scholarly journals P-P35 Textbook outcomes after pancreaticoduodenectomy in high risk patients: results from a high volume UK centre

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Syed Soulat Raza ◽  
Anisa Nutu ◽  
Sarah Powell-Brett ◽  
Nikolaos Chatzizacharias ◽  
Bobby Dasari ◽  
...  
Keyword(s):  
High Risk ◽  
Multivariable Analysis ◽  
Bile Leak ◽  
Binary Logistic Regression ◽  
High Volume ◽  
Vascular Resection ◽  
Binary Logistic Regression Analysis ◽  
High Risk Patients ◽  
Risk Patients ◽  
Severe Comorbidity

Abstract Background Textbook Outcome (TO) after pancreaticoduodenectomy (PD) is a quality metric that may be used to compare outcomes between centres, but the effect of casemix on TO is unknown. The aim of this study was to determine if TO after PD is affected by casemix. Methods TO was evaluated in a prospectively maintained database of 830 consecutive patients who underwent PD between 2009-2019 in a high volume centre. TO was defined as an absence of POPF, bile leak, haemorrhage, Clavien III+ complications, readmission and hospital mortality. Frequency of TO was compared between high and low risk cases. High risk was defined as any of the following: age ≥ 75 years, significant comorbidity (Charlson index ≥5), vascular resection or additional procedures. Multivariable analysis using binary logistic regression analysis was performed to assess factors associated with TO. Results Overall, 599/830 patients (72%) had TO after PD. There has been no change during the study period (2009-2013 v 2014-2018: 70% v 75%; p = 0.148). There was no difference in TO in elderly patients (p = 0.774), severe comorbidity (p = 0.483), vascular resection (p = 0.187) or additional procedures (p = 0.189). On multivariable analysis, cardiac disease (OR 0.47, 95%CI 0.28-0.81; p = 0.006), pancreatic adenocarcinoma (OR 1.55 95%CI 1.02-2.35; p = 0.039) and hard gland (OR 3.12, 95%CI 2.06-4.736; p < 0.001) were independently associated with TO. Conclusions Acceptable Textbook Outcomes can be achieved in high risk patients and those undergoing complex surgery, when performed in high volume specialist centres with appropriate patient selection.

scholarly journals Textbook outcomes after pancreaticoduodenectomy in high risk patients: results from a high volume UK centre

HPB ◽  
2021 ◽  
Vol 23 ◽  
pp. S841-S842
Author(s):  
S.S. Raza ◽  
A. Nutu ◽  
S. Powell-Brett ◽  
J. Hodson ◽  
N. Chatzizacharias ◽  
...  
Keyword(s):  
High Risk ◽  
High Volume ◽  
High Risk Patients ◽  
Risk Patients

The use of rotational atherectomy in high-risk patients: results from a high-volume centre

2018 ◽  
pp. 1360-1368
Author(s):  
Piotr Kübler ◽  
Wojciech Zimoch ◽  
Michał Kosowski ◽  
Brunon Tomasiewicz ◽  
Oscar Rakotoarison ◽  
...  
Keyword(s):  
High Risk ◽  
High Volume ◽  
Rotational Atherectomy ◽  
High Risk Patients ◽  
Risk Patients

Relationship between high-risk patients receiving prescription opioids and high-volume opioid prescribers

Addiction ◽  
2017 ◽  
Vol 113 (4) ◽  
pp. 677-686 ◽  
Author(s):  
Hsien-Yen Chang ◽  
Irene B. Murimi ◽  
Christopher M. Jones ◽  
G. Caleb Alexander
Keyword(s):  
High Risk ◽  
High Volume ◽  
Prescription Opioids ◽  
High Risk Patients ◽  
Risk Patients

scholarly journals The LACE Score as a Tool to Identify Radical Cystectomy Patients at Increased Risk of 90-Day Readmission and Mortality

2018 ◽  
Vol 12 (1) ◽  
pp. 20-26 ◽  
Author(s):  
Jennifer L. Saluk ◽  
Robert H. Blackwell ◽  
William S. Gange ◽  
Matthew A. C. Zapf ◽  
Anai N. Kothari ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
High Risk ◽  
Radical Cystectomy ◽  
Multivariable Analysis ◽  
Emergency Department Visits ◽  
High Risk Patients ◽  
Increased Risk ◽  
Patients At Risk ◽  
Risk Patients

