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Yan YX, Wang WD, Wei YL, Chen WZ, Wu QY. Predictors of mortality in patients with isolated gastrointestinal perforation. Exp Ther Med 2023; 26:556. [PMID: 37941588 PMCID: PMC10628647 DOI: 10.3892/etm.2023.12255] [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] [Received: 05/17/2023] [Accepted: 09/15/2023] [Indexed: 11/10/2023] Open
Abstract
Gastrointestinal (GI) perforation is common in the emergency department and has a high mortality rate. The present study aimed to identify risk factors for mortality in patients with GI perforation. The objective was to assess and prognosticate the surgical outcomes of patients, aiming to ascertain the efficacy of the procedure for individual patients. A retrospective cohort study of patients with GI perforation who underwent surgery in a public tertiary hospital in China from January 2012 to June 2022 was performed. Demographics, clinical characteristics, laboratory and imaging results, and outcomes were collected from electronic medical records. The primary outcome measure was in-hospital mortality, and patients were divided into survivor and non-survivor groups based on this measure. Univariate and multivariable logistic regression analyses were performed to obtain independent factors associated with mortality. A total of 529 patients with GI perforation were eligible for inclusion. The in-hospital mortality rate after emergency surgery was 10.59%. The median age of the patients was 60 years (interquartile range, 44-72 years). Multivariable logistic regression analysis indicated that age, shock on admission, elevated serum creatinine (sCr) and white blood cell (WBC) count <3.5x109 or >20x109 cells/l were predictors of in-hospital mortality. In conclusion, advanced age, shock on admission, elevated sCr levels and significantly abnormal WBC count are associated with higher in-hospital mortality following emergency laparotomy.
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Affiliation(s)
- Yi-Xing Yan
- Trauma Center and Emergency Surgery Department, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350000, P.R. China
| | - Wei-Di Wang
- Trauma Center and Emergency Surgery Department, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350000, P.R. China
| | - Yi-Liu Wei
- The First Clinical Medical School, Fujian Medical University, Fuzhou, Fujian 350000, P.R. China
| | - Wei-Zhi Chen
- Trauma Center and Emergency Surgery Department, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350000, P.R. China
| | - Qiao-Yi Wu
- Trauma Center and Emergency Surgery Department, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350000, P.R. China
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Nanack JJ, Ferndale L. Factors influencing outcome in patients with perforated peptic ulcer disease at a South African tertiary hospital. S AFR J SURG 2023; 61:207-211. [PMID: 38450692 DOI: 10.36303/sajs.4005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
BACKGROUND Perforated peptic ulcer (PPU) is associated with significant morbidity and mortality, particularly in low to middle income countries. This study aimed to scrutinise the clinical course of patients diagnosed with PPU and identify modifiable factors to improve outcomes. METHODS A retrospective review of the hybrid electronic medical record (HEMR) database at Grey's Hospital was performed. All patients diagnosed with PPU between January 2013 and December 2020 were entered into the study. The variables collected include age, ethnicity, comorbid profile, Boey score, type of surgery performed and complications. These factors were analysed to determine the factors responsible for morbidity and mortality. RESULTS One hundred and ninety four patients were diagnosed with PPU during the study period. Six patients were treated non-operatively, all of whom survived. In the surgically treated group, omental patch repair was performed in 159 (84.5%) patients, and primary closure in 26 (13.8%) patients. The leak rate was 32% in the cohort that underwent relaparotomy and the overall mortality was 14%. There was no significant relationship between the type of repair performed and outcome. All patients had a Boey score of 1 or more. The following factors were found to increase the probability of in-hospital mortality: age > 40 years (OR: 8.49, 95% CI 2.46-29.29 p < 0.01), female gender (OR: 2.509, CI 0.98-6.37, p = 0.048), need for relaparotomy (OR: 0.398, CI 0.17-0.91, p = 0.027) and Boey score > 1 (OR: 46.437, CI 6.13-350.28, p < 0.01). A Boey score > 1 was the only variable that increased the likelihood of finding a leaking repair at relaparotomy (p < 0.01). CONCLUSION The Boey score was a significant predictor of mortality and leak rate in our patients with PPU. Adding age as a variable may improve the ability to predict mortality in our setting, while the impact of gender and ethnicity needs further investigation.
