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Nzenwa IC, Abiad M, Rafaqat W, Lagazzi E, Panossian VS, Proaño-Zamudio JA, Hoekman AH, Arnold SC, Paranjape CN, DeWane MP, Velmahos GC, Hwabejire JO. Racial and Ethnic Disparities in Emergency General Surgery Outcomes Among Older Adult Patients. J Surg Res 2024; 301:674-680. [PMID: 39154423 DOI: 10.1016/j.jss.2024.07.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 07/11/2024] [Accepted: 07/19/2024] [Indexed: 08/20/2024]
Abstract
INTRODUCTION Racial and ethnic disparities in emergency general surgery (EGS) patients have been well described in the literature. Nonetheless, the burden of these disparities, specifically within the more vulnerable older adult population, is relatively unknown. This study aims to investigate racial and ethnic disparities in clinical outcomes among older adult patients undergoing EGS. METHODS This retrospective analysis used data from 2013 to 2019 American College of Surgeons National Surgery Quality Improvement Program database. EGS patients aged 65 y or older were included. Patients were categorized based on their self-reported race and ethnicity. The primary outcomes evaluated were in-hospital mortality, 30-d mortality, and overall morbidity. Multivariable logistic regression was performed to examine the relationship between race/ethnicity and postoperative outcomes while adjusting for relevant factors including age, comorbidities, functional status, preoperative conditions, and surgical procedure. RESULTS A total of 54,132 patients were included, of whom 79.8% identified as non-Hispanic White, 9.5% as non-Hispanic Black (NHB), 5.8% as Hispanic, and 4.2% as non-Hispanic Asian. After risk adjustment, compared to non-Hispanic White patients, NHB, non-Hispanic Asian, and Hispanic patients had decreased odds of 30-d mortality. For 30-d readmission and reoperation, differences among groups were comparable. However, NHB patients had significantly increased odds of overall morbidity (adjusted odds ratio, 1.18; 95% confidence interval: 1.10-1.26; P < 0.001) and postoperative complications including sepsis, venous thromboembolism, and unplanned intubation. Hispanic ethnicity was associated with lower odds of postoperative myocardial infarction and stroke. CONCLUSIONS Among older adult patients undergoing emergency general surgery, minority patients experienced higher morbidity rates, but paradoxical disparities in mortality were detected. Further research is necessary to identify the cause of these disparities and develop targeted interventions to eliminate them.
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Affiliation(s)
- Ikemsinachi C Nzenwa
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - May Abiad
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Wardah Rafaqat
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Emanuele Lagazzi
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Vahe S Panossian
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Jefferson A Proaño-Zamudio
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Anne H Hoekman
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Suzanne C Arnold
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Charudutt N Paranjape
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Michael P DeWane
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - George C Velmahos
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - John O Hwabejire
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts.
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Kloos J, Bassiri A, Ho VP, Sinopoli J, Vargas LT, Linden PA, Towe CW. Frailty is associated with 90-day mortality in urgent thoracic surgery conditions. JTCVS OPEN 2024; 17:336-343. [PMID: 38420542 PMCID: PMC10897653 DOI: 10.1016/j.xjon.2023.10.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 10/15/2023] [Accepted: 10/17/2023] [Indexed: 03/02/2024]
Abstract
Objective In patients undergoing elective thoracic surgery, frailty is associated with worse outcomes. However, the magnitude by which frailty influences outcomes of urgent thoracic surgery (UTS) is unknown. Methods We identified patients admitted with a UTS condition from January to September 2017 in the National Readmissions Database. UTS conditions were classified as esophageal perforation, hemo/pneumothorax, rib fracture, and obstructed hiatal hernia. Outcome of interest was mortality within 90 days of index admission. Frailty score was calculated using a deficit accumulation method. Cox proportional hazard modeling was used to calculate a hazard ratio for each combination of UTS disease type and frailty score, adjusted for sex, insurance payor, hospital size, and hospital and patient location, and was compared with the effect of frailty on elective lung lobectomy. Results We identified 107,487 patients with a UTS condition. Among UTS conditions overall, increasing frailty elements were associated with increased mortality (hazard ratio, 2270; 95% CI, 1463-3523; P < .001). Compared with patients without frailty undergoing elective lobectomy, increasing frailty demonstrated trending toward increased mortality in all diagnoses. The magnitude of the effect of frailty on 90-day mortality differed depending on the disease and level of frailty. Conclusions The effect of frailty on 90-day mortality after admission for urgent thoracic surgery conditions varies by disease type and level of frailty. Among UTS disease types, increasing frailty was associated with a higher 90-day risk of mortality. These findings suggest a valuable role for frailty evaluation in both clinical settings and administrative data for risk assessment.
