Association Between Use of Preoperative Antihypertensive Medication and 90-Day Mortality After Noncardiac Surgery: A Retrospective Cohort Study

Abstract Background This study aimed to determine whether use of preoperative antihypertensive medication is associated with postoperative 90-day mortality in the hypertensive adult population that underwent elective noncardiac surgery. Methods In this retrospective cohort study, medical records of preoperative hypertensive patients who underwent noncardiac surgery at a single tertiary academic hospital from 2012 to 2018 were reviewed. Among the hypertensive patients, those prescribed to take antihypertensive medication continuously for more than 1 month before admission were defined as the HTN MED group; others were defined as the non-HTN MED group. Multiple imputation, propensity score (PS) matching, and logistic regression analysis were used for statistical analysis. Results Overall, 35,589 preoperative hypertensive adult patients (HTN MED group: 26,154 patients, non-HTN MED group: 9,435 patients) were included in the analysis. After PS matching, each group comprised 6,205 patients; thus, 12,410 patients were included in the final analysis. The odds for 90-day mortality of the HTN MED group in the PS-matched cohort were 41% lower (odds ratio: 0.59, 95% confidence interval: 0.41–0.85; P = 0.005) than those of the non-HTN MED group. Comparable results were obtained in the multivariable logistic regression analysis of the entire cohort (odds ratio: 0.54, 95% confidence interval: 0.41–0.72; P < 0.001). Conclusions This study showed that the use of preoperative antihypertensive medication was associated with lower 90-day mortality among hypertensive patients who underwent noncardiac surgery. Therefore, preoperative screening and treatment with appropriate antihypertensive medication are important for hypertensive patients.

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Understanding patterns and factors associated with place of death in patients with end-stage kidney disease: A retrospective cohort study

Palliative Medicine ◽

10.1177/0269216316655747 ◽

2016 ◽

Vol 31 (3) ◽

pp. 283-288 ◽

Cited By ~ 9

Author(s):

Natasha Lovell ◽

Chris Jones ◽

Dawn Baynes ◽

Sarah Dinning ◽

Katie Vinen ◽

...

Keyword(s):

Cohort Study ◽

Kidney Disease ◽

Confidence Interval ◽

Retrospective Cohort Study ◽

Odds Ratio ◽

Retrospective Cohort ◽

Place Of Death ◽

Renal Unit ◽

End Stage Kidney Disease ◽

End Stage

Background: Meeting place-of-death preferences is an important measure of the quality of end-of-life care. Systematic review shows that 42% of end-stage kidney disease patients prefer home death. Little research has been undertaken on place of death. Aim: To understand patterns of place of death in patients with end-stage kidney disease known in one UK renal unit. Design: A retrospective cohort study of all patients with chronic kidney disease stage 4–5, age ⩾75 and known to one UK renal unit, who died between 2006 and 2012. Patients were categorised into three management pathways: haemodialysis, conservative and pre-dialysis. Results: A total of 321 patients (mean age, 82.7; standard deviation, 5.21) died (61.7% male). In all, 62.9% died in hospital (95% confidence interval, 57.5%–68.1%), 21.8% died in their usual place of residence (95% confidence interval, 17.5%–26.6%) and 15.3% died in an inpatient palliative care unit (95% confidence interval, 11.6%–19.5%). Management pathway and living circumstances were most strongly associated with place of death. Patients on the conservative pathway had four times the odds of dying out of hospital (odds ratio, 4.0; 95% confidence interval, 2.1–7.5; p < 0.01). Patients living alone were less likely to die out of hospital (odds ratio, 0.3; 95% confidence interval, 0.1–0.6; p < 0.01). There were also changes in place of death over time, with more patients dying out of hospital in 2012 compared to 2006 (odds ratio, 3.1; 95% confidence interval, 1.0–9.7; p < 0.05). Conclusion: Most patients with end-stage kidney disease die in hospital, but patients managed without dialysis are significantly more likely to die outside of hospital. Planning ahead is key to be able to meet preference for place of death.

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Development of a preoperative index-based nomogram for the prediction of hypokalemia in patients with pituitary adenoma: a retrospective cohort study

PeerJ ◽

10.7717/peerj.11650 ◽

2021 ◽

Vol 9 ◽

pp. e11650

Author(s):

Wenpeng Li ◽

Lexiang Zeng ◽

Deping Han ◽

Shanyi Zhang ◽

Bingxi Lei ◽

...