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Affiliation(s)
- J J Nanack
- Department of General Surgery, University of KwaZulu-Natal, South Africa
| | - L Ferndale
- Department of Gastro-Intestinal Surgery, Grey's Hospital, South Africa
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3
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Wang YH, Tee YS, Wu YT, Cheng CT, Fu CY, Liao CH, Hsieh CH, Wang SC. Sarcopenia provides extra value outside the PULP score for predicting mortality in older patients with perforated peptic ulcers. BMC Geriatr 2023; 23:269. [PMID: 37142974 PMCID: PMC10161495 DOI: 10.1186/s12877-023-03946-7] [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: 11/20/2022] [Accepted: 03/31/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND Perforated peptic ulcer (PPU) remains challenging surgically due to its high mortality, especially in older individuals. Computed tomography (CT)-measured skeletal muscle mass is a effective predictor of the surgical outcomes in older patients with abdominal emergencies. The purpose of this study is to assess whether a low CT-measured skeletal muscle mass can provide extra value in predicting PPU mortality. METHODS This retrospective study enrolled older (aged ≥ 65 years) patients who underwent PPU surgery. Cross-sectional skeletal muscle areas and densities were measured by CT at L3 and patient-height adjusted to obtain the L3 skeletal muscle gauge (SMG). Thirty-day mortality was determined with univariate, multivariate and Kaplan-Meier analysis. RESULTS From 2011 to 2016, 141 older patients were included; 54.8% had sarcopenia. They were further categorized into the PULP score ≤ 7 (n=64) or PULP score > 7 group (n=82). In the former, there was no significant difference in 30-day mortality between sarcopenic (2.9%) and nonsarcopenic patients (0%; p=1.000). However, in the PULP score > 7 group, sarcopenic patients had a significantly higher 30-day mortality (25.5% vs. 3.2%, p=0.009) and serious complication rate (37.3% vs. 12.9%, p=0.017) than nonsarcopenic patients. Multivariate analysis showed that sarcopenia was an independent risk factor for 30-day mortality in patients in the PULP score > 7 group (OR: 11.05, CI: 1.03-118.7). CONCLUSION CT scans can diagnose PPU and provide physiological measurements. Sarcopenia, defined as a low CT-measured SMG, provides extra value in predicting mortality in older PPU patients.
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Affiliation(s)
- Yu-Hao Wang
- Department of General Surgery, Chang Gung Memorial Hospital, No.5, Fuxing St., Guishan Dist, Taoyuan City, 333, Taiwan
| | - Yu-San Tee
- Division of Trauma and Emergency Surgery, Department of Surgery, Chang Gung Memorial Hospital, No.5, Fuxing St., Guishan Dist, Taoyuan City, 333, Taiwan
| | - Yu-Tung Wu
- Division of Trauma and Emergency Surgery, Department of Surgery, Chang Gung Memorial Hospital, No.5, Fuxing St., Guishan Dist, Taoyuan City, 333, Taiwan
| | - Chi-Tung Cheng
- Division of Trauma and Emergency Surgery, Department of Surgery, Chang Gung Memorial Hospital, No.5, Fuxing St., Guishan Dist, Taoyuan City, 333, Taiwan
| | - Chih-Yuan Fu
- Division of Trauma and Emergency Surgery, Department of Surgery, Chang Gung Memorial Hospital, No.5, Fuxing St., Guishan Dist, Taoyuan City, 333, Taiwan
| | - Chien-Hung Liao
- Division of Trauma and Emergency Surgery, Department of Surgery, Chang Gung Memorial Hospital, No.5, Fuxing St., Guishan Dist, Taoyuan City, 333, Taiwan
| | - Chi-Hsun Hsieh
- Division of Trauma and Emergency Surgery, Department of Surgery, Chang Gung Memorial Hospital, No.5, Fuxing St., Guishan Dist, Taoyuan City, 333, Taiwan.
