1
|
Mpody C, Best AF, Lee CN, Stahl DL, Raman VT, Urman RD, Tobias JD, Nafiu OO. Current Trends in Mortality Attributable to Racial or Ethnic Disparities in Post-Surgical Population in The United States: A Population-Based Study. Ann Surg Open 2023; 4:e342. [PMID: 38144482 PMCID: PMC10735112 DOI: 10.1097/as9.0000000000000342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 08/17/2023] [Indexed: 12/26/2023] Open
Abstract
Background No study has contextualized the excess mortality attributable to racial and ethnic disparities in surgical outcomes. Further, not much effort has been made to quantify the effort needed to eliminate these disparities. Objective We examined the current trends in mortality attributable to racial or ethnic disparities in the US postsurgical population. We then identified the target for mortality reduction that would be necessary to eliminate these disparities by 2030. Methods We performed a population-based study of 1,512,974 high-risk surgical procedures among adults (18-64 years) performed across US hospitals between 2000 and 2020. Results Between 2000 and 2020, the risk-adjusted mortality rates declined for all groups. Nonetheless, Black patients were more likely to die following surgery (adjusted relative risk 1.42; 95% CI, 1.39-1.46) driven by higher Black mortality in the northeast (1.60; 95% CI, 1.52-1.68), as well as the West (1.53; 95% CI, 1.43-1.62). Similarly, mortality risk remained consistently higher for Hispanics compared with White patients (1.21; 95% CI, 1.19-1.24), driven by higher mortality in the West (1.26; 95% CI, 1.21-1.31). Overall, 8364 fewer deaths are required for Black patients to experience mortality on the same scale as White patients. Similar figures for Hispanic patients are 4388. To eliminate the disparity between Black and White patients by 2030, we need a 2.7% annualized reduction in the projected mortality among Black patients. For Hispanics, the annualized reduction needed is 0.8%. Conclusions Our data provides a framework for incorporating population and health systems measures for eliminating disparity in surgical mortality within the next decade.
Collapse
Affiliation(s)
- Christian Mpody
- From the Department of Anesthesiology & Pain Medicine, Nationwide Children’s Hospital, Columbus, OH
- Department of Anesthesiology, The Ohio State University, Columbus, OH
| | - Ana F. Best
- Biostatistics Branch, Biometric Research Program, Division of Treatment and Diagnosis, National Cancer Institute, Bethesda, MD
| | - Clara N. Lee
- Department of Plastic and Reconstructive Surgery, The Ohio State University, Columbus, OH
| | - David L. Stahl
- Department of Anesthesiology, The Ohio State University, Columbus, OH
| | - Vidya T. Raman
- Department of Anesthesiology, The Ohio State University, Columbus, OH
| | - Richard D. Urman
- Department of Anesthesiology, The Ohio State University, Columbus, OH
| | - Joseph D. Tobias
- From the Department of Anesthesiology & Pain Medicine, Nationwide Children’s Hospital, Columbus, OH
- Department of Anesthesiology, The Ohio State University, Columbus, OH
| | - Olubukola O. Nafiu
- From the Department of Anesthesiology & Pain Medicine, Nationwide Children’s Hospital, Columbus, OH
- Department of Anesthesiology, The Ohio State University, Columbus, OH
| |
Collapse
|
2
|
Ghauri MS, Juste J, Shabbir T, Berry N, Reddy AJ, Farkoufar N, Masood S. Exploring the Surgical Outcomes of Pancreatic Cancer Resections Performed in Low- Versus High-Volume Centers. Cureus 2023; 15:e37112. [PMID: 37168146 PMCID: PMC10166277 DOI: 10.7759/cureus.37112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 04/04/2023] [Indexed: 05/13/2023] Open
Abstract
Introduction Pancreatic cancer resections comprise a class of complex surgical operations with a high postoperative morbidity rate. Due to the complicated nature of pancreatic resection, individuals who undergo this procedure are advised to visit a high-volume medical center that performs such pancreatic surgeries frequently. However, this specialized treatment option may not be available for uninsured patients or patients with other socioeconomic limitations that may restrict their access to these facilities. To gain a better understanding of the impact of healthcare disparities on surgical outcomes, we aimed to explore if there were significant differences in mortality rate post-pancreatic resection between high- and low-volume hospitals within San Bernardino, Riverside, Los Angeles, and Orange Counties. Methods We utilized the California Health and Human Services Agency (CHHS) California Hospital Inpatient Mortality Rates and Quality Ratings public dataset to compare risk-adjusted mortality rates (RA-MR) of pancreatic cancer resections procedures. We focused on procedures performed in hospitals within San Bernardino, Riverside, Los Angeles, and Orange County from 2012 to 2015. To assess post-resection outcomes in relation to hospital volume, we utilized an independent T-test (significance level was set equal to 0.05) to determine if there is a statistically significant difference in RA-MR after pancreatic resection between high- and low-volume hospitals. Results During the 2012-2015 study period, 57 hospitals across San Bernardino, Riverside, Orange, and Los Angeles Counties were identified to perform a total of 6,204 pancreatic resection procedures. The low-volume hospital group (N=2,539) was associated with a higher RA-MR of M=4.45 (SD=11.86). By comparison, the high-volume hospital group (N=3,665) was associated with a lower RA-MR of M=1.72 (SD=2.61). Conclusion Pancreatic resection surgeries performed at low-volume hospitals resulted in a significantly higher RA-MR compared to procedures done at high-volume hospitals in California.
Collapse
Affiliation(s)
- Muhammad S Ghauri
- Neurosurgery, California University of Science and Medicine, Colton, USA
| | - Jonathan Juste
- School of Medicine, California University of Science and Medicine, Colton, USA
| | - Talha Shabbir
- School of Medicine, California University of Science and Medicine, Colton, USA
| | - Nicole Berry
- School of Medicine, California University of Science and Medicine, Colton, USA
| | - Akshay J Reddy
- School of Medicine, California University of Science and Medicine, Colton, USA
| | - Navid Farkoufar
- School of Medicine, California University of Science and Medicine, Colton, USA
| | - Shabana Masood
- Community and Global Health, Claremont Graduate University, Claremont, USA
- Medical Education, California University of Science and Medicine, Colton, USA
| |
Collapse
|
3
|
Gault JM, Hosokawa P, Kramer D, Saks ER, Appelbaum PS, Thompson JA, Olincy A, Cascella N, Sawa A, Goodman W, Moukaddam N, Sheth SA, Anderson WS, Davis RA. Postsurgical morbidity and mortality favorably informs deep brain stimulation for new indications including schizophrenia and schizoaffective disorder. Front Surg 2023; 10:958452. [PMID: 37066004 PMCID: PMC10098000 DOI: 10.3389/fsurg.2023.958452] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 03/07/2023] [Indexed: 04/18/2023] Open
Abstract
Background Deep brain stimulation (DBS) shows promise for new indications like treatment-refractory schizophrenia in early clinical trials. In the first DBS clinical trial for treatment refractory schizophrenia, despite promising results in treating psychosis, one of the eight subjects experienced both a symptomatic hemorrhage and an infection requiring device removal. Now, ethical concerns about higher surgical risk in schizophrenia/schizoaffective disorder (SZ/SAD) are impacting clinical trial progress. However, insufficient cases preclude conclusions regarding DBS risk in SZ/SAD. Therefore, we directly compare adverse surgical outcomes for all surgical procedures between SZ/SAD and Parkinson's disease (PD) cases to infer relative surgical risk relevant to gauging DBS risks in subjects with SZ/SAD. Design In the primary analysis, we used browser-based statistical analysis software, TriNetX Live (trinetx.com TriNetX LLC, Cambridge, MA), for Measures of Association using the Z-test. Postsurgical morbidity and mortality after matching for ethnicity, over 39 risk factors, and 19 CPT 1003143 coded surgical procedures from over 35,000 electronic medical records, over 19 years, from 48 United States health care organizations (HCOs) through the TriNetX Research Network™. TriNetXis a global, federated, web-based health research network providing access and statistical analysis of aggregate counts of deidentified EMR data. Diagnoses were based on ICD-10 codes. In the final analysis, logistic regression was used to determine relative frequencies of outcomes among 21 diagnostic groups/cohorts being treated with or considered for DBS and 3 control cohorts. Results Postsurgical mortality was 1.01-4.11% lower in SZ/SAD compared to the matched PD cohort at 1 month and 1 year after any surgery, while morbidity was 1.91-2.73% higher and associated with postsurgical noncompliance with medical treatment. Hemorrhages and infections were not increased. Across the 21 cohorts compared, PD and SZ/SAD were among eight cohorts with fewer surgeries, nine cohorts with higher postsurgical morbidity, and fifteen cohorts within the control-group range for 1-month postsurgical mortality. Conclusions Given that the subjects with SZ or SAD, along with most other diagnostic groups examined, had lower postsurgical mortality than PD subjects, it is reasonable to apply existing ethical and clinical guidelines to identify appropriate surgical candidates for inclusion of these patient populations in DBS clinical trials.
