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.

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 Analysis of urgent/emergent conversions from monitored anesthesia care to general anesthesia with airway instrumentation

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sang Kim ◽  
Brian A. Chang ◽  
Amreen Rahman ◽  
Hung-Mo Lin ◽  
Samuel DeMaria ◽  
...  
Keyword(s):  
Risk Factors ◽  
General Anesthesia ◽  
Mount Sinai Hospital ◽  
Anesthesia Care ◽  
Monitored Anesthesia Care ◽  
Surgical Specialty ◽  
Factors Associated ◽  
Physical Status Classification ◽  
American Society ◽  
American Society Of Anesthesiologists

Abstract Background Monitored Anesthesia Care (MAC) is an anesthetic service involving the titration of sedatives/analgesics to achieve varying levels of sedation while avoiding general anesthesia (GA) and airway instrumentation. The goal of our study was to determine the overall incidence of conversion from MAC to general anesthesia with airway instrumentation and elucidate reasons and risk factors for conversion. Methods In this retrospective observational study, all non-obstetric adult patients who received MAC from July 2002 to July 2015 at Mount Sinai Hospital were electronically screened for inclusion via a clinical database. Patient, procedure, anesthetic, and practitioner data were all collected and analyzed to generate descriptive analyses. Subsequent univariate and multivariate analyses were used to identify specific risk factors associated with conversion to GA. Results Overall, 0.50% (1097/219,061) of MAC cases were converted to GA. Approximately half of conversions were due to the patient’s “intolerance” of MAC (with or without failed regional anesthesia), while the other half were due to physiologic derangements. Body mass index, male sex, American Society of Anesthesiologists Physical Status Classification, anesthesia team composition, and surgical specialty were all associated with risk of conversion to GA. Conclusions This is one of the first and largest retrospective studies aimed at identifying reasons and risk factors associated with the conversion of MAC to GA. These findings may be used to help better anticipate or prevent these events.

scholarly journals Epidemiology and risk factors associated with surgical site infection following surgery on thoracic aorta

2018 ◽  
Vol 146 (14) ◽  
pp. 1841-1844
Author(s):  
K. Morikane
Keyword(s):  
Risk Factors ◽  
Surgical Site Infection ◽  
Thoracic Aorta ◽  
Artery Bypass ◽  
Univariate Analysis ◽  
National Database ◽  
Site Infection ◽  
Factors Associated ◽  
American Society ◽  
American Society Of Anesthesiologists

AbstractSurgical site infection (SSI) following cardiovascular surgery has been well documented, possibly owing to its highly invasive nature, but SSI following surgery on the thoracic aorta has not. This study aimed to describe the epidemiology and assess risk factors associated with the latter in Japan using a national database for SSI. Data on surgery on thoracic aorta performed between 2012 and 2014 were extracted from the Japan Nosocomial Infections Surveillance (JANIS) database. Risk factors were assessed initially by univariate analysis, and then entered into a logistic regression model for final evaluation. The cumulative incidence of SSI was 4.1% (146/3538) and staphylococci were the most frequent pathogens isolated. Factors such as the duration of operation, emergency surgery and male gender were significantly associated with SSI. These findings differ from previous studies on open heart and coronary artery bypass surgery, in which the American Society of Anesthesiologists (ASA) score was significantly associated with SSI, but gender was not. This study suggests that risk stratification in the JANIS system might be improved by incorporating additionally identified factors for risk adjustment, when comparing the incidence of SSI between hospitals.

scholarly journals Prescribing Habits of Providers and Risk Factors for Nonadherence to Opioid Prescribing Guidelines

2020 ◽  
pp. 000313482095633
Author(s):  
Tommy Ivanics ◽  
Hassan Nasser ◽  
Pridvi Kandagatla ◽  
Shravan Leonard-Murali ◽  
Adam Jones ◽  
...  
Keyword(s):  
Risk Factors ◽  
Guideline Implementation ◽  
Multivariable Analysis ◽  
Acute Care Surgery ◽  
Factors Associated ◽  
Opioid Prescribing ◽  
Academic Center ◽  
American Society ◽  
Care Surgery ◽  
American Society Of Anesthesiologists

