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Lagina M, Ashana DC, Viglianti EM. Sex-Based Differences in Receipt of ICU Care: Nuances in Understanding "Less Is Better?". Crit Care Med 2024; 52:136-138. [PMID: 38095518 PMCID: PMC10751064 DOI: 10.1097/ccm.0000000000006088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Affiliation(s)
- Madeline Lagina
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI
| | - Deepshikha C Ashana
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Duke University, Durham, NC
| | - Elizabeth M Viglianti
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI
- Center for Clinical Management Research (CCMR) Veteran Affairs Ann Arbor, Ann Arbor VA
- Institute for Healthcare Policy and Innovation (IHPI), University of Michigan, Ann Arbor, MI
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Sridharan G, Fleury Y, Hergafi L, Doll S, Ksouri H. Triage of Critically Ill Patients: Characteristics and Outcomes of Patients Refused as Too Well for Intensive Care. J Clin Med 2023; 12:5513. [PMID: 37685579 PMCID: PMC10488145 DOI: 10.3390/jcm12175513] [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: 07/31/2023] [Revised: 08/15/2023] [Accepted: 08/21/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND The appropriate selection of patients for the intensive care unit (ICU) is a concern in acute care settings. However, the description of patients deemed too well for the ICU has been rarely reported. METHODS We conducted a single-centre retrospective observational study of all patients either deemed "too well" for or admitted to the ICU during one year. Refused patients were screened for unexpected events within 7 days, defined as either ICU admission without another indication, or death without treatment limitations. Patients' characteristics and organisational factors were analysed according to refusal status, outcome and delay in ICU admission. RESULTS Among 2219 enrolled patients, the refusal rate was 10.4%. Refusal was associated with diagnostic groups, treatment limitations, patients' location on a ward, night time and ICU occupancy. Unexpected events occurred in 16 (6.9%) refused patients. A worse outcome was associated with time spent in hospital before refusal, patients' location on a ward, SOFA score and physician's expertise. Delayed ICU admissions were associated with ICU and hospital length of stay. CONCLUSIONS ICU triage selected safely most patients who would have probably not benefited from the ICU. We identified individual and organisational factors associated with ICU refusal, subsequent ICU admission or death.
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Affiliation(s)
- Govind Sridharan
- Department of Intensive Care Medicine, Fribourg Hospital, CH-1700 Fribourg, Switzerland; (Y.F.); (L.H.); (S.D.); (H.K.)
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Baumann SM, De Stefano P, Kliem PSC, Grzonka P, Gebhard CE, Sarbu OE, De Marchis GM, Hunziker S, Rüegg S, Kleinschmidt A, Pugin J, Quintard H, Marsch S, Seeck M, Sutter R. Sex-related differences in adult patients with status epilepticus: a seven-year two-center observation. Crit Care 2023; 27:308. [PMID: 37543625 PMCID: PMC10403848 DOI: 10.1186/s13054-023-04592-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 07/28/2023] [Indexed: 08/07/2023] Open
Abstract
BACKGROUND Conflicting findings exist regarding the influence of sex on the development, treatment, course, and outcome of status epilepticus (SE). Our study aimed to investigate sex-related disparities in adult SE patients, focusing on treatment, disease course, and outcome at two Swiss academic medical centers. METHODS In this retrospective study, patients treated for SE at two Swiss academic care centers from Basel and Geneva from 2015 to 2021 were included. Primary outcomes were return to premorbid neurologic function, death during hospital stay and at 30 days. Secondary outcomes included characteristics of treatment and disease course. Associations with primary and secondary outcomes were assessed using multivariable logistic regression. Analysis using propensity score matching was performed to account for the imbalances regarding age between men and women. RESULTS Among 762 SE patients, 45.9% were women. No sex-related differences were found between men and women, except for older age and lower frequency of intracranial hemorrhages in women. Compared to men, women had a higher median age (70 vs. 66, p = 0.003), had focal nonconvulsive SE without coma more (34.9% vs. 25.5%; p = 0.005) and SE with motor symptoms less often (52.3% vs. 63.6%, p = 0.002). With longer SE duration (1 day vs. 0.5 days, p = 0.011) and a similar proportion of refractory SE compared to men (36.9% vs. 36.4%, p = 0.898), women were anesthetized and mechanically ventilated less often (30.6% vs. 42%, p = 0.001). Age was associated with all primary outcomes in the unmatched multivariable analyses, but not female sex. In contrast, propensity score-matched multivariable analyses revealed decreased odds for return to premorbid neurologic function for women independent of potential confounders. At hospital discharge, women were sent home less (29.7% vs. 43.7%, p < 0.001) and to nursing homes more often (17.1% vs. 10.0%, p = 0.004). CONCLUSIONS This study identified sex-related disparities in the clinical features, treatment modalities, and outcome of adult patients with SE with women being at a disadvantage, implying that sex-based factors must be considered when formulating strategies for managing SE and forecasting outcomes.
