Piercarlo Ballo’s research while affiliated with Santa Maria Goretti Hospital and other places

Background It is common to observe a gap between the day on which the discharge criteria are reached and the actual day of discharge after colorectal surgery. The aim of this study is to understand the reasons for this difference and its clinical impact on the overall length of stay (LOS). Methods All patients enrolled in the prospective iCral3 study were analyzed regarding any difference and reason between the “fit for discharge” (FFD) and “actual discharge” (AD) dates. The association between the gap and the LOS in the whole population was then assessed through a multivariate regression model including other confounding variables. Results The analysis included 4529 patients, with a median [IQR] LOS of 6 [4–8] days. The median [IQR] LOS was 6 [4–8] days in the no-gap group (3,910 patients, 86.3%), significantly lower (p < .001) than 7 [6–10] days in the gap group (619 patients, 13.7%). Among the gap reasons, the “need for postoperative rehabilitation” compared to “not willing to return home” and “social constraints” was associated with the longest LOS (9 [6.0–12.5] days, p < 0.001 vs other reasons). The existence of the gap independently determined a 2.3-day lengthening of LOS. Conclusions Among other factors, the gap between FFD and AD had an independent impact on LOS. The most frequent reasons for this gap were “not willing to return home” and “social constraint”, while the “need for postoperative rehabilitation” had the greater clinical impact. Supplementary Information The online version contains supplementary material available at 10.1186/s13741-025-00492-1.

Background and Aims The assessment of left ventricular (LV) outflow velocity time integral (LVOT‐VTI) has gained favor in the stratification of patients with heart failure (HF). We evaluated the prognostic significance of LVOT‐VTI compared with the commonly used indices of LV outflow: cardiac index (CI) and stroke volume index (SVI), their reproducibility and cut‐off values. Methods and Results A total of 424 outpatients diagnosed with HF and LV systolic dysfunction (LV ejection fraction < 50%) underwent a Doppler echocardiographic examination, including the assessment of CI, SVI, and LVOT‐VTI. The Bland–Altman analysis showed LVOT‐VTI the most reproducible outflow index. The study follow‐up duration was 3.5 years (interquartile range 1.6–6.5), at the end of which there were 94 cardiovascular deaths (29%). Cox regression univariate analysis showed that LVOT‐VTI was the most predictive of the study end‐point. The ratio of tricuspid annular displacement‐to‐pulmonary artery systolic pressure (TAPSE/PASP) ( p < 0.0001), LVOT‐VTI ( p = 0.0011), and end‐systolic volume index ( p = 0.0036) independently predicted the study end‐point. At receiver‐operating characteristic (ROC) analysis, LVOT‐VTI < 12.0 cm had the best sensitivity and specificity for predicting cardiovascular mortality. Reduced LV EF ( p = 0.0011), raised BNP levels ( p = 0.0053), and high LV filling pressure ( p = 0.044) were associated with low LVOT‐VTI in multivariate logistic regression analysis. Patients with low LVOT‐VTI and TAPSE/PASP < 0.32 mm/mmHg exhibited the worst prognosis on Kaplan–Meier survival curves ( p < 0.0001). Conclusions A LVOT‐VTI < 12.0 cm represents the best predictor of the cardiovascular outcome and proved the most reproducible index of LV forward flow in patients with chronic HF and systolic dysfunction. The combination of impaired LVOT‐VTI with TAPSE/PASP showed the worst survival.

Background: Pectoral nerve block (PECS) is increasingly performed in breast surgery. Aim: The study evaluated the clinical impact of these blocks in the postoperative course. Patients & methods: In this case–control study, patients undergoing breast surgery with ‘enhanced recovery after surgery’ pathways were divided into group 1 (57 patients) in whom PECS was performed before general anesthesia, and group 2 (57 patients) in whom only general anesthesia was effected. Results: Postoperative opioid consumption (p < 0.002), pain at 32 h after surgery (p < 0.005) and the length of stay (p < 0.003) were significantly lower in group 1. Conclusion: Reducing opioid consumption and pain after surgery, PECS could favor a faster recovery with a reduction in length of stay, ensuring a higher turnover of patients undergoing breast surgery.

