Proximal humeral fracture in patients with high Charlson comorbidity index: mortality rate according to treatment choice

Abstract Background We designed a retrospective study to compare prognostic outcomes based on whether or not surgical resection was performed in elderly patients aged(≥75 years) with resectable pancreatic cancer. Methods We retrospectively analyzed 49 patients with resectable pancreatic cancer (surgery group, resection was performed for 38 cases; no surgery group, resection was not performed for 11 cases) diagnosed from January 2003 to December 2014 at the National Cancer Center, Korea. Results There was no significant difference in demographics between the two groups. The surgery group showed significantly better overall survival after diagnosis than the no surgery group (2-year survival rate, 40.7% vs. 0%; log-rank test, p = 0.015). Multivariate analysis revealed that not having undergone surgical resection [hazard ratio (HR) 2.412, P = 0.022] and a high Charlson comorbidity index (HR 5.252, P = 0.014) were independent prognostic factors for poor overall survival in elderly patients with early stage pancreatic cancer. Conclusions In the present study, surgical resection resulted in better prognosis than non-surgical resection for elderly patients with resectable pancreatic cancer. Except for patients with a high Charlson comorbidity index, an aggressive surgical approach seems to be beneficial for elderly patients with resectable pancreatic cancer.

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Single- and multistage surgical treatment of patients with degenerative sagittal imbalance

Hirurgiâ pozvonočnika ◽

10.14531/ss2021.2.44-53 ◽

2021 ◽

Vol 18 (2) ◽

pp. 44-53

Author(s):

E. S. Baikov ◽

A. V. Peleganchuk ◽

A. J. Sanginov ◽

O. N. Leonova ◽

A. V. Krutko

Keyword(s):

Surgical Treatment ◽

Blood Loss ◽

Charlson Comorbidity Index ◽

Sagittal Imbalance ◽

Group I ◽

Duration Of Surgery ◽

Comorbidity Index ◽

Group Ii ◽

Clinical And Radiological Results ◽

High Charlson Comorbidity Index

Objective. To analyze the nearest clinical and radiological results of simultaneous and staged surgical treatment of patients with degenerative sagittal imbalance.Material and Methods. Retrospective monocentric cohort study included analysis of data from 54 patients who underwent simultaneous combination of surgical methods with obligatory corrective anterior fusion at the L4–L5 or at L4–L5 and L5–S1 levels (Group I, n = 27) or similar surgical intervention though divided into stages with an interval of 5 days or more (Group II, n = 27). A comparison of clinical, radiological, and operational data during inpatient treatment was carried out.Results. The duration of surgery was 410.93 ± 76.34 minutes in Group I and 594.63 ± 102.61 minutes in Group II (p = 0.000001); the blood loss was 926.67 ± 378.63 ml versus 1345.19 ± 522.97 ml, respectively (p = 0.001575). Postoperative clinical and radiological parameters did not differ between groups: VAS back (p = 0.248647), VAS leg (p = 0.196140), PT (p = 0.115965), SVA (p = 0.208449), LL (p = 0.023654), LDI (p = 0.931646), PI-LL (p = 0.693045), GAP (p = 0.823504), and restoration of the ideal Russoly type (p = 0.111476). The incidence of perioperative complications in groups was comparable: 17 (62.96 %) in Group I and 15 (55.56 %) in Group II (p = 0.583171). Patients with a high Charlson comorbidity index had a significantly higher incidence of complications (p = 0.023471). The index of surgical invasiveness in Group I had a significant correlation with the total number of complications (r = 0.421332).Conclusion. Clinical and radiological results and the incidence of complications are comparable between single- and multistage approaches to correct sagittal balance disorders. In staged treatment, the total duration of surgery and the volume of blood loss are significantly higher. With a high Charlson comorbidity index and Mirza surgical invasiveness index, a multistage approach to the treatment of patients with sagittal imbalance is preferred.

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109. Clinical Characteristics and Outcomes of Staphylococcus aureus Bacteremia From a Biliary Source

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.184 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S86-S86

Author(s):

