Morbidity and Mortality of Urgent Surgery and the Implications for Risk-Stratification

Obstetric emergencies during COVID-19 pandemic pose an enormous challenge to the concerned obstetrician. Risk stratification during obstetric triage will guide in the initial assessment & planning of further management to reduce maternal and fetal morbidity and mortality rates. As the health system adapts to cope with this pandemic, special attention needs to be given to the several moral and ethical dilemmas that may occur during patient care.

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Acute gastrointestinal bleeding

InnovAiT Education and inspiration for general practice ◽

10.1177/17557380211046972 ◽

2021 ◽

pp. 175573802110469

Author(s):

Victoria Evans ◽

Helen King

Keyword(s):

Risk Stratification ◽

Gastrointestinal Bleeding ◽

Mortality Rates ◽

Morbidity And Mortality ◽

Significant Morbidity ◽

Acute Gastrointestinal Bleeding ◽

Surgical Emergency

Acute gastrointestinal bleeding is a common medical and/or surgical emergency that can be caused by a range of diverse pathologies. Gastrointestinal Bleeding can be divided into upper and lower in nature, presenting in sometimes subtly different fashions, but with differing requirements for investigation and management. Prompt identification, risk stratification and treatment are required in order to minimise the ongoing significant morbidity and mortality rates associated with severe presentations of gastrointestinal bleeding.

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Incorporating Ensemble approach into Automated Machine Learning in an attempt to predict survival time in patients with anaplastic oligodendroglioma: Analysis on the Surveillance, Epidemiology, and End Results (SEER) database

10.31219/osf.io/hnyaq ◽

2021 ◽

Author(s):

Ali Haider Bangash ◽

Tauseef Ullah ◽

Arshiya Fatima ◽

Saiqa Zehra

Keyword(s):

Machine Learning ◽

Risk Stratification ◽

Survival Time ◽

Predictive Models ◽

Morbidity And Mortality ◽

Anaplastic Oligodendroglioma ◽

Seer Database ◽

Ensemble Approach ◽

Automated Machine Learning ◽

End Results

Automated machine learning is explored to develop survival time predictive models for anaplastic oligodendroglioma by adopted data from the Surveillance, Epidemiology, and End Results (SEER) database. Such models, when incorporated into risk stratification protocols, would optimize the outcomes and translate into the reduction of morbidity and mortality associated with this neoplastic condition.

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Modern Radiotherapy and Risk of Cardiotoxicity

Chemotherapy ◽

10.1159/000510573 ◽

2020 ◽

Vol 65 (3-4) ◽

pp. 65-76

Author(s):

Efstratios Koutroumpakis ◽

Nicolas L. Palaskas ◽

Steven H. Lin ◽

Jun-ichi Abe ◽

Zhongxing Liao ◽

...

Keyword(s):

Heart Disease ◽

Early Detection ◽

Risk Stratification ◽

Cancer Survivors ◽

Clinical Presentation ◽

Basic Mechanism ◽

Morbidity And Mortality ◽

Common Cause ◽

Radiation Induced ◽

Modern Radiotherapy

Despite the advancements of modern radiotherapy, radiation-induced heart disease remains a common cause of morbidity and mortality amongst cancer survivors. This review outlines the basic mechanism, clinical presentation, risk stratification, early detection, possible mitigation, and treatment of this condition.

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Use of the modified frailty index to predict 30-day morbidity and mortality from spine surgery

Journal of Neurosurgery Spine ◽

10.3171/2015.10.spine14582 ◽

2016 ◽

Vol 25 (4) ◽

pp. 537-541 ◽

Cited By ~ 97

Author(s):

Rushna Ali ◽

Jason M. Schwalb ◽

David R. Nerenz ◽

Heath J. Antoine ◽

Ilan Rubinfeld

Keyword(s):

