scholarly journals Intraoperative Cardiac Arrests in Adults Undergoing Noncardiac Surgery

2012 ◽  
Vol 117 (5) ◽  
pp. 1018-1026 ◽  
Author(s):  
Sumeet Goswami ◽  
Joanne E. Brady ◽  
Desmond A. Jordan ◽  
Guohua Li
Keyword(s):  
Risk Factors ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Significant Risk ◽  
Case Fatality ◽  
Epidemiological Data ◽  
Noncardiac Surgery ◽  
Improvement Program ◽  
American Society ◽  
American Society Of Anesthesiologists

Background Intraoperative cardiac arrest (ICA) is a rare but potentially catastrophic event. There is a paucity of recent epidemiological data on the incidence and risk factors for ICA. The objective of this study was to assess the incidence, risk factors, and survival outcome of ICAs in adults undergoing noncardiac surgery. Methods The authors analyzed prospectively collected data for all noncardiac cases in the American College of Surgeons National Surgical Quality Improvement Program database from the years 2005 to 2007 (n = 362,767). Results The incidence of ICA was 7.22 per 10,000 surgeries. After adjustment for American Society of Anesthesiologists physical status and other covariates, the odds of ICA increased progressively with the amount of transfusion (adjusted odds ratios = 2.51, 7.59, 11.40, and 29.68 for those receiving 1-3, 4-6, 7-9, and ≥ 10 units of erythrocytes, respectively). Other significant risk factors for ICA were emergency surgery (adjusted odds ratio = 2.04, 95% CI = 1.45-2.86) and being functionally dependent presurgery (adjusted odds ratio = 2.33, 95% CI = 1.69-3.22). Of the 262 patients with ICA, 116 (44.3%) died within 24 h, and 164 (62.6%) died within 30 days. Conclusions Intraoperative blood loss as indicated by the amount of transfusion was the most important predictor of ICA. The urgency of surgery and the preoperative composite indicators of health such as American Society of Anesthesiologists status and functional status were other important risk factors. The high case fatality suggests that primary prevention might be the key to reducing mortality from ICA.

scholarly journals Risk Factors and Indications for 30-Day Readmission After Primary Surgery for Epithelial Ovarian Cancer

2015 ◽  
Vol 25 (2) ◽  
pp. 193-202 ◽  
Author(s):  
Mariam AlHilli ◽  
Carrie Langstraat ◽  
Christine Tran ◽  
Janice Martin ◽  
Amy Weaver ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ovarian Cancer ◽  
Postoperative Complications ◽  
Epithelial Ovarian Cancer ◽  
Odds Ratio ◽  
Residual Disease ◽  
Factors Associated ◽  
Primary Surgery ◽  
American Society ◽  
American Society Of Anesthesiologists

BackgroundTo identify patients at risk for postoperative morbidities, we evaluated indications and factors associated with 30-day readmission after epithelial ovarian cancer surgery.MethodsPatients undergoing primary surgery for epithelial ovarian cancer between January 2, 2003, and December 29, 2008, were evaluated. Univariable and multivariable logistic regression models were fit to identify factors associated with 30-day readmission. A parsimonious multivariable model was identified using backward and stepwise variable selection.ResultsIn total, 324 (60.2%) patients were stage III and 91 (16.9%) were stage IV. Of all 538 eligible patients, 104 (19.3%) were readmitted within 30 days. Cytoreduction to no residual disease was achieved in 300 (55.8%) patients, and 167 (31.0%) had measurable disease (≤1 cm residual disease). The most common indications for readmission were surgical site infection (SSI; 21.2%), pleural effusion/ascites management (14.4%), and thromboembolic events (12.5%). Multivariate analysis identified American Society of Anesthesiologists score of 3 or higher (odds ratio, 1.85; 95% confidence interval, 1.18–2.89;P= 0.007), ascites [1.76 (1.11–2.81);P= 0.02], and postoperative complications during initial admission [grade 3–5 vs none, 2.47 (1.19–5.16); grade 1 vs none, 2.19 (0.98–4.85); grade 2 vs none, 1.28 (0.74–2.21);P= 0.048] to be independently associated with 30-day readmission (c-index = 0.625). Chronic obstructive pulmonary disease was the sole predictor of readmission for SSI (odds ratio, 3.92; 95% confidence interval, 1.07–4.33;P= 0.04).ConclusionsClinically significant risk factors for 30-day readmission include American Society of Anesthesiologists score of 3 or higher, ascites and postoperative complications at initial admission. The SSI and pleural effusions/ascites are common indications for readmission. Systems can be developed to predict patients needing outpatient management, improve care, and reduce costs.

