ASA PHYSICAL classification SYSTEM, Lee Risk Index, and a modified Customised Probability Index as predictors of mortality and morbidity in patients undergoing vascular noncardiac surgery

2012 ◽  
Vol 29 ◽  
pp. 65
Author(s):  
D. Kalantonis ◽  
E. Arnaoutoglou ◽  
G. Kouvelos ◽  
N. Pappas ◽  
M. Matsagkas ◽  
...  
Keyword(s):  
Classification System ◽  
Risk Index ◽  
Noncardiac Surgery ◽  
Mortality And Morbidity ◽  
Predictors Of Mortality ◽  
Physical Classification ◽  
Probability Index

scholarly journals Association between Intraoperative Blood Transfusion and Mortality and Morbidity in Patients Undergoing Noncardiac Surgery

2011 ◽  
Vol 114 (2) ◽  
pp. 283-292 ◽  
Author(s):  
Laurent G. Glance ◽  
Andrew W. Dick ◽  
Dana B. Mukamel ◽  
Fergal J. Fleming ◽  
Raymond A. Zollo ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Noncardiac Surgery ◽  
Pulmonary Complications ◽  
Wound Complications ◽  
Severe Anemia ◽  
Thromboembolic Complications ◽  
Mortality And Morbidity ◽  
Risk Of Death ◽  
Increased Risk ◽  
The Impact

Background The impact of intraoperative erythrocyte transfusion on outcomes of anemic patients undergoing noncardiac surgery has not been well characterized. The objective of this study was to examine the association between blood transfusion and mortality and morbidity in patients with severe anemia (hematocrit less than 30%) who are exposed to one or two units of erythrocytes intraoperatively. Methods This was a retrospective analysis of the association of blood transfusion and 30-day mortality and 30-day morbidity in 10,100 patients undergoing general, vascular, or orthopedic surgery. We estimated separate multivariate logistic regression models for 30-day mortality and for 30-day complications. Results Intraoperative blood transfusion was associated with an increased risk of death (odds ratio [OR], 1.29; 95% CI, 1.03-1.62). Patients receiving an intraoperative transfusion were more likely to have pulmonary, septic, wound, or thromboembolic complications, compared with patients not receiving an intraoperative transfusion. Compared with patients who were not transfused, patients receiving one or two units of erythrocytes were more likely to have pulmonary complications (OR, 1.76; 95% CI, 1.48-2.09), sepsis (OR, 1.43; 95% CI, 1.21-1.68), thromboembolic complications (OR, 1.77; 95% CI, 1.32-2.38), and wound complications (OR, 1.87; 95% CI, 1.47-2.37). Conclusions Intraoperative blood transfusion is associated with a higher risk of mortality and morbidity in surgical patients with severe anemia. It is unknown whether this association is due to the adverse effects of blood transfusion or is, instead, the result of increased blood loss in the patients receiving blood.

Outcomes and Predictors of Mortality and Stroke after On-Pump and Off-Pump Coronary Artery Bypass Surgery in Octogenarians

2013 ◽  
Vol 8 (4) ◽  
pp. 269-275 ◽  
Author(s):  
Shahzad G. Raja ◽  
Jaymin Shah ◽  
Manoraj Navaratnarajah ◽  
Fouad Amin ◽  
Mohamed Amrani
Keyword(s):  
Coronary Artery ◽  
Hospital Mortality ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Mortality And Morbidity ◽  
Off Pump ◽  
Predictors Of Mortality ◽  
Major Complications ◽  
Significant Difference ◽  
Pump Cabg