Collapse
Affiliation(s)
- Judith M. Gault
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
- Correspondence: Judith M. Gault
| | - Patrick Hosokawa
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Daniel Kramer
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Elyn R. Saks
- The Law School, University of Southern California, Los Angeles, CA, United States
| | - Paul S. Appelbaum
- Department of Psychiatry, Columbia University, New York, Ny, United States Of America
| | - John A. Thompson
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Ann Olincy
- VA Eastern Colorado Medical Center, Aurora, CO, United States
| | - Nicola Cascella
- Department of Psychiatry, Johns Hopkins University, Baltimore, MD, United States
| | - Akira Sawa
- Department of Psychiatry, Johns Hopkins University, Baltimore, MD, United States
| | - Wayne Goodman
- Department of Psychiatry, Baylor College of Medicine, Houston, TX, United States
| | - Nidal Moukaddam
- Department of Psychiatry, Baylor College of Medicine, Houston, TX, United States
| | - Sameer A. Sheth
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, United States
| | - William S. Anderson
- Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, United States
| | - Rachel A. Davis
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| |
Collapse
|
4
|
Liu KH, Hung YS, Lee SH, Lai CC, Chen SC, Kao WL, Cheng HW, Hsu MH, Tsai CY, Hsueh SW, Hung CY, Lin YC, Chou WC. External validation of a risk model for survival prediction in older patients with cancer undergoing elective abdominal surgery: a prospective cohort study. Am J Cancer Res 2022; 12:5085-5094. [PMID: 36504897 PMCID: PMC9729892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 10/30/2022] [Indexed: 12/15/2022] Open
Abstract
We previously developed a Chang Gung Memorial Hospital (CGMH) model to predict the 1-year postoperative mortality risk in patients with solid cancer undergoing cancer surgery. This study aimed to externally validate the CGMH score for survival outcome and surgical complication prediction in a prospective patient cohort. A total of 345 consecutive patients aged ≥65 years who underwent elective abdominal surgery for cancer treatment were prospectively enrolled. Patients were categorized into the low, intermediate, high, and very high-risk groups according to the CGMH score for comparison. The postoperative 1-year mortality rate was 12.5% in the entire cohort. The postoperative 1-year mortality rates were 0%, 2.2%, 14.0%, and 31.6% among patients in the low, intermediate, high, and very-high risk groups, respectively. The c-statistic of the CGMH model was 0.82 (95% confidence interval [CI], 0.76-0.88) for predicting the 1-year mortality risk. Hazard ratios for overall survival were 3.73 (95% CI, 2.11-6.57; P<0.001) and 10.1 (95% CI, 5.84-17.6; P<0.001) when comparing the high and very-high risk groups with the low/intermediate risk groups, respectively. Patients in the higher CGMH risk groups had higher risks of adverse surgical outcomes in terms of longer length of hospital stay, major surgical complications, postoperative intensive care unit stay, and in-hospital death. The CGMH model accurately predicted thesurvival probabilityand risk of adverse surgical outcomes in older patients with cancer undergoing elective abdominal surgery. Our study justifies the prospective use of the CGMH model for survival outcome and safety profile predictionfor cancer surgery in older patients.
Collapse
Affiliation(s)
- Keng-Hao Liu
- Department of General Surgery, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung UniversityTaoyuan, Taiwan
| | - Yu-Shin Hung
- Department of Hematology and Oncology, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung UniversityTaoyuan, Taiwan
| | - Shu-Hui Lee
- Department of Nursing, Linkou Chang Gung Memorial HospitalTaoyuan, Taiwan,Chang Gung University of Science and Technology, Cardinal Tien Junior College of Healthcare and ManagementTaoyuan, Taiwan
| | - Cheng-Chou Lai
- Department of Colon and Rectal Surgery, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung UniversityTaoyuan, Taiwan
| | - Shu-Chen Chen
- Department of Nursing, Linkou Chang Gung Memorial HospitalTaoyuan, Taiwan,Department of Cancer Center, Linkou Chang Gung Memorial HospitalTaoyuan, Taiwan
| | - Wei-Ling Kao
- Department of Nursing, Linkou Chang Gung Memorial HospitalTaoyuan, Taiwan,Department of Cancer Center, Linkou Chang Gung Memorial HospitalTaoyuan, Taiwan
| | - Hui-Wen Cheng
- Department of Nursing, Linkou Chang Gung Memorial HospitalTaoyuan, Taiwan,Department of Cancer Center, Linkou Chang Gung Memorial HospitalTaoyuan, Taiwan
| | - Mei-Hui Hsu
- Department of Nursing, Linkou Chang Gung Memorial HospitalTaoyuan, Taiwan
| | - Chun-Yi Tsai
- Department of General Surgery, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung UniversityTaoyuan, Taiwan
| | - Shun-Wen Hsueh
- Department of Oncology, Chang Gung Memorial Hospital at KeelungKeelung, Taiwan
| | - Chia-Yen Hung
- Division of Hematology and Oncology, Department of Internal Medicine, Mackay Memorial HospitalTaipei, Taiwan
| | - Yung-Chang Lin
- Department of Hematology and Oncology, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung UniversityTaoyuan, Taiwan
| | - Wen-Chi Chou
- Department of Hematology and Oncology, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung UniversityTaoyuan, Taiwan
| |
Collapse
|
5
|
Torlot F, Yew CY, Reilly JR, Phillips M, Weber DG, Corcoran TB, Ho KM, Toner AJ. External validity of four risk scores predicting 30-day mortality after surgery. BJA Open 2022; 3:100018. [PMID: 37588588 PMCID: PMC10430818 DOI: 10.1016/j.bjao.2022.100018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 05/23/2022] [Indexed: 08/18/2023]
Abstract
Background Surgical risk prediction tools can facilitate shared decision-making and efficient allocation of perioperative resources. Such tools should be externally validated in target populations before implementation. Methods Predicted risk of 30-day mortality was retrospectively derived for surgical patients at Royal Perth Hospital from 2014 to 2021 using the Surgical Outcome Risk Tool (SORT) and the related NZRISK (n=44 031, 53 395 operations). In a sub-population (n=31 153), the Physiology and Operative Severity Score for the enumeration of Mortality (POSSUM) and the Portsmouth variant of this (P-POSSUM) were matched from the Copeland Risk Adjusted Barometer (C2-Ai, Cambridge, UK). The primary outcome was risk score discrimination of 30-day mortality as evaluated by area-under-receiver operator characteristic curve (AUROC) statistics. Calibration plots and outcomes according to risk decile and time were also explored. Results All four risk scores showed high discrimination (AUROC) for 30-day mortality (SORT=0.922, NZRISK=0.909, P-POSSUM=0.893; POSSUM=0.881) but consistently over-predicted risk. SORT exhibited the best discrimination and calibration. Thresholds to denote the highest and second-highest deciles of SORT risk (>3.92% and 1.52-3.92%) captured the majority of deaths (76% and 13%, respectively) and hospital-acquired complications. Year-on-year SORT calibration performance drifted towards over-prediction, reflecting a decrease in 30-day mortality over time despite an increase in the surgical population risk. Conclusions SORT was the best performing risk score in predicting 30-day mortality after surgery. Categorising patients based on SORT into low, medium (80-90th percentile), and high risk (90-100th percentile) might guide future allocation of perioperative resources. No tools were sufficiently calibrated to support shared decision-making based on absolute predictions of risk.