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Affiliation(s)
- Sira M Baumann
- Clinic for Intensive Care Medicine, Department of Acute Care, University Hospital Basel, Basel, Switzerland
| | - Pia De Stefano
- Neuro-Intensive Care Unit, Department of Intensive Care, University Hospital of Geneva, Geneva, Switzerland
- EEG & Epilepsy Unit, Department of Clinical Neurosciences, University Hospital of Geneva, Geneva, Switzerland
| | - Paulina S C Kliem
- Clinic for Intensive Care Medicine, Department of Acute Care, University Hospital Basel, Basel, Switzerland
| | - Pascale Grzonka
- Clinic for Intensive Care Medicine, Department of Acute Care, University Hospital Basel, Basel, Switzerland
| | - Caroline E Gebhard
- Clinic for Intensive Care Medicine, Department of Acute Care, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Oana E Sarbu
- Neuro-Intensive Care Unit, Department of Intensive Care, University Hospital of Geneva, Geneva, Switzerland
- EEG & Epilepsy Unit, Department of Clinical Neurosciences, University Hospital of Geneva, Geneva, Switzerland
| | - Gian Marco De Marchis
- Department of Neurology, University Hospital Basel, Basel, Switzerland
- Medical Faculty of the University of Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Sabina Hunziker
- Clinic for Intensive Care Medicine, Department of Acute Care, University Hospital Basel, Basel, Switzerland
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Stephan Rüegg
- Department of Neurology, University Hospital Basel, Basel, Switzerland
- Medical Faculty of the University of Basel, Basel, Switzerland
| | - Andreas Kleinschmidt
- EEG & Epilepsy Unit, Department of Clinical Neurosciences, University Hospital of Geneva, Geneva, Switzerland
- Medical Faculty of the University of Geneva, Geneva, Switzerland
| | - Jérôme Pugin
- Neuro-Intensive Care Unit, Department of Intensive Care, University Hospital of Geneva, Geneva, Switzerland
- Medical Faculty of the University of Geneva, Geneva, Switzerland
| | - Hervé Quintard
- Neuro-Intensive Care Unit, Department of Intensive Care, University Hospital of Geneva, Geneva, Switzerland
- Medical Faculty of the University of Geneva, Geneva, Switzerland
| | - Stephan Marsch
- Clinic for Intensive Care Medicine, Department of Acute Care, University Hospital Basel, Basel, Switzerland
- Medical Faculty of the University of Basel, Basel, Switzerland
| | - Margitta Seeck
- EEG & Epilepsy Unit, Department of Clinical Neurosciences, University Hospital of Geneva, Geneva, Switzerland
- Medical Faculty of the University of Geneva, Geneva, Switzerland
| | - Raoul Sutter
- Clinic for Intensive Care Medicine, Department of Acute Care, University Hospital Basel, Basel, Switzerland.
- Department of Neurology, University Hospital Basel, Basel, Switzerland.
- Medical Faculty of the University of Basel, Basel, Switzerland.
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland.