Unplanned Intubation after Surgery: Risk Factors, Prognosis, and Medical Emergency Team Effects

2009 ◽  
Vol 75 (9) ◽  
pp. 834-838 ◽  
Author(s):  
Christopher W. Snyder ◽  
Roshan D. Patel ◽  
Emily P. Roberson ◽  
Mary T. Hawn
Keyword(s):  
Risk Factors ◽  
Medical Emergency Team ◽  
Significant Risk ◽  
Case Fatality ◽  
Incidence Rates ◽  
Medical Emergency ◽  
Chronic Obstructive ◽  
Improvement Program ◽  
Emergency Team ◽  
Emergent Operation

Unplanned intubation after surgery is a marker for severe adverse events. We investigated the incidence, risk factors, and prognosis of unplanned intubation after general and vascular surgery and sought to determine whether the deployment of a hospital-wide medical emergency team (MET) had a preventive effect. We included all patients undergoing general and vascular surgical procedures between April 1, 2006, and June 30, 2008, from our American College of Surgeons National Surgical Quality Improvement Program data. Risk factors and incidence rates of unplanned intubation were compared before (preMET) and after (postMET) June 7, 2007. Chart review identified case details and fatality rates. There were 2426 patients included (1815 preMET, 611 postMET). The overall incidence of unplanned intubation was 2.6 per cent; significant risk factors included chronic obstructive pulmonary disease, dependent functional status, and emergent operation. Most (84%) unplanned intubations occurred in a critical care setting and the most common underlying reason was sepsis (40%). The overall case fatality rate was 43 per cent but varied significantly depending on the underlying reason for unplanned intubation. Incidence rates of unplanned intubation did not change significantly after MET deployment, suggesting that other strategies are needed to prevent this rare but highly morbid and mortal event.

scholarly journals Performance Improvement System and Postoperative Corneal Injuries

2009 ◽  
Vol 111 (2) ◽  
pp. 320-326 ◽  
Author(s):  
David P. Martin ◽  
Toby N. Weingarten ◽  
Paul W. Gunn ◽  
KunMoo Lee ◽  
Michael A. Mahr ◽  
...  
Keyword(s):  
Risk Factors ◽  
Performance Improvement ◽  
Odds Ratio ◽  
Injury Rate ◽  
Student Nurse ◽  
Perioperative Outcomes ◽  
Physical Status ◽  
Corneal Injury ◽  
American Society ◽  
American Society Of Anesthesiologists

Background The authors' department conducted a performance improvement initiative aimed to reduce the rate of perioperative corneal injuries. This study reports the effects of the initiative and examines the risk factors for corneal injury. Method The rate of corneal injuries during nonophthalmologic procedures under anesthesia was compared between the two time periods: preinitiative baseline (August 1, 2005-December 31, 2005) and initiative period (January 1, 2006-April 30, 2007). To examine the risk factors for corneal injury, a nested case-control study with a 2:1 matched-set design was separately performed and included cases between January 1, 2006 and July 31, 2008. Results During the baseline period, the corneal injury rate was 1.51 per 1,000, and it decreased to 0.79 per 1,000 during the performance initiative (P = 0.008). Independent risk factors were longer anesthetics (odds ratio = 1.2, 95% confidence interval (CI) 1.1-1.3 per 30 min), lower American Society of Anesthesiologists physical status (odds ratio 0.5, 95% CI 0.3-0.8 for American Society of Anesthesiologists physical status 3-4 vs. 1-2), and student nurse anesthetist as a primary anesthesia provider (odds ratio 2.6, 95% CI 1.3-5.0). Conclusion Corneal injury rate in our institution was significantly reduced and remains at low levels long after initiation of perioperative eye care improvement initiative. The higher rate of corneal injuries among student nurse anesthetists highlights the importance of standardizing education and supervision among all anesthesia providers. We believe that our model of performance improvement initiative can be used to improve other perioperative outcomes.