Risk Stratification ◽

Spine Surgery ◽

Postoperative Morbidity ◽

Frailty Index ◽

Surgical Site Infections ◽

Perioperative Risk ◽

Morbidity And Mortality ◽

Improvement Program ◽

Gastrointestinal Problems ◽

Modified Frailty Index

OBJECTIVE Limited tools exist to stratify perioperative risk in patients undergoing spinal procedures. The modified frailty index (mFI) based on the Canadian Study of Health and Aging Frailty Index (CSHA-FI), constructed from standard demographic variables, has been applied to various other surgical populations for risk stratification. The authors hypothesized that it would be predictive of postoperative morbidity and mortality in patients undergoing spine surgery. METHODS The 2006–2010 National Surgical Quality Improvement Program (NSQIP) data set was accessed for patients undergoing spine surgeries based on Current Procedural Terminology (CPT) codes. Sixteen preoperative clinical NSQIP variables were matched to 11 CSHA-FI variables (changes in daily activities, gastrointestinal problems, respiratory problems, clouding or delirium, hypertension, coronary artery and peripheral vascular disease, congestive heart failure, and so on). The outcomes assessed were 30-day occurrences of adverse events. These were then summarized in groups: any infection, wound-related complication, Clavien IV complications (life-threatening, requiring ICU admission), and mortality. RESULTS A total of 18,294 patients were identified. In 8.1% of patients with an mFI of 0 there was at least one morbid complication, compared with 24.3% of patients with an mFI of ≥ 0.27 (p < 0.001). An mFI of 0 was associated with a mortality rate of 0.1%, compared with 2.3% for an mFI of ≥ 0.27 (p < 0.001). Patients with an mFI of 0 had a 1.7% rate of surgical site infections and a 0.8% rate of Clavien IV complications, whereas patients with an mFI of ≥ 0.27 had rates of 4.1% and 7.1% for surgical site infections and Clavien IV complications, respectively (p < 0.001 for both). Multivariate analysis showed that the preoperative mFI and American Society of Anesthesiologists classification of ≥ III had a significantly increased risk of leading to Clavien IV complications and death. CONCLUSIONS A higher mFI was associated with a higher risk of postoperative morbidity and mortality, providing an additional tool to improve perioperative risk stratification.

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Morbidity and mortality in patients undergoing lower limb arthroplasty surgery during the initial surge of the COVID-19 pandemic in the UK at a single-speciality orthopaedic hospital

Bone & Joint Open ◽

10.1302/2633-1462.25.bjo-2021-0001.r1 ◽

2021 ◽

Vol 2 (5) ◽

pp. 323-329

Author(s):

Yuvraj Agrawal ◽

Ashish Vasudev ◽

Akash Sharma ◽

George Cooper ◽

Jonathan Stevenson ◽

...

Keyword(s):

Lower Limb ◽

Early Postoperative Period ◽

Morbidity And Mortality ◽

Effective Vaccine ◽

Restoration Planning ◽

Emergency Procedures ◽

Urgent Surgery ◽

Significant Difference ◽

American Society ◽

The Uk

Aims The COVID-19 pandemic posed significant challenges to healthcare systems across the globe in 2020. There were concerns surrounding early reports of increased mortality among patients undergoing emergency or non-urgent surgery. We report the morbidity and mortality in patients who underwent arthroplasty procedures during the UK first stage of the pandemic. Methods Institutional review board approval was obtained for a review of prospectively collected data on consecutive patients who underwent arthroplasty procedures between March and May 2020 at a specialist orthopaedic centre in the UK. Data included diagnoses, comorbidities, BMI, American Society of Anesthesiologists grade, length of stay, and complications. The primary outcome was 30-day mortality and secondary outcomes were prevalence of SARS-CoV-2 infection, medical and surgical complications, and readmission within 30 days of discharge. The data collated were compared with series from the preceding three months. Results There were 167 elective procedures performed in the first three weeks of the study period, prior to the first national lockdown, and 57 emergency procedures thereafter. Three patients (1.3%) were readmitted within 30 days of discharge. There was one death (0.45%) due to SARS-CoV-2 infection after an emergency procedure. None of the patients developed complications of SARS-CoV-2 infection after elective arthroplasty. There was no observed spike in complications during in-hospital stay or in the early postoperative period. There was no statistically significant difference in survival between pre-COVID-19 and peri-COVID-19 groups (p = 0.624). We observed a higher number of emergency procedures performed during the pandemic within our institute. Conclusion An international cohort has reported 30-day mortality as 28.8% following orthopaedic procedures during the pandemic. There are currently no reports on clinical outcomes of patients treated with lower limb reconstructive surgery during the same period. While an effective vaccine is developed and widely accepted, it is very likely that SARS-CoV2 infection remains endemic. We believe that this report will help guide future restoration planning here in the UK and abroad. Cite this article: Bone Jt Open 2021;2(5):323–329.