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Aamodt WW, Bilker WB, Willis AW, Farrar JT. Sociodemographic and Geographic Disparities in End-of-Life Health Care Intensity Among Medicare Beneficiaries With Parkinson Disease. Neurol Clin Pract 2023; 13:e200171. [PMID: 37251369 PMCID: PMC10212234 DOI: 10.1212/cpj.0000000000200171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 03/30/2023] [Indexed: 05/31/2023]
Abstract
Background and Objective Current studies of end-of-life care in Parkinson disease (PD) do not focus on diverse patient samples or provide national views of end-of-life resource utilization. We determined sociodemographic and geographic differences in end-of-life inpatient care intensity among persons with PD in the United States (US). Methods This retrospective cohort study included Medicare Part A and Part B beneficiaries 65 years and older with a qualifying PD diagnosis who died between January 1, 2017, and December 31, 2017. Medicare Advantage beneficiaries and those with atypical or secondary parkinsonism were excluded. Primary outcomes included rates of hospitalization, intensive care unit (ICU) admission, in-hospital death, and hospice discharge in the last 6 months of life. Descriptive analyses and multivariable logistic regression models compared differences in end-of-life resource utilization and treatment intensity. Adjusted models included demographic and geographic variables, Charlson Comorbidity Index score, and Social Deprivation Index score. The national distribution of primary outcomes was mapped and compared by hospital referral region using Moran I. Results Of 400,791 Medicare beneficiaries with PD in 2017, 53,279 (13.3%) died. Of decedents, 33,107 (62.1%) were hospitalized in the last 6 months of life. In covariate-adjusted regression models using White male decedents as the reference category, odds of hospitalization was greater for Asian (AOR 1.38; CI 1.11-1.71) and Black (AOR 1.23; CI 1.08-1.39) male decedents and lower for White female decedents (AOR 0.80; CI 0.76-0.83). ICU admissions were less likely in female decedents and more likely in Asian, Black, and Hispanic decedents. Odds of in-hospital death was greater among Asian (AOR 2.49, CI 2.10-2.96), Black (AOR 1.11, CI 1.00-1.24), Hispanic (AOR 1.59; CI 1.33-1.91), and Native American (AOR 1.49; CI 1.05-2.10) decedents. Asian and Hispanic male decedents were less likely to be discharged to hospice. In geographical analyses, rural-dwelling decedents had lower odds of ICU admission (AOR 0.77; CI 0.73-0.81) and hospice discharge (AOR 0.69; CI 0.65-0.73) than urban-dwelling decedents. Nonrandom clusters of primary outcomes were observed across the US, with highest rates of hospitalization in the South and Midwest (Moran I = 0.134; p < 0.001). Discussion Most persons with PD in the US are hospitalized in the last 6 months of life, and treatment intensity varies by sex, race, ethnicity, and geographic location. These group differences emphasize the importance of exploring end-of-life care preferences, service availability, and care quality among diverse populations with PD and may inform new approaches to advance care planning.
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Affiliation(s)
- Whitley W Aamodt
- Department of Neurology (WWA, AWW); Translational Center of Excellence for Neuroepidemiology and Neurology Outcomes Research (WWA, AWW); Department of Biostatistics (WBB, AWW, JTF), Epidemiology, and Informatics, Perelman School of Medicine; and Leonard Davis Institute of Health Economics (AWW), University of Pennsylvania, Philadelphia
| | - Warren B Bilker
- Department of Neurology (WWA, AWW); Translational Center of Excellence for Neuroepidemiology and Neurology Outcomes Research (WWA, AWW); Department of Biostatistics (WBB, AWW, JTF), Epidemiology, and Informatics, Perelman School of Medicine; and Leonard Davis Institute of Health Economics (AWW), University of Pennsylvania, Philadelphia
| | - Allison W Willis
- Department of Neurology (WWA, AWW); Translational Center of Excellence for Neuroepidemiology and Neurology Outcomes Research (WWA, AWW); Department of Biostatistics (WBB, AWW, JTF), Epidemiology, and Informatics, Perelman School of Medicine; and Leonard Davis Institute of Health Economics (AWW), University of Pennsylvania, Philadelphia
| | - John T Farrar
- Department of Neurology (WWA, AWW); Translational Center of Excellence for Neuroepidemiology and Neurology Outcomes Research (WWA, AWW); Department of Biostatistics (WBB, AWW, JTF), Epidemiology, and Informatics, Perelman School of Medicine; and Leonard Davis Institute of Health Economics (AWW), University of Pennsylvania, Philadelphia
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Taccone FS. Ableism in the intensive care unit. Intensive Care Med 2023; 49:898-899. [PMID: 37115259 PMCID: PMC10140718 DOI: 10.1007/s00134-023-07084-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 04/18/2023] [Indexed: 04/29/2023]
Affiliation(s)
- Fabio S Taccone
- Department of Intensive Care, Hôpital Universitaire de Bruxelles (HUB), Université Libre de Bruxelles (ULB), Route de Lennik, 1070, 808, Brussels, Belgium.