scholarly journals Risk Factors for Exposure of Baerveldt Glaucoma Drainage Implants: A Case-Control Study

2020 ◽  
Author(s):  
Ayaka Edo ◽  
Koji Jian ◽  
Yoshiaki Kiuchi
Keyword(s):  
Risk Factors ◽  
Confidence Interval ◽  
Medical Records ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Significant Risk ◽  
University Hospital ◽  
Implant Surgery ◽  
Implant Exposure ◽  
Patients With Diabetes

Abstract Background: Glaucoma drainage implant exposure is one of the serious complications after glaucoma drainage implant surgery. The purpose of this study is to evaluate the risk factors for exposure of the device after implantation of a Baerveldt glaucoma drainage implant.Methods: This is a retrospective review of the medical records of all patients who underwent Baerveldt glaucoma drainage implant surgery at the Hiroshima University Hospital between April 1, 2012 and October 31, 2016, and who were followed for at least 6 months after surgery. We examined the risk factors for implant exposure based on data obtained from the medical records, with particular focus on the differences in implant models.Results: A total of 80 eyes from 80 patients were identified; all patients were Japanese. In this study, the rate of Baerveldt glaucoma drainage implant exposure was 15.0% (12 of 80). The exposure rate of the BG 102-350 was tended to be higher than that for the BG 101-350 and BG 103-250 (p=0.092; adjusted odds ratio=3.34; 95% confidence interval, 0.82–13.58). In the patients who had diabetic mellitus, the BG 102-350 showed a significant risk of implant exposure (p=0.038; adjusted odds ratio =15.36; 95% confidence interval, 1.17–202.59).Conclusions: In Baerveldt glaucoma drainage implant surgery in patients with diabetes, using the BG 102-350 was associated with greater risk of implant exposure compared with using BG 101-350 or BG 103-250.

Risk Factors for Blood Transfusion with Neck Dissection

2019 ◽  
Vol 161 (6) ◽  
pp. 922-928 ◽  
Author(s):  
Monica C. Azmy ◽  
Juanita Pinto ◽  
Nirali M. Patel ◽  
Aparna Govindan ◽  
Evelyne Kalyoussef
Keyword(s):  
Risk Factors ◽  
Weight Loss ◽  
Neck Dissection ◽  
Free Flaps ◽  
Unplanned Readmission ◽  
Improvement Program ◽  
Acs Nsqip Database ◽  
American Society ◽  
Associated Risk Factors ◽  
American Society Of Anesthesiologists

Objectives To identify risk factors of perioperative blood transfusions (PBTs) for neck dissection and identify the association of PBTs with other postoperative outcomes. Methods This is a retrospective study of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. The database was queried for neck dissection procedures performed by otolaryngologists from 2006 to 2014. Multivariable logistic regression was used to determine associations between demographic and preoperative factors, mortality, unplanned reoperation, and unplanned readmission with PBTs. Results Of the 3090 patients included in our study, 346 (11.2%) received a PBT, 249 patients (72.0%) received blood intraoperatively or on postoperative day (POD) 0, and 97 patients (28.0%) received blood within 5 PODs. American Society of Anesthesiologists (ASA) class ≥3 (odds ratio [OR], 2.1; 95% confidence interval [CI], 1.4-3.2), preoperative weight loss (OR, 2.2; 95% CI, 1.5-3.2), and anemia (OR, 5.5; 95% CI, 4.1-7.6) were independently associated with PBTs. Free flaps were also significantly associated with PBTs. PBTs were significantly associated with unplanned return to the operating room within 30 days (OR, 4.31; 95% CI, 3.01-6.18) but not with 30-day unplanned readmission or 30-day mortality. Discussion Eleven percent of patients undergoing neck dissection receive a PBT. Identifying associated risk factors may reduce PBT among patients with cancer. Comorbid data, such as weight loss, anemia, and ASA class, may be useful in determining risk for transfusion during these procedures. Implications for Practice Awareness of preoperative risk factors for PBT may lead surgeons to reduce the risk of PBT, anticipate the need for transfusion, and manage these patients carefully to prevent unplanned reoperation.