Background: Current literature underlines the role of periodical feed-back to improve Enhanced Recovery After Surgery (ERAS) path adherence during implementation program. The aim of this retrospective study was to evaluate the clinical impact of an audit program in an ERAS path. Methods: All elective patients submitted to elective colorectal surgery from November 2018 to January 2020 in our Institution were considered. The sample was divided into two study groups: group 1, including patients enrolled in the first sixth months of ERAS program until the first audit; group 2, patients enrolled in a time period of a six months after the first audit. Results: The final analysis included 46 patients in group 1 and 64 in group 2. Group 2 showed a higher ASA Score (P<0.03), a higher prevalence of right hemicolectomy, and a lower prevalence of left hemicolectomy and anterior rectum resection (RAR) (P<0.016). Group 2 also had a lower prevalence of anastomotic leakage (AL) (P<0.004). Intraoperative normothermia (T>36 C°) in this group was achieved in a larger number of patients in comparison with group 1 (39% vs. 19.5%) (P<0.01). Group 2 experienced a higher average body temperature at admission in recovery room (RR) when compared to Group 1 (35.8 vs. 35.1 C°, P<0.01). Conclusions: Audit program may represent a useful tool to promote advantageous changes in clinical practice and to favor a better compliance to ERAS program.

Purpose: The purpose of thisstudy was to evaluate the clinical impact of the Recovery Room (RR) in an Enhanced Recovery After Surgery (ERAS) pathway in colorectal surgery. Design: Single-center retrospective study. Methods: From November 2019 until September 2021, a total of 149 consecutive patients that underwent to colon-rectal surgery were enrolled. The patients were divided into two study groups: RR Group if admitted to RR after surgery, and no-Recovery Room (NRR) Group if monitored directly on the ward, bypassing the RR. The postoperative ERAS items adherence was assessed in the two study groups. Findings: Final analysis included 119 patients in the RR Group and 30 patients in NRR Group. Patients that started clear liquid oral intake within two hours postoperatively were 118 in the RR group and 19 in the NRR group (99.1% vs 63.3%, P < .001). A total of 98 patients and 18 patients were mobilized on day 0 in the RR group and in NRR group, respectively (84.4% vs 15.5%, P < .05). In the RR group, postoperative adherence to the ERAS protocol components was higher in comparison with the NRR group (P < .003); adherence to the all protocol components was also higher (P < .004). Conclusions: Among patients undergoing colorectal surgery admitted to RR after surgery, the RR nurse guaranteed effective patient assistance and ensured appropriate compliance to the postoperative ERAS items.

Background The purpose of the study was to analyze the adherence to a newly adopted Enhanced Recovery After Surgery (ERAS) program in a nonspecialized center as well as its impact on postoperative outcomes. Methods All patients who underwent elective colorectal surgery within ERAS protocol in the study period were enrolled. The sample was divided into group 1 (patients with protocol adherence < 85%) and group 2 (patients with protocol adherence > 85%). Clinical outcomes in terms of postoperative complications, readmission, reoperation rates, and length of stay were evaluated in the two groups. Results A total of 150 patients were included in the study. All procedures were performed laparoscopically (99.3%) except for one case. The overall adherence rate to the ERAS protocol components was 88.0 ± 10.5% and the overall length of stay was 5.9 ± 3.3 days. Group 2 (n = 101) experienced lower length of stay than group 1 (n = 49) ( P < 0.028). No differences in postoperative complications, readmission, and reoperation rates were observed between the two groups. Conclusions The implementation methods were effective in achieving relevant adherence rate and the newly adopted ERAS program applicable even in nonspecialized centers.

Anticoagulant drugs (i.e., unfractionated heparin, low-molecular-weight heparins, vitamin K antagonists, and direct oral anticoagulants) are widely employed in preventing and treating venous thromboembolism (VTE), in preventing arterial thromboembolism in nonvalvular atrial fibrillation (NVAF), and in treating acute coronary diseases early. In certain situations, such as bleeding, urgent invasive procedures, and surgical settings, the evaluation of anticoagulant levels and the monitoring of reversal therapy appear essential. Standard coagulation tests (i.e., activated partial thromboplastin time (aPTT) and prothrombin time (PT)) can be normal, and the turnaround time can be long. While the role of viscoelastic hemostatic assays (VHAs), such as rotational thromboelastometry (ROTEM), has successfully increased over the years in the management of bleeding and thrombotic complications, its usefulness in detecting anticoagulants and their reversal still appears unclear.