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Sex-Related Differences in Acuity and Postoperative Complications, Mortality and Failure to Rescue. J Surg Res 2023; 282:34-46. [PMID: 36244225 PMCID: PMC10024256 DOI: 10.1016/j.jss.2022.09.012] [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: 03/03/2022] [Revised: 08/16/2022] [Accepted: 09/15/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Yentl syndrome describing sex-related disparities has been extensively studied in medical conditions but not after surgery. This retrospective cohort study assessed the association of sex, frailty, presenting with preoperative acute serious conditions (PASC), and the expanded Operative Stress Score (OSS) with postoperative complications, mortality, and failure-to-rescue. METHODS The National Surgical Quality Improvement Program from 2015 to 2019 evaluating 30-d complications, mortality, and failure-to-rescue. RESULTS Of 4,860,308 cases (43% were male; mean [standard deviation] age of 56 [17] y), 6.0 and 0.8% were frail and very frail, respectively. Frailty score distribution was higher in men versus women (P < 0.001). Most cases were low-stress OSS2 (44.9%) or moderate-stress OSS3 (44.5%) surgeries. While unadjusted 30-d mortality rates were higher (P < 0.001) in males (1.1%) versus females (0.8%), males had lower odds of mortality (adjusted odds ratio (aOR) = 0.92, 95% confidence interval [CI] = 0.90-0.94, P < 0.001) after adjusting for frailty, OSS, case status, PASC, and Clavien-Dindo IV (CDIV) complications. Males have higher odds of PASC (aOR = 1.33, CI = 1.31-1.35, P < 0.001) and CDIV complications (aOR = 1.13, CI = 1.12-1.15, P < 0.001). Male-PASC (aOR = 0.76, CI = 0.72-0.80, P < 0.001) and male-CDIV (aOR = 0.87, CI = 0.83-0.91, P < 0.001) interaction terms demonstrated that the increased odds of mortality associated with PASC or CDIV complications/failure-to-rescue were lower in males versus females. CONCLUSIONS Our study provides a comprehensive analysis of sex-related surgical outcomes across a wide range of procedures and health care systems. Females presenting with PASC or experiencing CDIV complications had higher odds of mortality/failure to rescue suggesting sex-related care differences. Yentl syndrome may be present in surgical patients; possibly related to differences in presenting symptoms, patient care preferences, or less aggressive care in female patients and deserves further study.
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Yan Q, Kim J, Hall DE, Shinall MC, Reitz KM, Stitzenberg KB, Kao LS, George EL, Youk A, Wang CP, Silverstein JC, Bernstam EV, Shireman PK. Association of Frailty and the Expanded Operative Stress Score with Preoperative Acute Serious Conditions, Complications, and Mortality in Males Compared to Females: A Retrospective Observational Study. Ann Surg 2023; 277:e294-e304. [PMID: 34183515 PMCID: PMC8709872 DOI: 10.1097/sla.0000000000005027] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE The aim of this study was to expand Operative Stress Score (OSS) increasing procedural coverage and assessing OSS and frailty association with Preoperative Acute Serious Conditions (PASC), complications and mortality in females versus males. SUMMARY BACKGROUND DATA Veterans Affairs male-dominated study showed high mortality in frail veterans even after very low stress surgeries (OSS1). METHODS Retrospective cohort using NSQIP data (2013-2019) merged with 180-day postoperative mortality from multiple hospitals to evaluate PASC, 30-day complications and 30-, 90-, and 180-day mortality. RESULTS OSS expansion resulted in 98.2% case coverage versus 87.0% using the original. Of 82,269 patients (43.8% male), 7.9% were frail/very frail. Males had higher odds of PASC [adjusted odds ratio (aOR) = 1.31, 95% confidence interval (CI) = 1.21-1.41, P < 0.001] and severe/life-threatening Clavien-Dindo IV (CDIV) complications (aOR = 1.18, 95% CI = 1.09-1.28, P < 0.001). Although mortality rates were higher (all time-points, P < 0.001) in males versus females, mortality was similar after adjusting for frailty, OSS, and case status primarily due to increased male frailty scores. Additional adjustments for PASC and CDIV resulted in a lower odds of mortality in males (30-day, aOR = 0.81, 95% CI = 0.71-0.92, P = 0.002) that was most pronounced for males with PASC compared to females with PASC (30-day, aOR = 0.75, 95% CI = 0.56-0.99, P = 0.04). CONCLUSIONS Similar to the male-dominated Veteran population, private sector, frail patients have high likelihood of postoperative mortality, even after low-stress surgeries. Preoperative frailty screening should be performed regardless of magnitude of the procedure. Despite males experiencing higher adjusted odds of PASC and CDIV complications, females with PASC had higher odds of mortality compared to males, suggesting differences in the aggressiveness of care provided to men and women.
