scholarly journals The Association Between Revised Cardiac Risk Index and Postoperative Mortality Following Elective Colon Cancer Surgery: A Retrospective Nationwide Cohort Study

2021 ◽  
pp. 145749692110375
Author(s):  
Rebecka Ahl Hulme ◽  
Maximilian Peter Forssten ◽  
Arvid Pourlotfi ◽  
Yang Cao ◽  
Gary Alan Bass ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Risk Stratification ◽  
Risk Index ◽  
Postoperative Mortality ◽  
Cardiac Risk ◽  
Cancer Surgery ◽  
Cardiac Risk Index ◽  
Increased Risk ◽  
Colon Cancer Surgery ◽  
Elective Colon

Introduction: Despite improvements in the perioperative care during the last decades for oncologic colon resection, there is still a substantial risk for postoperative complications and mortality. Opportunities exist for improvement in preoperative risk stratification in this patient population. We hypothesize that the Revised Cardiac Risk Index, a user-friendly tool, could better identify patients with high postoperative mortality risks. Methods: A retrospective analysis of operated patients between the years 2007 and 2017 was undertaken, using the prospectively recorded Swedish Colorectal Cancer Registry, which has a 99.5% national coverage for all cases of colon cancer. Patients were cross-referenced with the Swedish National Board of Health and Welfare dataset, a government registry of mortality and comorbidity data. Revised Cardiac Risk Index (RCRI) scores were calculated for each patient and stratified into four groups (RCRI 1, 2, 3, ⩾ 4). A Poisson regression model with robust standard errors of variance was employed to correlate the 90-day postoperative survival with each level of the Revised Cardiac Risk Index. Results: A total of 24,198 patients met the study inclusion criteria. 90-day postoperative mortality increased from 2.4% in patients with RCRI 1 to 10.1% in patients with RCRI ⩾ 4 ( p < 0.001). Adjusted 90-day postoperative mortality increased linearly with an increasing RCRI, where an RCRI of 2, 3, and ≥ 4 respectively led to a 46%, 80%, and 167% increased risk of mortality compared to RCRI 1 ( p < 0.001). Conclusions: A strong association between an increasing Revised Cardiac Risk Index score and increased 90-day postoperative mortality risk was detected. The Revised Cardiac Risk Index may facilitate risk stratification of patients undergoing elective colon cancer surgery.

Effects of beta-blocker therapy on mortality after elective colon cancer surgery

2019 ◽  
Vol 31 ◽  
pp. 108
Author(s):  
R. Ahl ◽  
P. Matthiessen ◽  
G. Sjolin ◽  
Y. Cao ◽  
O. Ljungqvist ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Beta Blocker ◽  
Cancer Surgery ◽  
Blocker Therapy ◽  
Beta Blocker Therapy ◽  
Colon Cancer Surgery ◽  
Elective Colon

Effects of early beta-blockade on morbidity and mortality outcomes after elective colon cancer surgery

2018 ◽  
Vol 25 ◽  
pp. 196-197
Author(s):  
Rebecka Ahl ◽  
Peter Matthiessen ◽  
Xin Fang ◽  
Yang Cao ◽  
Göran Wallin ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Cancer Surgery ◽  
Morbidity And Mortality ◽  
Beta Blockade ◽  
Colon Cancer Surgery ◽  
Elective Colon

scholarly journals Mortality risk stratification in isolated severe traumatic brain injury using the revised cardiac risk index

2021 ◽  
Author(s):  
Maximilian Peter Forssten ◽  
Gary Alan Bass ◽  
Kai-Michael Scheufler ◽  
Ahmad Mohammad Ismail ◽  
Yang Cao ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Risk Stratification ◽  
Hospital Mortality ◽  
Severe Traumatic Brain Injury ◽  
Mortality Risk ◽  
Risk Index ◽  
Cardiac Risk ◽  
Increased Risk ◽  
Severe Tbi