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Cohort Study ◽

Pituitary Adenoma ◽

Logistic Regression Analysis ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Close Monitoring ◽

Training Set ◽

Nonlinear Association

Objective To develop and validate a preoperative index-based nomogram for the prediction of hypokalemia in patients with pituitary adenoma (PA). Methods This retrospective cohort study included 205 patients with PAs between January 2013 and April 2020 in the Sun Yat-sen Memorial Hospital, Guangzhou, China. The patients were randomly classified into either a training set (N = 143 patients) and a validation set (N = 62 patients) at a ratio of 7:3. Variables, which were identified by using the LASSO regression model were included for the construction of a nomogram, and a logistic regression analysis was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) in the training set. The area under the curve (AUC) was used to evaluate the performance of the nomogram for predicting hypokalemia. Multivariate logistic regression analysis with a restricted cubic spline analysis was conducted to identify a potential nonlinear association between the preoperative index and hypokalemia. Results The incidence of hypokalemia was 38.05%. Seven preoperative indices were identified for the construction of the nomogram: age, type of PA, weight, activated partial thromboplastin time, urea, eosinophil percentage, and plateletocrit. The AUCs of the nomogram for predicting hypokalemia were 0.856 (95% CI [0.796–0.915]) and 0.652 (95% CI [0.514–0.790]) in the training and validation sets, respectively. Restricted cubic splines demonstrated that there was no nonlinear association between hypokalemia and the selected variables. Conclusion In this study, we constructed a preoperative indices-based nomogram that can assess the risk of hypokalemia after the surgical treatment of pituitary adenomas. This nomogram may also help to identify high risk patients who require close monitoring of serum potassium.

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Deep sedation using propofol target-controlled infusion for gastrointestinal endoscopic procedures: a retrospective cohort study*

10.21203/rs.3.rs-32195/v2 ◽

2020 ◽

Author(s):

María. E. García Guzzo ◽

María Sol Fernandez ◽

Delfina Sánchez Novas ◽

Sandra S. Salgado ◽

Sergio A. Terrasa ◽

...

Keyword(s):

Cohort Study ◽

Adverse Events ◽

Confidence Interval ◽

Retrospective Cohort Study ◽

Odds Ratio ◽

Retrospective Cohort ◽

Gastrointestinal Endoscopy ◽

Oxygen Desaturation ◽

Endoscopic Procedures ◽

Target Controlled Infusion

Abstract Background: Propofol sedation is effective for gastrointestinal endoscopic procedures, but its narrow therapeutic window highlights the importance of identifying an optimal administration technique regarding effectiveness and safety. This study aimed to determine the incidence of significant adverse events in adult patients scheduled for gastrointestinal endoscopy under anaesthetist-performed sedation using propofol target-controlled infusion and determine its potentially improved safety over other anaesthetic strategies. Methods: This single-centre, retrospective cohort study took place in a tertiary referral university hospital. Medical records of 823 patients (age >18 years, American Society of Anesthesiologists physical status classification scores I–III) who had undergone elective gastrointestinal endoscopy under propofol target-controlled infusion sedation during September 2018 were reviewed. Outcomes included hypoxia, hypotension, and bradycardia events, requirement of vasoactive drugs, unplanned tracheal intubation or supraglottic device insertion, and need for advanced cardiac life support. Results: The most frequently encountered adverse event was oxygen desaturation <95% with an incidence of 22.35%. Vasoactive drug administration, hypotension, and oxygen desaturation <90% followed, with incidences of 19.2%, 12.64%, and 9.92%, respectively. Only 0.5% of patients required advanced airway management. Multivariate analysis revealed an association between hypotension events, colonoscopic procedures, and propofol doses (odds ratio: 3.08, 95% confidence interval: 1.43 to 6.61; P=0.004 and odds ratio: 1.14, 95% confidence interval: 1.00 to 1.29; P=0.046). A strong dose-effect relationship was found between hypoxia and obesity; patients with body mass index ≥40 were nine times (odds ratio: 10.22, confidence interval: 95% 2.83 to 36.99) more likely to experience oxygen desaturation <90% events. Conclusions: Propofol sedation using target-controlled infusion appears to be a safe and effective anaesthetic technique for gastrointestinal endoscopic procedures with low rates of adverse events and could be more widely adopted in clinical practice.