| | - Stewart C Wang
- Division of Acute Care Surgery, University of Michigan Medical School, 1301 Catherine St, Ann Arbor, MI, USA
- Morphomic Analysis Group, University of Michigan, 1301 Catherine St, Ann Arbor, MI, USA
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4
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Costa G, Fransvea P, Lepre L, Liotta G, Mazzoni G, Biloslavo A, Bianchi V, Occhionorelli S, Costa A, Sganga G. Perforated peptic ulcer (PPU) treatment: an Italian nationwide propensity score-matched cohort study investigating laparoscopic vs open approach. Surg Endosc 2023:10.1007/s00464-023-09998-5. [PMID: 36944740 PMCID: PMC10030074 DOI: 10.1007/s00464-023-09998-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 02/27/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND Perforated peptic ulcer (PPU) remain a surgical emergency accounting for 37% of all peptic ulcer-related deaths. Surgery remains the standard of care. The benefits of laparoscopic approach have been well-established even in the elderly. However, because of inconsistent results with specific regard to some technical aspects of such technique surgeons questioned the adoption of laparoscopic approach. This leads to choose the type of approach based on personal experience. The aim of our study was to critically appraise the use of the laparoscopic approach in PPU treatment comparing it with open procedure. METHODS A retrospective study with propensity score matching analysis of patients underwent surgical procedure for PPU was performed. Patients undergoing PPU repair were divided into: Laparoscopic approach (LapA) and Open approach (OpenA) groups and clinical-pathological features of patients in the both groups were compared. RESULTS A total of 453 patients underwent PPU simple repair. Among these, a LapA was adopted in 49% (222/453 patients). After propensity score matching, 172 patients were included in each group (the LapA and the OpenA). Analysis demonstrated increased operative times in the OpenA [OpenA: 96.4 ± 37.2 vs LapA 88.47 ± 33 min, p = 0.035], with shorter overall length of stay in the LapA group [OpenA 13 ± 12 vs LapA 10.3 ± 11.4 days p = 0.038]. There was no statistically significant difference in mortality [OpenA 26 (15.1%) vs LapA 18 (10.5%), p = 0.258]. Focusing on morbidity, the overall rate of 30-day postoperative morbidity was significantly lower in the LapA group [OpenA 67 patients (39.0%) vs LapA 37 patients (21.5%) p = 0.002]. When stratified using the Clavien-Dindo classification, the severity of postoperative complications was statistically different only for C-D 1-2. CONCLUSIONS Based on the present study, we can support that laparoscopic suturing of perforated peptic ulcers, apart from being a safe technique, could provide significant advantages in terms of postoperative complications and hospital stay.
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Affiliation(s)
- Gianluca Costa
- Surgery Center, Colorectal Surgery Research Unit - Fondazione Policlinico Universitario Campus Bio-Medico, University Campus Bio-Medico of Rome, Rome, Italy
| | - Pietro Fransvea
- Emergency Surgery and Trauma - Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Catholic University of Sacred Heart, Largo A. Gemelli 8, 00168, Rome, Italy.
| | - Luca Lepre
- General Surgery Unit, Santo Spirito in Sassia Hospital, ASL Roma 1, Rome, Italy
| | - Gianluca Liotta
- General and Emergency Surgery Unit, Azienda Ospedaliera San Camillo-Forlanini, Rome, Italy
| | - Gianluca Mazzoni
- General Surgery Unit, G.B. Grassi Hospital, ASL Roma 3, Rome, Italy
| | - Alan Biloslavo
- Department of General Surgery, Cattinara University Hospital, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Valentina Bianchi
- Emergency Surgery and Trauma - Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Catholic University of Sacred Heart, Largo A. Gemelli 8, 00168, Rome, Italy
| | - Savino Occhionorelli
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
- Department of Surgery, University Hospital Arcispedale Sant'Anna, Ferrara, Italy
| | - Alessandro Costa
- UniCamillus School of Medicine - Saint Camillus International University of Health and Medical Sciences, Rome, Italy
| | - Gabriele Sganga
- Emergency Surgery and Trauma - Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Catholic University of Sacred Heart, Largo A. Gemelli 8, 00168, Rome, Italy
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5
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Mulder WW, Arko-Cobbah E, Joubert G. Are admission laboratory values in isolation meaningful for predicting surgical outcome in patients with perforated peptic ulcers? Surg Open Sci 2022; 11:62-68. [PMID: 36570627 PMCID: PMC9768370 DOI: 10.1016/j.sopen.2022.11.003] [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] [Received: 10/17/2022] [Revised: 11/10/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022] Open
Abstract
Background The study aimed to calculate the predictive value of admission laboratory values in patients with perforated peptic ulcers. Methods A retrospective, cohort analytical, observational study was performed, including patients with surgically confirmed perforated peptic ulcers over a 5-year period. Demographic data and admission laboratory values were collected from hospital electronic databases. Outcomes measured were in-hospital mortality, intensive care unit (ICU) admission and length of stay. The significance of categorical variables was calculated by chi-square and Fisher's exact test. Logistic regression analysis was performed to determine univariately statistically significant variables. Results In total, 188 patients met the inclusion criteria. The median age was 46 (range 15-87) years with a male predominance of 71.3 % (n = 134). The median length of hospital stay was 7 (range 1-94) days and 31.4 % (n = 59) of patients were admitted to the ICU. Post-operative in-hospital mortality was 25.0 % (n = 47). Predicting the categorical outcome of in-hospital mortality, abnormal haemoglobin, platelet count, urea, creatinine and potassium levels were all found to be statistically significant in the univariate analysis. Age (odds ratio [OR] 1.03), haemoglobin (OR 4.36) and creatinine (OR 7.76) levels were significant in the multivariate analysis. Conclusions Mortality rate among patients with perforated peptic ulcer disease is still substantial. Admission laboratory values showed statistical significance as outcome indicators and were valuable to assist in predicting the prognosis. An abnormally high serum creatinine level was the strongest single predictor of both mortality and ICU admission. Key message Initial laboratory findings of patients admitted for perforated peptic ulcer showed that an abnormally high serum creatinine level was the strongest single predictor of both mortality and ICU admission.