Collapse
Affiliation(s)
| | | | - Jennifer R. Reilly
- Department of Anaesthesiology and Perioperative Medicine, Alfred Hospital, Melbourne, Australia
- Department of Anaesthesia and Perioperative Medicine, Monash University, Melbourne, Australia
| | | | - Dieter G. Weber
- Royal Perth Hospital, Perth, Australia
- University of Western Australia, Perth, Australia
| | - Tomas B. Corcoran
- Royal Perth Hospital, Perth, Australia
- University of Western Australia, Perth, Australia
| | - Kwok M. Ho
- Royal Perth Hospital, Perth, Australia
- University of Western Australia, Perth, Australia
| | - Andrew J. Toner
- Royal Perth Hospital, Perth, Australia
- University of Western Australia, Perth, Australia
| |
Collapse
|
6
|
Uemura S, Endo H, Ichihara N, Miyata H, Maeda H, Hasegawa H, Kamiya K, Kakeji Y, Yoshida K, Yasuyuki S, Yamaue H, Yamamoto M, Kitagawa Y, Hanazaki K. Day of surgery and mortality after pancreatoduodenectomy: A retrospective analysis of 29 270 surgical cases of pancreatic head cancer from Japan. J Hepatobiliary Pancreat Sci 2022; 29:778-784. [PMID: 34496150 DOI: 10.1002/jhbp.1043] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 08/27/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND/PURPOSE The day of the week can impact medical treatment outcomes; however, few large-scale, disease-specific studies have focused on the association between the day of the week and mortality in patients after pancreatoduodenectomy for pancreatic head cancer. METHODS Data were obtained from the National Clinical Database. Twenty-two clinical variables were adopted for hierarchal logistic regression modeling to determine adjusted odds ratios (ORs) for surgical mortality after elective pancreatoduodenectomy. RESULTS The 30-day mortality and surgical mortality rates were 1.0% and 1.7%, respectively (n = 29 720). Surgeries were performed the least on Fridays (13.4%) compared with other weekdays. Crude rates of severe postoperative complications (mean, 14.1%; range, 13.5%-14.8%) and pancreatic fistulas (mean, 10.0%; range, 9.6%-10.3%) remained stable throughout the week. Unadjusted/adjusted ORs did not significantly differ between Friday and Monday (0.868, 95% CI: 0.636-1.173, P = .365, and 0.928, 95% CI: 0.668-1.287, P = .653, respectively), and results were similar for the remaining weekdays. Nineteen independent factors were associated with surgical mortality. CONCLUSIONS The rate of perioperative mortality for elective pancreatoduodenectomy is low in Japan, with no evidence of disparities in surgical mortality rates between weekdays.
Collapse
Affiliation(s)
- Sunao Uemura
- Department of Surgery, Kochi Medical School, Kochi, Japan
| | - Hideki Endo
- Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Japan
| | - Nao Ichihara
- Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Japan
| | - Hiroaki Miyata
- Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Japan
| | | | - Hiroshi Hasegawa
- Project Management Subcommittee, The Japanese Society of Gastroenterological Surgery, Tokyo, Japan
| | - Kinji Kamiya
- Project Management Subcommittee, The Japanese Society of Gastroenterological Surgery, Tokyo, Japan
| | - Yoshihiro Kakeji
- Database Committee, The Japanese Society of Gastroenterological Surgery, Tokyo, Japan
| | - Kazuhiro Yoshida
- Department of Surgical Oncology, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Seto Yasuyuki
- Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Japan
| | - Hiroki Yamaue
- Second Department of Surgery, School of Medicine, Wakayama Medical University, Wakayama, Japan
| | - Masakazu Yamamoto
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Shinjuku-ku, Japan
| | - Yuko Kitagawa
- The Japanese Society of Gastroenterological Surgery, Tokyo, Japan
| | | |
Collapse
|
7
|
Montemurro N, Perrini P, Lawton MT. Unsuccessful bypass and trapping of a giant dolichoectatic thrombotic basilar trunk aneurysm. What went wrong? Br J Neurosurg 2022:1-4. [PMID: 35579078 DOI: 10.1080/02688697.2022.2077306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 10/25/2021] [Accepted: 05/09/2022] [Indexed: 11/02/2022]
Abstract
Aneurysms of the basilar trunk represent an exceptional challenge to the neurosurgeon, due to high mortality and surgical morbidity. We present a 69-year-old man with a giant dolichoectatic thrombotic basilar trunk aneurysm (BTA), who underwent right orbitozygomatic craniotomy, posterior cerebral artery (PCA) to right middle cerebral artery (MCA) bypass and trapping of the BTA. Unfortunately, patient died after surgery due to multiple foci of intraparenchymal haemorrhage and thrombosis of a short segment proximal to aneurysm trapped and his body was donated to the hospital, giving us the unique opportunity to compare intraoperative details with anatomical dissection findings, according to our previously published cadaveric neurosurgical research. The great and unique opportunity of this reported case, to learn by watching and watching again what has been done during surgery, to observe small vessels and brainstem perforators and to look at stiches of the bypass, SVG and the position of the clips, permits to refine the theoretical and practical skills for the treatment of complex aneurysms such as that one reported.
