175 Risk Factors and Clinical Impact of Perioperative Neurological Deficits Following Thoracolumbar Arthrodesis: National Inpatient Sample Analysis

Neurosurgery ◽  
2017 ◽  
Vol 64 (CN_suppl_1) ◽  
pp. 245-245
Author(s):  
Enyinna Levi Nwachuku ◽  
Amol Mehta ◽  
Nima Alan ◽  
James Zhou ◽  
David O Okonkwo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hospital Mortality ◽  
Female Gender ◽  
Patient Characteristics ◽  
The United States ◽  
Population Based ◽  
Neurological Deficits ◽  
Mortality And Morbidity ◽  
Cord Injury ◽  
Independent Risk Factors

Abstract INTRODUCTION The rates of arthrodesis performed in the United States and globally have increased tremendously in the last 10–15 years. Amongst the most devastating complications are neurological deficits including spinal cord injury, nerve root irritation, and cauda equine syndrome. The purpose of this study is to understand the risk factors for perioperative neurological deficits in patients undergoing thoracolumbar fusion and additionally, to investigate the contribution of perioperative neurological deficits to in-hospital mortality and morbidity. Lastly, we aimed to explore the early trends in outcomes and patient characteristics across our 13-year study period. METHODS This is a retrospective cohort study.Data from the Nationwide Inpatient Sample between the years of 1999–2011 was analyzed. We included patients between the ages of 18 and 65 who had undergone thoracolumbar fusion. We excluded patients who had undergone the procedure as a result of trauma or a malignancy. The primary outcome was perioperative neurological deficits.We compiled an extensive list of covariates, including demographic variables, pre-operative and post operative variables that are known to increase the risk of perioperative neurological deficits. We additionally used the van Walraven score, a weighted numerical surrogate for the Elixhauser comorbidity index as a covariate. RESULTS >Our analysis on 37,899 patients yielded an overall rate of perioperative neurological deficits, mortality, and morbidity of 1.20%, 0.27%, and 29.27% respectively. Risk factors for perioperative neurological deficits included increasing age (OR 1.023 95% CI 1.018-1.029), VWR 5–14 (OR 1.535 95% CI 1.054-2.235), and pre-operative paralysis (OR 2.551 95% CI 1.674-3.886. We found that perioperative neurological deficits were independent risk factors predictors of in-hospital mortality (OR 3.467 95% CI 1.473-8.158 P < 0.005) and morbidity (OR 4.084 95% CI 3.187-5.233 p<.0001). The rates of perioperative neurological deficits and morbidity trended upwards, as did the average age and van Walraven score. CONCLUSION In this large, longitudinal, and population based study, we found that age, higher comorbid burden, and pre-operative paralysis increased the risk of perioperative neurological deficits while female gender and hypertension were found to be protective. Additionally, we found that perioperative neurological deficits are in fact independent risk factors for in-hospital mortality and morbidity after thoracolumbar fusion.

scholarly journals Incidence, Risk Factors, and Outcomes of Preterm and Early Term Births: A Population-Based Register Study

2021 ◽  
Vol 18 (11) ◽  
pp. 5865
Author(s):  
Salma Younes ◽  
Muthanna Samara ◽  
Rana Al-Jurf ◽  
Gheyath Nasrallah ◽  
Sawsan Al-Obaidly ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hospital Mortality ◽  
Gestational Age ◽  
Neonatal Intensive Care ◽  
Population Based ◽  
Incidence Rates ◽  
Large For Gestational Age ◽  
Mortality And Morbidity ◽  
Early Term ◽  
Incidence Risk

Preterm birth (PTB) and early term birth (ETB) are associated with high risks of perinatal mortality and morbidity. While extreme to very PTBs have been extensively studied, studies on infants born at later stages of pregnancy, particularly late PTBs and ETBs, are lacking. In this study, we aimed to assess the incidence, risk factors, and feto-maternal outcomes of PTB and ETB births in Qatar. We examined 15,865 singleton live births using 12-month retrospective registry data from the PEARL-Peristat Study. PTB and ETB incidence rates were 8.8% and 33.7%, respectively. PTB and ETB in-hospital mortality rates were 16.9% and 0.2%, respectively. Advanced maternal age, pre-gestational diabetes mellitus (PGDM), assisted pregnancies, and preterm history independently predicted both PTB and ETB, whereas chromosomal and congenital abnormalities were found to be independent predictors of PTB but not ETB. All groups of PTB and ETB were significantly associated with low birth weight (LBW), large for gestational age (LGA) births, caesarean delivery, and neonatal intensive care unit (NICU)/or death of neonate in labor room (LR)/operation theatre (OT). On the other hand, all or some groups of PTB were significantly associated with small for gestational age (SGA) births, Apgar <7 at 1 and 5 minutes and in-hospital mortality. The findings of this study may serve as a basis for taking better clinical decisions with accurate assessment of risk factors, complications, and predictions of PTB and ETB.