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Affiliation(s)
- Jacqueline Kloos
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Aria Bassiri
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Vanessa P Ho
- Division of Trauma, Critical Care, Burns, and Acute Care Surgery, MetroHealth Medical Center, Cleveland, Ohio
| | - Jillian Sinopoli
- Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Leonidas Tapias Vargas
- Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Philip A Linden
- Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Christopher W Towe
- Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
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Hsuan C, Segel JE, Hsia RY, Wang Y, Rogowski J. Association of emergency department crowding with inpatient outcomes. Health Serv Res 2023; 58:828-843. [PMID: 36156243 PMCID: PMC10315392 DOI: 10.1111/1475-6773.14076] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE To examine the association of higher emergency department (ED) census with inpatient outcomes on the day of discharge (inpatient length of stay, in-hospital mortality, ED revisits, and readmissions). DATA SOURCES AND STUDY SETTING All-payer ED and inpatient discharge data and hospital characteristics data from all non-federal, general, and acute care hospitals in the state of California from October 1, 2015 to December 31, 2017. STUDY DESIGN In retrospective data analysis, we examined whether ED census was associated with inpatient outcomes for all inpatients, including those not admitted through the ED. The main predictor variable was ED census on day of discharge, categorized based on hospital year and day of week. Separate linear regression models with robust SEs and hospital fixed effects examined the association of ED census on inpatient outcomes (length of stay, 3-day ED revisit, 30-day all-cause readmission, in-hospital mortality), controlling for patient and visit-level factors. We stratified analyses by whether admission was elective or unscheduled. EXTRACTION METHODS Inpatient discharges in non-federal, general medical hospitals with EDs. PRINCIPAL FINDINGS We examined 5,784,253 discharges. The adjusted model showed that, compared to when the ED was below the median, higher ED census on the day of discharge was associated with longer inpatient length of stay, lower readmissions, and higher in-hospital mortality (90th percentile for length of stay: +0.8% [95% confidence interval, CI: +0.6% to +1.1%]; readmissions: -0.59 percentage points [or -5.6%] [95% CI: -0.0071 to -0.0048]; mortality: +0.14 percentage points [or +5.4%] [95% CI: +0.0009 to +0.0018]). [Correction added on 18 November 2022, after first online publication: '[odds rato, OR -5.6%]' and '[OR +5.4%]' of the preceding sentence have been corrected to '[or -5.6%]' and '[or +5.4%]', respectively, in this version.] Results for length of stay were primarily driven by patients with elective admissions, while results for readmissions and in-hospital mortality were primarily driven by patients with unscheduled admissions. CONCLUSIONS This study suggests that ED crowding may affect inpatients throughout the hospital, even patients who are already admitted to the hospital.