Collapse
Affiliation(s)
- Nicola Montemurro
- Department of Neurosurgery, Azienda Ospedaliera Universitaria Pisana (AOUP), University of Pisa, Pisa, Italy
| | - Paolo Perrini
- Department of Neurosurgery, Azienda Ospedaliera Universitaria Pisana (AOUP), University of Pisa, Pisa, Italy
| | - Michael T Lawton
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| |
Collapse
|
8
|
Young E, Kopunic HS, Trochsler MI, Maddern GJ. Predictors of interhospital transfer delays in acute surgical patient deaths in Australia: a retrospective study. ANZ J Surg 2022; 92:1322-1331. [PMID: 35373494 DOI: 10.1111/ans.17669] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 03/08/2022] [Accepted: 03/10/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Interhospital transfers in Australia facilitate access to acute surgical services, however transfer delays can occur. The aims of this study were to examine Australian mortality audit data on acute surgical patients who were transferred after presenting with a surgical emergency, and to identify modifiable predictors of transfer delay. METHODS Surgical admissions between 1 January 2001 and 18 August 2020 were retrospectively extracted from the Australian and New Zealand Audit of Surgical Mortality database. Relevant factors and themes of interest were collated. Results were presented as odds ratios (OR) and 95% confidence intervals (CI), with statistical significance defined as P <0.05. RESULTS After exclusion, a final 8270 cases were analysed. Non-modifiable predictors identified were female gender (OR 1.34, 95% CI 1.05-1.70, P = 0.0184), comorbidities (OR 1.50, 95% CI 1.40-161, P <0.0001) and major non-trauma non-vascular specialty (OR 1.54 to 7.77, depending on specialty, P < 0.05). Modifiable predictors were inadequate clinical assessment (OR 49.48, 95% CI 32.91-74.38, P <0.0001), poor communication (OR 6.62, 95% CI 3.70-11.85, P <0.0001) and multiple transfers (OR 6.30, OR 95% 4.31-9.21, P <0.0001). Age, lack of bed and after-hours transfer did not predict transfer delays. Metropolitan transfers was protective against transfer delays (OR 0.64, 95% CI 0.47-0.86, P = 0.0035). CONCLUSION In the view of the receiving surgeon or assessor, all transfer delays potentially contributed to patient deaths, and may have been preventable. Strategies directed at modifiable factors could minimize delays. Increased surgical services in non-metropolitan regions could reduce need for transfer. Prospective data is required to examine if the same predictors are observed in surgical patients who survive.
Collapse
Affiliation(s)
- Edward Young
- The University of Adelaide, Faculty of Health and Medical Sciences, Adelaide, South Australia, Australia
| | - Helena S Kopunic
- Australian and New Zealand Audit of Surgical Mortality (ANZASM), Royal Australasian College of Surgeons, Adelaide, South Australia, Australia
| | - Markus I Trochsler
- The University of Adelaide Discipline of Surgery, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - Guy J Maddern
- Australian and New Zealand Audit of Surgical Mortality (ANZASM), Royal Australasian College of Surgeons, Adelaide, South Australia, Australia.,The University of Adelaide Discipline of Surgery, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| |
Collapse
|
9
|
Okamoto K, Kaku R, Oshio Y, Hanaoka J. Impact of thoracic esophageal displacement after lobectomy on the continuity of oral adjuvant chemotherapy. Asian Cardiovasc Thorac Ann 2022; 30:573-579. [PMID: 35179062 DOI: 10.1177/02184923221081701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Adjuvant tegafur-uracil therapy has prolonged postoperative survival in patients with non-small cell lung cancer. Some patients experience treatment discontinuation due to gastrointestinal disorders such as anorexia, and the associated factors and the impact of lobectomy remain unclear. This study aimed to assess the postoperative esophageal displacement after lobectomy and to clarify its impact on the continuity of tegafur-uracil treatment. METHODS Patients who received adjuvant tegafur-uracil therapy after lobectomy between April 2009 and March 2019 were retrospectively analyzed. Patient background, perioperative characteristics, treatment findings, and the degree of esophageal displacement measured by computed tomography were compared between the treatment completion group and the discontinuation group. A subgroup comparative analysis was further performed in the groups divided according to the degree of esophageal displacement. RESULTS A total of 68 patients were reviewed, including 41 males and 27 females with a mean age of 66.2 years old. A total of 41 patients completed the 2-year adjuvant treatment and 27 patients discontinued it. The overall survival and relapse-free survival between the two groups were statistically significant (p = 0.027, p = 0.010). The degree of esophageal displacement at the Th7 level was a significant predictor of treatment discontinuation (p = 0.046, odds ratio [OR]: 1.138, 95% confidence interval [CI]: 1.002-1.291). Among the patients with a high degree of esophageal displacement above the baseline determined from the receiver operating characteristic curve, the cause of discontinuation was anorexia, which was significant in multivariate analysis (p = 0.013, OR: 14.72, 95% CI: 1.745-124.2). CONCLUSIONS Our study suggested that anatomical displacement of the esophagus after lobectomy may affect the discontinuation of oral adjuvant chemotherapy in patients with lung cancer.
Collapse
Affiliation(s)
- Keigo Okamoto
- Department of Cardiothoracic Surgery, 13051Shiga University of Medical Science, Otsu, Japan
| | - Ryosuke Kaku
- Department of Cardiothoracic Surgery, 13051Shiga University of Medical Science, Otsu, Japan
| | - Yasuhiko Oshio
- Department of Cardiothoracic Surgery, 13051Shiga University of Medical Science, Otsu, Japan
| | - Jun Hanaoka
- Department of Cardiothoracic Surgery, 13051Shiga University of Medical Science, Otsu, Japan
| |
Collapse
|
10
|
Kuryba A, Boyle JM, Blake HA, Aggarwal A, van der Meulen J, Braun M, Walker K, Fearnhead NS. Surgical Treatment and Outcomes of Colorectal Cancer Patients During the COVID-19 Pandemic: A National Population-based Study in England. Ann Surg Open 2021; 2:e071. [PMID: 34240077 PMCID: PMC8223908 DOI: 10.1097/as9.0000000000000071] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 05/01/2021] [Indexed: 12/30/2022] Open
Abstract
To compare the management and outcomes of colorectal cancer (CRC) patients during the first 2 months of the COVID-19 pandemic with the preceding 6 months. BACKGROUND The pandemic has affected the diagnosis and treatment of CRC patients worldwide. Little is known about the safety of major resection and whether creating "cold" sites (COVID-free hospitals) is effective. METHODS A national study in England used administrative hospital data for 14,930 CRC patients undergoing surgery between October 1, 2019, and May 31, 2020. Mortality of CRC resection was compared before and after March 23, 2020 ("lockdown" start). RESULTS The number of elective CRC procedures dropped sharply during the pandemic (from average 386 to 214 per week), whereas emergency procedures were hardly affected (from 88 to 84 per week). There was little change in characteristics of surgical patients during the pandemic. Laparoscopic surgery decreased from 62.5% to 35.9% for elective and from 17.7% to 9.7% for emergency resections. Surgical mortality increased slightly (from 0.9% to 1.2%, P = 0.06) after elective and markedly (from 5.6% to 8.9%, P = 0.003) after emergency resections. The observed increase in mortality during the first phase of the pandemic was similar in "cold" and "hot" sites (P > 0.5 elective and emergency procedures). CONCLUSIONS The pandemic resulted in a 50% reduction in elective CRC procedures during the initial surge and a substantial increase in mortality after emergency resection. There was no evidence that surgery in COVID-free "cold" sites led to better outcomes in the first 2 months.
