Validation of the days alive and out of hospital outcome measure after emergency laparotomy: a retrospective cohort study

2022 ◽  
Author(s):  
Leigh-James Spurling ◽  
S. Ramani Moonesinghe ◽  
C. Matthew Oliver
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Outcome Measure ◽  
Emergency Laparotomy ◽  
Hospital Outcome

Frequency of Neonatal Bilirubin Testing and Hyperbilirubinemia in a Large Health Maintenance Organization

PEDIATRICS ◽  
1999 ◽  
Vol 104 (Supplement_6) ◽  
pp. 1198-1203 ◽  
Author(s):  
Thomas B. Newman ◽  
Gabriel J. Escobar ◽  
Veronica M. Gonzales ◽  
Mary Anne Armstrong ◽  
Marla N. Gardner ◽  
...  
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Outcome Measure ◽  
Health Maintenance Organization ◽  
Northern California ◽  
Kaiser Permanente ◽  
Health Maintenance ◽  
Main Outcome Measure

Objective. To determine the frequency and interhospital variation of bilirubin testing and identified hyperbilirubinemia in a large health maintenance organization. Design. Retrospective cohort study. Setting. Eleven Northern California Kaiser Permanente hospitals. Subjects. A total of 51 387 infants born in 1995–1996 at ≥36 weeks' gestation and ≥2000 g. Main Outcome Measure. Bilirubin tests and maximum bilirubin levels recorded in the first month after birth. Results. The proportion of infants receiving ≥1 bilirubin test varied across hospitals from 17% to 52%. The frequency of bilirubin levels ≥20 mg/dL (342 μmol/L) varied from .9% to 3.4% (mean: 2.0%), but was not associated with the frequency of bilirubin testing (R2 = .02). Maximum bilirubin levels ≥25 mg/dL (428 μmol/L) were identified in .15% of infants and levels ≥30 mg/dL (513 μmol/L) in .01%. Conclusions. Significant interhospital differences exist in bilirubin testing and frequency of identified hyperbilirubinemia. Bilirubin levels ≥20 mg/dL were commonly identified, but levels ≥25 mg/dL were not.

scholarly journals Retrospective cohort study of the relationship between systolic blood pressure variability and multiple sclerosis disability

BMJ Open ◽  
2020 ◽  
Vol 10 (2) ◽  
pp. e034355 ◽  
Author(s):  
Myla D Goldman ◽  
Seulgi Min ◽  
Jennifer M Lobo ◽  
Min-Woong Sohn
Keyword(s):  
Multiple Sclerosis ◽  
Blood Pressure ◽  
Cohort Study ◽  
Systolic Blood Pressure ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Outcome Measure ◽  
Patient Reported Outcome ◽  
Patient Reported ◽  
The Relationship

ObjectiveTo examine the relationship between visit-to-visit systolic blood pressure (SBP) variability and patient-reported outcome measure of disability in multiple sclerosis (MS) patients.DesignA retrospective cohort study of individuals with MS who completed a patient-determined disease steps (PDDS) scale between 2011 and 2015 at an MS specialty clinic.ParticipantsIndividuals with MS for whom both a completed PDDS scale and ≥3 SBP measures within the prior 12 months of the survey were available.Main outcome measureParticipants were grouped into three classes of disability (no or mild (PDDS 0–1), moderate (2–3), severe (4–7)). SBP variability was calculated as within-subject SD using all SBP measures taken during the past 12 months. SBP variability was analysed by Tertile groups.ResultsNinety-two subjects were included in this analysis. Mean PDDS score was 2.22±1.89. Compared with subjects in Tertile 1 (lowest variability), the odds of being in a higher disability group was 3.5 times higher (OR=3.48; 95% CI: 1.08 to 11.25; p=0.037) in Tertile 2 and 5.2 times higher (OR=5.19; 95% CI: 1.53 to 17.61; p=0.008) in Tertile 3 (highest variability), independent of mean SBP, age, sex, race/ethnicity, body mass index and comorbidities (p for trend=0.008). Mean PDDS scores were 1.52±1.18 in Tertile 1, 2.73±1.02 in Tertile 2 and 2.42±0.89 in Tertile 3 after adjusting for the same covariates.ConclusionsOur results show a significant gradient relationship between SBP variability and MS-related disability. More research is needed to determine the underlying pathophysiological relationship between SBP variability and MS disability progression.