Abstract Purpose Traumatic brain injury (TBI) continues to be a significant cause of mortality and morbidity worldwide. As cardiovascular events are among the most common extracranial causes of death after a severe TBI, the Revised Cardiac Risk Index (RCRI) could potentially aid in the risk stratification of this patient population. This investigation aimed to determine the association between the RCRI and in-hospital deaths among isolated severe TBI patients. Methods All adult patients registered in the TQIP database between 2013 and 2017 who suffered an isolated severe TBI, defined as a head AIS ≥ 3 with an AIS ≤ 1 in all other body regions, were included. Patients were excluded if they had a head AIS of 6. The association between different RCRI scores (0, 1, 2, 3, ≥ 4) and in-hospital mortality was analyzed using a Poisson regression model with robust standard errors while adjusting for potential confounders, with RCRI 0 as the reference. Results 259,399 patients met the study’s inclusion criteria. RCRI 2 was associated with a 6% increase in mortality risk [adjusted IRR (95% CI) 1.06 (1.01–1.12), p = 0.027], RCRI 3 was associated with a 17% increased risk of mortality [adjusted IRR (95% CI) 1.17 (1.05–1.31), p = 0.004], and RCRI ≥ 4 was associated with a 46% increased risk of in-hospital mortality [adjusted IRR(95% CI) 1.46 (1.11–1.90), p = 0.006], compared to RCRI 0. Conclusion An elevated RCRI ≥ 2 is significantly associated with an increased risk of in-hospital mortality among patients with an isolated severe traumatic brain injury. The simplicity and bedside applicability of the index makes it an attractive choice for risk stratification in this patient population.

scholarly journals Long‐term survival following elective colon cancer surgery in the aged. A population‐based cohort study

2020 ◽  
Vol 22 (11) ◽  
pp. 1585-1596
Author(s):  
S. Niemeläinen ◽  
H. Huhtala ◽  
A. Ehrlich ◽  
J. Kössi ◽  
E. Jämsen ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Cohort Study ◽  
Population Based ◽  
Cancer Surgery ◽  
Term Survival ◽  
Long Term Survival ◽  
Colon Cancer Surgery ◽  
Elective Colon

scholarly journals Complete state-wide outcomes in elective colon cancer surgery

2018 ◽  
Vol 88 (11) ◽  
pp. 1174-1177 ◽  
Author(s):  
Ian G. Faragher ◽  
Michael K.-Y. Hong ◽  
Douglas Stupart ◽  
David A. Watters ◽  
Justin Yeung
Keyword(s):  
Colon Cancer ◽  
Cancer Surgery ◽  
Complete State ◽  
Colon Cancer Surgery ◽  
Elective Colon

scholarly journals Risk factors of short-term survival in the aged in elective colon cancer surgery: a population-based study

2019 ◽  
Vol 35 (2) ◽  
pp. 307-315 ◽  
Author(s):  
Susanna Niemeläinen ◽  
Heini Huhtala ◽  
Anu Ehrlich ◽  
Jyrki Kössi ◽  
Esa Jämsen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Colon Cancer ◽  
Postoperative Complications ◽  
Population Based ◽  
Cancer Surgery ◽  
Mortality Data ◽  
Short Term ◽  
Population Based Study ◽  
Colon Cancer Surgery ◽  
Elective Colon

Abstract Purpose Patients aged > 80 years represent an increasing proportion of colon cancer diagnoses. Selecting patients for elective surgery is challenging because of possibly compromised health status and functional decline. The aim of this retrospective, population-based study was to identify risk factors and health measures that predict short-term mortality after elective colon cancer surgery in the aged. Methods All patients > 80 years operated electively for stages I–III colon cancer from 2005 to 2016 in four Finnish hospitals were included. The prospectively collected data included comorbidities, functional status, postoperative surgical and medical outcomes as well as mortality data. Results A total of 386 patients (mean 84.0 years, range 80–96, 56% female) were included. Male gender (46% vs 35%, p = 0.03), higher BMI (51% vs 37%, p = 0.02), diabetes mellitus (51% vs 37%, p = 0.02), coronary artery disease (52% vs 36%, p = 0.003) and rheumatic diseases (67% vs 39%, p = 0.03) were related to higher risk of complications. The severe complications were more common in patients with increased preoperative hospitalizations (31% vs 15%, p = 0.05) and who lived in nursing homes (30% vs 17%, p = 0.05). The 30-day and 1-year mortality rates were 6.0% and 15% for all the patients compared with 30% and 45% in patients with severe postoperative complications (p < 0.001). Severe postoperative complications were the only significant patient-related variable affecting 1-year mortality (OR 9.60, 95% CI 2.33–39.55, p = 0.002). Conclusions The ability to identify preoperatively patients at high risk of decreased survival and thus prevent severe postoperative complications could improve overall outcome of aged colon cancer patients.