scholarly journals Risk factors for exposure of Baerveldt glaucoma drainage implants: a case-control study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Ayaka Edo ◽  
Koji Jian ◽  
Yoshiaki Kiuchi
Keyword(s):  
Risk Factors ◽  
Confidence Interval ◽  
Medical Records ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Significant Risk ◽  
University Hospital ◽  
Implant Surgery ◽  
Implant Exposure ◽  
Patients With Diabetes

Abstract Background Glaucoma drainage implant exposure is one of the serious complications after glaucoma drainage implant surgery. The purpose of this study is to evaluate the risk factors for exposure of the device after implantation of a Baerveldt glaucoma drainage implant. Methods This is a retrospective review of the medical records of all patients who underwent Baerveldt glaucoma drainage implant surgery at the Hiroshima University Hospital between April 1, 2012 and October 31, 2016, and who were followed for at least 6 months after surgery. We examined the risk factors for implant exposure based on data obtained from the medical records, with a particular focus on the differences in implant models. Results A total of 80 eyes from 80 patients were identified; all patients were Japanese. In this study, the rate of Baerveldt glaucoma drainage implant exposure was 15.0% (12 of 80 eyes). The exposure rate for the BG 102-350 tended to be higher than that for the BG 101-350 and BG 103-250 (p = 0.092; adjusted odds ratio = 3.34; 95% confidence interval, 0.82–13.58). In the patients who had diabetic mellitus, the BG 102-350 showed a significant risk of implant exposure (p = 0.038; adjusted odds ratio = 15.36; 95% confidence interval, 1.17–202.59). Conclusions In Baerveldt glaucoma drainage implant surgery in patients with diabetes, using the BG 102-350 was associated with greater risk of implant exposure compared with using the BG 101-350 or BG 103-250.

scholarly journals Community- versus hospital-acquired acute kidney injury in hospitalised COVID-19 patients

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Jack S Bell ◽  
Benjamin D James ◽  
Saif Al-Chalabi ◽  
Lynne Sykes ◽  
Philip A Kalra ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Acute Kidney Injury ◽  
Risk Factor ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Significant Risk ◽  
Kidney Injury ◽  
Significant Risk Factor ◽  
Hospital Acquired

Abstract Background Acute kidney injury (AKI) is a recognised complication of coronavirus disease 2019 (COVID-19), yet the reported incidence varies widely and the associated risk factors are poorly understood. Methods Data was collected on all adult patients who returned a positive COVID-19 swab while hospitalised at a large UK teaching hospital between 1st March 2020 and 3rd June 2020. Patients were stratified into community- and hospital-acquired AKI based on the timing of AKI onset. Results Out of the 448 eligible patients with COVID-19, 118 (26.3 %) recorded an AKI during their admission. Significant independent risk factors for community-acquired AKI were chronic kidney disease (CKD), diabetes, clinical frailty score and admission C-reactive protein (CRP), systolic blood pressure and respiratory rate. Similar risk factors were significant for hospital-acquired AKI including CKD and trough systolic blood pressure, peak heart rate, peak CRP and trough lymphocytes during admission. In addition, invasive mechanical ventilation was the most significant risk factor for hospital-acquired AKI (adjusted odds ratio 9.1, p < 0.0001) while atrial fibrillation conferred a protective effect (adjusted odds ratio 0.29, p < 0.0209). Mortality was significantly higher for patients who had an AKI compared to those who didn’t have an AKI (54.3 % vs. 29.4 % respectively, p < 0.0001). On Cox regression, hospital-acquired AKI was significantly associated with mortality (adjusted hazard ratio 4.64, p < 0.0001) while community-acquired AKI was not. Conclusions AKI occurred in over a quarter of our hospitalised COVID-19 patients. Community- and hospital-acquired AKI have many shared risk factors which appear to converge on a pre-renal mechanism of injury. Hospital- but not community acquired AKI was a significant risk factor for death.

scholarly journals Risk Factors for Exposure of Baerveldt Glaucoma Drainage Implants: A Case-Control Study