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Smoking increases the risk of surgical site infection after hydrocelectomy in adults: a retrospective cohort study in Brazil

The Journal of Infection in Developing Countries ◽

10.3855/jidc.9450 ◽

2018 ◽

Vol 11 (12) ◽

pp. 950-956

Author(s):

Thiago Silva Da Costa ◽

Paulo José De Medeiros ◽

Mauro José Costa Salles

Keyword(s):

Risk Factors ◽

Cohort Study ◽

Confidence Interval ◽

Surgical Site Infection ◽

Retrospective Cohort Study ◽

Odds Ratio ◽

Retrospective Cohort ◽

Univariate Analysis ◽

Smoking Habits ◽

Site Infection

Introduction: Surgical site infection (SSI) following hydrocelectomy is relatively uncommon, but it is one of the main post-operative problems. We aimed to describe the prevalence of SSI following hydrocelectomy among adult patients, and to assess predisposing risk factors for infection. Methodology: This retrospective cohort study was carried out at a university hospital and included hydrocelectomies performed between January 2007 and December 2014. Diagnosis of SSI was performed according to the Center for Diseases Control (CDC) guidelines. Multivariable logistic regression analysis was used to identify independent risk factors. Results: A total of 196 patients were included in the analysis. Overall, 30 patients were diagnosed with SSI (15.3%) and of these, 63.3% (19/30) were classified as having superficial SSI, while 36.7% (11/30) had deep SSI. The main signs and symptoms of infection were the presence of surgical wound secretion (70%) and inflammatory superficial signs such as hyperemia, edema and pain (60%). Among the 53 patients presenting chronic smoking habits, 26.4% (14⁄53) developed SSI, which was associated with a higher risk for SSI (odds ratio [OR] = 2.84, 95% confidence interval [CI] = 1.27 to 6.35, p < 0.01) in the univariate analysis. In the adjusted multivariable analysis, smoking habits were also statistically associated with SSI after hydrocelectomy (odds ratio [OR] = 2.84, 95% confidence interval [CI] = 1.30 to 6.24, p = 0.01). No pre-, intra-, or post-operative variable analyzed showed an independent association to SSI following hydrocelectomy. Conclusions: Smoking was the only independent modifiable risk factor for SSI in the multivariate analysis.

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Deep Sedation using Propofol Target-Controlled Infusion for Gastrointestinal Endoscopic Procedures: A Retrospective Cohort Study*

10.21203/rs.3.rs-32195/v1 ◽

2020 ◽

Author(s):

MARIA EUGENIA GARCIA GUZZO ◽

María Sol Fernandez ◽

Delfina Sánchez Novas ◽

Sandra S. Salgado ◽

Sergio A. Terrasa ◽

...

Keyword(s):

Cohort Study ◽

Adverse Events ◽

Confidence Interval ◽

Retrospective Cohort Study ◽

Odds Ratio ◽

Retrospective Cohort ◽

Gastrointestinal Endoscopy ◽

Oxygen Desaturation ◽

Endoscopic Procedures ◽

Target Controlled Infusion

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Iron Packaging Regulations in the United States and Pediatric Morbidity: A Retrospective Cohort Study

Clinical Pediatrics ◽

10.1177/0009922819901010 ◽

2020 ◽

Vol 59 (4-5) ◽

pp. 375-379 ◽

Cited By ~ 1

Author(s):

James B. Leonard ◽

Elizabeth Quaal Hines ◽

Wendy Klein-Schwartz

Keyword(s):

United States ◽

Cohort Study ◽

Confidence Interval ◽

Retrospective Cohort Study ◽

Odds Ratio ◽

Retrospective Cohort ◽

Early Time ◽

The United States ◽

Morbidity And Mortality ◽

Pediatric Morbidity

Iron poisoning was a leading cause of pediatric morbidity and mortality. We sought to assess whether the removal of strict iron packaging requirements in 2003 resulted in an increase in iron-related morbidity and mortality in pediatric exposures. We performed a retrospective cohort study utilizing the National Poison Data System from 2000 to 2017. A total of 4110 exposures met inclusion criteria: 847 from before (2000-2003) and 3263 after removal of unit-dose package regulations (2004-2017). The incidence of any marker of severity (7.2% vs 3.8%; odds ratio = 0.51, 95% confidence interval = 0.37-0.69) and frequency of deferoxamine use were both higher in the early time period (2.6% vs 1.0%; odds ratio = 0.38, 95% confidence interval = 0.22-0.66). There was no difference in the frequency of key serious effects (acidosis, elevated transaminases, hypotension). Despite removal of iron packaging regulations in the United States, there continues to be a decrease in the incidence of severe iron exposures in children.

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D6 blastocyst transfer on day 6 in frozen-thawed cycles should be avoided: a retrospective cohort study

BMC Pregnancy and Childbirth ◽

10.1186/s12884-020-03224-z ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Huiling Xu ◽

Shumin Qiu ◽

Xiaojing Chen ◽

Suqin Zhu ◽

Yan Sun ◽

...