Introduction: Radical cystectomy for bladder cancer is associated with high rates of readmission. We investigated the LACE score, a validated prediction tool for readmission and mortality, in the radical cystectomy population. Materials &amp; Methods: Patients who underwent radical cystectomy for bladder cancer were identified by ICD-9 codes from the Healthcare Cost and Utilization Project State Inpatient Database for California years 2007-2010. The LACE score was calculated as previously described, with components of L: length of stay, A: acuity of admission, C: comorbidity, and E: number of emergency department visits within 6 months preceding surgery. Results: Of 3,470 radical cystectomy patients, 638 (18.4%) experienced 90-day readmission, and 160 (4.6%) 90-day mortality. At a previously validated “high-risk” LACE score ≥ 10, patients experienced an increased risk of 90-day readmission (22.8 vs. 17.7%, p = 0.002) and mortality (9.1 vs. 3.5%, p < 0.001). On adjusted multivariable analysis, “high risk” patients by LACE score had increased 90-day odds of readmission (adjusted OR = 1.24, 95% CI: 0.99-1.54, p = 0.050) and mortality (adjusted OR = 2.09, 95% CI: 1.47-2.99, p < 0.001). Conclusion: The LACE score reasonably identifies patients at risk for 90-day mortality following radical cystectomy, but only poorly predicts readmission. Providers may use the LACE score to target high-risk patients for closer follow-up or intervention.

Eight-years trends and outcomes in TAVI performed in a high-volume center

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Tagliari ◽  
P.K Haager ◽  
M Miura ◽  
G Russo ◽  
A Pozzoli ◽  
...  
Keyword(s):  
High Risk ◽  
Severe Aortic Stenosis ◽  
High Volume ◽  
Chronic Obstructive ◽  
Funding Source ◽  
Femoral Access ◽  
High Risk Patients ◽  
Risk Patients ◽  
High Volume Center ◽  
Sts Score

Abstract Introduction Since the first transcatheter aortic valve implantation (TAVI), remarkable changes in procedure features and patients' profile have been reported, making it a widespread treatment for severe aortic stenosis in all risk-class patients. Purpose To evaluate TAVI contemporary trends and outcomes in the last 8 years in a high-volume TAVI center. Methods Data of adult patients submitted to TAVI from April 2012 to April 2019 in a high-volume center were obtained from the Swiss TAVI registry, a prospective national multi-center database. Patients were divided according to implant period in two groups: 1) TAVI performed from 2012 to 2016, and 2) TAVI performed from 2017 to 2019. Results Over a 8-years period, a total of 1485 procedures were performed, increasing from 95 in 2012 to 320 in 2018 (p&lt;0.001). A remarkable modification in patients' profile and procedure characteristics can be seen in Table 1. Despite higher age and surgical risk, a significant decrease in 1-year mortality (6.8% vs. 3.2%; p&lt;0.001) was observed in the last 3 years. This difference was especially notable in the subgroup of high-risk patients (STS score ≥8), who presented a decrease in 30-days (5% vs. 3.3%; p=0.001) and 1-year mortality (13.1% vs. 4.9%; p&lt;0.001). In multivariate analysis, age (OR 1.05, 95% CI: 1.0–1.1), non-femoral access (OR 2.7, 95% CI: 1.2–6.0), and STS score (OR 1.07, 95% CI: 1.0–1.1) were independent predictors of in-hospital mortality, while male gender (OR 1.8, 95% CI: 1.0–3.2), chronic obstructive pulmonary disease (OR 2.1, 95% CI: 1.1–3.9), and STS score (OR 1.07, 95% CI: 1.01–1.14) were predictors of 1-year mortality. Conclusion Significant changes in patients' profile and procedure characteristics were observed in the last 3 years of TAVI experience. Even performed in elderly and high-risk patients, TAVI was associated with low early and 1-year mortality. The Swiss TAVI registry offers a unique opportunity to monitor trends and outcomes in patient submitted to TAVI. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): APT is a Ph.D. study and her scientific research is supported by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brasil (Capes) - Finance Code 001.

scholarly journals Feasibility and Safety of Bariatric Surgery in High-Risk Patients: A Single-Center Experience