Collapse
Affiliation(s)
- Angela Kuryba
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, United Kingdom
| | - Jemma M Boyle
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, United Kingdom
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Helen A Blake
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, United Kingdom
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Ajay Aggarwal
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Clinical Oncology, Guy's & St Thomas' NHS Trust, London, United Kingdom
| | - Jan van der Meulen
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, United Kingdom
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Michael Braun
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Kate Walker
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, United Kingdom
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Nicola S Fearnhead
- Department of Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| |
Collapse
|
11
|
Ong YLR, Sambrook P, Maddern G. Oral squamous cell carcinoma resection and neck dissection mortality: a 10-year national audit study. ANZ J Surg 2020; 91:145-151. [PMID: 33244898 DOI: 10.1111/ans.16463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 11/02/2020] [Accepted: 11/04/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Oral squamous cell carcinoma (OSCC) is a significant public health issue. Australia had 448 deaths from lip and oral cavity cancer in 2018, some of which could be prevented. Consideration of the factors contributing to mortality after OSCC resection can provide a greater insight into how deaths can be prevented. METHODS This paper used data from the Australia and New Zealand Audit of Surgical Mortality from the last 10 years from 1 January 2009 to 31 December 2018 for analysis. All surgical deaths were captured as the treating surgeons were mandated to complete a surgical case form for assessment by an independent surgeon from the same specialty. RESULTS This study found 25 cases of death after OSCC resection. In 44% of cases, death was related to cardiac causes and 40% was related to respiratory causes. Fourteen cases were found to have issues with management, and 25 issues were raised. In 36% of issues, it was found to be related to decision to operate. There were no obvious differences between the patients who had neck dissections and those who did not. CONCLUSION The decision to operate on high-risk patients, cardiovascular and respiratory causes were the major contributors to surgical mortality. The small number of deaths and the limitation of using existing data limited statistical analysis and conclusions. Changes could be made to the Australia and New Zealand Audit of Surgical Mortality to improve the results for analysis.
Collapse
Affiliation(s)
- Yi Long Roy Ong
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Paul Sambrook
- Department of Oral and Maxillofacial Surgery, Adelaide Dental School, The University of Adelaide, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Oral and Maxillofacial Surgery, Royal Australasian College of Dental Surgeons, Sydney, New South Wales, Australia
| | - Guy Maddern
- Discipline of Surgery, The University of Adelaide, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia.,Australian and New Zealand Audit of Surgical Mortality, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia
| |
Collapse
|
12
|
Dandena F, Leulseged B, Suga Y, Teklewold B. Magnitude and Pattern of Inpatient Surgical Mortality in a Tertiary Hospital in Addis Ababa, Ethiopia. Ethiop J Health Sci 2020; 30:371-377. [PMID: 32874080 PMCID: PMC7445947 DOI: 10.4314/ejhs.v30i3.8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Inpatient mortality is among regularly collected data in Key performance indicators in the Ethiopian healthcare system, and it is generally reported to the Federal Ministry of Health and is used as one of inpatient services quality indicators. This study was undertaken to identify the magnitude, causes and pattern of mortalities among patients who are admitted and treated in surgical wards in Saint Paul Hospital Millennium Medical College for a period of three years. Methods A retrospective review was done on all patients admitted and died in the Department of Surgery in St. Paul's Hospital Millennium Medical College from January 1, 2016–Dec 30, 2018. Result There were 10,259 admissions over three years and out of which there were 350 deaths between 2016–2018 making a crude mortality rate of 3.41 %. The commonest mode of admission was for emergency conditions, 195(62.7%). Out of emergency admissions, 139 mortalities were from general emergency surgery and 75 patients died from elective general surgery admissions. Eighty-four (26.9%) patients had comorbidity and the commonest comorbidity was anemia 21(25%). The commonest possible cause of death was multi-organ failure secondary to septic shock, 159(51%). Mortality rate patterns along the three years (2016, 2017, 2018) showed 3.34% (112/3360), 2.87% (102/3552) and 2.92% (98/3347) respectively. Conclusion The mortality rate of this study is much higher than global rates, but still there is a significant difference from other developing countries and also other researches in this country. Pattern of mortality did not show any difference across years of the study period.
Collapse
Affiliation(s)
- Firaol Dandena
- St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Belayneh Leulseged
- Department of Public Health, St Paul Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Yisihak Suga
- Department of Surgery, St Paul hospital Millennium Medical College, Addis Ababa, Ethiopia
| | | |
Collapse
|
13
|
Ong YLR, Tivey D, Huang L, Sambrook P, Maddern G. Factors affecting surgical mortality of oral squamous cell carcinoma resection. Int J Oral Maxillofac Surg 2020; 50:1-6. [PMID: 32773113 DOI: 10.1016/j.ijom.2020.07.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 04/16/2020] [Accepted: 07/03/2020] [Indexed: 01/04/2023]
Abstract
Survival rates for oral squamous cell carcinoma (OSCC) has remained stagnant in recent years and improving surgical mortality could be an avenue to enhance outcomes. This systematic review aims to identify the causes of mortalities, determine both the modifiable and non-modifiable factors involved and target a reduction in postoperative 30-day mortality. In May 2019, a comprehensive search of key databases including PubMed, EMBASE, Cochrane Library was conducted. Blinded selection by two researchers identified papers that included participants who received oral squamous cell carcinoma resection and suffered an in-hospital or 30-day mortality. Selection identified two relevant papers that meet the inclusion criteria. One study had one death in its population sample but only had the cause of death described. Another study had an overall surgical mortality rate of 1% in a population of 21,681. Patients with multiple factors had the highest mortality rates; 4.6% in patients >85 years old and have a T4 diagnosis, 3.9% in patients with a Comorbidity Index ≥1 and a T4 diagnosis. These studies did not determine relationships between factors and causes of death. There are significant knowledge gaps in the literature, that can be addressed through further population analysis studies.
Collapse
Affiliation(s)
- Y L R Ong
- University of Adelaide, Adelaide, SA, Australia.