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Affiliation(s)
- Wikus W. Mulder
- Department of Surgery, School of Clinical Medicine, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa,Corresponding author at: Department of Surgery, Faculty of Health Sciences, University of the Free State, 2015 Nelson Mandela Drive, Bloemfontein 9300, South Africa.
| | - Emmanuel Arko-Cobbah
- Department of Surgery, School of Clinical Medicine, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - Gina Joubert
- Department of Biostatistics, School of Biomedical Sciences, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
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Risk factors for leak after omentopexy for duodenal ulcer perforations. Eur J Trauma Emerg Surg 2022; 49:1163-1167. [PMID: 35870005 DOI: 10.1007/s00068-022-02058-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 07/03/2022] [Indexed: 11/29/2022]
Abstract
AIMS Duodenal ulcer perforations are frequently encountered but there is limited literature regarding risk factors for leak after omentopexy. METHODOLOGY The record of 100 patients of duodenal ulcer perforation undergoing omentopexy by open approach was prospectively maintained to identify any significant factors contributing towards leak. RESULTS Out of 100 patients undergoing omentopexy, 9 (9%) developed leak; when leak occurred, the mortality was very high (44.4%). Patients who developed leak (09) were compared against those who did not (91), and it was seen that seen that duration of symptoms before surgery (> 3 days), amount of intra-abdominal contamination (> 2 L), low body mass index (BMI < 19.35 kg/m2), serum creatinine (> 1.5 mg/dl), and deranged International Normalized Ratio (INR) were found to be significant on univariate analysis; however, multivariate analysis revealed only low BMI and high creatinine to be contributory towards leak. CONCLUSION Leak after omentopexy carries a high morbidity and mortality. Identification of risk factors may help in optimizing patients at risk and reduce the incidence of leak and its sequelae. TRIAL REGISTRATION NUMBER CTRI/2020/03/023798.
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Koranne A, Byakodi KG, Teggimani V, Kamat VV, Hiregoudar A. A Comparative Study between Peptic Ulcer Perforation Score, Mannheim Peritonitis Index, ASA Score, and Jabalpur Score in Predicting the Mortality in Perforated Peptic Ulcers. Surg J (N Y) 2022; 8:e162-e168. [PMID: 35928546 PMCID: PMC9345676 DOI: 10.1055/s-0042-1743526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 01/24/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction
Peptic ulcer disease continues to be a major public health in most developing countries despite the advances in medical management. The incidence of perforations remains high and has the highest mortality rate of any complication of ulcer disease. Risk stratification of cases will lead to better preoperative management and efficient utilization of intensive care unit resources. The purpose of the present study is to compare different existing scoring systems and identify the most accurate predictor of mortality in perforated peptic ulcer (PPU) cases.
Materials and Methods
This is an observational study conducted in Karnataka Institute of Medical Sciences, Hubli, India. All cases of PPU disease admitted from December 2017 to August 2019 who were treated surgically were included in the study. Demographic data were collected and peptic ulcer perforation (PULP) score, Mannheim peritonitis index (MPI), American Society of Anesthesiologists (ASA) score, and Jabalpur score (JS) were calculated for individual patient and compared. The patient was followed up during the postoperative period.
Observation
A total of 45 patients were included in the study with a mean age of 42.5 years. Most of the patients presented with 24 hours of the onset of symptoms. Nonsteroidal anti-inflammatory drug use was noted in 8.9% patients, and steroid use was present in 2.2% patients. Of the 45 patients, 7 deaths were reported. Between the various scoring systems, the MPI and JS were better predictors of mortality with a
p
-value of <0.001 and 0.007, respectively. In contrast, the PULP and ASA scores had
p
-value not statistically significant. However, the PULP score was a better predictor of postoperative complication with a
p
-value of 0.047.
