scholarly journals Hospital Stay and Mortality Are Increased in Patients Having a “Triple Low” of Low Blood Pressure, Low Bispectral Index, and Low Minimum Alveolar Concentration of Volatile Anesthesia

2012 ◽  
Vol 116 (6) ◽  
pp. 1195-1203 ◽  
Author(s):  
Daniel I. Sessler ◽  
Jeffrey C. Sigl ◽  
Scott D. Kelley ◽  
Nassib G. Chamoun ◽  
Paul J. Manberg ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Bispectral Index ◽  
Minimum Alveolar Concentration ◽  
Cleveland Clinic ◽  
Reference Value ◽  
Prolonged Length ◽  
Hazard Ratios ◽  
Volatile Anesthesia ◽  
Duration Of Hospitalization ◽  
Complications And Mortality

Background Low mean arterial pressure (MAP) and deep hypnosis have been associated with complications and mortality. The normal response to high minimum alveolar concentration (MAC) fraction of anesthetics is hypotension and low Bispectral Index (BIS) scores. Low MAP and/or BIS at lower MAC fractions may represent anesthetic sensitivity. The authors sought to characterize the effect of the triple low state (low MAP and low BIS during a low MAC fraction) on duration of hospitalization and 30-day all-cause mortality. Methods Mean intraoperative MAP, BIS, and MAC were determined for 24,120 noncardiac surgery patients at the Cleveland Clinic, Cleveland, Ohio. The hazard ratios associated with combinations of MAP, BIS, and MAC values greater or less than a reference value were determined. The authors also evaluated the association between cumulative triple low minutes, and excess length-of-stay and 30-day mortality. Results Means (±SD) defining the reference, low, and high states were 87 ± 5 mmHg (MAP), 46 ± 4 (BIS), and 0.56 ± 0.11 (MAC). Triple lows were associated with prolonged length of stay (hazard ratio 1.5, 95% CI 1.3-1.7). Thirty-day mortality was doubled in double low combinations and quadrupled in the triple low group. Triple low duration ≥60 min quadrupled 30-day mortality compared with ≤15 min. Excess length of stay increased progressively from ≤15 min to ≥60 min of triple low. Conclusions The occurrence of low MAP during low MAC fraction was a strong and highly significant predictor for mortality. When these occurrences were combined with low BIS, mortality risk was even greater. The values defining the triple low state were well within the range that many anesthesiologists tolerate routinely.

scholarly journals Cumulative Duration of “Triple Low” State of Low Blood Pressure, Low Bispectral Index, and Low Minimum Alveolar Concentration of Volatile Anesthesia Is Not Associated with Increased Mortality

2014 ◽  
Vol 121 (1) ◽  
pp. 18-28 ◽  
Author(s):  
Miklos D. Kertai ◽  
William D. White ◽  
Tong J. Gan
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Bispectral Index ◽  
Cox Regression ◽  
Minimum Alveolar Concentration ◽  
Risk Index ◽  
Noncardiac Surgery ◽  
Arterial Blood ◽  
Volatile Anesthesia ◽  
Cumulative Duration

Abstract Background: Mortality after noncardiac surgery has been associated with the “triple low state,” a combination of low mean arterial blood pressure (<75 mmHg), low bispectral index (<45), and low minimum alveolar concentration of volatile anesthesia (<0.70). The authors set out to determine whether duration of a triple low state and aggregate risk associated with individual diagnostic and procedure codes are independently associated with perioperative and intermediate-term mortality. Methods: The authors studied 16,263 patients (53 ± 16 yr) who underwent noncardiac surgery at Duke University Medical Center between January 2006 and December 2009. Multivariable logistic and Cox regression analyses were used to determine whether perioperative factors were independently associated with perioperative and intermediate-term all-cause mortality. Results: The 30-day mortality rate was 0.8%. There were statistically significant associations between 30-day mortality and various perioperative risk factors including age, American Society of Anesthesiologists Physical Status, emergency surgery, higher Cleveland Clinic Risk Index score, and year of surgery. Cumulative duration of triple low state was not associated with 30-day mortality (multivariable odds ratio, 0.99; 95% CI, 0.92 to 1.07). The clinical risk factors for 30-day mortality remained predictors of intermediate-term mortality, whereas cumulative duration of triple low was not associated with intermediate-term mortality (multivariable hazard ratio, 0.98; 95% CI, 0.97 to 1.01). The multivariable logistic regression (c-index = 0.932) and Cox regression (c-index = 0.860) models showed excellent discriminative abilities. Conclusion: The authors found no association between cumulative duration of triple low state and perioperative or intermediate-term mortality in noncardiac surgery patients.

