Browsing by Author "Shrestha, Sunil"
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Publication Analysis of Outcomes of Critically ill Surgical Patients using SAPS II Score(Institute of Medicine, 2019) Paudel, Prakash; Rai, Subash; Shrestha, Sunil; Pradhan, Giridhar BN; Bhattachan, Chitra LABSTRACT Introduction Several prognostic models have been implemented for risk assessment and mortality prediction in critically ill patients admitted in ICU. The availability of such sophisticated methods has facilitated in clinical decision making and comparison of outcomes. However, none are universally accepted as standard method to predict mortality. We have decided to use SAPS II score because of the simplicity and easy availability of its variables to analyse the outcomes of critically ill surgical patients admitted to ICU at our centre. Methods The study was conducted between September 2016 and August 2018 at Nepal Medical College and Teaching Hospital, Kathmandu, Nepal. We prospectively collected data on surgical patients consecutively admitted to the ICU during the study period. The variables of SAPS II score were collected from the physiological, laboratory, and patient characteristics mentioned in the ICU scoring data sheet at 24 hours. The SAPS II score and predicted mortality was calculated using computer software programme. The predictive mortality based on the score was compared with the actual outcome to derive the standardized mortality ratio (SMR). Results During the period of study, 64 patients met the inclusion criteria. The mean age of the patients was 54±17.9 (20-84) years and length of ICU stay was 5.3 ±3.5 (3-22) days. GI malignancy was most common pathology comprising 43.8% (n=28). The mean SAPS II score was 24.9±16.4 (3-68). There was no statistical difference in mean SAPS II score between patients with different gender, nature of disease and type of surgical intervention The mean predicted mortality was 13.4% and the observed ICU mortality was 15.6% (n=10). The calculated mean SAPS II score and predicted mortality was higher in nonsurvivors compared to survivors (p<0.0001). The calculated SMR for our study population was 0.85 ranging from 0.01 to 5.2. The number of patients with SMR greater than 1 was only 17 % (11/64). There was significant correlation of mortality with SMR greater than 1 (p=<0.0001). Conclusion The variables in SAPS II score are readily available. Neither special samples nor cumbersome procedures are required. SAPS II can be used as simple and rapid tool to predict mortality in critically ill surgical patients in our set up. Keywords: Critically ill, intensive care unit, mortality, outcome, SAPS IIPublication Hernia among Patients Admitted to the Department of Surgery of a Tertiary Care Centre(Nepal Medical Association, 2023) Yadav, Raj Nandan; Maharjan, Jemesh Singh; Bajracharya, Jasmine; Pradhan, Giridhar B.N.; Shrestha, SunilAbstract Introduction: Hernia is one of the most common surgical conditions causing disability and requiring hospital admission and surgery. The aim of this study was to find out the prevalence of hernia among patients admitted to the Department of Surgery of a tertiary care centre. Methods: A descriptive cross-sectional study was conducted among patients admitted to the Department of Surgery between 14 April 2021 and 13 April 2023 and were collected from 1 July 2023 to 31 July 2023 from the hospital records. Ethical approval was obtained from the Institutional Review Committee. The patient admitted to the Department of Surgery was included and those with incomplete data were excluded. Convenience sampling was used. The point estimate was calculated at a 95% Confidence Interval. Results: Out of 2057 patients, the prevalence of hernia was 247 (12.01%) (10.61-13.41, 95% Confidence Interval). A total of 31 (12.55%) hernias were irreducible and 15 (6.07%) were operated in the emergency setting. The most common type of hernia was inguinal hernia found in 169 (68.42%) and hypertension was the most common comorbidities found in 48 (19.43%). Conclusions: The prevalence of hernia was similar to other studies done in similar settings. Hernia accounts for a major surgical burden in our setting. So, early diagnosis and treatment could reduce the morbidity and mortality related to it.