| | - D Tivey
- Royal Australasian College of Surgeons
| | - L Huang
- Department of Surgery, Flinders Medical Centre, Bedford Park, South Australia; College of Medicine and Public Health, Flinders University, Bedford Park, South Australia
| | - P Sambrook
- Department of Oral and Maxillofacial Surgery, University of Adelaide, Royal Adelaide Hospital, Adelaide, SA, Australia; Royal Australasian College of Dental Surgeons
| | - G Maddern
- Discipline of Surgery, The University of Adelaide, The Queen Elizabeth Hospital, Adelaide, SA, Australia; Australian and New Zealand Audit of Surgical Mortality, Royal Australasian College of Surgeons, Adelaide, SA, Australia
| |
Collapse
|
14
|
Mpody C, Humphrey L, Kim S, Tobias JD, Nafiu OO. Racial Differences in Do-Not-Resuscitate Orders among Pediatric Surgical Patients in the United States. J Palliat Med 2020; 24:71-76. [PMID: 32543271 DOI: 10.1089/jpm.2020.0053] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Very few studies have investigated the racial differences in do-not-resuscitate (DNR) orders in children, and these studies are limited to oncological cases. We aim to characterize the racial difference in DNR orders among U.S. pediatric surgical patients. Methods: We retrospectively evaluated the mortality of all children who underwent an inpatient surgery between 2012 and 2017 from the National Surgical Quality Improvement Program. We used log-binomial models to estimate the relative risk (RR) and 95% confidence interval (CI) of DNR use comparing white with African American (AA) children. To estimate the risk-adjusted difference in DNR orders, we controlled the analyses for age, prematurity status, emergent case status, American Society of Anesthesiologists class, year of operation, surgical specialty, and surgical complexity. Results: Between 2012 and 2017, a total of 276,917 children underwent inpatient surgery, of whom 0.8% (n = 1601) died within 30 days of operation. Of the 1601 mortality cases, we retained 1212 children who were of either AA (26.0%, n = 350) or white (63.9%, n = 862) race. Most children were neonates, had an American Society of Anesthesiologists class ≥4 (70.0%, n = 811), and developed one or more postoperative complications (68.7%, n = 833). Overall, AA children were more likely to be neonates at the time of surgery (42.0% vs. 40.3%, p < 0.001), to be premature (66.3% vs. 49.0%, p < 0.001), and develop one or more postoperative complications (73.7% vs. 66.7%, p = 0.017). White children were three times more likely to have a DNR order than their AA peers (adjusted RR: 3.01, 95% CI: 1.09-8.56, p = 0.044). Conclusion: Among pediatric surgical patients in the United States, children of white race were three times more likely to have a DNR order in place than their AA peers despite the latter being "sicker" and more likely to develop postoperative complications. The mechanisms underlying this racial difference deserve further elucidation to improve shared decision making and goal-concordant care.
Collapse
Affiliation(s)
- Christian Mpody
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Lisa Humphrey
- Division of Palliative Care, Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA
| | - Stephani Kim
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Joseph D Tobias
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Olubukola O Nafiu
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
| |
Collapse
|
15
|
Abstract
In this study we describe nurse-physician teamwork, estimate its association with surgical patient outcomes (30-day mortality and failure-to-rescue), and determine whether these relationships depend upon other modifiable hospital nursing characteristics (nurse staffing and education levels) known to be associated with patient outcomes. This cross-sectional analysis included linked data from 29,391 nurses representing 665 acute care hospitals and 1,321,904 adult patients who underwent a general surgical, vascular, or orthopedic procedure. Surgical patients cared for in hospitals with better nurse-physician teamwork had significantly lower odds of 30-day mortality (odds ratio [OR] = 0.95) and failure-to-rescue (OR = 0.95). In addition, the odds of death and failure-to-rescue were lower for patients in hospitals with both higher nurse-physician teamwork and more favorable patient-to-nurse staffing ratios. Similar trends were observed related to nursing education levels. Improving interprofessional teamwork is one strategy to improve patient outcomes with the added importance of also considering additional features of their nursing workforce.
Collapse
|
16
|
El Hadj Sidi C, Mgarrech I, Tarmiz A, Jerbi S. External validation of the European System for Cardiac Operative Risk Evaluation II in a Tunisian population. J Card Surg 2019; 34:266-273. [PMID: 30873659 DOI: 10.1111/jocs.14015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 02/17/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The main objective of this study is to evaluate the performance of the predictive model (EuroSCORE II) on a Tunisian population to validate its use in our country. METHODS This is a retrospective study of data from 418 adult patients undergoing cardiac surgery with cardiopulmonary bypass between 1 January 2015 and 31 December 2016 in the department of cardiovascular and thoracic surgery of the Sahloul University Hospital of Sousse. The EuroSCORE ΙΙ is calculated using the application validated on the site www.euroscore.org. The performance of the score is evaluated by analyzing its discriminative power by constructing the receiver operating characteristic (ROC) curve and analyzing its calibration using the Hosmer-Lemeshow statistics. RESULTS The EuroSCORE II shows good discriminative power in our population with an area under the ROC curve more than 0.7 in all study groups (0.864 ± 0.032 for general cardiac surgery, 0.822 ± 0.061 for coronary surgery, 0.864 ± 0.052 for valvular surgery, and 0.900 ± 0.041 for urgent cardiac surgery). The model appears to be calibrated as well by obtaining P values above the statistical significance level of 0.05 (0.638 for general cardiac surgery, 0.543 for coronary surgery, 0.179 for valvular surgery, and 0.082 for urgent cardiac surgery). CONCLUSION The EuroSCORE II presents acceptable performance in our population, attested by a good discriminative power and an adequate calibration.
Collapse
Affiliation(s)
- Chighaly El Hadj Sidi
- Department of Cardiovascular and Thoracic Surgery, Sahloul University Hospital, Sousse, Tunisia
| | - Imen Mgarrech
- Department of Cardiovascular and Thoracic Surgery, Sahloul University Hospital, Sousse, Tunisia
| | - Amine Tarmiz
- Department of Cardiovascular and Thoracic Surgery, Sahloul University Hospital, Sousse, Tunisia
| | - Sofiane Jerbi
- Department of Cardiovascular and Thoracic Surgery, Sahloul University Hospital, Sousse, Tunisia
| |
Collapse
|
17
|
Abstract
Background The optimal glycemic target during the perioperative period is still controversial. We aimed to explore the effects of tight glycemic control (TGC) on surgical mortality and morbidity. Methods PubMed, EMBASE and CENTRAL were searched from January 1, 1946 to February 28, 2018. Appropriate trails comparing the postoperative outcomes (mortality, hypoglycemic events, acute kidney injury, etc.) between different levels of TGC and liberal glycemic control were identified. Quality assessments were performed with the Jadad scale combined with the allocation concealment evaluation. Pooled relative risk (RR) and 95% CI were calculated using random effects models. Heterogeneity was detected by the I2 test. Results Twenty-six trials involving a total of 9315 patients were included in the final analysis. The overall mortality did not differ between tight and liberal glycemic control (RR, 0.92; 95% CI, 0.78-1.07; I 2 = 20.1%). Among subgroup analyses, obvious decreased risks of mortality were found in the short-term mortality, non-diabetic conditions, cardiac surgery conditions and compared to the very liberal glycemic target. Furthermore, TGC was associated with decreased risks for acute kidney injury, sepsis, surgical site infection, atrial fibrillation and increased risks of hypoglycemia and severe hypoglycemia. Conclusions Compared to liberal control, perioperative TGC (the upper level of glucose goal ≤150 mg/dL) was associated with significant reduction of short-term mortality, cardic surgery mortality, non-diabetic patients mortality and some postoperative complications. In spite of increased risks of hypoglycemic events, perioperative TGC will benefits patients when it is done carefully.