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Affiliation(s)
- Charleen Hsuan
- Department of Health Policy and AdministrationPennsylvania State UniversityState CollegePennsylvaniaUSA
| | - Joel E. Segel
- Department of Health Policy and AdministrationPennsylvania State UniversityState CollegePennsylvaniaUSA
- Penn State Cancer InstituteHersheyPennsylvaniaUSA
- Department of Public Health SciencesPennsylvania State UniversityState CollegePennsylvaniaUSA
| | - Renee Y. Hsia
- Department of Emergency MedicineUniversity of CaliforniaSan FranciscoCaliforniaUSA
- Philip R. Lee Institute for Health Policy StudiesUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Yinan Wang
- Department of Health Policy and AdministrationPennsylvania State UniversityState CollegePennsylvaniaUSA
| | - Jeannette Rogowski
- Department of Health Policy and AdministrationPennsylvania State UniversityState CollegePennsylvaniaUSA
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Jacobs MA, Tetley JC, Kim J, Schmidt S, Brimhall BB, Mika V, Wang CP, Manuel LS, Damien P, Shireman PK. Association of Cumulative Colorectal Surgery Hospital Costs, Readmissions, and Emergency Department/Observation Stays with Insurance Type. J Gastrointest Surg 2023; 27:965-979. [PMID: 36690878 PMCID: PMC10133377 DOI: 10.1007/s11605-022-05576-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 12/17/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND/PURPOSE Medicare's Hospital Readmission Reduction Program disproportionately penalizes safety-net hospitals (SNH) caring for vulnerable populations. This study assessed the association of insurance type with 30-day emergency department visits/observation stays (EDOS), readmissions, and cumulative costs in colorectal surgery patients. METHODS Retrospective inpatient cohort study using the National Surgical Quality Improvement Program (2013-2019) with cost data in a SNH. The odds of EDOS and readmissions and cumulative variable (index hospitalization and all 30-day EDOS and readmissions) costs were modeled adjusting for frailty, case status, presence of a stoma, and open versus laparoscopic surgery. RESULTS The cohort had 245 private, 195 Medicare, and 590 Medicaid/uninsured cases, with a mean age 55.0 years (SD = 13.3) and 52.9% of the cases were performed on male patients. Most cases were open surgeries (58.7%). Complication rates were 41.8%, EDOS 12.0%, and readmissions 20.1%. Medicaid/uninsured had increased odds of urgent/emergent surgeries (aOR = 2.15, CI = 1.56-2.98, p < 0.001) and complications (aOR = 1.43, CI = 1.02-2.03, p = 0.042) versus private patients. Medicaid/uninsured versus private patients had higher EDOS (16.6% versus 4.1%) and readmissions (22.9% versus 14.3%) rates and higher odds of EDOS (aOR = 4.81, CI = 2.57-10.06, p < 0.001), and readmissions (aOR = 1.62, CI = 1.07-2.50, p = 0.025), while Medicare patients had similar odds versus private. Cumulative variable cost %change was increased for Medicare and Medicaid/uninsured, but Medicaid/uninsured was similar to private after adjusting for urgent/emergent cases. CONCLUSIONS Increased urgent/emergent cases in Medicaid/uninsured populations drive increased complications odds and higher costs compared to private patients, suggesting lack of access to outpatient care. SNH care for higher cost populations, receive lower reimbursements, and are penalized by value-based programs. Increasing healthcare access for Medicaid/uninsured patients could reduce urgent/emergent surgeries, resulting in fewer complications, EDOS/readmissions, and costs.
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Affiliation(s)
- Michael A Jacobs
- Department of Surgery, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Jasmine C Tetley
- Department of Surgery, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Jeongsoo Kim
- Department of Surgery, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Susanne Schmidt
- Department of Population Health Sciences, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Bradley B Brimhall
- Department of Pathology and Laboratory Medicine, University of Texas Health San Antonio, San Antonio, TX, USA
- University Health, San Antonio, TX, USA
| | | | - Chen-Pin Wang
- Department of Population Health Sciences, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Laura S Manuel
- Business Intelligence and Data Analytics, University of Texas Health Physicians, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Paul Damien
- Department of Information, Risk, and Operations Management, School of Business, University of Texas, Red McCombs, Austin, TX, USA
| | - Paula K Shireman
- Department of Surgery, University of Texas Health San Antonio, San Antonio, TX, USA.
- University Health, San Antonio, TX, USA.
- Departments of Primary Care & Rural Medicine and Medical Physiology, School of Medicine, Texas A&M Health, Bryan, TX, USA.
