scholarly journals Preoperative hyponatremia predicts complications in older patients undergoing digestive tract surgery: a propensity score matching analysis

2021 ◽  
Author(s):  
Chun-Qing Li ◽  
Chen Zhang ◽  
Fan Yu ◽  
Hao Kong ◽  
Chun-Mei Deng
Keyword(s):  
Postoperative Complications ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Digestive Tract ◽  
Older Patients ◽  
Infectious Complications ◽  
Increased Risk ◽  
Life Threatening ◽  
Digestive Tract Surgery ◽  
Complications And Mortality

Abstract Purpose Whether preoperative hyponatremia increases the risk of postoperative complications in older patients undergoing digestive tract surgery remains unclear. The purpose of the study was to investigate the association between preoperative hyponatremia and life-threatening postoperative complications (including death) among older patients undergoing digestive tract surgery. Methods This was a propensity score-matched, retrospective cohort study. We recruited older patients (≥ 65 years of age) who underwent digestive tract surgery in our institution. The propensity score matching (PSM; 1:2) was used to balance a range of covariates between patients with preoperative hyponatremia (serum sodium [Na+] levels < 135 mmol/L) and those with normal [Na+] levels (135–145 mmol/L). The primary outcome was the occurrence of life-threatening postoperative complications and mortality (i.e., Clavien–Dindo grade IV and V [CD IV and V] complications) during hospital stay. The relationship between preoperative hyponatremia and the development of CD IV and V complications was identified with logistic regression analysis. Results A total of 1076 patients were analyzed (mean age 73.9 years; 421 female [39.1%]). Preoperative hyponatremia was identified in 122 patients. After matching, 312 patients were included in the analyses (104 patients with preoperative hyponatremia and 208 patients with normal [Na+] levels; mean age, 76.3 years; 130 female [41.7%]). When compared with normal [Na+] levels, preoperative hyponatremia was associated with an increased risk of CD IV and V complications (odds ratio [OR] 2.082, 95% confidential interval [CI] 1.041–4.164, P = 0.038). Preoperative hyponatremia was also significantly associated with a higher risk of postoperative infectious complications (OR 2.158, 95% CI 1.138–4.091, P = 0.018). Conclusion Preoperative hyponatremia can predict an increased risk of life-threatening postoperative complications and mortality in older patients undergoing digestive tract surgery.

Impact of the introduction of an enhanced recovery pathway in esophageal cancer surgery: a cohort study and propensity score matching analysis

2021 ◽  
Author(s):  
J Moons ◽  
L Depypere ◽  
T Lerut ◽  
T van Achterberg ◽  
W Coosemans ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Blood Transfusion ◽  
Length Of Stay ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Enhanced Recovery ◽  
Infectious Complications ◽  
Propensity Score Matching Analysis ◽  
Postoperative Blood Transfusion ◽  
The Impact

Summary Enhanced recovery pathways (ERP) have the potential to improve clinical outcomes. Aim of this study was to determine the impact of ERP on perioperative results as compared with traditional care (TC) after esophagectomy. In this study, two cohorts were compared. Cohort 1 represented 296 patients to whom TC was provided. Cohort 2 consisted of 200 unselected ERP patients. Primary endpoints were postoperative complications. Secondary endpoints were the length of stay and 30-day readmission rates. To confirm the possible impact of ERP, a propensity matched analysis (1:1) was conducted. A significant decrease in complications was found in ERP patients, especially for pneumonia and respiratory failure requiring reintubation (39% in TC and 14% in ERP; P&lt;0.0001 and 17% vs. 12%; P&lt;0.0001, respectively) and postoperative blood transfusion (26.7%–11%; P&lt;0.0001). Furthermore, median length of stay was also significantly shorter: 13 days (interquartile range [IQR] 10–23) in TC compared with 10 days (IQR 8–14) in ERP patients (P&lt;0.0001). The 30-day readmission rate (5.4% in TC and 9% in ERP; P=0.121) and in-hospital mortality rate (4.4% in TC and 2.5% in ERP; P=0.270) were not significantly affected. A propensity score matching confirmed a significant impact on pneumonia (P=0.0001), anastomotic leak (P=0.047), several infectious complications (P=0.01–0.034), blood transfusion (P=0.001), Comprehensive Complications Index (P=0.01), and length of stay (P=0.0001). We conclude that ERP for esophagectomy is associated with significantly fewer postoperative complications and blood transfusions, which results in a significant decrease of length of stay without affecting readmission and mortality rates.