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Affiliation(s)
- Qi Yan
- Department of Surgery, University of Texas Health San Antonio, San Antonio, Texas
- South Texas Veterans Health Care System, San Antonio, Texas
- University Health, San Antonio, Texas
| | - Jeongsoo Kim
- Department of Surgery, University of Texas Health San Antonio, San Antonio, Texas
| | - Daniel E. Hall
- Center for Health Equity Research and Promotion, and Geriatric Research Education and Clinical Care Center, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
- Wolff Center, UPMC, Pittsburgh, Pennsylvania
| | - Myrick C. Shinall
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Karyn B. Stitzenberg
- Department of Surgery, University of North Carolina, Chapel Hill, North Carolina
| | - Lillian S. Kao
- Department of Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Elizabeth L. George
- Department of Surgery, Stanford University School of Medicine, Stanford, California
- Division of Health Services Research and Development, VA Palo Alto Healthcare System, Palo Alto, California
| | - Ada Youk
- Center for Health Equity Research and Promotion, and Geriatric Research Education and Clinical Care Center, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
- Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Chen-Pin Wang
- South Texas Veterans Health Care System, San Antonio, Texas
- Department of Population Health Sciences, University of Texas Health San Antonio, San Antonio, Texas
| | | | - Elmer V Bernstam
- School of Biomedical Informatics, The University of Texas Health Science Center at Houston, TX, United States
- Division of General Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, TX, United States
| | - Paula K. Shireman
- Department of Surgery, University of Texas Health San Antonio, San Antonio, Texas
- South Texas Veterans Health Care System, San Antonio, Texas
- University Health, San Antonio, Texas
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Brandi G, Stumpo V, Gilone M, Tosic L, Sarnthein J, Staartjes VE, Wang SSY, Van Niftrik B, Regli L, Keller E, Serra C. Sex-related differences in postoperative complications following elective craniotomy for intracranial lesions: An observational study. Medicine (Baltimore) 2022; 101:e29267. [PMID: 35801766 PMCID: PMC9259102 DOI: 10.1097/md.0000000000029267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION The integration of sex-related differences in neurosurgery is crucial for new, possible sex-specific, therapeutic approaches. In neurosurgical emergencies, such as traumatic brain injury and aneurysmal subarachnoid hemorrhage, these differences have been investigated. So far, little is known concerning the impact of sex on frequency of postoperative complications after elective craniotomy. This study investigates whether sex-related differences exist in frequency of postoperative complications in patients who underwent elective craniotomy for intracranial lesion. MATERIAL AND METHODS All consecutive patients who underwent an elective intracranial procedure over a 2-year period at our center were eligible for inclusion in this retrospective study. Demographic data, comorbidities, frequency of postoperative complications at 24 hours following surgery and at discharge, and hospital length of stay were compared among females and males. RESULTS Overall, 664 patients were considered for the analysis. Of those, 339 (50.2%) were females. Demographic data were comparable among females and males. More females than males suffered from allergic, muscular, and rheumatic disorders. No differences in frequency of postoperative complications at 24 hours after surgery and at discharge were observed among females and males. Similarly, the hospital length of stay was comparable. CONCLUSIONS In the present study, no sex-related differences in frequency of early postoperative complications and at discharge following elective craniotomy for intracranial lesions were observed.