scholarly journals Associations Between Malignancy and Cardiovascular Complications Following Emergency Laparotomy – a Retrospective Cohort Study

2020 ◽  
Author(s):  
Rasmus Peuliche Vogelsang ◽  
Jacob Hartmann Søby ◽  
Mai-Britt Tolstrup ◽  
Jakob Burcharth ◽  
Sarah Ekeløf ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Malignant Disease ◽  
Multivariate Logistic Regression Analysis ◽  
Cardiovascular Complications ◽  
Emergency Laparotomy ◽  
Asa Score ◽  
Increased Risk

Abstract Background Several studies have shown a possible causal relationship between the occurrence of systemic inflammation in patients with malignant disease and increased risk of cardiovascular events. Our objective was to estimate the association between malignant disease and postoperative cardiovascular complications. Secondarily, we aimed to identify risk factors for postoperative cardiovascular complications. Methods We conducted a retrospective cohort study of all patients ≥ 18 years undergoing emergency laparotomy between 2010 and 2016 at the Department of Surgery at Zealand University Hospital, Denmark. Complications were graded according to the Clavien-Dindo (CD) classification of surgical complications. A multivariate logistic regression analysis was performed to estimate the association between malignant disease and cardiovascular complications within 30 days of emergency laparotomy and to identify other risk factors for postoperative cardiovascular complications after emergency laparotomy. Results We identified 1188 patients ≥ 18 years undergoing emergency laparotomy between 2010 and 2016, in which 254 (21%) had malignant disease. Within 30 days of emergency laparotomy, 89 (9.5%) of patients without malignancy died, as compared with 45 (18%) of patients with malignancy (p < 0.001). Severe cardiovascular complication graded CD 3–5 occurred in 93 (8%) of all patients within 30 days of emergency laparotomy. We found no association between malignancy and postoperative cardiovascular complications. Increasing age and ASA physical status classification system (ASA) score ≥ III were the only independent risk factors of cardiovascular complications graded CD 3–5. Conclusions Malignancy was not associated with postoperative cardiovascular complications after emergency laparotomy. Risk factors for major cardiovascular complications after emergency abdominal surgery were age and ASA score ≥ III.

scholarly journals EP.WE.573Outcomes of Emergency Laparotomies during the COVID-19 Pandemic - A retrospective cohort study

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Nader Habib Bedwani ◽  
William English ◽  
Christopher Smith ◽  
Shailendra Singh ◽  
Paul Vulliamy ◽  
...  
Keyword(s):  
Critical Care ◽  
Cohort Study ◽  
Respiratory Failure ◽  
Length Of Stay ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Emergency Laparotomy ◽  
Platelet Counts ◽  
Critical Care Admission ◽  
Grade 3

Abstract Aims A better understanding of patient monitoring and outcomes is required following emergency laparotomy. We aimed to evaluate recovery following emergency laparotomy during the ‘first wave’ of the COVID-19 pandemic and assess for COVID-19-associated coagulopathy in this group. Methods We performed a single-centre, retrospective cohort study on adult patients undergoing emergency laparotomy from 23rdMarch – 16thMay 2020 comparing patients with or without suspected or confirmed SARS-CoV-2. Main outcome measures included; 30-day mortality, post-operative respiratory failure, ARDS and other complications, critical care admission and length of stay (CCLOS) and total length of stay (LOS). Laboratory results were collected for three days post-operatively including platelet counts and clotting screen. Results 33 patients undergoing 36 emergency laparotomies were included, of which 9 had confirmed or suspected COVID-19. Patients with COVID-19 were more likely to have severe complications (Clavien-Dindo grade ≥3) (9/9 vs 5/24; p &lt; 0.001), post-operative respiratory failure (9/9 vs 2/24; p &lt; 0.001), ARDS (3/9 vs 0/24; p = 0.015) and need for critical care stay (9/9 vs 12/24; p = 0.012) with a longer LOS and CCLOS (17 vs 7 days; p = 0.004 and 6 vs 1 day; p &lt; 0.001 respectively). Platelet counts were consistently lower on all peri-operative days and patients had a higher incidence of coagulopathy (7/11 vs 3/17; p = 0.020). Conclusions Emergency laparotomy is associated with increased post-operative morbidity in patients with confirmed or suspected COVID-19 with increased respiratory complications and critical care stay. Post-operative patients with COVID-19 show mildly reduced platelet counts and deranged clotting that may be part of a COVID-19-associated coagulopathy.

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