Background The Michigan Opioid Prescribing Engagement Network introduced guidelines in October 2017 to combat opioid overprescription following various surgical procedures. We sought to evaluate changes in opioid prescribing at our academic center and identify factors associated with nonadherence to recently implemented opioid prescribing guidelines. Methods This retrospective review analyzed opioid prescribing data for appendectomy, cholecystectomy, and hernia repair from January 2015 through September 2017 (pre-guidelines group) and November 2017 through December 2018 (post-guidelines group). October 2017 data were excluded to allow for guideline implementation. Opioid prescribing data were recorded as total morphine equivalents (TMEs). Results Of 1493 cases (903 pre-vs. 590 post-guidelines), the mean TME prescribed significantly decreased post-guidelines (231.9 ± 108.6 vs. 112.7 ± 73.9 mg; P < .01). More providers prescribed within recommended limits post-guidelines (2.8% vs. 44.8%; P < .01). On multivariable analysis, independent risk factors for guideline nonadherence were the American Society of Anesthesiologists class > 2 (adjusted odds ratio [AOR]:1.65, 95% confidence interval[CI] 1.09-2.49; P = .02), general surgery vs. acute care surgery service (AOR 1.89, 95% CI 1.15-3.10; P = .01), oxycodone vs. hydrocodone (AOR:1.90, 95% CI:1.06-3.41; P = .03), and nonphysician provider vs. resident prescriber (AOR:2.10, 95% CI:1.14-3.11; P < .01). Conclusions Opioid prescribing significantly reduced after the adoption of opioid prescribing guidelines at our institution. Numerous factors associated with provider guideline nonadherence may identify actionable targets to minimize opioid overprescribing further.

Preoperative predictors of suboptimal primary surgical cytoreduction in women with clinical evidence of advanced primary epithelial ovarian cancer

2004 ◽  
Vol 14 (1) ◽  
pp. 42-50 ◽  
Author(s):  
E. C. Brockbank ◽  
T. E. J. Ind ◽  
D. P. J. Barton ◽  
J. H. Shepherd ◽  
M. E. Gore ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Epithelial Ovarian Cancer ◽  
Clinical Evidence ◽  
Residual Disease ◽  
Preoperative Assessment ◽  
Figo Stage ◽  
Ca 125 ◽  
Primary Surgery ◽  
Preoperative Serum ◽  
Primary Epithelial Ovarian Cancer

IntroductionWomen with epithelial ovarian cancer (EOC) are conventionally treated with primary cytoreductive surgery. For those with a low probability of optimal primary surgical debulking, an alternative management option is primary chemotherapy with delayed primary surgery. Selection criteria are required to identify women who may benefit from this approach.Patients and methodsPatient age, presence of ascites, preoperative serum CA-125 level, surgical procedures performed, postoperative residual disease, FIGO stage, and histology data were collected on 97 women with preoperative clinical evidence of advanced EOC. Univariate and multivariate analysis was performed to identify which preoperative factors predict disease that will be suboptimally debulked. Receiver–operator curves were constructed for CA-125 level as a predictor for residual disease.ResultsThe best predictor of disease suboptimally cytoreduced was serum CA-125 level (OR = 22.76, 95% CI = 7.13–72.69). Other predictive factors included age over 60 years (OR = 3.16, 95% CI = 1.04–9.56) and clinical evidence of ascites (OR = 3.30, 95% CI = 1.03–10.62). The optimal cut-off for serum CA-125 as a predictor of suboptimal debulking was 586 IU (sensitivity 80.0%, specificity 88.5%, PPV 85.7%).ConclusionSerum CA-125 level is a reliable component of the preoperative assessment of women with EOC.

Sign in / Sign up

Export Citation Format

Share Document