköterskan kan använda i mötet med patienten. Ett sätt kan vara att använda det sokratiska samtalet för att kommunicera om känslor. Vidare forskning om det sokratiska samtalets betydelse i omvårdnaden, för att minska oro hos patienten är av intresse.</p>

Många patienter upplever en känsla av oro och frustration under vårdvistelsen. Obehandlad oro kan leda till ökade komplikationer. Oro och ångest är vanligt förekommande hos patienter, men går ofta sjuksköterskan obemärkt förbi. Det är av betydelse att sjuksköterskan kan identifiera och kommunicera om känslor med patienten, samt känna trygghet i sitt sätt att kommunicera. Syftet var att belysa hur sjuksköterskan genom kommunikation kan hjälpa patienten att reducera oro och ångest under vårdvistelsen. Studien genomfördes som en litteraturstudie baserad på 16 vetenskapliga artiklar. Resultatet visade att identifiering är en förutsättning för att kunna reducera oro hos patienten. Faktorer som ökar oro är rädsla, tid och bristande kommunikationsfärdigheter hos sjuksköterskan. Patientcentrerad vård, samt interpersonell förmåga är av stor betydelse för att minska oro. Effektiv reducering av oro sker när sjuksköterskan tillämpar interaktionsprocesser. Betydelsen ligger i att finna kommunikativa tekniker som sjuksköterskan kan använda i mötet med patienten. Ett sätt kan vara att använda det sokratiska samtalet för att kommunicera om känslor. Vidare forskning om det sokratiska samtalets betydelse i omvårdnaden, för att minska oro hos patienten är av intresse.