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Yusef Moulla ◽  
Orestis Lyros ◽  
Matthias Blüher ◽  
Philipp Simon ◽  
Arne Dietrich
Keyword(s):  
Bariatric Surgery ◽  
High Risk ◽  
Postoperative Complications ◽  
Length Of Hospital Stay ◽  
High Volume ◽  
University Hospital ◽  
Perioperative Morbidity ◽  
High Risk Patients ◽  
Operative Revision ◽  
Risk Patients

Introduction. Despite the feasibility and safety of bariatric procedures nowadays, high-risk patients with vast obesity and severe comorbidities demonstrate relatively high perioperative morbidity and mortality rates and, therefore, form a distinguished challenge for the bariatric surgeons. Methods. We retrospectively analyzed high-risk patients, who underwent bariatric surgery in University Hospital Leipzig between May 2012 and December 2016. High-risk patients were defined when (Bergeat et al., 2016) at least one of the following risk factors was met: age ≥ 70 years, body mass index (BMI) > 70 kg/m2, liver cirrhosis, end-organ failure, or immunosuppression by status after organ transplantation along with (Birkmeyer et al., 2010) at least two comorbidities associated with obesity. Our analysis included early postoperative complications. Results. A total of 25 high-risk obese patients were identified. All patients had a standardized postoperative management with a mean length of hospital stay of 4 ± 1.4 days. One patient required an operative revision due to a stapler line leak after sleeve gastrectomy. No other major postoperative complications occurred. Conclusion. Bariatric surgery for severe high-risk patients can be performed safely in high-volume centers following standardized procedures.

Surgical High-risk Patients With ASA ≥ 3 Undergoing Radical Cystectomy: Morbidity, Mortality, and Predictors for Major Complications in a High-volume Tertiary Center

2018 ◽  
Vol 16 (6) ◽  
pp. e1141-e1149 ◽  
Author(s):  
Gerald B. Schulz ◽  
Tobias Grimm ◽  
Alexander Buchner ◽  
Friedrich Jokisch ◽  
Alexander Kretschmer ◽  
...  
Keyword(s):  
High Risk ◽  
Radical Cystectomy ◽  
High Volume ◽  
High Risk Patients ◽  
Major Complications ◽  
Tertiary Center ◽  
Risk Patients

Charlson score to predict overall survival and cancer-related death in elderly patients featuring high-risk prostate cancer.

2015 ◽  
Vol 33 (7_suppl) ◽  
pp. 84-84
Author(s):  
Guzman Ordaz ◽  
Rafael Sanchez-Salas ◽  
Arjun Sivaraman ◽  
Steven Joniau ◽  
Marco Giorgio Bianchi ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Elderly Patients ◽  
Multivariable Analysis ◽  
Treatment Strategies ◽  
Binary Logistic Regression ◽  
High Volume ◽  
Charlson Score ◽  
High Risk Prostate Cancer ◽  
Risk Prostate Cancer

84 Background: In elderly patients, Charlson score among other features, might allow clinicians to limit the use of aggressive adjuvant treatment strategies or even primary surgical treatment to those who might not achieve benefit during their lifetime. Methods: Retrospective analysis, 7,650 case multicenter high-risk prostate cancer (Pca) radical prostatectomy database selecting >= 70 years old cases. We predicted death from all causes (DAC) and cancer related death (CRD) including all clinical and pathological data. Multivariable analysis were performed to identify independent predictors of DAC and CRD with binary logistic regression, using STATA® software, version 13.1. Results: 2,106 patients from 14 high-volume centers were included. Mean age was 72.8 years (SD 2.46). 206 (9.78%) patients were classified as ASA 3-4 and 497 (23.6%) as CS >=1. Mean PSA was 21.7 ng/ml (SD 50.5). At final histopathology, 800 (38%) had pT3b-T4 disease, GS was 8-10 in 589 (28%), LNI was found in 518 (24.6%) and 822 (39%) PSM. Adjuvant RT, ADT and RT+ADT were administered in 359 (17%), 391 (18.6%) and 437 (20.7%), respectively. Mean follow up was 5.18 years (DS 4.47). BCR occur in 649 (30.8%) and CF in 150 (7.1%) of which distant in 59 (2.8%). Total deaths accounted 341 (16.2%) and CRD for 100 (4.7%) cases. Conclusions: Multicenter data confirms that elderly patients survival harboring high risk prostate cancer will benefit from radical treatment if they are Charlson score 1 or less. [Table: see text] [Table: see text]

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