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Prediction Models and Scores in Pulmonary Hypertension: A Systematic Review

Current Pharmaceutical Design ◽

10.2174/1381612824999201105163437 ◽

2020 ◽

Vol 26 ◽

Author(s):

Sophia Anastasia Mouratoglou ◽

Ahmed A. Bayoumy ◽

Anton Vonk Noordegraaf

Keyword(s):

Systematic Review ◽

Risk Stratification ◽

Prediction Models ◽

Prognostic Significance ◽

Morbidity And Mortality ◽

Prognostic Models ◽

Risk Scores ◽

Patient Treatment ◽

Discrimination Ability ◽

Mesh Terms

Background:: pulmonary arterial hypertension (PAH) is a serious disease with increased morbidity and mortality. The need of an individualized patient treatment approach necessitates the use of risk assessment in PAH patients. That may include a range of hemodynamic, clinical, imaging and biochemical parameters, derived from clinical studies and registry data. Objective:: in current systematic review, we summarize the available data on risk prognostic models and scores in PAH and we explore the possible concordance amongst different risk stratification tools in PAH. Methods:: PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines aided the performance of this systematic review. Eligible studies were identified through literature search in the electronic databases PubMed, Science Direct, Google Scholar and Cochrane with the use of various combinations of MeSH and non-MeSH terms, with focus on PAH Results:: overall, 25 studies were included in the systematic review, out of them, 9 were studies deriving prognostic equations and risk scores and 16 were validating studies of an existing score. The majority of risk stratification scores use hemodynamic data for the assessment of prognosis, while other also include clinical and demographic variables in their equations. The risk discrimination in the overall PAH population, was adequate, especially in differentiating the low versus high risk patients, but their discrimination ability in the intermediate groups remained lower. Current ESC/ERS proposed risk stratification score utilizes a limited number of parameters with prognostic significance, whose prognostic ability is validated in European patient populations. Conclusion:: despite improvement in risk estimation of prognostic tools of the disease, PAH morbidity and mortality remain high, necessitating the need for the risk scores to undergo periodic re-evaluation and refinements to incorporate new data on predictors of disease progression and mortality and, thereby, maintain their clinical utility

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Delayed Surgery Does Not Increase Risk in Urgent Colectomy for Ulcerative Colitis

The American Surgeon ◽

10.1177/0003134820971576 ◽

2020 ◽

pp. 000313482097157

Author(s):

Simon Peter T. Tiu ◽

Luv N. Hajirawala ◽

Claudia Leonardi ◽

Kurt G. Davis ◽

Guy R. Orangio ◽

...

Keyword(s):

Ulcerative Colitis ◽

Quality Improvement ◽

Univariate Analysis ◽

Morbidity And Mortality ◽

Short Term ◽

Improvement Program ◽

Delayed Surgery ◽

Acs Nsqip ◽

Urgent Surgery ◽

Significant Difference

Background Medical management is the cornerstone of therapy for ulcerative colitis (UC). In the setting of fulminant disease, hospitalized patients may undergo medical rescue therapy (MRT) or urgent surgery. We hypothesized that delayed attempts at MRT result in increased morbidity and mortality following urgent surgery for UC. Objective The aim is to assess the outcomes for patients requiring urgent, inpatient surgery for UC in a prompt or delayed fashion. Design The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) general and colectomy-specific databases from 2013 to 2016 were queried. Urgent surgery was defined as nonelective, nonemergency surgery. Patients were divided into prompt and delayed groups based on time from admission to surgery of <48 hours or >48 hours. Baseline characteristics and 30-day outcomes were compared using univariate and multivariate analyses. Setting The ACS NSQIP database from 2013 to 2016 was evaluated. Patients Adult patients undergoing nonelective, nonemergency colectomy for UC. Main Outcome Measures 30-day morbidity and mortality. Results 921 patients underwent urgent inpatient surgery for UC. In univariate analysis, there was no significant difference between prompt and delayed surgery for wound infection, sepsis, return to operating room, or readmission. Limitations Retrospective study of a quality improvement database. Patients who underwent successful MRT did not receive surgery, so are not included in the database. Conclusions Delaying surgery to further attempt MRT does not alter short-term outcomes and may allow conversion to elective future surgery. Contrarily, medical optimization does not improve short-term outcomes.

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