Objective Octogenarians, as the fastest growing stratum of the population and with the highest prevalence of coronary artery disease, are being increasingly referred for coronary artery bypass grafting (CABG). The general perception is that the presence of comorbidities and the propensity for neurological injury expose them to a higher risk for mortality and morbidity after conventional on-pump CABG, and therefore, off-pump CABG should be preferentially offered to octogenarians to improve outcomes. This study evaluates the in-hospital outcomes and predictors of mortality and stroke in octogenarians undergoing on- and off-pump CABG at our institution. Methods From January 2000 to December 2010, a total of 290 octogenarians underwent off-pump (n = 217) and on-pump (n = 73) CABG. Their data were prospectively entered into the cardiac surgery database (Patients Analysis & Tracking System; Dendrite Clinical Systems, Ltd, Oxford, England, United Kingdom) and analyzed retrospectively. Outcome measures included in-hospital mortality, major complications, and length of stay. Multivariate analysis was performed to identify predictors of combined outcome of in-hospital mortality and stroke. Results The mean ± SD age of the patients was 82 ± 2.0 years. Preoperative demographics were similar for the on-pump and off-pump groups. The patients who underwent off-pump CABG had a lower number of distal anastomoses performed compared with the patients who underwent on-pump CABG [mean difference, 0.2; 95% confidence interval (CI), 0.02–0.4; P = 0.03]. However, the ratio of grafts (received/needed) was the same in both groups. In-hospital mortality for the entire cohort was 7.2%, with no significant difference between the groups for death (6.0% vs 11.0%; P = 0.08), stroke (2.8% vs 2.8%; P = 1.0), other major complications, and length of hospital stay. Independent predictors of combined outcome identified from the multiple logistic model included heart failure [odds ratio (OR), 4.4; 95% CI, 1.5–13.0; P = 0.008], diabetes (OR, 2.6; 95% CI, 1.0–6.0; P = 0.046), nitrate infusion (OR, 2.9; 95% CI, 1.1–8.0; P = 0.04), postoperative renal failure requiring hemofiltration (OR, 8.6; 95% CI, 3.5–21.1; P < 0.001), and postoperative ventricular arrhythmias (OR, 7.3; 95% CI, 1.9–27.8; P = 0.009). Conclusions Both on-pump and off-pump CABG are reasonable revascularization strategies in octogenarians. Careful patient selection and individualized treatment decisions can minimize postoperative mortality and morbidity in octogenarians undergoing on- and off-pump CABG.

Abstract 12444: Outcomes After Starting Beta-Blockade Within a Clinically Sensible Period Before Major Elective Noncardiac Surgery

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Duminda N Wijeysundera ◽  
Dennis T Ko ◽  
Harindra C Wijeysundera ◽  
Lingsong Yun ◽  
W. Scott Beattie
Keyword(s):  
Cohort Study ◽  
Beta Blockers ◽  
Risk Index ◽  
Cardiac Risk ◽  
Population Based ◽  
Noncardiac Surgery ◽  
Beta Blockade ◽  
Matched Cohort ◽  
Post Surgery ◽  
Median Daily Dose

INTRODUCTION: Guidelines recommend that perioperative beta-blockade be started days to weeks before surgery. Nonetheless, all randomized trials except for the controversial DECREASE trials started treatment ≤1 day before surgery, while most observational studies did not distinguish between long-term beta-blockade versus beta-blockers started for perioperative reasons. We thus conducted a population-based cohort study of the effectiveness of beta-blockade started within a clinically sensible period (8-60 days) before surgery. METHODS: Following research ethics approval, we conducted a cohort study of patients (≥66 years) who underwent major elective noncardiac surgery from 2003 and 2012 in Ontario, Canada. Propensity-score methods were used to form a matched cohort that reduced important differences between patients who started beta-blockers 8-60 days before surgery versus controls (no beta-blockers within 1 year before surgery). We measured the association of beta-blockade with 30-day (death, MI, stroke) and 1-year (death) outcomes post-surgery. Subgroup analyses were performed based on Revised Cardiac Risk Index class and history of prior CAD. RESULTS: The cohort included 4268 beta-blocked patients and 154,357 controls. Metoprolol (median daily dose 50 mg) was prescribed to 36% of beta-blocked patients, atenolol (median 25 mg) to 26%, and bisoprolol (median 5 mg) to 37%. In the matched cohort (n=8492), beta-blockade was not associated with death (RR 0.96; CI 0.70-1.32), MI (RR 0.92; CI 0.72-1.17), and stroke (RR 1.31; CI 0.68-2.52) at 30-days, or death at 1-year (Figure). Associations with outcomes did not differ significantly across subgroups. CONCLUSIONS: Outcomes were not altered in patients who start perioperative beta-blockade within a clinically sensible period before surgery. A large randomized trial is needed to determine if the continued use of perioperative beta-blockade in clinical practice is justified.

