Doppler Ultrasound Devices Like Deltex CardioQ Could Help Address Excess Length of Stay in Bowel Surgery Patients With Major Complications


In Fluid Imbalance

By: James Pitt  Oct. 22, 2018

In goal-directed fluid therapy (GDT or GDFT), physicians use hemodynamic variables such as stroke volume (the amount of fluid the heart moves with each beat) to estimate the amount of fluid in circulation. Physicians provide fluid as needed to keep these hemodynamics variables near target values.

Randomized clinical trials have found that GDT with esophageal Doppler ultrasound reduces length of stay after surgery. Most such trials were small and specific to a single procedure; but December 2017 results from the FEDORA randomized clinical trial (n=450) found that GDFT using esophageal Doppler ultrasound to monitor stroke volume was associated with significantly lower postoperative complications and shorter length of stay after a variety of intermediate-risk surgical procedures.

In major bowel surgery patients, goal directed therapy with the Deltex CardioQ Doppler ultrasound has been associated with reduced length of stay (from 11.5 to 10 days) compared to conventional fluid management.

To study the burden of fluid imbalance on major bowel surgery patients, Dexur analysts examined length of stay in Medicare inpatient discharges with major bowel procedures with major complications or comorbidities (DRG 329) at 27 hospitals in Connecticut from 2013-2016. The weighted mean average length of stay was 14.8 days overall, 13.6 days in patients without fluid imbalance.

Effect of Fluid Imbalance on Length of Stay in Major Bowel Surgery w/ Major Complications/ Comorbidities Connecticut

The largest gap in length of stay between DRG 329 patients with fluid imbalance and DRG 329 patients overall was 4.04 days, at Milford Hospital (Milford, CT). If the finding that Doppler ultrasound-guided GDT can reduce LOS by 1.5 days in major bowel surgery patients is transferable to this Connecticut population, it could help reduce this length-of-stay gap at the 23 hospitals where fluid imbalance patients had excess lengths of stay.

DEXUR PRO MEMBERS GET ACCESS TO:

  1. Total DRG Discharges
  2. Total Fluid Imbalance Discharges at DRG
  3. % of Fluid Imbalance Discharges at DRG
  4. Avg. LOS at DRG
  5. Avg. LOS without Fluid Imbalance at DRG
  6. Avg. LOS with Fluid Imbalance at DRG
  7. Avg. Difference in LOS with & without Fluid Imbalance
  8. State Avg. Difference in LOS
  9. National Avg. Difference in LOS

For Medicare-eligible inpatient discharges with major bowel surgery, including diagnosis-related group 329, DRG 330, and DRG 331, from 2013-2016, at the following hospitals:

  1. Bridgeport Hospital (267 GRANT ST, BRIDGEPORT, CT, 06610)
  2. Bristol Hospital (41 BREWSTER RD, BRISTOL, CT, 06011)
  3. Charlotte Hungerford Hospital (540 LITCHFIELD ST, TORRINGTON, CT, 06790)
  4. CHI Health Lakeside (16901 LAKESIDE HILLS CT, OMAHA, NE, 68130)
  5. Danbury Hospital (24 HOSPITAL AVE, DANBURY, CT, 06810)
  6. Day Kimball Hospital (320 POMFRET STREET, PUTNAM, CT, 06260)
  7. Greenwich Hospital (5 PERRYRIDGE RD, GREENWICH, CT, 06830)
  8. Griffin Hospital (130 DIVISION ST, DERBY, CT, 06418)
  9. Hartford Hospital (80 SEYMOUR ST, HARTFORD, CT, 06102)
  10. Lawrence & Memorial Hospital (365 MONTAUK AVENUE, NEW LONDON, CT, 06320)
  11. Manchester Memorial Hospital (71 HAYNES ST, MANCHESTER, CT, 06040)
  12. Middlesex Hospital (28 CRESCENT ST, MIDDLETOWN, CT, 06457)
  13. MidState Medical Center (435 LEWIS AVE, MERIDEN, CT, 06451)
  14. Milford Hospital (300 SEASIDE AVE, MILFORD, CT, 06460)
  15. Norwalk Hospital (34 MAPLE ST, NORWALK, CT, 06850)
  16. Rockville General Hospital (31 UNION ST, VERNON, CT, 06066)
  17. Sharon Hospital (50 HOSPITAL HILL RD, SHARON, CT, 06069)
  18. Sharp Chula Vista Medical Center (751 MEDICAL CENTER CT, CHULA VISTA, CA, 91911)
  19. St Francis Hospital & Medical Center (114 WOODLAND ST, HARTFORD, CT, 06105)
  20. St Marys Hospital (56 FRANKLIN ST, WATERBURY, CT, 06706)
  21. St Vincents Medical Center (2800 MAIN ST, BRIDGEPORT, CT, 06606)
  22. Stamford Hospital (30 SHELBURNE RD, STAMFORD, CT, 06904)
  23. The Hospital of Central Connecticut - Bradley (100 GRAND ST, NEW BRITAIN, CT, 06052)
  24. The William W Backus Hospital (326 WASHINGTON ST, NORWICH, CT, 06360)
  25. UConn John Dempsey Hospital (263 FARMINGTON AVENUE, FARMINGTON, CT, 06030)
  26. Waterbury Hospital (64 ROBBINS ST, WATERBURY, CT, 06708)
  27. West Suburban Medical Center (3 ERIE CT, OAK PARK, IL, 60302)
  28. Windham Hospital (112 MANSFIELD AVE, WILLIMANTIC, CT, 06226)
  29. Yale New Haven Hospital (20 YORK ST, NEW HAVEN, CT, 06504)

ABOUT THE AUTHOR

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James Pitt

James Pitt is a science writer with experience in medical devices and textbook publishing. His hobbies include reading, flintknapping, and squinting at RStudio. He received a bachelor's in Human Evolutionary Biology from Harvard.