Conclusion
Of the four scoring systems validated, the MPI and JS were better predictors of mortality in the given population. PULP score is a better predictor of postoperative complications in the present study.
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Affiliation(s)
- Aboli Koranne
- Department of Surgery, Karnataka Institute of Medical Sciences, Hubli, Karnataka, India
| | - K G. Byakodi
- Department of Surgery, Karnataka Institute of Medical Sciences, Hubli, Karnataka, India
| | - Vasant Teggimani
- Department of Surgery, Karnataka Institute of Medical Sciences, Hubli, Karnataka, India
| | - Vijay V. Kamat
- Department of Surgery, Karnataka Institute of Medical Sciences, Hubli, Karnataka, India
| | - Abhijith Hiregoudar
- Department of Surgery, Karnataka Institute of Medical Sciences, Hubli, Karnataka, India
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Hansen JB, Humble CAS, Møller AM, Vester-Andersen M. The prognostic value of surgical delay in patients undergoing major emergency abdominal surgery: a systematic review and meta-analysis. Scand J Gastroenterol 2022; 57:534-544. [PMID: 35019790 DOI: 10.1080/00365521.2021.2024250] [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] [Indexed: 02/04/2023]
Abstract
BACKGROUND Mortality following major emergency abdominal surgery is high. Surgical delay is regarded as an important modifiable prognostic factor. Current care-bundles aim at reducing surgical delay, most often using a six-hour cut-off. We aimed to investigate the evidence supporting the in-hospital delay cutoffs currently used. METHODS MEDLINE, EMBASE and the Cochrane Library were searched. We included studies assessing in-hospital surgical delay in major emergency abdominal surgery patients. Studies were only included if they performed adjusted analysis. Surgical delay beyond six hours was the primary cutfrom interest. The primary outcome was mortality at longest follow-up. Meta-analyses were conducted if possible. RESULTS Eleven observational studies were included with 16,772 participants. Two studies evaluated delay in unselected major emergency abdominal surgery patients. Three studies applied a six-hour cutoff, but only a study on acute mesenteric ischemia showed an association between delay and mortality. Meta-analysis showed no association with mortality at this cutoff. An association was seen between hourly delay and mortality risk estimate, 1.02 (95% confidence interval [CI], 1.00 - 1.03), and on subgroup analysis of hourly delay in perforated peptic ulcer patients, risk estimate, 1.02 (95% CI, 1.0 - 1.03). All risk estimates had a very low Grading of Recommendations Assessment, Development, and Evaluation score. CONCLUSION Little evidence supports a six-hour cutoff in unselected major emergency abdominal surgical patients. We found an association between hourly delay and increased mortality; however, evidence supporting this was primarily in patients undergoing surgery for perforated peptic ulcer. This review is limited by the quality of the individual studies.
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Affiliation(s)
- Jannick Brander Hansen
- Herlev Anaesthesia Critical and Emergency Care Science Unit (ACES), Department of Anaesthesiology, Copenhagen University Hospital Herlev-Gentofte, Copenhagen, Denmark
| | - Caroline Anna Sofia Humble
- Herlev Anaesthesia Critical and Emergency Care Science Unit (ACES), Department of Anaesthesiology, Copenhagen University Hospital Herlev-Gentofte, Copenhagen, Denmark.,Centre of Anaesthesiological Research, Department of Anaesthesiology, Zealand University Hospital, Køge, Denmark
| | - Ann Merete Møller
- Herlev Anaesthesia Critical and Emergency Care Science Unit (ACES), Department of Anaesthesiology, Copenhagen University Hospital Herlev-Gentofte, Copenhagen, Denmark
| | - Morten Vester-Andersen
- Herlev Anaesthesia Critical and Emergency Care Science Unit (ACES), Department of Anaesthesiology, Copenhagen University Hospital Herlev-Gentofte, Copenhagen, Denmark
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Konishi T, Goto T, Fujiogi M, Michihata N, Kumazawa R, Matsui H, Fushimi K, Tanabe M, Seto Y, Yasunaga H. New machine learning scoring system for predicting postoperative mortality in gastroduodenal ulcer perforation: A study using a Japanese nationwide inpatient database. Surgery 2021; 171:1036-1042. [PMID: 34538648 DOI: 10.1016/j.surg.2021.08.