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Connelly TM, Clancy C, Cheong JY, Jia X, Bhama AR, Lightner A, Kessler H, Valente M, Holubar SD. What is the real morbidity after emergency colectomy for Crohn's disease? A propensity score matched study. Tech Coloproctol 2023; 27:309-315. [PMID: 36376698 DOI: 10.1007/s10151-022-02727-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 11/01/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND In the inflammatory bowel disease literature, emergency surgery for Crohn's disease (CD) is associated with worse postoperative outcomes as compared to elective surgery. Previous studies have compared heterogeneous groups only. We hypothesized that this association would be lost after matched analysis. We aimed to compare matched CD patients undergoing elective vs emergency surgery. METHODS The National Surgical Quality Improvement database (01/2005-12/2019) was utilized to identify adult CD surgical patients. Univariate and conditional logistic regression models were used to analyze unmatched and matched cohorts. Propensity-score matching was performed to match emergency to non-emergency patients 1:1. Our primary outcome was a composite of any complication. Our secondary endpoints were hospital readmission, unplanned reoperation and 30-day morbidity and mortality. RESULTS In the unmatched analyses (n = 12,181/95.28% elective and n = 603/4.72% emergency) of Crohn's patients undergoing colectomy, 20% of elective and 42% of emergency patients experienced a complication (p < 0.001). Over 20 outcomes measured including length of stay (LOS), readmission, infections and respiratory, cardiovascular and renal complications, were worse in the emergency cohort. In the matched analyses (n = 400 emergency/400 elective patients) only the categories of any complication (OR 1.44, 1.06-1.96 95% CI, p = 0.02), any surgical site infection (SSI, OR 1.53, 1.07-2.19 95% CI, p = 0.02), superficial SSI (OR 2.25, 1.14-4.44 95% CI, p = 0.02), organ space SSI (1.58 OR 1.04-2.4 95% CI, p = 0.03), unplanned intubation (OR 5.0, 1.45-17.27 95% CI, p = 0.01), ventilation > 48 h (OR 9.0, 1.4-38.79 95% CI, p = 0.003) and septic shock (OR 4.5, 1.86-10.9 95% CI, p < 0.001) were higher in the emergency cohort. CONCLUSIONS Matching CD patients resulted in a loss of the observed increase in cardiovascular and renal complications, reoperation and LOS following emergency surgery; however, SSIs and respiratory complications remained increased despite matching.
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Affiliation(s)
- T M Connelly
- Digestive Disease and Surgery Institute, Department of Colorectal Surgery, Cleveland Clinic, 9500 Euclid Ave/A 30, Cleveland, OH, 44195, USA
| | - C Clancy
- Digestive Disease and Surgery Institute, Department of Colorectal Surgery, Cleveland Clinic, 9500 Euclid Ave/A 30, Cleveland, OH, 44195, USA
| | - J Y Cheong
- Digestive Disease and Surgery Institute, Department of Colorectal Surgery, Cleveland Clinic, 9500 Euclid Ave/A 30, Cleveland, OH, 44195, USA
| | - X Jia
- Digestive Disease and Surgery Institute, Department of Colorectal Surgery, Cleveland Clinic, 9500 Euclid Ave/A 30, Cleveland, OH, 44195, USA
| | - A R Bhama
- Digestive Disease and Surgery Institute, Department of Colorectal Surgery, Cleveland Clinic, 9500 Euclid Ave/A 30, Cleveland, OH, 44195, USA
| | - A Lightner
- Digestive Disease and Surgery Institute, Department of Colorectal Surgery, Cleveland Clinic, 9500 Euclid Ave/A 30, Cleveland, OH, 44195, USA
| | - H Kessler
- Digestive Disease and Surgery Institute, Department of Colorectal Surgery, Cleveland Clinic, 9500 Euclid Ave/A 30, Cleveland, OH, 44195, USA
| | - M Valente
- Digestive Disease and Surgery Institute, Department of Colorectal Surgery, Cleveland Clinic, 9500 Euclid Ave/A 30, Cleveland, OH, 44195, USA
| | - S D Holubar
- Digestive Disease and Surgery Institute, Department of Colorectal Surgery, Cleveland Clinic, 9500 Euclid Ave/A 30, Cleveland, OH, 44195, USA.
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Seeto AH, Nabi H, Burstow MJ, Lancashire RP, Grundy J, Gillespie C, Nguyen K, Naidu S, Chua TC. Perioperative outcomes of emergency and elective colorectal surgery: a bi-institutional study. ANZ J Surg 2022; 93:926-931. [PMID: 36203389 DOI: 10.1111/ans.18091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 09/21/2022] [Accepted: 09/22/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Emergency colorectal surgery tends to be associated with poorer outcomes compared to elective colorectal surgery. This study assessed the morbidity and mortality in patients undergoing emergency and elective colorectal resection in two metropolitan hospitals. METHODS Patients were identified retrospectively from two institutions between April 2018 and July 2020. Baseline, operative and postoperative parameters were collected for comparative analysis between emergency and elective surgery groups. A binary logistic regression was performed to identify independent predictors of postoperative complications. RESULTS During the study period, 454 patients underwent colorectal resection, 135 were emergency cases (29.74%) and 319 were elective cases (70.26%). Compared with elective resections, patients undergoing emergency resections were observed to have a higher American Society of Anesthesiologists (ASA) score of III to IV (53.33% vs. 38.56%) (P = 0.004). The mortality rate was similar between the emergency and elective group (1.48% vs. 0.63%, P = 0.369). The overall complication rate was higher in patients undergoing emergency resections (64.44% vs. 36.68%, P < 0.001), but the major complication rate was similar between groups (12.59% vs. 10.34%, P = 0.484). Independent predictors for postoperative complications included emergency surgery (Odds Ratio (OR) 2.77, 95% Confidence Interval (CI): 1.66 to 4.61) and an ASA Score of III to IV (OR 2.87, 95% CI: 1.84 to 4.47). CONCLUSION The overall complication rate was higher in patients undergoing emergency colorectal resection, however, rates of major complications and mortality were similar between groups. Higher complication rates reflect advanced disease pathology in patients who are more comorbid.