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Cohort Study ◽

Logistic Regression Analysis ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Hormone Replacement ◽

Implantation Rate ◽

Blastocyst Transfer ◽

Miscarriage Rate

Abstract Background There is no definitive evidence about the suitable timing to transfer blastocysts formed and cryopreserved on day 6 (D6 blastocysts) in frozen-thawed embryo transfer (FET) cycles. This study aimed to investigate the suitable timing to transfer D6 blastocysts in FET cycles and to identify factors affecting clinical pregnancy rate (CPR) and early miscarriage rate (EMR) in FET cycles with blastocysts. Methods This retrospective cohort study included 1788 FET cycles with blastocysts. There were 518 cycles with D6 blastocysts, and 1270 cycles with blastocysts formed and cryopreserved on day 5 (D5 blastocysts) (D5 group). According to the blastocyst transfer timing, the cycles with D6 blastocysts were divided into cycles with D6 blastocysts transferred on day 5 (D6-on-D5 group, 103 cycles) and cycles with D6 blastocysts transferred on day 6 (D6-on-D6 group, 415 cycles). The chi-square test, independent t-test or Mann-Whitney test, and logistic regression analysis were used for data analysis. Results The CPR and implantation rate (IR) were significantly higher in the D6-on-D5 group than in the D6-on-D6 group (55.3% vs. 37.3%, 44.8% vs. 32.6%, P < 0.01). The CPR and IR were significantly higher in the D5 group than in the D6-on-D5 group (66.0% vs. 55.3%, 62.1% vs. 44.8%, P < 0.05), and the EMR was significantly lower in the D5 group than in the D6-on-D5 group (11.2% vs. 21.1%, P < 0.05). Logistic regression analysis demonstrated that transfer D6 blastocysts on day 5, instead of day 6, could significantly increase the CPR (odds ratio[OR]: 2.031, 95% confidence interval (CI): 1.296–3.182, P = 0.002). FET cycles with D6 blastocysts transferred on day 5 had a higher EMR than those with D5 blastocysts (OR: 2.165, 95% CI: 1.040–4.506, P = 0.039). Hormone replacement therapy (HRT) cycles exhibited a higher EMR than natural cycles (OR: 1.953, 95% CI: 1.254–3.043, P = 0.003), while no difference was observed in the CPR (P > 0.05). Conclusions These results indicate that the suitable timing to transfer D6 blastocysts in FET cycles may be day 5, and D6 blastocyst transfer on day 6 in FET cycles should be avoided. D6 blastocysts transfer and HRT cycles may be associated with a higher EMR.

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Inhaled Albuterol Use and Impaired Lactate Clearance in Patients With Sepsis: A Retrospective Cohort Study

Journal of Intensive Care Medicine ◽

10.1177/0885066619901095 ◽

2020 ◽

pp. 088506661990109 ◽

Cited By ~ 1

Author(s):

Tetsuro Maeda ◽

Janvi Paralkar ◽

Toshiki Kuno ◽

Paru Patrawalla

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Cohort Study ◽

Hospital Mortality ◽

Logistic Regression Analysis ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Multivariate Logistic Regression Analysis ◽

Lactate Clearance ◽

Multivariate Logistic Regression

Background: Lactate clearance has become important in the management of sepsis. However, factors unrelated to sepsis-induced hyperlactatemia, including β-2 adrenergic agonists, can interfere with lactate clearance. Objectives: To investigate the association of inhaled albuterol with lactate clearance in patients with sepsis. Methods: This was a single-center retrospective cohort study. Adult patients with sepsis diagnosed in the emergency department from May 2015 to May 2016 with initial lactate levels >2 mmol/L and serial lactate measurements 2 to 6 hours apart were included. Patients were divided into 2 groups based on whether they received inhaled albuterol between lactate measurements. The primary end point was lactate clearance of 10%. Secondary end points included intensive care unit (ICU) consultation and in-hospital mortality. A multivariate logistic regression analysis was performed to assess the effect of inhaled albuterol on lactate clearance. Results: Of 269 patients included, 58 (22%) received inhaled albuterol between lactate measurements. This group had a significantly higher prevalence of pulmonary disease and a lower initial lactate compared to those who did not receive inhaled albuterol. They had a significantly lower rate of lactate clearance (45% vs 77%, P < .001); however, ICU consultation (71% vs 57%, P = .066) and in-hospital mortality (19% vs 22%, P = .64) were not significantly different. A multivariate logistic regression analysis adjusting for age, sex, chronic kidney disease, cirrhosis, cancer, septic shock or severe sepsis, and the amount of intravenous fluids received showed that inhaled albuterol was independently associated with impaired lactate clearance (adjusted odds ratio: 0.26, 95% confidence interval: 0.14-0.50, P < .001). Conclusions: Inhaled albuterol in patients with sepsis was associated with impaired lactate clearance without an increase in ICU consultation or in-hospital mortality. Impaired lactate clearance in patients with sepsis who receive inhaled albuterol should be interpreted with caution.