scholarly journals The composite risk index based on frailty predicts postoperative complications in older patients recovering from elective digestive tract surgery: a retrospective cohort study

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Chun-Qing Li ◽  
Chen Zhang ◽  
Fan Yu ◽  
Xue-Ying Li ◽  
Dong-Xin Wang
Keyword(s):  
Cohort Study ◽  
Postoperative Complications ◽  
Digestive Tract ◽  
Older Patients ◽  
Retrospective Cohort ◽  
Risk Index ◽  
Frailty Index ◽  
Modified Frailty Index ◽  
Digestive Tract Surgery ◽  
Composite Risk

Abstract Background Limitations exist in available studies investigating effect of preoperative frailty on postoperative outcomes. This study was designed to analyze the association between composite risk index, an accumulation of preoperative frailty deficits, and the risk of postoperative complications in older patients recovering from elective digestive tract surgery. Methods This was a retrospective cohort study. Baseline and perioperative data of older patients (age ≥ 65 years) who underwent elective digestive tract surgery from January 1, 2017 to December 31, 2018 were collected. The severity of frailty was assessed with the composite risk index, a composite of frailty deficits including modified frailty index. The primary endpoint was the occurrence of postoperative complications during hospital stay. The association between the composite risk index and the risk of postoperative complications was assessed with a multivariable logistic regression model. Results A total of 923 patients were included. Of these, 27.8% (257) developed postoperative complications. Four frailty deficits, i.e., modified frailty index ≥0.27, malnutrition, hemoglobin < 90 g/L, and albumin ≤30 g/L, were combined to generate a composite risk index. Multivariable analysis showed that, when compared with patients with composite risk index of 0, the odds ratios (95% confidence intervals) were 2.408 (1.714–3.383, P <  0.001) for those with a composite risk index of 1, 3.235 (1.985–5.272, P <  0.001) for those with a composite risk index of 2, and 9.227 (3.568–23.86, P <  0.001) for those with composite risk index of 3 or above. The area under receiver-operator characteristic curve to predict postoperative complications was 0.653 (95% confidence interval 0.613–0.694, P <  0.001) for composite risk index compared with 0.622 (0.581–0.663, P <  0.001) for modified frailty index. Conclusion For older patients following elective digestive tract surgery, high preoperative composite risk index, a combination of frailty deficits, was independently associated with an increased risk of postoperative complications.

Comparison of clinical outcomes between enucleation and regular pancreatectomy in patients with non-functional pancreatic neuroendocrine tumors: a retrospective multicenter and propensity score-matched study

2021 ◽  
Author(s):  
Zhen Yang ◽  
Hengjun Gao ◽  
Jun Lu ◽  
Zheyu Niu ◽  
Huaqiang Zhu ◽  
...  
Keyword(s):  
Overall Survival ◽  
Postoperative Complications ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Neuroendocrine Tumors ◽  
Disease Free Survival ◽  
Pancreatic Neuroendocrine Tumors ◽  
Free Survival ◽  
Estimated Blood Loss ◽  
Disease Free