Risk Factors for Development of Symptoms Post Autologous Transplant for Multiple Myeloma.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 1771-1771
Author(s):  
Erica Campagnaro ◽  
Rima Saliba ◽  
Karen Anderson ◽  
Linda Roden ◽  
Floralyn Mendoza ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multiple Myeloma ◽  
Symptom Burden ◽  
Disease Status ◽  
Female Gender ◽  
Patient Characteristics ◽  
The United States ◽  
Charlson Score ◽  
Female Ratio ◽  
Post Transplant

Abstract Background: Multiple myeloma (MM) is the most common indication for autografting in the United States. Although safe, autografting can be associated with substantial morbidity due to the toxic side effects of chemotherapy. Strategies aimed at minimizing symptoms post autografting may result in better tolerance. The risk factors for symptom development post autografting for MM have not been well characterized. Purpose: To define pretransplant conditions which may be predictive of post-transplant symptom burden. Methods: We performed prospective evaluation of symptom burden among 64 myeloma patients undergoing autograft at MDACC as well as retrospective review of pretransplant variables including patient demographics, performance status, albumin, disease status, and Charlson Comorbidity Index (CCI). Univariate analysis was performed to correlate pretransplant variables with posttransplant symptom burden as defined by M.D. Anderson Symptom Inventory (MDASI) scores at different timepoints post transplant. Results: 64 patients were studied from 6/2000 to 5/2003. Patient characteristics are summarized in Table 1. Symptom burden increased from baseline to day 0 to nadir, with most patients returning to their baseline by day 30 post transplant (Figure 1). Table 2 summarizes the potential impact of pre-transplant variables on median MDASI scores at nadir. Patients with the highest MDASI scores at baseline had the highest MDASI scores at nadir in quartile analysis(p=.001). Patients with Charlson score of ≥ 3, age &gt; 60, β 2M &gt; 3, albumin ≤ 4, and female gender had a trend towards higher nadir MDASI scores. Other pre-transplant variables, including Durie-Salmon stage, LDH, hemoglobin, disease status at time of autograft, and time from diagnosis to autograft had no apparent correllation with symptom burden throughout transplant (data not shown). Conclusions: Autografting for MM is associated with significant but reversible symptom burden during the first 30 days of the procedure. Baseline symptom burden is the most important predictor of post transplant symptom burden. Other potential predictors include Charlson score, age, β 2M, albumin, and female gender. The MDASI scoring system is a potentially useful means of following symptom burden post autografting that could be used to assess interventions aimed at reducing transplant related morbidity in MM patients. Patient Characteristics Median (range) Age at transplantation, years 55.2 (30–74) Time to SCT, months 7.5 (2.5–73.3) Albumin at transplantation 3.74 (2.9–4.5) β2M at transplantation 3.79 (1.4–19.3) Charlson score at transplantation 3.48 (2–6) Disease status at transplantation n (%) First remission 42 (65.6) Primary refractory 14 (21.9) Other 8 (13.6) Preparative regimen n (%) Melphalan 53 (82.8) Other 11 (17.2) Male to female ratio 1.5 : 1 Impact of Pre-transplant Variables on Nadir MDASI Scores n Median (range) Charlson score &lt; 3 50 22 (1–97) ≥ 3 14 41 (3–72) .09 Age ≤ 60 years 43 23 (1–97) &gt; 60 years 21 31 (3–72) .2 β 2M ≤3.0 34 20 (1–85) &gt; 3.0 27 28 (4–97) .2 Albumin ≤ 4.0 50 27 (1–97) &gt; 4.0 14 19 (1–16) .2 Gender Female 26 30 (5–85) Male 38 23 (1–97) .2 Figure Figure

scholarly journals Candida infective endocarditis: A retrospective study of patient characteristics and risk factors for death in 703 U.S. cases, 2015-2019

2020 ◽  
Author(s):  
Jonathan P Huggins ◽  
Samuel Hohmann ◽  
Michael Z David
Keyword(s):  
Risk Factors ◽  
Hospital Mortality ◽  
Liver Failure ◽  
Patient Characteristics ◽  
Medication Administration ◽  
Small Sample ◽  
Risk Of Death ◽  
Opiate Abuse ◽  
Small Sample Sizes ◽  
Valve Pathology