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Affiliation(s)
- Alexander H Seeto
- Department of General Surgery, Queen Elizabeth II Jubilee Hospital, Brisbane, Queensland, Australia.,School of Medicine, Griffith University, Gold Coast, Queensland, Australia
| | - Hajir Nabi
- Department of General Surgery, Logan Hospital, Brisbane, Queensland, Australia
| | - Matthew J Burstow
- School of Medicine, Griffith University, Gold Coast, Queensland, Australia.,Department of General Surgery, Logan Hospital, Brisbane, Queensland, Australia
| | - Raymond P Lancashire
- Department of General Surgery, Queen Elizabeth II Jubilee Hospital, Brisbane, Queensland, Australia
| | - Joshua Grundy
- Department of General Surgery, Queen Elizabeth II Jubilee Hospital, Brisbane, Queensland, Australia
| | - Christopher Gillespie
- Department of General Surgery, Queen Elizabeth II Jubilee Hospital, Brisbane, Queensland, Australia
| | - Khuong Nguyen
- Department of General Surgery, Queen Elizabeth II Jubilee Hospital, Brisbane, Queensland, Australia
| | - Sanjeev Naidu
- Department of General Surgery, Queen Elizabeth II Jubilee Hospital, Brisbane, Queensland, Australia
| | - Terence C Chua
- Department of General Surgery, Queen Elizabeth II Jubilee Hospital, Brisbane, Queensland, Australia.,School of Medicine, Griffith University, Gold Coast, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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Minimally-invasive approach to emergent colorectal surgery in aging adults: A report from the Surgical Care Outcomes Assessment Program. Am J Surg 2022; 224:751-756. [DOI: 10.1016/j.amjsurg.2022.03.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 02/07/2022] [Accepted: 03/31/2022] [Indexed: 11/23/2022]
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Huang CB, Hong CX, Xu TH, Zhao DY, Wu ZY, Chen L, Xie J, Jin C, Wang BZ, Yang L. Risk Factors for Pulmonary Embolism in ICU Patients: A Retrospective Cohort Study from the MIMIC-III Database. Clin Appl Thromb Hemost 2022; 28:10760296211073925. [PMID: 35043708 DOI: 10.1177/10760296211073925] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Pulmonary embolism (PE) is a common and potentially lethal form of venous thromboembolic disease in ICU patients. A limited number of risk factors have been associated with PE in ICU patients. In this study, we aimed to screen the independent risk factors of PE in ICU patients that can be used to evaluate the patient's condition and provide targeted treatment. We performed a retrospective cohort study using a freely accessible critical care database Medical Information Mart for Intensive Care (MIMIC)-III. The ICU patients were divided into two groups based on the incidence of PE. Finally, 9871 ICU patients were included, among which 204 patients (2.1%) had pulmonary embolism. During the multivariate logistic regression analysis, sepsis, hospital_LOS (the length of stay in hospital), type of admission, tumor, APTT (activated partial thromboplastin time) and platelet were independent risk factors for patients for PE in ICU, with OR values of 1.471 (95%CI 1.001-2.162), 1.001 (95%CI 1.001-1.001), 3.745 (95%CI 2.187-6.414), 1.709 (95%CI 1.247-2.341), 1.014 (95%CI 1.010-1.017) and 1.002 (95%CI 1.001-1.003) (Ps < 0.05). ROC curve analysis showed that the composite indicator had a higher predictive value for ICU patients with PE, with a ROC area under the curve (AUC) of 0.743 (95%CI 0.710 -0.776, p < 0.001). Finally, sepsis, tumor, platelet count, length of stay in the hospital, emergency admission and APTT were independent predictors of PE in ICU patients.