scholarly journals Predictive factors for prolonged hospitalisation in acute pyelonephritis patients admitted to the emergency medicine ward

2021 ◽  
pp. 102490792110009
Author(s):  
Howard Tat Chun Chan ◽  
Ling Yan Leung ◽  
Alex Kwok Keung Law ◽  
Chi Hung Cheng ◽  
Colin A Graham
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
Length Of Stay ◽  
Acute Pyelonephritis ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Prolonged Length ◽  
Reactive Protein ◽  
Prolonged Hospital ◽  
Emergency Medicine Ward

Background: Acute pyelonephritis is a bacterial infection of the upper urinary tract. Patients can be admitted to a variety of wards for treatment. However, at the Prince of Wales Hospital in Hong Kong, they are managed initially in the emergency medicine ward. The aim of the study is to identify the risk factors that are associated with a prolonged hospital length of stay. Methods: This was a retrospective cohort study conducted in Prince of Wales Hospital. The study recruited patients who were admitted to the emergency medicine ward between 1 January 2014 and 31 December 2017. These patients presented with clinical features of pyelonephritis, received antibiotic treatment and had a discharge diagnosis of pyelonephritis. The length of stay was measured and any length of stay over 72 h was considered to be prolonged. Results: There were 271 patients admitted to the emergency medicine ward, and 118 (44%) had a prolonged hospital length of stay. Univariate and multivariate analyses showed that the only statistically significant predictor of prolonged length of stay was a raised C-reactive protein (odds ratio 1.01; 95% confidence 1.01–1.02; p < 0.0001). Out of 271 patients, 261 received antibiotics in the emergency department. All 10 patients (8.5%) who did not receive antibiotics in emergency department had a prolonged length of stay (p = 0.0002). Conclusion: In this series of acute pyelonephritis treated in the emergency medicine ward, raised C-reactive protein levels were predictive for prolonged length of stay. Patients who did not receive antibiotics in the emergency department prior to emergency medicine ward admission had prolonged length of stay.

scholarly journals Population Characteristics of Cats Adopted from an Urban Cat Shelter and the Influence of Physical Traits and Reason for Surrender on Length of Stay

Animals ◽  
2019 ◽  
Vol 9 (11) ◽  
pp. 940 ◽  
Author(s):  
Miller ◽  
Ward ◽  
Beatty
Keyword(s):  
Length Of Stay ◽  
Animal Welfare ◽  
Coat Color ◽  
Population Characteristics ◽  
Study Cohort ◽  
Potential Predictor ◽  
Use Of Resources ◽  
Stray Cats ◽  
Hazard Ratios ◽  
Physical Traits

Measures aimed at reducing the length of stay (LOS) of cats in shelters can promote animal welfare and more efficient use of resources. The extent to which variables shown to impact LOS are broadly applicable is unclear. The aim of this study was to describe a population of cats adopted from an urban shelter, and to analyze the association between potential predictor variables and LOS. A study cohort was identified retrospectively from shelter records (n = 2584), 48.8% of which were < 12 weeks old at admission, and 80.7% were stray. Among 445 cats relinquished by owners, reasons for surrender were primarily owner-related (87.2%). Overall, reason for surrender and coat color were significantly associated with LOS. Hazard ratios showed that all reasons for surrender for owner-relinquished cats were associated with a shorter LOS than stray cats and this association was significant (p < 0.05) for all except cat behavioral or medical reasons. In contrast to previous reports, white cats had a significantly (p < 0.05) longer LOS than black cats. This study highlights an important role for shelter-specific baseline data to inform and measure the effect of interventional studies aimed at improving animal welfare by reducing LOS in shelter-housed cats

PD18-07 QUANTIFYING THE “EYEBALL TEST”: PREOPERATIVE PREDICTORS OF PROLONGED LENGTH OF STAY AFTER RADICAL CYSTECTOMY

2014 ◽  
Vol 191 (4S) ◽  
Author(s):  
Sarah Psutka ◽  
Stephen Boorjian ◽  
Suzanne Stewart ◽  
Prabin Thapa ◽  
Robert Tarrell ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Radical Cystectomy ◽  
Prolonged Length ◽  
Preoperative Predictors
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