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Affiliation(s)
- Giovanna Brandi
- Institute for Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
- * Correspondence: Giovanna Brandi, MD, Neurosurgical Intensive Care Unit, Institute for Intensive Care Medicine, University Hospital Zurich, Rämistrasse 100, CH-8006 Zurich, Switzerland. (e-mail: )
| | | | - Marco Gilone
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Division of Neurosurgery, Università degli Studi di Napoli “Federico II,” Naples, Italy
| | - Lazar Tosic
- Department of Neurosurgery and Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Johannes Sarnthein
- Department of Neurosurgery and Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Victor E. Staartjes
- Department of Neurosurgery and Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
| | | | - Bas Van Niftrik
- Department of Neurosurgery and Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Luca Regli
- Department of Neurosurgery and Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Emanuela Keller
- Institute for Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
- Department of Neurosurgery and Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Carlo Serra
- Department of Neurosurgery and Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
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A Tale of Two ICUs: One for Women and One for Men? Crit Care Med 2022; 50:1012-1015. [PMID: 35612440 DOI: 10.1097/ccm.0000000000005538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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10
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Todorov A, Kaufmann F, Arslani K, Haider A, Bengs S, Goliasch G, Zellweger N, Tontsch J, Sutter R, Buddeberg B, Hollinger A, Zemp E, Kaufmann M, Siegemund M, Gebhard C, Gebhard CE. Gender differences in the provision of intensive care: a Bayesian approach. Intensive Care Med 2021; 47:577-587. [PMID: 33884452 PMCID: PMC8139895 DOI: 10.1007/s00134-021-06393-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 03/24/2021] [Indexed: 12/23/2022]
Abstract
Purpose It is currently unclear whether management and outcomes of critically ill patients differ between men and women. We sought to assess the influence of age, sex and diagnoses on the probability of intensive care provision in critically ill cardio- and neurovascular patients in a large nationwide cohort in Switzerland. Methods Retrospective analysis of 450,948 adult patients with neuro- and cardiovascular disease admitted to all hospitals in Switzerland between 01/2012 and 12/2016 using Bayesian modeling. Results For all diagnoses and populations, median ages at admission were consistently higher for women than for men [75 (64;82) years in women vs. 68 (58;77) years in men, p < 0.001]. Overall, women had a lower likelihood to be admitted to an intensive care unit (ICU) than men, despite being more severely ill [odds ratio (OR) 0.78 (0.76–0.79)]. ICU admission probability was lowest in women aged > 65 years (OR women:men 0.94 (0.89–0.99), p < 0.001). Women < 45 years had a similar ICU admission probability as men in the same age category [OR women:men 1.03 (0.94–1.13)], in spite of more severe illness. The odds to die were significantly higher in women than in men per unit increase in Simplified Acute Physiology Score (SAPS) II (OR 1.008 [1.004–1.012]). Conclusion In the care of the critically ill, our study suggests that women are less likely to receive ICU treatment regardless of disease severity. Underuse of ICU care was most prominent in younger women < 45 years. Although our study has several limitations that are imposed by the limited data available from the registries, our findings suggest that current ICU triage algorithms could benefit from careful reassessment. Further, and ideally prospective, studies are needed to confirm our findings. Supplementary Information The online version contains supplementary material available at 10.1007/s00134-021-06393-3.
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Affiliation(s)
- Atanas Todorov
- Intensive Care Unit, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.,Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland.,Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland
| | - Fabian Kaufmann
- Intensive Care Unit, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Ketina Arslani
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | - Ahmed Haider
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland.,Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland
| | - Susan Bengs
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland.,Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland
| | - Georg Goliasch
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Núria Zellweger
- Intensive Care Unit, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Janna Tontsch
- Intensive Care Unit, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Raoul Sutter
- Intensive Care Unit, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.,Department of Clinical Research, University Hospital Basel, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Bigna Buddeberg
- Department of Anesthesiology, University Hospital Basel, Basel, Switzerland
| | - Alexa Hollinger
- Intensive Care Unit, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Elisabeth Zemp
- University of Basel, Basel, Switzerland.,Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Mark Kaufmann
- Department of Anesthesiology, University Hospital Basel, Basel, Switzerland
| | - Martin Siegemund
- Intensive Care Unit, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.,Department of Clinical Research, University Hospital Basel, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Cathérine Gebhard
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland.,Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland
| | - Caroline E Gebhard
- Intensive Care Unit, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.