Collapse
Affiliation(s)
- Zhou-Qing Kang
- Department of Nursing, Jin Qiu Hospital of Liaoning Province, Geriatric Hospital of Liaoning Province, Shenyang, Liaoning Province, China
- Correspondence should be addressed to Z-Q Kang:
| | - Jia-Ling Huo
- Department of Respiratory Medicine, Jin Qiu Hospital of Liaoning Province, Geriatric Hospital of Liaoning Province, Shenyang, Liaoning Province, China
| | - Xiao-Jie Zhai
- Department of Nursing, Jin Qiu Hospital of Liaoning Province, Geriatric Hospital of Liaoning Province, Shenyang, Liaoning Province, China
| |
Collapse
|
18
|
Bennett JM, Wise ES, Hocking KM, Brophy CM, Eagle SS. Hyperlactemia Predicts Surgical Mortality in Patients Presenting With Acute Stanford Type-A Aortic Dissection. J Cardiothorac Vasc Anesth 2016; 31:54-60. [PMID: 27493094 DOI: 10.1053/j.jvca.2016.03.133] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Inspired by the limited facility of the Penn classification, the authors aimed to determine a rapid and optimal preoperative assessment tool to predict surgical mortality after acute Stanford type-A aortic dissection (AAAD) repair. DESIGN Patients who underwent an attempted surgical repair of AAAD were determined using a de-identified single institution database. The charts of 144 patients were reviewed retrospectively for preoperative demographics and surrogates for disease severity and malperfusion. Bivariate analysis was used to determine significant (p≤0.05) predictors of in-hospital and 1-year mortality, the primary endpoints. Receiver operating characteristic curve generation was used to define optimal cut-off values for continuous predictors. SETTING Single center, level 1 trauma, university teaching hospital. PARTICIPANTS The study included 144 cardiac surgical patients with acute type-A aortic dissection presenting for surgical correction. INTERVENTIONS Surgical repair of aortic dissection with preoperative laboratory samples drawn before patient transfer to the operating room or immediately after arterial catheter placement intraoperatively. MEASUREMENTS AND MAIN RESULTS The study cohort comprised 144 patients. In-hospital mortality was 9%, and the 1-year mortality rate was 17%. Variables that demonstrated a correlation with in-hospital mortality included an elevated serum lactic acid level (odds ratio [OR] 1.5 [1.3-1.9], p<0.001), a depressed ejection fraction (OR 0.91 [0.86-0.96], p = .001), effusion (OR 4.8 [1.02-22.5], p = 0.04), neurologic change (OR 5.3 [1.6-17.4], p = 0.006), severe aortic regurgitation (OR 8.2 [2.0-33.9], p = 0.006), and cardiopulmonary resuscitation (OR 6.8 [1.7-26.9], p = 0.01). Only an increased serum lactic acid level demonstrated a trend with 1-year mortality using univariate Cox regression (hazard ratio 1.1 [1.0-1.1], p = 0.006). Receiver operating characteristic analysis revealed optimal cut-off lactic acid levels of 6.0 mmol/L and 6.9 mmol/L for in-hospital and 1-year mortality, respectively. CONCLUSION Lactic acidosis, ostensibly as a surrogate for systemic malperfusion, represents a novel, accurate, and easily obtainable preoperative predictor of short-term mortality after attempted AAAD repair. These data may improve identification of patients who would not benefit from surgery.
Collapse
Affiliation(s)
- Jeremy M Bennett
- Division of Cardiovascular Anesthesiology, Vanderbilt University Medical Center, Nashville, TN.
| | - Eric S Wise
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Kyle M Hocking
- Biomedical Engineering Department, Vanderbilt University Medical Center, Nashville, TN
| | - Colleen M Brophy
- Division of Vascular Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Susan S Eagle
- Division of Cardiovascular Anesthesiology, Vanderbilt University Medical Center, Nashville, TN
| |
Collapse
|
19
|
Liebelt JJ, Yang Y, DeRose JJ, Taub CC. Ventricular septal rupture complicating acute myocardial infarction in the modern era with mechanical circulatory support: a single center observational study. Am J Cardiovasc Dis 2016; 6:10-16. [PMID: 27073732 PMCID: PMC4788724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 09/28/2015] [Indexed: 06/05/2023]
Abstract
Ventricular septal rupture (VSR) is a rare but devastating complication after acute myocardial infarction (AMI). While the incidence has decreased, the mortality rate from VSR has remained extremely high. The use of mechanical circulatory support with intra-aortic balloon pump (IABP) and extracorporal membrane oxygenation (ECMO) may be useful in providing hemodynamic stability and time for myocardial scarring. However, the optimal timing for surgical repair remains an enigma. Retrospective analysis of 14 consecutive patients diagnosed with VSR after AMI at Montefiore Medical Center between January 2009 and June 2015. A chart review was performed with analysis of baseline characteristics, hemodynamics, imaging, percutaneous interventions, surgical timing, and outcomes. The survival group had a higher systolic BP (145 vs 98, p<0.01), higher MAP (96 vs 76, p=0.03), and lower HR (75 vs 104, p=0.05). Overall surgical timing was 6.5 ± 3.7 days after indexed myocardial infarction with a significant difference between survivors and non-survivors (9.8 vs 4.3, p=0.01). The number of pre-operative days using IABP was longer in survivors (6.5 vs 3.2, p=0.36) as was post-operative ECMO use (4.5 vs 2 days, p=0.35). The overall 30-day mortality was 71.4% with a 60% surgical mortality rate. Hemodynamics at the time of presentation and a delayed surgical approach of at least 9 days showed significant association with improved survival. Percutaneous coronary intervention (PCI) was more common in non-survivors. The use of IABP in the pre-operative period and post-operative ECMO use likely provide a survival benefit.
Collapse
Affiliation(s)
- Jared J Liebelt
- Department of Medicine, Jacobi Medical Center, Albert Einstein College of MedicineBronx, NY, USA
| | - Yuanquan Yang
- Department of Medicine, Montefiore Medical Center-Wakefield DivisionBronx, NY, USA
| | - Joseph J DeRose
- Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center, Albert Einstein College of MedicineBronx, NY, USA
| | - Cynthia C Taub
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of MedicineBronx, NY, USA
| |
Collapse
|
20
|
Hosainey SAM, Lassen B, Helseth E, Meling TR. Cerebrospinal fluid disturbances after 381 consecutive craniotomies for intracranial tumors in pediatric patients. J Neurosurg Pediatr 2014; 14:604-14. [PMID: 25325416 DOI: 10.3171/2014.8.peds13585] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The aim of this study was to investigate the incidence of CSF disturbances before and after intracranial surgery for pediatric brain tumors in a large, contemporary, single-institution consecutive series. METHODS All pediatric patients (those < 18 years old), from a well-defined population of 3.0 million inhabitants, who underwent craniotomies for intracranial tumors at Oslo University Hospital in Rikshospitalet between 2000 and 2010 were included. The patients were identified from the authors' prospectively collected database. A thorough review of all medical charts was performed to validate all the database data. RESULTS Included in the study were 381 consecutive craniotomies, performed on 302 patients (50.1% male, 49.9% female). The mean age of the patients in the study was 8.63 years (range 0-17.98 years). The follow-up rate was 100%. Primary craniotomies were performed in 282 cases (74%), while 99 cases (26%) were secondary craniotomies. Tumors were located supratentorially in 249 cases (65.3%), in the posterior fossa in 105 (27.6%), and in the brainstem/diencephalon in 27 (7.1%). The surgical approach was supratentorial in 260 cases (68.2%) and infratentorial in 121 (31.8%). Preoperative hydrocephalus was found in 124 cases (32.5%), and 71 (86.6%) of 82 achieved complete cure with tumor resection only. New-onset postoperative hydrocephalus was observed in 9 (3.5%) of 257 cases. The rate of postoperative CSF leaks was 6.3%. CONCLUSIONS Preoperative hydrocephalus was found in 32.5% of pediatric patients with brain tumors treated using craniotomies. Tumor resection alone cured preoperative hydrocephalus in 86.6% of cases and the incidence of new-onset hydrocephalus after craniotomy was only 3.5%.