OBJETIVOS: Avaliar o tempo de internação hospitalar e fatores preditores de internação prolongada após PRR realizada em instituição de ensino de alto volume cirúrgico. Objetivos secundários incluíram avaliar taxa de visitas não planejadas ao ambulatório e ao pronto-atendimento, readmissões hospitalares e taxa de complicações perioperatórias utilizando método de classificação padronizado. MÉTODOS: Foi realizada análise retrospectiva de dados prospectivamente coletados em base de dados padronizada para doentes portadores de câncer de próstata localizado submetidos a PRR no ICESP. Os procedimentos foram realizados por residentes do último ano de Urologia sob supervisão de um médico assistente (com experiência superior a 300 PRRs). Internação prolongada foi definida com internação > 2 dias (quartil superior). Um modelo de regressão logística incluindo apenas variáveis pré-operatórias foi inicialmente construído para determinar os fatores que predizem internação prolongada antes do ato cirúrgico; subsequentemente um segundo modelo incluindo tanto variáveis pré como intra e pós-operatórias foi analisado. As variáveis pré-operatórias incluídas no modelo foram: Idade, raça, IMC, PSA, índice de comorbidade de Charlson ajustado e não ajustado por idade, escore de ASA, cirurgias abdominais prévias, estádio clínico, volume prostático, Gleason da biópsia e porcentagem de fragmentos positivos, estratificação de risco NCCN. Os fatores intra e pós-operatórios incluídos na análise foram: tipo de anestesia, tempo operatório, sangramento estimado, transfusão sanguínea, preservação do feixe neurovascular, dissecção linfonodal, peso da próstata, volume tumoral, escore de Gleason do espécime, status da margem cirúrgica, estádio patológico e, finalmente, presença de complicações pós-operatórias (de acordo com o sistema de Clavien). RESULTADOS: Entre janeiro de 2010 e janeiro de 2012, 1011 pacientes foram submetidos a PRR em nossa instituição. A mediana de tempo de internação foi de 2 dias, sendo que 217 (21,5%) pacientes apresentaram internação prolongada. Os fatores preditores de internação prolongada dentre as variáveis pré-operatórias foram ICCa (OR. 1,317, IC95% 1,106-1,568, p=0,002) ou ICC não ajustado e idade separadamente (OR. 1,401, IC95% 1,118-1,756, p=0,003 e OR 1,050, IC95% 1,023-1,078, p < 0,001, respectivamente), escore de ASA 3 (OR. 3,260, IC95% 1,646-6,455, p < 0,001), volume prostático no USG-TR (OR, 1,005, IC95% 1,001-1,011, p=0,038) e raça negra (OR. 2,235, IC95% 1291-3,869, p=0,004); considerando-se também fatores intra e pós-operatórios na regressão, o tempo operatório (OR 1,007, IC95% 1,001-1,013, p=0,022) e presença de complicações de qualquer grau (OR 2,013, IC95% 1,192-3,399, p=0,009) ou complicações maiores (OR 2,357, IC95% 1,228-4,521, p=0,01) também foram correlacionados de maneira independente com internação prolongada. A taxa de readmissão hospitalar nesta série foi de 2,7%; visitas não programadas ao pronto atendimento ocorreram em 7,3% dos casos. A taxa global de complicações (intra e pós-operatórias) foi de 14,5%; a incidência de complicações pós-operatórias menores (graus 1 e 2) e maiores (Grau 3 ou 4) foi de 8,5% e 5,4%, respectivamente. CONCLUSÃO: Os fatores preditores independentes de internação prolongada dentre as variáveis pré-operatórias foram ICCa (ou ICC não ajustado e idade separadamente), escore de ASA 3, volume prostático no USG-TR e raça negra; considerando-se também fatores intra e pós-operatórios, o tempo operatório e presença de complicações de qualquer grau e complicações maiores foram correlacionados de maneira independente com internação prolongada. A identificação destes fatores permite não só auxiliar no planejamento de gastos e aconselhamento de pacientes, mas potencialmente promover modificações de variáveis que possam reduzir o tempo de admissão dos pacientes após PRR / OBJECTIVES: To evaluate the length hospital stay and predictors of prolonged hospitalization after RRP performed in a high-surgical volume teaching institution. Secondary objectives were to analyze the rate of unplanned visits to the office and emergency care, hospital readmissions and perioperative complications rates using a standardized classification system. METHODS: Retrospective analysis of prospectively collected data in a standardized database for patients with localized prostate cancer undergoing RRP in our institution. The procedures were performed by senior residents under the supervision of a staff surgeon (with prior experience larger than 300 RRPs). Prolonged hospitalization was defined as hospital stay longer than 2 days (upper quartile). A logistic regression model including only preoperative variables was initially built to determine the factors that predict prolonged hospital stay before the surgical procedure; subsequently, a second model including both pre and intraoperative variables was analyzed. Preoperative variables included in the model were age, race, BMI, PSA, Charlson comorbidity index (adjusted and not adjusted for age), ASA score, previous abdominal surgery, clinical stage, prostate volume, biopsy Gleason and percentage of positive cores, NCCN risk stratification. Intra and postoperative factors included in the analysis were: type of anesthesia, operative time, estimated bleeding loss, transfusion, nerve-sparing approach, lymph node dissection, prostate weight, tumor volume, Gleason score specimen, positive margin rates, pathologic stage, and, finally, the presence of postoperative complications (according to Clavien grading system). RESULTS: Between January 2010 and January 2012, 1011 patients underwent RRP at our institution. The median hospital stay was 2 days, and 217 (21.5%) patients had prolonged hospitalization. Predictors of prolonged hospital stay among the preoperative variables were ICCa (OR. 1.317, 95% CI 1.106 to 1.568, p = 0.002) or unadjusted ICC and age separately (OR. 1.401, 95% CI 1.118 to 1.756, p = 0.003 and OR 1.050, 95% CI 1.023 to 1.078, p < 0.001, respectively), ASA score of 3 (OR. 3.260, 95% CI 1.646 to 6.455, p < 0.001), prostate volume on USG-TR (OR, 1.005; 95% CI 1.001 -1.011, p = 0.038) and African-American race (OR 2.235, 95% CI 1291 to 3.869, p = 0.004).; considering also intra and postoperative factors, operative time (OR 1.007, 95% CI 1.001 to 1.013, p = 0.022) and the presence of any complications (OR 2.013, 95% CI 1.192 to 3.399, p = 0.009) or major complications (OR 2.357, 95% CI 1.228 to 4.521, p = 0.01) were also correlated independently with prolonged hospital stay. Hospital readmission rate in this series was 2.7%; unscheduled visits to emergency care occurred in 7.3% of cases. The complication rate was 14.5%; the incidence of minor (grades 1 and 2) and major complications (Grade 3 or 4) was 8.5% and 5.4%, respectively. CONCLUSION: The independent predictors of prolonged hospitalization among the preoperative variables were ICCa (or unadjusted ICC and age separately), ASA score of 3, prostate volume on USG-TR and African-American race; considering also intra and postoperative factors, operative time, presence of any complications and major complications were correlated independently with prolonged hospital stay. The identification of these factors allows not only better planning the institutional costs related to RRP but also proper counseling of patients undergoing RRP; potentially modifiable risk factors can be optimized to shorter length of hospital stay after RRP

Background: Sleep is one of mankind's basic needs and important for the experience of health, as well as essential for the patient's ability to recover. Lack of sleep has a negative effect on the ability to recover from the consequences of illness. Patients states that they have a negative quality of sleep during hospital stay. Aim: The aim of this study was to describe factors that influencing the night sleep of patients during hospital stay. Method: An overview of the literature was performed. Six quantitative, three qualitative and two mixed-method studies were included. Results: Two main categories emerged, which were; Environmental factors and physical- and psychological factors. The result showed that patients experienced environmental factor such as noise and lights, comfort and routines. Physical- and psychological factors experienced by patients was symptoms, anxiety and thoughts and also nurse's bedside manners. Conclusion: Nurses bedside manners have significant importance for patient's ability to experience a quality sleep. The result shows that factors affecting patients sleep are possible to influence and alter in order to enable best possible sleep for patients during hospital stay.