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Seven-day services in surgery and weekend effect at a Japanese teaching hospital: a retrospective cohort study

10.21203/rs.2.10542/v1 ◽

2019 ◽

Author(s):

Masaaki Matoba ◽

Takashi Suzuki ◽

Hirotaka Ochiai ◽

Takako Shirasawa ◽

Takahiko Yoshimoto ◽

...

Keyword(s):

Cohort Study ◽

Confidence Interval ◽

Retrospective Cohort Study ◽

Odds Ratio ◽

Retrospective Cohort ◽

Weekend Effect ◽

Emergency Setting ◽

Academic Medical Centre ◽

Risk Of Death ◽

Increased Risk

Abstract Background Hospitals deliver 24-hour, 7-day care on a 5-day workweek model, as fewer resources are available on weekends. In prior studies, poorer outcome with weekend admission or surgery was observed. The purpose of this study was to investigate if 7-day service at a hospital affects the likelihood of the “weekend effect” in surgery. The 7-day service included outpatient consultations, diagnostic examinations, and elective surgeries. Methods This was a retrospective cohort study of patients who underwent surgery between April 2014 and October 2016 at an academic medical centre in Tokyo, Japan. The main outcome measure was thirty-day in-hospital mortality from the index surgery. The characteristics of the participants were compared using the Mann–Whitney U test or the chi-squared test as appropriate. Logistic regression was used to test for differences in the mortality rate between the two groups, and propensity score adjustments were made. Results A total of 7442 surgeries were identified, of which, 1386 (19%) took place on the weekend. Of the 947 emergency surgeries, 25% (235) were performed on the weekend. The mortality following emergency weekday surgery was 21‰ (15/712), compared with 55‰ (13/235) following weekend surgery. Of the 6495 elective surgeries, 18% (1151) were performed on the weekend. The mortality following elective weekday surgery was 2.3‰ (12/5344), compared with 0.87‰ (1/1151) following weekend surgery. After adjustment, weekend surgeries were associated with an increased risk of death, especially in the emergency setting (emergency odds ratio: 2.7, 95% confidence interval: 1.2–6.5 vs. elective odds ratio: 0.4, 95% confidence interval: 0.05–3.2). Conclusions Patients undergoing surgery on weekends had higher 30-day mortality than did those undergoing surgery on weekdays, especially in the emergency setting. These findings have potential implications for health administrators and policy makers who may try to restructure the hospital workweek or consider weekend elective surgery.

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Laparoscopic cholecystectomy in anemia patients: a retrospective cohort study

International Surgery Journal ◽

10.18203/2349-2902.isj20180368 ◽

2018 ◽

Vol 5 (2) ◽

pp. 643

Author(s):

Abdulrahman Saleh Al-Mulhim

Keyword(s):

Logistic Regression ◽

Cohort Study ◽

Laparoscopic Cholecystectomy ◽

Clinical Outcome ◽

Confidence Interval ◽

Odds Ratio ◽

Retrospective Cohort ◽

Hemoglobin Level ◽

Adverse Outcomes ◽

Preoperative Anemia

Background: Preoperative anemia is associated with adverse outcomes after surgery, but no evidence study demonstrates this risk after laparoscopic cholecystectomy. This study aimed to measure the prevalence of preoperative anemia, and to assess its effect on early clinical outcome in laparoscopic cholecystectomy patients.Methods: Data of 6342 consecutive laparoscopic cholecystectomy patients between Januarys 1995 to January 2015 were evaluated. Preoperative anemia was defined as a hemoglobin level of less than 120gm/l in female, and less than 130gm/l in male. Logistic regression used for analysis.Results: Preoperative anemia identified in 37.4% of laparoscopic cholecystectomy patients and it more prevalence in women. Analysis showed that patients with severe [odds ratio1.83 (95% Confidence interval 1.62-3.66)], moderate [odds ratio 1.21 (95% Confidence interval 1.11-1.38)], and mild [odds ratio 1.04 (95% Confidence interval 0.91-1.13)] anemia had higher morbidity than those with normal preoperative hemoglobin.Conclusions: Anemia is common among laparoscopic cholecystectomy patients, and it is associated with more complications.

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