Abstract Background Candida endocarditis is a rare, sometimes fatal complication of candidemia. Past investigations of this condition are limited by small sample sizes. We used the Vizient clinical database to report on characteristics of patients with Candida endocarditis and to examine risk factors for in-hospital mortality. Methods This was a multicenter, retrospective cohort study of 703 inpatients admitted to 179 United States hospitals between October 2015 and April 2019. We reviewed demographic, diagnostic, medication administration, and procedural data from each patient’s initial encounter. Univariate and multivariate logistic regression analyses were used to identify predictors of in-hospital mortality. Results Of 703 patients, 114 (16.2%) died during the index encounter. One hundred and fifty-eight (22.5%) underwent an intervention on a cardiac valve. On multivariate analysis, acute and subacute liver failure was the strongest predictor of death (OR 9.2, 95% CI 4.8 –17.7). Female sex (OR 1.9, 95% CI 1.2 – 3.0), transfer from an outside medical facility (OR 1.8, 95% CI 1.1 – 2.8), aortic valve pathology (OR 2.7, 95% CI 1.5 – 4.9), hemodialysis (OR 2.1, 95% CI 1.1 – 4.0), cerebrovascular disease (OR 2.2, 95% CI 1.2 – 3.8), neutropenia (OR 2.5, 95% CI 1.3 – 4.8), and alcohol abuse (OR 2.9, 95% CI 1.3 – 6.7) were also associated with death on adjusted analysis, whereas opiate abuse was associated with a lower odds of death (OR 0.5, 95% CI 0.2 – 0.9). Conclusions We found that the inpatient mortality rate was 16.2% among patients with Candida endocarditis. Acute and subacute liver failure was associated with a high risk of death while opiate abuse was associated with a lower risk of death.

scholarly journals Stroke prediction in patients presenting with isolated dizziness in the emergency department

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
June-sung Kim ◽  
Hong Jun Bae ◽  
Muyeol Kim ◽  
Shin Ahn ◽  
Chang Hwan Sohn ◽  
...  
Keyword(s):  
Risk Factors ◽  
Emergency Department ◽  
Multivariate Analysis ◽  
Acute Stroke ◽  
Neurological Deficits ◽  
Cerebrovascular Injury ◽  
Risk Patients ◽  
History Of ◽  
Independent Risk Factors ◽  
Record Review

AbstractDiagnosing stroke in patients experiencing dizziness without neurological deficits is challenging for physicians. The aim of this study was to evaluate the prevalence of acute stroke in patients who presented with isolated dizziness without neurological deficits at the emergency department (ED), and determine the relevant stroke predictors in this population. This was an observational, retrospective record review of consecutive 2215 adult patients presenting with dizziness at the ED between August 2019 and February 2020. Multivariate analysis was performed to identify risk factors for acute stroke. 1239 patients were enrolled and analyzed. Acute stroke was identified in 55 of 1239 patients (4.5%); most cases (96.3%) presented as ischemic stroke with frequent involvement (29.1%) of the cerebellum. In the multivariate analysis, the history of cerebrovascular injury (odds ratio [OR] 3.08 [95% confidence interval {CI} 1.24 to 7.67]) and an age of > 65 years (OR 3.01 [95% CI 1.33 to 6.83]) were the independent risk factors for predicting acute stroke. The combination of these two risks showed a higher specificity (94.26%) than that of each factor alone. High-risk patients, such as those aged over 65 years or with a history of cerebrovascular injury, may require further neuroimaging workup in the ED to rule out stroke.

Prenatal and postnatal risk factors for infantile pneumonia in a representative birth cohort

2011 ◽  
Vol 140 (7) ◽  
pp. 1277-1285 ◽  
Author(s):  
C. H. CHEN ◽  
H. J. WEN ◽  
P. C. CHEN ◽  
S. J. LIN ◽  
T. L. CHIANG ◽  
...  
Keyword(s):  
Risk Factors ◽  
Family Environment ◽  
Large Population ◽  
Multivariate Logistic Regression Analysis ◽  
Antibiotic Use ◽  
Population Based ◽  
Study Cohort ◽  
Mortality And Morbidity ◽  
Smoking During Pregnancy ◽  
Maternal Overweight

SUMMARYPneumonia is an important cause of mortality and morbidity in infants. However, information of risk factors for pneumonia in children aged <6 months is limited. This study aimed to evaluate the risk factors and their contribution to infantile pneumonia in a large population-based survey. Of 24 200 randomly sampled main caregivers invited, 21 248 (87·8%) participated in this study. A structured questionnaire was used to interview the main caregivers. Information regarding whether hospitalization was required, family environment, and medical history were obtained. The prevalence of pneumonia was 0·62% in our study cohort. Multivariate logistic regression analysis showed that preterm birth, congenital cardiopulmonary disease, antibiotic use during pregnancy, maternal overweight, daily prenatal exposure to environmental tobacco smoke, maternal smoking during pregnancy, and visible mould on walls at home are risk factors associated with infantile pneumonia. Further study is warranted to investigate the causality and mechanisms of these novel factors.

scholarly journals Age-Related Risk Factors and Complications of Patients With COVID-19: A Population-Based Retrospective Study