Abstract Objective There are limited data from retrospective studies on whether therapeutic outcomes after regular pancreatectomy are superior to those after enucleation in patients with small, peripheral and well-differentiated non-functional pancreatic neuroendocrine tumors. This study aimed to compare the short- and long-term outcomes of regular pancreatectomy and enucleation in patients with non-functional pancreatic neuroendocrine tumors. Methods Between January 2007 and July 2020, 227 patients with non-functional pancreatic neuroendocrine tumors who underwent either enucleation (n = 89) or regular pancreatectomy (n = 138) were included. Perioperative complications, disease-free survival, and overall survival probabilities were compared. Propensity score matching was performed to balance the baseline differences between the two groups. Results The median follow-up period was 60.76 months in the enucleation group and 43.29 months in the regular pancreatectomy group. In total, 34 paired patients were identified after propensity score matching. The average operative duration in the enucleation group was significantly shorter than that in the regular pancreatectomy group (147.94 ± 42.39 min versus 217.94 ± 74.60 min, P &lt; 0.001), and the estimated blood loss was also significantly lesser (P &lt; 0.001). The matched patients who underwent enucleation displayed a similar overall incidence of postoperative complications (P = 0.765), and a comparable length of hospital stay (11.12 ± 3.90 days versus 9.94 ± 2.62 days, P = 0.084) compared with those who underwent regular pancreatectomy. There were no statistically significant differences between the two groups in disease-free survival and overall survival after propensity score matching. Conclusion Enucleation in patients with non-functional pancreatic neuroendocrine tumors was associated with shorter operative time, lesser intraoperative bleeding, similar overall morbidity of postoperative complications, and comparable 5-year disease-free survival and overall survival when compared with regular pancreatectomy.

scholarly journals Relationship between benzodiazepine prescription, aggressive behavior, and behavioral disinhibition: a retrospective study in a Swiss prison

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Stéphanie Baggio ◽  
Vladan Starcevic ◽  
Patrick Heller ◽  
Karen Brändle ◽  
Irina Franke ◽  
...  
Keyword(s):  
Propensity Score ◽  
Aggressive Behavior ◽  
Propensity Score Matching ◽  
Potential Role ◽  
Behavioral Disinhibition ◽  
Increased Risk ◽  
Benzodiazepine Use ◽  
Logistic Regressions ◽  
Relationship Of ◽  
The Relationship

Abstract Background Benzodiazepines are commonly prescribed in prisons amidst the controversies surrounding their potential role in causing behavioral disinhibition and aggressive behavior and their association with use and trafficking of illicit and addictive substances. The present study aimed to (1) ascertain the relationship between benzodiazepine prescription (including their dosage and duration of use) and aggressive behavior and behavioral disinhibition in prison and (2) investigate whether there was an association between benzodiazepine prescription, (including their dosage and duration of use) and using and trafficking illicit and addictive substances during imprisonment. Methods Data were extracted from the electronic database of an “open” Swiss prison (n = 1206, 1379 measures) over a 5-year period (2010–2015). Measures included benzodiazepine prescription, duration of benzodiazepine use and mean dosage, and punishable behaviors (physical and verbal aggression, disinhibited but not directly aggressive behaviors, property damage or theft, substance-related offenses, and rule transgression). We assessed the relationship between benzodiazepine prescription and punishable behaviors after propensity score matching. Logistic regressions were also used to test the relationship of benzodiazepine use duration and dosage with punishable behaviors among participants who received benzodiazepines. Results After propensity score matching, benzodiazepine prescription was not significantly associated with any punishable behavior. Among detained persons who took benzodiazepines, there was no significant association of dosage and duration of use with offenses involving illicit or addictive substance use or trafficking. Conclusions Our study did not empirically support the occurrence of increased aggressive or disinhibited behaviors or increased risk of substance abuse in detained persons who received benzodiazepines in prison. This suggests a need to reconsider restrictions in prescribing benzodiazepines in the prison setting.

scholarly journals Colorectal endoscopic mucosal resection with submucosal injection of epinephrine versus hypertonic saline in patients taking antithrombotic agents: propensity-score-matching analysis

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Daisuke Yamaguchi ◽  
Hisako Yoshida ◽  
Kei Ikeda ◽  
Yuki Takeuchi ◽  
Shota Yamashita ◽  
...  
Keyword(s):  
Propensity Score ◽  
Adverse Events ◽  
Propensity Score Matching ◽  
Endoscopic Mucosal Resection ◽  
Hypertonic Saline ◽  
Colon Polyps ◽  
Antithrombotic Agents ◽  
Submucosal Injection ◽  
Mucosal Resection ◽  
Increased Risk