Eunmi Yang ◽

Seongman Bae ◽

Hyeonji Seo ◽

Eunbeen Cho ◽

Su-Jin Park ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Biliary Tract ◽

Broad Spectrum ◽

Solid Tumor ◽

Charlson Comorbidity Index ◽

Clinical Characteristics ◽

Apache Ii Score ◽

Metastatic Infection ◽

Comorbidity Index ◽

High Charlson Comorbidity Index

Abstract Background Staphylococcus aureus can cause various types of infection, but involvement of biliary tract is rare. There were only few case reports and no clinical studies. We assessed the clinical characteristics and outcomes of S. aureus bacteremia from a biliary source (biliary SAB) in a large cohort of SAB patients and compared the cases with those of catheter-related SAB. Methods We performed a matched case–control study within a prospective observational cohort of patients with SAB at a 2,700-bed tertiary hospital. All adult patients with SAB were observed for 12 weeks from July 2008 to July 2018. Biliary SAB was defined as the case of S.aureus isolated from blood culture with appropriate clinical biliary infection symptoms (fever, abdominal pain, or jaundice) and signs (abdominal tenderness or liver enzyme elevation with obstructive pattern). Biliary SAB cases were matched 1:3 to control patients with catheter-related SAB based on age, gender, ward, and case year. Results A total of 1,818 patients with SAB were enrolled in the entire cohort, and 42 (2%) were biliary SAB. Among patients with biliary SAB, 32 (76%) had solid tumor involving pancreaticobiliary tract or liver, 30 (71%) had biliary drainage stent, 14 (33%) were biliary procedure-related infection, and 24 (57%) had recent broad-spectrum antibiotics exposure (Table 1). When biliary SAB patients were compared with 126 patients with catheter-related SAB, they were significantly more likely to have community-onset SAB, solid tumor, and lower APACHE II score; and less likely to have metastatic infection (P = 0.03) (Table 2). Biliary SAB, solid tumor, and a high Charlson comorbidity index were associated with 12-week mortality. In multivariate analysis, biliary SAB (aOR, 5.5; 95% CI, 2.47–12.25) and a high Charlson comorbidity index (aOR, 1.32; 95% CI, 1.12–1.54) were independent risk factors for 12-week mortality. Conclusion Biliary SAB was relatively rare and developed mainly in pancreaticobiliary cancer patients and in recent broad-spectrum antibiotic users. High mortality was probably attributable to underlying cancers. When biliary tract infection caused by S. aureus is clinically suspected, early aggressive treatment for SAB should be considered. Disclosures All authors: No reported disclosures.

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The Charlson comorbidity index (CCI) for adjustment of hip fracture mortality in the elderly: analysis of the importance of recording secondary diagnoses

Cadernos de Saúde Pública ◽

10.1590/s0102-311x2008000200010 ◽

2008 ◽

Vol 24 (2) ◽

pp. 315-322 ◽

Cited By ~ 27

Author(s):

Rômulo Cristovão de Souza ◽

Rejane Sobrino Pinheiro ◽

Cláudia Medina Coeli ◽

Kenneth Rochel de Camargo Jr.

Keyword(s):

Hip Fracture ◽

Mortality Rate ◽

Risk Adjustment ◽

Charlson Comorbidity Index ◽

The Elderly ◽

Predictive Capacity ◽

Logistic Regression Models ◽

Highest Weight ◽

Comorbidity Index ◽

Hip Fracture Mortality

This study evaluates the role of the number of secondary diagnoses for calculating the Charlson comorbidity index (CCI) in risk adjustment of the 90-day mortality rate after hip fracture surgical repair. Comorbidities were selected by reviewing the medical records of 390 patients 50 years of age or older in a teaching hospital in Rio de Janeiro from 1995 to 2000. Logistic regression models were fitted including the variables age, sex, and CCI. The CCI was calculated based on: (1) all patients' comorbidities; (2) only the comorbidity with the highest weight; and (3) a single randomly selected comorbidity. There was a gradient in the prediction of the CCI mortality rate when all comorbidities were used (OR = 6.53; 95%CI: 2.27-18.77, for scores <FONT FACE=Symbol>³</FONT> 3). The predictive capacity of the CCI was observed even when it was calculated using only one comorbidity: with the highest weight (OR = 2.83; 95%CI: 1.11-7.22); and randomly selected (OR = 2.90; 95%CI: 1.07-7.81). Using all comorbidities for CCI calculation is important. Severity indices based on a single comorbidity can be useful for risk adjustment procedures.

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The Risk-Adjusted Charlson Comorbidity Index as a New Predictor of One-year Mortality rate in Elderly Chinese Patients who underwent Hip Fracture Surgery

Orthopaedics & Traumatology Surgery & Research ◽

10.1016/j.otsr.2021.102860 ◽

2021 ◽

pp. 102860

Author(s):

Fei Xing ◽

Rong Luo ◽

Wei Chen ◽

Zhou Xiang

Keyword(s):

Hip Fracture ◽

Mortality Rate ◽

Charlson Comorbidity Index ◽

Chinese Patients ◽

Hip Fracture Surgery ◽

Elderly Chinese ◽

Comorbidity Index ◽

One Year ◽

Fracture Surgery

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The effect of antidementia drugs on mortality in patients with Alzheimer’s disease

Journal of Psychopharmacology ◽

10.1177/0269881119845795 ◽

2019 ◽

Vol 33 (8) ◽

pp. 986-993

Author(s):

Wei-Hao Lin ◽

Ching-Herng Lin ◽

Po-Hsun Hou ◽

Tsuo-Hung Lan

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Mortality Rate ◽

Charlson Comorbidity Index ◽

Index Date ◽

Charlson Comorbidity Index Score ◽

Research Database ◽

Exposure Group ◽

Antidementia Drugs ◽

Comorbidity Index

Introduction: Alzheimer’s disease is associated with a higher mortality rate after the diagnosis. We hypothesized that patients with Alzheimer’s disease who received antidementia drugs may have a lower mortality rate than those without such treatment. Methods: Patients with newly diagnosed Alzheimer’s disease aged ⩾65 years during 2001–2006 were identified in the National Health Institute Research Database, Taiwan. We included patients with Alzheimer’s disease who received antidementia drugs as the exposure group (ADD group), and compared them with a non-exposure group who did not receive any antidementia drugs (non-ADD group) matched for age at the index date, gender and Charlson Comorbidity Index score before the index date. All-cause mortality rates and Charlson Comorbidity Index scores at one and two years after the index date were compared between the ADD and non-ADD groups. Results: There were 529 patients in non-ADD group and 529 in the ADD group. The mortality rate was significantly lower in the ADD group compared with the non-ADD group (42% versus 58.6%; p<0.0001). Conclusion: Our results suggest that antidementia drugs may have a protective effect against mortality in patients with Alzheimer’s disease.

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