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Stey AM, Kanzaria HK, Dudley RA, Bilimoria KY, Knudson MM, Callcut RA. Emergency Department Length of Stay and Mortality in Critically Injured Patients. J Intensive Care Med 2021; 37:278-287. [PMID: 33641512 DOI: 10.1177/0885066621995426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Multicenter data from 2 decades ago demonstrated that critically ill and injured patients spending more than 6 hours in the emergency department (ED) before transfer to the intensive care unit (ICU) had higher mortality rates. A contemporary analysis of ED length of stay in critically injured patients at American College of Surgeons' Trauma Quality Improvement Program (ACS-TQIP) centers was performed to test whether prolonged ED length of stay is still associated with mortality. METHODS This was an observational cohort study of critically injured patients admitted directly to ICU from the ED in ACS-TQIP centers from 2010-2015. Spending more than 6 hours in the ED was defined as prolonged ED length of stay. Patients with prolonged ED length of stay were matched to those with non-prolonged ED length of stay and mortality was compared. MAIN RESULTS A total of 113,097 patients were directly admitted from the ED to the ICU following injury. The median ED length of stay was 167 minutes. Prolonged ED length of stay occurred in 15,279 (13.5%) of patients. Women accounted for 29.4% of patients with prolonged ED length of stay but only 25.8% of patients with non-prolonged ED length of stay, P < 0.0001. Mortality rates were similar after matching-4.5% among patients with prolonged ED length of stay versus 4.2% among matched controls. Multivariable logistic regression of the matched cohorts demonstrated prolonged ED length of stay was not associated with mortality. However, women had higher adjusted mortality compared to men Odds Ratio = 1.41, 95% Confidence Interval 1.28 -1.61, P < 0.0001. CONCLUSION Prolonged ED length of stay is no longer associated with mortality among critically injured patients. Women are more likely to have prolonged ED length of stay and mortality.
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Affiliation(s)
- Anne M Stey
- Northwestern University Feinberg School of Medicine, IL, Chicago
| | - Hemal K Kanzaria
- University of California San Francisco, San Francisco, CA.,Zuckerberg San Francisco General Hospital, San Francisco, CA
| | | | - Karl Y Bilimoria
- Northwestern University Feinberg School of Medicine, IL, Chicago
| | - M Margaret Knudson
- University of California San Francisco, San Francisco, CA.,Zuckerberg San Francisco General Hospital, San Francisco, CA
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Hill A, Ramsey C, Dodek P, Kozek J, Fransoo R, Fowler R, Doupe M, Wong H, Scales D, Garland A. Examining mechanisms for gender differences in admission to intensive care units. Health Serv Res 2019; 55:35-43. [PMID: 31709536 DOI: 10.1111/1475-6773.13215] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To evaluate whether the male predominance of older people admitted to intensive care units (ICUs) is due to gender differences in the presence of spouses, partners, or children; rates of gender-specific disease; or triage decisions made by health system personnel. DATA SOURCES AND COLLECTION Three population-based datasets, 2004-2012, of Canadians ≥65 years: provincial health care data from Manitoba (n = 250 190) and national data of nursing home residents (n = 133 982) and community-based homecare recipients (n = 210 090). STUDY DESIGN Retrospective observational study, using multivariable Cox proportional hazards and logistic regression. PRINCIPAL FINDINGS Males predominated in ICU admissions: from Manitoba (hazard ratio [HR] = 1.87, 95% CI = 1.80-1.95), nursing homes (HR = 1.47, 1.35-1.60), and homecare (odds ratio = 1.14, 1.11-1.17). Adjustment for spouses, partners, and children did not attenuate this effect. The HR for gender was lower by 13.5 percent, relative, after excluding ICU care for cardiac causes. Male predominance was not present during a second ICU admission among survivors of a first ICU-containing hospitalization (HR = 1.07, 0.96-1.20). CONCLUSIONS In three older cohorts, the male predominance of ICU admission was not explained by gender differences in the presence of a spouse, partner, or children, or cardiac disease rates. The third finding suggests that triage bias is unlikely to be responsible for the male predominance.
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Affiliation(s)
- Andrea Hill
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Clare Ramsey
- Department of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Peter Dodek
- Center for Health Evaluation and Outcome Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Jean Kozek
- Department of Family and Community Medicine, Providence Health Care, Vancouver, BC, Canada
| | - Randy Fransoo
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB, Canada
| | - Robert Fowler
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Malcolm Doupe
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Hubert Wong
- CIHR Canadian HIV Trials Network, Vancouver, BC, Canada
| | - Damon Scales
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Allan Garland
- Department of Medicine, University of Manitoba, Winnipeg, MB, Canada
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