Abstract Background Endoscopic mucosal resection (EMR) to remove colon polyps is increasingly common in patients taking antithrombotic agents. The safety of EMR with submucosal saline injection has not been clearly demonstrated in this population. Aims The present study aimed to evaluate the efficacy and safety of submucosal injection of saline–epinephrine versus hypertonic saline in colorectal EMR of patients taking antithrombotic agents. Methods This study enrolled 204 patients taking antithrombotic agents among 995 consecutive patients who underwent colonic EMR from April 2012 to March 2018 at Ureshino Medical Center. Patients were divided into two groups according to the injected solution: saline–epinephrine or hypertonic (10%) saline (n = 102 in each group). Treatment outcomes and adverse events were evaluated in each group and risk factors for immediate and post-EMR bleeding were investigated. Results There were no differences between groups in patient or polyp characteristics. The main antithrombotic agents were low-dose aspirin, warfarin, and clopidogrel. Propensity-score matching created 80 matched pairs. Adjusted comparisons between groups showed similar en bloc resection rates (95.1% with saline–epinephrine vs. 98.0% with hypertonic saline). There were no significant differences in adverse events (immediate EMR bleeding, post-EMR bleeding, perforation, or mortality) between groups. Multivariate analyses revealed that polyp size over 10 mm was associated with an increased risk of immediate EMR bleeding (odds ratio 12.1, 95% confidence interval 2.0–74.0; P = 0.001). Conclusions Two tested solutions in colorectal EMR were considered to be both safe and effective in patients taking antithrombotic agents.

scholarly journals Clostridium difficileInfection Worsens the Prognosis of Ulcerative Colitis

2014 ◽  
Vol 28 (7) ◽  
pp. 373-380 ◽  
Author(s):  
María E Negrón ◽  
Herman W Barkema ◽  
Kevin Rioux ◽  
Jeroen De Buck ◽  
Sylvia Checkley ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Postoperative Complications ◽  
Population Based ◽  
Infectious Complications ◽  
Future Studies ◽  
Laboratory Services ◽  
Increased Risk ◽  
Health Zone ◽  
The Impact ◽  
Control Study

BACKGROUND: The impact ofClostridium difficileinfections among ulcerative colitis (UC) patients is well characterized. However, there is little knowledge regarding the association betweenC difficileinfections and postoperative complications among UC patients.OBJECTIVE: To determine whetherC difficileinfection is associated with undergoing an emergent colectomy and experiencing postoperative complications.METHODS: The present population-based case-control study identified UC patients admitted to Calgary Health Zone hospitals for a flare between 2000 and 2009.C difficiletoxin tests ordered in hospital or 90 days before hospital admission were provided by Calgary Laboratory Services (Calgary, Alberta). Hospital records were reviewed to confirm diagnoses and to extract clinical data. Multivariate logistic regression analyses were performed among individuals tested forC difficileto examine the association betweenC difficileinfection and emergent colectomy and diagnosis of any postoperative complications and, secondarily, an infectious postoperative complication. Estimates were presented as adjusted ORs with 95% CIs.RESULTS:C difficilewas tested in 278 (58%) UC patients and 6.1% were positive.C difficileinfection was associated with an increased risk for emergent colectomy (adjusted OR 3.39 [95% CI 1.02 to 11.23]). Additionally, a preoperative diagnosis ofC difficilewas significantly associated with the development of postoperative infectious complications (OR 4.76 [95% CI 1.10 to 20.63]).CONCLUSION:C difficilediagnosis worsened the prognosis of UC by increasing the risk of colectomy and postoperative infectious complications following colectomy. Future studies are needed to explore whether early detection and aggressive management ofC difficileinfection will improve UC outcomes.

scholarly journals Clinical outcome of out-of-hospital vs. in-hospital cardiac arrest survivors presenting with ventricular tachyarrhythmias