scholarly journals Effects of beta-blocker therapy on mortality after elective colon cancer surgery: a Swedish nationwide cohort study

BMJ Open ◽  
2020 ◽  
Vol 10 (7) ◽  
pp. e036164 ◽  
Author(s):  
Rebecka Ahl ◽  
Peter Matthiessen ◽  
Gabriel Sjölin ◽  
Yang Cao ◽  
Göran Wallin ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Beta Blocker ◽  
Beta Blockers ◽  
Cancer Surgery ◽  
Beta Blockade ◽  
Blocker Therapy ◽  
Colon Cancer Surgery ◽  
Cancer Specific Mortality ◽  
Elective Colon

ObjectiveColon cancer surgery remains associated with substantial postoperative morbidity and mortality despite advances in surgical techniques and care. The trauma of surgery triggers adrenergic hyperactivation which drives adverse stress responses. We hypothesised that outcome benefits are gained by reducing the effects of hyperadrenergic activity with beta-blocker therapy in patients undergoing colon cancer surgery. This study aims to test this hypothesis.DesignRetrospective cohort study.Setting and participantsThis is a nationwide study which includes all adult patients undergoing elective colon cancer surgery in Sweden over 10 years. Patient data were collected from the Swedish Colorectal Cancer Registry. The national drugs registry was used to obtain information about beta-blocker use. Patients were subdivided into exposed and unexposed groups. The association between beta-blockade, short-term and long-term mortality was evaluated using Poisson regression, Kaplan-Meier curves and Cox regression.Primary and secondary outcomesPrimary outcome of interest was 1-year all-cause mortality. Secondary outcomes included 90-day all-cause and 5-year cancer-specific mortality.ResultsThe study included 22 337 patients of whom 36.1% were prescribed preoperative beta-blockers. Survival was higher in patients on beta-blockers up to 1 year after surgery despite this group being significantly older and of higher comorbidity. Regression analysis demonstrated significant reductions in 90-day deaths (IRR 0.29, 95% CI 0.24 to 0.35, p<0.001) and a 43% risk reduction in 1-year all-cause mortality (adjusted HR 0.57, 95% CI 0.52 to 0.63, p<0.001) in beta-blocked patients. In addition, cancer-specific mortality up to 5 years after surgery was reduced in beta-blocked patients (adjusted HR 0.80, 95% CI 0.73 to 0.88, p<0.001).ConclusionPreoperative beta-blockade is associated with significant reductions in postoperative short-term and long-term mortality following elective colon cancer surgery. Its potential prophylactic effect warrants further interventional studies to determine whether beta-blockade can be used as a way of improving outcomes for this patient group.

Optimal duration of prophylactic antibiotic administration for elective colon cancer surgery: A randomized, clinical trial

Surgery ◽  
2011 ◽  
Vol 149 (2) ◽  
pp. 171-178 ◽  
Author(s):  
Toshiyuki Suzuki ◽  
Sotaro Sadahiro ◽  
Yuji Maeda ◽  
Akira Tanaka ◽  
Kazutake Okada ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Colon Cancer ◽  
Randomized Clinical Trial ◽  
Prophylactic Antibiotic ◽  
Cancer Surgery ◽  
Antibiotic Administration ◽  
Optimal Duration ◽  
Colon Cancer Surgery ◽  
Elective Colon
Sign in / Sign up

Export Citation Format

Share Document