2020 ◽  
Author(s):  
Ayaka Edo ◽  
Koji Jian ◽  
Yoshiaki Kiuchi
Keyword(s):  
Risk Factors ◽  
Confidence Interval ◽  
Medical Records ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Significant Risk ◽  
University Hospital ◽  
Implant Surgery ◽  
Implant Exposure ◽  
Patients With Diabetes

Abstract Background Glaucoma drainage implant exposure is one of the serious complications after glaucoma drainage implant surgery. The purpose of this study is to evaluate the risk factors for exposure of the device after implantation of a Baerveldt glaucoma drainage implant. Methods This is a retrospective review of the medical records of all patients who underwent Baerveldt glaucoma drainage implant surgery at the Hiroshima University Hospital between April 1, 2012 and October 31, 2016, and who were followed for at least 6 months after surgery. We examined the risk factors for implant exposure based on data obtained from the medical records, with particular focus on the differences in implant models. Results A total of 80 eyes from 80 patients were identified; all patients were Japanese. In this study, the rate of Baerveldt glaucoma drainage implant exposure was 15.0% (12 of 80). The exposure rate of the BG 102–350 was tended to be higher than that for the BG 101–350 and BG 103–250 (p = 0.092; adjusted odds ratio = 3.34; 95% confidence interval, 0.82–13.58). In the patients who had diabetic mellitus, the BG 102–350 showed a significant risk of implant exposure (p = 0.038; adjusted odds ratio = 15.36; 95% confidence interval, 1.17–202.59). Conclusions In Baerveldt glaucoma drainage implant surgery in patients with diabetes, using the BG 102–350 was associated with greater risk of implant exposure compared with using BG 101–350 or BG 103–250.

Trends and Complications of Vulvar Reconstruction After Vulvectomy: A Study of a Nationwide Cohort

2018 ◽  
Vol 28 (8) ◽  
pp. 1606-1615
Author(s):  
Alexandra L. Martin ◽  
J. Ryan Stewart ◽  
Harshitha Girithara-Gopalan ◽  
Jeremy T. Gaskins ◽  
Nicole J. McConnell ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Univariate Analysis ◽  
Significant Risk ◽  
Pulmonary Complications ◽  
Improvement Program ◽  
Surgical Quality ◽  
Vulvar Reconstruction ◽  
Increased Risk ◽  
American Society ◽  
American Society Of Anesthesiologists

ObjectivesThe objective of this study was to determine complications associated with primary closure compared with reconstruction after vulvar excision and predisposing factors to these complications.MethodsPatients undergoing vulvar excision with or without reconstruction from 2011 to 2015 were abstracted from the National Surgical Quality Improvement Program database. Common Procedural Terminology codes were used to characterize surgical procedures as vulvar excision alone or vulvar excision with reconstruction. Patient characteristics and 30-day outcomes were used to compare the 2 procedures. Descriptive and univariate statistics were performed. Adjusted odds ratios and confidence intervals were calculated using a logistic regression model to control for potential confounders. Two-sided α with P < 0.05 was designated as significant.ResultsA total of 2698 patients were identified; 78 (2.9%) underwent reconstruction. There were no differences in age, race, body mass index, diabetes, hypertension, tobacco use, heart failure, renal failure, or functional status between the 2 groups. American Society of Anesthesiologists class 3 and 4 patients and those with disseminated cancer were more likely to undergo reconstruction (both P < 0.001). On univariate analysis, reconstruction was associated with increased risk of readmission, surgical site infection, pulmonary complications, urinary tract infection, transfusion, deep venous thrombosis, sepsis, septic shock, unplanned reoperation, longer hospital stay, need for skilled nursing or subacute rehab on discharge, and death within 30 days. On logistic regression analysis, disseminated cancer, American Society of Anesthesiologists classes 3 and 4 and reconstruction remained significant risk factors for readmission and any postoperative complication.ConclusionsPatients undergoing vulvar excision with reconstruction are at increased risk for readmission and postoperative complications compared with those undergoing excision alone. Careful patient selection and efforts to optimize surgical readiness are needed to improve outcomes. Long-term data could help determine if these 30-day outcomes are a reliable measure of surgical quality in vulvar surgery.

Sign in / Sign up

Export Citation Format

Share Document