2022 ◽  
Vol 8 ◽  
Author(s):  
Han Zhang ◽  
Yingying Wu ◽  
Yuqing He ◽  
Xingyuan Liu ◽  
Mingqian Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Retrospective Study ◽  
Age Groups ◽  
Clinical Manifestations ◽  
Population Based ◽  
Male Gender ◽  
Poor Correlation ◽  
Age Related ◽  
Related Risk ◽  
Independent Risk Factors

Objective: To study the differences in clinical characteristics, risk factors, and complications across age-groups among the inpatients with the coronavirus disease 2019 (COVID-19).Methods: In this population-based retrospective study, we included all the positive hospitalized patients with COVID-19 at Wuhan City from December 29, 2019 to April 15, 2020, during the first pandemic wave. Multivariate logistic regression analyses were used to explore the risk factors for death from COVID-19. Canonical correlation analysis (CCA) was performed to study the associations between comorbidities and complications.Results: There are 36,358 patients in the final cohort, of whom 2,492 (6.85%) died. Greater age (odds ration [OR] = 1.061 [95% CI 1.057–1.065], p &lt; 0.001), male gender (OR = 1.726 [95% CI 1.582–1.885], p &lt; 0.001), alcohol consumption (OR = 1.558 [95% CI 1.355–1.786], p &lt; 0.001), smoking (OR = 1.326 [95% CI 1.055–1.652], p = 0.014), hypertension (OR = 1.175 [95% CI 1.067–1.293], p = 0.001), diabetes (OR = 1.258 [95% CI 1.118–1.413], p &lt; 0.001), cancer (OR = 1.86 [95% CI 1.507–2.279], p &lt; 0.001), chronic kidney disease (CKD) (OR = 1.745 [95% CI 1.427–2.12], p &lt; 0.001), and intracerebral hemorrhage (ICH) (OR = 1.96 [95% CI 1.323–2.846], p = 0.001) were independent risk factors for death from COVID-19. Patients aged 40–80 years make up the majority of the whole patients, and them had similar risk factors with the whole patients. For patients aged &lt;40 years, only cancer (OR = 17.112 [95% CI 6.264–39.73], p &lt; 0.001) and ICH (OR = 31.538 [95% CI 5.213–158.787], p &lt; 0.001) were significantly associated with higher odds of death. For patients aged &gt;80 years, only age (OR = 1.033 [95% CI 1.008–1.059], p = 0.01) and male gender (OR = 1.585 [95% CI 1.301–1.933], p &lt; 0.001) were associated with higher odds of death. The incidence of most complications increases with age, but arrhythmias, gastrointestinal bleeding, and sepsis were more common in younger deceased patients with COVID-19, with only arrhythmia reaching statistical difference (p = 0.039). We found a relatively poor correlation between preexisting risk factors and complications.Conclusions: Coronavirus disease 2019 are disproportionally affected by age for its clinical manifestations, risk factors, complications, and outcomes. Prior complications have little effect on the incidence of extrapulmonary complications.

scholarly journals Stroke prediction in patients presenting with isolated dizziness in the emergency department

2020 ◽  
Author(s):  
June-sung Kim ◽  
Hong Jun Bae ◽  
Muyeol Kim ◽  
Shin Ahn ◽  
Chang Hwan Sohn ◽  
...  
Keyword(s):  
Risk Factors ◽  
Emergency Department ◽  
Multivariate Analysis ◽  
Acute Stroke ◽  
Neurological Deficits ◽  
Cerebrovascular Injury ◽  
Risk Patients ◽  
History Of ◽  
Independent Risk Factors ◽  
Record Review

Abstract Diagnosing stroke in patients experiencing dizziness without neurological deficits is challenging for physicians. This study tried to evaluate the prevalence of acute stroke in patients who presented with isolated dizziness without neurological deficits at the emergency department (ED), and determine the relevant stroke predictors in this population. This was an observational, retrospective record review of consecutive 2,215 adult patients presenting with dizziness at the ED between August 2019 and February 2020. Multivariate analysis was performed to identify risk factors for acute stroke. 1,239 patients were enrolled and analyzed. Acute stroke was identified in 55 of 1,239 patients (4.5%); most cases (96.3%) presented as ischemic stroke with frequent involvement (29.1%) of the cerebellum. In the multivariate analysis, the history of cerebrovascular injury (odds ratio [OR] 3.08 [95% confidence interval {CI} 1.24 to 7.67]) and an age of > 65 years (OR 3.01 [95% CI 1.33 to 6.83]) were the independent risk factors for predicting acute stroke. The combination of these two risks showed a higher specificity (94.26%) than that of each factor alone. High-risk patients, such as those aged over 65 years or with a history of cerebrovascular injury, may require further neuroimaging workup in the ED to rule out stroke.

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