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 08/14/2021] [Accepted: 08/19/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Conventional prediction models for estimating risk of postoperative mortality in gastroduodenal ulcer perforation have suboptimal prediction ability. We aimed to develop and validate new machine learning models and an integer-based score for predicting the postoperative mortality. METHODS We retrospectively identified patients with gastroduodenal ulcer perforation who underwent surgical repair, using a nationwide Japanese inpatient database. In a derivation cohort from July 2010 to March 2016, we developed 2 machine learning-based models, Lasso and XGBoost, using 45 candidate predictors, and also developed an integer-based score for clinical use by including important variables in Lasso. In a validation cohort from April 2016 to March 2017, we measured the prediction performances of the models by computing area under the curve and comparing it to the conventional American Society of Anesthesiology risk score. RESULTS Of 25,886 patients, 1,176 (4.5%) died after surgical repair. For the validation cohort, Lasso and XGBoost had significantly higher prediction abilities than the American Society of Anesthesiology score (Lasso area under the curve = 0.84; 95% confidence interval 0.81-0.86; American Society of Anesthesiology score area under the curve = 0.70; 95% confidence interval 0.65-0.74, P < .001). The integer-based risk score, which had 13 factors, had a prediction ability similar to those of Lasso and XGBoost (area under the curve = 0.83; 95% confidence interval 0.81-0.86). According to the integer-based score, the mortalities were 0.1%, 2.3%, 9.3%, and 29.0% for the low (score, 0), moderate (1-2), high (3-4), and very high (≥5) score groups, respectively. CONCLUSION Machine learning models and the integer-based risk score performed well in predicting risk of postoperative mortality in gastroduodenal ulcer perforation. These models will help in decision making.
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Affiliation(s)
- Takaaki Konishi
- Department of Breast and Endocrine Surgery, Graduate School of Medicine, University of Tokyo, Japan; Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Japan.
| | - Tadahiro Goto
- Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Japan; TXP Medical Co. Ltd, Tokyo, Japan
| | - Michimasa Fujiogi
- Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Japan; Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Nobuaki Michihata
- Department of Health Services Research, Graduate School of Medicine, University of Tokyo, Japan
| | - Ryosuke Kumazawa
- Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School, Japan
| | - Masahiko Tanabe
- Department of Breast and Endocrine Surgery, Graduate School of Medicine, University of Tokyo, Japan
| | - Yasuyuki Seto
- Department of Breast and Endocrine Surgery, Graduate School of Medicine, University of Tokyo, Japan; Department of Gastrointestinal Surgery, Graduate School of Medicine, University of Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Japan
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Chen B, Liu XY, Zhang HM, Zhang BJ, Wang YT. Psychological effect of comprehensive nursing intervention in elderly patients with perforated peptic ulcer: A protocol of systematic review. Medicine (Baltimore) 2020; 99:e22226. [PMID: 32991417 PMCID: PMC7523801 DOI: 10.1097/md.0000000000022226] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND This study aims to assess the psychological effect of comprehensive nursing intervention (CNI) in elderly patients with perforated peptic ulcer (PPU). METHODS This protocol will search all potential studies from inception to the present in electronic database sources (Cochrane Library, PUBMED, EMBASE, PsycINFO, WANGFANG, CBM, and CNKI), and other sources (such as clinical trial registry, and conference proceedings). We will not apply limitations to language and publication status. Two independent authors will scan literature, extract data, and appraise study quality. A third author will be invited to solve any disagreements between 2 authors. We will utilize RevMan 5.3 software for statistical analysis. If necessary, we will also carry out subgroup group, sensitivity analysis, and reporting bias. RESULTS This protocol will summarize high quality evidence to evaluate the psychological effect of CNI in elderly patients with PPU. CONCLUSION The results of this study may provide evidence to determine whether CNI is effective or not on psychological effect in elderly patients with PPU. STUDY REGISTRATION INPLASY202080069.
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Affiliation(s)
- Bing Chen
- Department of Gastroenterology, The Second Affiliated Hospital of Mudanjiang Medical University
| | - Xiu-Yu Liu
- Department of Gastroenterology, The Second Affiliated Hospital of Mudanjiang Medical University
| | - Hong-Mei Zhang
- Department of Gastroenterology, The Second Affiliated Hospital of Mudanjiang Medical University
| | - Bai-Jun Zhang
- Department of Emergency, Mudanjiang Forestry Central Hospital
| | - Ying-Ting Wang
- Department of Geriatrics, The Second Affiliated Hospital of Mudanjiang Medical University, Mudanjiang, China
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