Identifying the broken heart: predictors of mortality and morbidity in suspected blunt cardiac injury

2016 ◽  
Vol 211 (6) ◽  
pp. 982-988 ◽  
Author(s):  
Bellal Joseph ◽  
Tahereh O. Jokar ◽  
Mazhar Khalil ◽  
Ansab A. Haider ◽  
Narong Kulvatunyou ◽  
...  
Keyword(s):  
Cardiac Injury ◽  
Mortality And Morbidity ◽  
Predictors Of Mortality ◽  
Blunt Cardiac Injury

Su1459 PREDICTORS OF MORTALITY AND MORBIDITY IN PATIENTS WITH ACUTE NECROTIZING PANCREATITIS.

2020 ◽  
Vol 158 (6) ◽  
pp. S-586-S-587 ◽  
Author(s):  
C. Roberto Simons-Linares ◽  
Vibhu Chittajallu ◽  
Ariel Sims ◽  
Christian Cuvillier ◽  
Mohannad Abou Saleh ◽  
...  
Keyword(s):  
Necrotizing Pancreatitis ◽  
Acute Necrotizing Pancreatitis ◽  
Mortality And Morbidity ◽  
Predictors Of Mortality ◽  
Acute Necrotizing

scholarly journals The Use of Lee and Co-Workers’ Index to Assist a Risk Adjusted Audit of Perioperative Cardiac Outcome

2008 ◽  
Vol 36 (2) ◽  
pp. 167-173 ◽  
Author(s):  
P. J. Moran ◽  
T. Ghidella ◽  
G. Power ◽  
A. S. Jenkins ◽  
D. Whittle
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Positive Result ◽  
Cardiac Event ◽  
Risk Index ◽  
Cardiac Risk ◽  
Noncardiac Surgery ◽  
Frequent Use ◽  
Cardiac Outcome ◽  
The Impact

Lee and co-workers’ revised cardiac risk index was used to study the perioperative cardiac outcome of 296 patients. The index uses a history of ischaemic heart disease, congestive cardiac failure, diabetes treated with insulin, a creatinine greater than 180 μmol/l, cerebrovascular disease and high risk surgery as the risk factors involved in predicting a perioperative cardiac event. It was derived on the basis of data from patients over the age of 50 years undergoing elective, noncardiac surgery with an expected inpatient stay of two or more days. The presence of one, two and three or more risk factors predicted a risk of a major cardiac event of 1.3% (95% confidence interval [CI] 0.7 to 2.1), 3.6% (95% CI 2.1 to 5.6) and 9% (95% CI 5.5 to 13.8) respectively in Lee's derivation group of 2,893 patients. In our audit of 296 patients we observed a cardiac event rate of 0.8% (95% CI 0 to 2.3%), 6.7% (95% CI 1.6 to 10%) and 2% (95% CI 0 to 5.9%), in patients with one, two and three or more risk factors respectively. The more frequent use of ECGs and troponin levels in the routine postoperative care of high risk patients undergoing major noncardiac surgery is recommended on the basis of the frequency of a positive result and the impact of a positive result on a patient's management.

scholarly journals Predictors of mortality and morbidity in peritonitis in a developing country

2013 ◽  
Vol 29 (3) ◽  
pp. 124-130 ◽  
Author(s):  
Parwez Sajad Khan ◽  
Latif Ahmad Dar ◽  
Humera Hayat
Keyword(s):  
Developing Country ◽  
Mortality And Morbidity ◽  
Predictors Of Mortality
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