2021 ◽  
Author(s):  
Julian Müller ◽  
Michael Behnes ◽  
Tobias Schupp ◽  
Linda Reiser ◽  
Gabriel Taton ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Cox Regression ◽  
Prognostic Impact ◽  
Ventricular Tachyarrhythmias ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Hospital Cardiac Arrest

AbstractLimited data regarding the prognostic impact of ventricular tachyarrhythmias related to out-of-hospital (OHCA) compared to in-hospital cardiac arrest (IHCA) is available. A large retrospective single-center observational registry with all patients admitted due to ventricular tachyarrhythmias was used including all consecutive patients with ventricular tachycardia (VT) and fibrillation (VF) on admission from 2002 to 2016. Survivors discharged after OHCA were compared to those after IHCA using multivariable Cox regression models and propensity-score matching for evaluation of the primary endpoint of long-term all-cause mortality at 2.5 years. Secondary endpoints were all-cause mortality at 6 months and cardiac rehospitalization at 2.5 years. From 2.422 consecutive patients with ventricular tachyarrhythmias, a total of 524 patients survived cardiac arrest and were discharged from hospital (OHCA 62%; IHCA 38%). In about 50% of all cases, acute myocardial infarction was the underlying disease leading to ventricular tachyarrhythmias with consecutive aborted cardiac arrest. Survivors of IHCA were associated with increased long-term all-cause mortality compared to OHCA even after multivariable adjustment (28% vs. 16%; log rank p = 0.001; HR 1.623; 95% CI 1.002–2.629; p = 0.049) and after propensity-score matching (28% vs. 19%; log rank p = 0.045). Rates of cardiac rehospitalization rates at 2.5 years were equally distributed between OHCA and IHCA survivors. In patients presenting with ventricular tachyarrhythmias, survivors of IHCA were associated with increased risk for all-cause mortality at 2.5 years compared to OHCA survivors.

scholarly journals COVID-19 and Rheumatology: so far, so close

2020 ◽  
pp. 135-143
Author(s):  
B. S. Belov ◽  
N. M. Muravyeva ◽  
G. M. Tarasova
Keyword(s):  
Pneumococcal Infection ◽  
Infectious Complications ◽  
Inflammatory Rheumatic Diseases ◽  
Prophylactic Efficacy ◽  
Extreme Caution ◽  
Increased Risk ◽  
Life Threatening ◽  
Tract Involvement ◽  
Social Importance

The disease caused by the new coronavirus COVID-19 is considered by the world community as an emergency of internationalimportance. Along with the huge social importance, the COVID-19 pandemic has highlighted a number of principally new clinical and fundamental problems of immunopathology of human diseases. This problem is extremely urgent for patients suffering from immune-inflammatory rheumatic diseases (IIRD) due to their higher exposure to infectious complications. Achieving and maintaining control over the activity of IIRD plays an important role in reducing the incidence of comorbid infections in these patients. It has been shown that patients with IIRD undergoing active anti-rheumatic therapy are most likely not characterized by increased risk of respiratory or other life-threatening complications within COVID-19 compared to the general population. Given the need for continued monitoring of patients receiving these therapy, unjustified “prophylactic” cancellation should nevertheless be avoided, thereby increasing the risk of relapse of major IIRD. The article also discusses the issues related to the use of basic anti-rheumatic drugs in COVID-19. Currently there is no evidence to support the therapeutic and prophylactic efficacy of chloroquine or hydroxychloroquine in COVID-19. Tocilizumab can be considered as “lifesaving therapy” for patients with acute respiratory distress syndrome in COVID-19, if other treatments have failed or are unavailable. The use of baricitinib in hospitalized pneumonia patients as part of COVID-19 should be considered with extreme caution. The need for further research to assess the potential role of baricitinib for these patients is highlighted. In the absence of a COVID-19 vaccine in a continuing pandemic, vaccination against influenza and pneumococcal infection should be strongly recommended to the absolute majority of patients with IIRD. This is associated with a high risk of fatal respiratory infection in rheumatological patients, especially given the high respiratory tract involvement in COVID-19.

Sign in / Sign up

Export Citation Format

Share Document