Collapse
|
21
|
Jones MD, Parry MC, Whitehouse MR, Blom AW. Early death following primary total hip arthroplasty. J Arthroplasty 2014; 29:1625-8. [PMID: 24650899 DOI: 10.1016/j.arth.2014.02.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2013] [Revised: 01/30/2014] [Accepted: 02/03/2014] [Indexed: 02/01/2023] Open
Abstract
This study aims to describe the timing, cause of death, and excess surgical mortality associated with primary total hip arthroplasty when compared to a population awaiting primary total hip arthroplasty. Mortality rates were calculated at cutoffs of 30 and 90 days post-operation or following the addition to the waiting list. Cause of death was recorded from the death certificate. An excess surgical mortality of 0.256% at 30 days (P = 0.002) and 0.025% at 90 days post-operation (P = 0.892), unaffected by age or gender, was seen with myocardial infarction and pneumonia the cause of death in the majority of cases. By using a more appropriate control population, an excess surgical mortality at 30 days post-operation is demonstrated; the effect diminishes at 90 days post-operation.
Collapse
Affiliation(s)
- Mark D Jones
- Musculoskeletal Research Unit, University of Bristol, Avon Orthopaedic Centre, Southmead Hospital, Bristol, UK
| | - Michael C Parry
- Musculoskeletal Research Unit, University of Bristol, Avon Orthopaedic Centre, Southmead Hospital, Bristol, UK
| | - Michael R Whitehouse
- Musculoskeletal Research Unit, University of Bristol, Avon Orthopaedic Centre, Southmead Hospital, Bristol, UK
| | - Ashley W Blom
- Musculoskeletal Research Unit, University of Bristol, Avon Orthopaedic Centre, Southmead Hospital, Bristol, UK
| |
Collapse
|
22
|
Uchida K, Io A, Akita S, Munakata H, Hibino M, Fujii K, Kato W, Sakai Y, Tajima K, Mizobata Y. Recent risk factors for open surgical mortality in patients with ruptured abdominal aortic aneurysm. Acute Med Surg 2014; 1:207-213. [PMID: 29930850 DOI: 10.1002/ams2.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Accepted: 02/24/2014] [Indexed: 11/06/2022] Open
Abstract
Aim We examined recent relevant prognostic factors for the outcome of open surgical treatment of ruptured abdominal aortic aneurysm. Methods Between 2006 and 2012, 35 patients received emergency open surgical treatment for ruptured abdominal aortic aneurysm at our institute. We reviewed ambulance activity logs and clinical records of 34 infrarenal ruptured abdominal aortic aneurysm patients retrospectively. Univariate and multivariate logistic regression analyses were carried out to identify risk factors for surgical outcomes. Results Eight patients died during surgery or within a few hours following surgery completion. Through univariate analysis, body mass index, serum lactate level, arterial blood pH, base excess, platelet count, prothrombin time-international normalized ratio, activated partial thromboplastin time, type of ruptured aneurysm, response to i.v. fluid resuscitation within 2,000 mL in the initial therapy, and volume of blood loss during surgery were detected to be significant variants. Multivariate logistic regression analysis revealed the patients who were hemodynamically stabilized after primary volume loading had a 13.2 times higher possibility of survival. Body mass index, high serum lactate level, and volume of blood loss were also found to be independent risk factors of mortality. Conclusion The risk factors of open surgical ruptured abdominal aortic aneurysm repair, body mass index, lactate level, volume of intraoperative blood loss, and response to initial 2,000 mL fluid resuscitation were correlated to survival.
Collapse
Affiliation(s)
- Kenichiro Uchida
- Department of Cardiovascular Surgery Nagoya Daini Redcross Hospital Nagoya Japan
| | - Akinori Io
- Department of Cardiovascular Surgery Nagoya Daini Redcross Hospital Nagoya Japan
| | - Sho Akita
- Department of Cardiovascular Surgery Nagoya Daini Redcross Hospital Nagoya Japan
| | - Hisaaki Munakata
- Department of Cardiovascular Surgery Nagoya Daini Redcross Hospital Nagoya Japan
| | - Makoto Hibino
- Department of Cardiovascular Surgery Nagoya Daini Redcross Hospital Nagoya Japan
| | - Kei Fujii
- Department of Cardiovascular Surgery Nagoya Daini Redcross Hospital Nagoya Japan
| | - Wataru Kato
- Department of Cardiovascular Surgery Nagoya Daini Redcross Hospital Nagoya Japan
| | - Yoshimasa Sakai
- Department of Cardiovascular Surgery Nagoya Daini Redcross Hospital Nagoya Japan
| | - Kazuyoshi Tajima
- Department of Cardiovascular Surgery Nagoya Daini Redcross Hospital Nagoya Japan
| | - Yasumitsu Mizobata
- Department of Traumatology, and Critical Care Medicine Graduate School of Medicine Osaka City University Osaka Japan
| |
Collapse
|
23
|
Stranjalis G, Kalamatianos T, Stavrinou LC, Mathios D, Koutsarnakis C, Tzavara C, Loufardaki M, Protopappa D, Argyrakos T, Rontogianni DP, Sakas DE. The Evangelismos hospital central nervous system tumor registry: Analysis of 1414 cases (1998-2009). Surg Neurol Int 2013; 4:23. [PMID: 23533006 PMCID: PMC3604820 DOI: 10.4103/2152-7806.107893] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Accepted: 01/04/2013] [Indexed: 12/24/2022] Open
Abstract
Background: The Evangelismos Hospital central nervous system (CNS) Tumor Registry represents the current effort of the Departments of Neurosurgery and Pathology to collect data for primary and metastatic CNS tumor patients. In the present study, 12-year hospital data (1998-2009) were reviewed and analyzed. Methods: Patients that underwent surgery for CNS tumors for the first time were identified. Histologically confirmed tumor rates by age and gender were compared. Time trends in annual rates for specific tumor types were investigated. In-hospital mortality rates and length of hospital stay were analyzed by age and gender and their putative variations across the study period investigated. Results: A total of 1414 patients (age 15-89 years) were identified. The most frequently encountered histologies were gliomas and meningiomas, accounting for, respectively, 32.8% and 29.1% of the total sample. A greater proportion of meningiomas was found in women; the proportion of glioblastomas and metastatic tumors, as well as of mixed gliomas, were greater in men. Increased rates of glioblastoma and meningioma with advancing age at diagnosis were also apparent. There were no significant variations in time trends for specific tumor types. In-hospital mortality was significantly higher for older patients (≥70 years). An increase in the length of hospital stay was apparent between the first and middle third of the study period. Conclusions: Analysis of tumor rates in relation to age at diagnosis and gender showed significant bias in accordance with salient literature. Available data indicated no significant variations in time trends for specific tumor types across the study period, while an adverse effect of advanced age on in-hospital mortality was shown. The present findings can guide the formulation of future treatment programs and preventive strategies and provide the basis for further intra- and/or interdepartmental research.
Collapse
Affiliation(s)
- George Stranjalis
- Department of Neurosurgery, University of Athens, Evangelismos Hospital, Athens, Greece ; Hellenic Center of Neurosurgical Research (HCNR), "Professor Petros S. Kokkalis", Athens, Greece
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|