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Affiliation(s)
- Cheng-Bin Huang
- 26452The Second Affiliated Hospital and Yuying Childrens Hospital of Wenzhou Medical University, Wenzhou, China.,Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, China
| | - Chen-Xuan Hong
- 26452The Second Affiliated Hospital and Yuying Childrens Hospital of Wenzhou Medical University, Wenzhou, China.,Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, China
| | - Tian-Hao Xu
- 26452The Second Affiliated Hospital and Yuying Childrens Hospital of Wenzhou Medical University, Wenzhou, China.,Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, China
| | - Ding-Yun Zhao
- 26452The Second Affiliated Hospital and Yuying Childrens Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zong-Yi Wu
- 26452The Second Affiliated Hospital and Yuying Childrens Hospital of Wenzhou Medical University, Wenzhou, China
| | - Liang Chen
- 26452The Second Affiliated Hospital and Yuying Childrens Hospital of Wenzhou Medical University, Wenzhou, China.,Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, China
| | - Jun Xie
- 26452The Second Affiliated Hospital and Yuying Childrens Hospital of Wenzhou Medical University, Wenzhou, China.,Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, China
| | - Chen Jin
- 26452The Second Affiliated Hospital and Yuying Childrens Hospital of Wenzhou Medical University, Wenzhou, China.,Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, China
| | - Bing-Zhang Wang
- 26452The Second Affiliated Hospital and Yuying Childrens Hospital of Wenzhou Medical University, Wenzhou, China.,Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, China
| | - Lei Yang
- 26452The Second Affiliated Hospital and Yuying Childrens Hospital of Wenzhou Medical University, Wenzhou, China.,Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, China
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Hajirawala LN, Krishnan V, Leonardi C, Bevier-Rawls ER, Orangio GR, Davis KG, Klinger AL, Barton JS. Minimally Invasive Surgery is Associated with Improved Outcomes Following Urgent Inpatient Colectomy. JSLS 2022; 26:JSLS.2021.00075. [PMID: 35281708 PMCID: PMC8896814 DOI: 10.4293/jsls.2021.00075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objectives The use of minimally invasive techniques for urgent colectomies remains understudied. This study compares short-term outcomes following urgent minimally invasive colectomies to those following open colectomies. Methods & Procedures The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) colectomy database was queried between January 1, 2013 and December 31, 2018. Patients who underwent elective and emergency colectomies, based on the respective NSQIP variables, were excluded. The remaining patients were divided into two groups, minimally invasive surgery (MIS) and open. MIS colectomies with unplanned conversion to open were included in the MIS group. Baseline characteristics and 30-day outcomes were compared using univariable and multivariable regression analyses. Results A total of 29,345 patients were included in the study; 12,721 (43.3%) underwent MIS colectomy, while 16,624 (56.7%) underwent open colectomy. Patients undergoing MIS colectomy were younger (60.6 vs 63.8 years) and had a lower prevalence of either American Society of Anesthesiology (ASA) IV (9.9 vs 15.5%) or ASA V (0.08% vs 2%). After multivariable analysis, MIS colectomy was associated with lower odds of mortality (odds ratio = 0.75, 95% confidence interval: 0.61, 0.91 95% confidence interval), and most short-term complications recorded in the ACS NSQIP. While MIS colectomies took longer to perform (161 vs 140 min), the length of stay was shorter (12.2 vs 14.1 days). Conclusions MIS colectomy affords better short-term complication rates and a reduced length of stay compared to open colectomy for patients requiring urgent surgery. If feasible, minimally invasive colectomy should be offered to patients necessitating urgent colon resection.
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Affiliation(s)
- Luv N Hajirawala
- Section of Colorectal Surgery, Department of Surgery Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Varun Krishnan
- Section of Colorectal Surgery, Department of Surgery Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Claudia Leonardi
- School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Elyse R Bevier-Rawls
- Section of Colorectal Surgery, Department of Surgery Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Guy R Orangio
- Section of Colorectal Surgery, Department of Surgery Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Kurt G Davis
- Section of Colorectal Surgery, Department of Surgery Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Aaron L Klinger
- Section of Colorectal Surgery, Department of Surgery Louisiana State University Health Sciences Center, New Orleans, LA, USA
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