Factors Predictive of 90-Day Morbidity, Readmission, and Costs in Patients Undergoing Pelvic Exenteration

ObjectivePelvic exenteration for recurrent gynecological malignancies is characterized by a high rate of severe complications. Factors predictive of morbidity, readmission, and cost were analyzed.MethodsData of consecutive patients undergoing pelvic exenteration between January 2007 and December 2016 were prospectively evaluated.ResultsFifty-eight patients were included in the analysis. Anterior, posterior, and total exenterations were executed in 39 (67%), 9 (16%), and 10 (17%) patients, respectively. Ten (15.5%) severe complications occurred: 8 (20.5%), 0 (0%), and 1 (10%) after anterior, posterior, and total exenterations, respectively. Radiotherapy dosage, time between radiotherapy and surgery, and previous administration of chemotherapy did not influence 90-day complications and readmission. At multivariable analysis, albumin levels less than 3.5 g/dL (odds ratio, 16.2 [95% confidence interval, 2.85–92.8]; P = 0.002) and history of deep vein thrombosis (odds ratio, 9.6 [95% confidence interval, 0.93–98.2]; P = 0.057) were associated with 90-day morbidity. Low albumin levels independently correlated with readmission (P = 0.011). The occurrence of 90-day postoperative complications and readmission increased costs of a median of +12,500 and +6000 euros, respectively (P < 0.05).ConclusionsPreoperative patient selection is a key point for the reduction of postoperative complications after pelvic exenteration. Further prospective studies are warranted to improve patient selection.

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Primary Uterine Cancer in Maryland: Impact of Distance on Access to Surgical Care at High-Volume Hospitals

International Journal of Gynecological Cancer ◽

10.1097/igc.0b013e31829ea002 ◽

2013 ◽

Vol 23 (7) ◽

pp. 1244-1251 ◽

Cited By ~ 11

Author(s):

Camille C. Gunderson ◽

Ana I. Tergas ◽

Aimee C. Fleury ◽

Teresa P. Diaz-Montes ◽

Robert L. Giuntoli

Keyword(s):

Confidence Interval ◽

Odds Ratio ◽

Uterine Cancer ◽

Multivariable Analysis ◽

Community Setting ◽

Surgical Care ◽

High Volume ◽

High Volume Hospital ◽

To Receive ◽

Zip Code

ObjectiveTo evaluate the influence of distance on access to high-volume surgical treatment for patients with uterine cancer in Maryland.MethodsThe Maryland Health Services Cost Review Commission database was retrospectively searched to identify primary uterine cancer surgical cases from 1994 to 2010. Race, type of insurance, year of surgery, community setting, and both surgeon and hospital volume were collected. Geographical coordinates of hospital and patient’s zip code were used to calculate primary independent outcomes of distance traveled and distance from nearest high-volume hospital (HVH). Logistic regression was used to calculate odds ratios and confidence intervals.ResultsFrom 1994 to 2010, 8529 women underwent primary surgical management of uterine cancer in Maryland. Multivariable analysis demonstrated white race, rural residence, surgery by a high-volume surgeon and surgery from 2003 to 2010 to be associated with both travel 50 miles or more to the treating hospital and residence 50 miles or more from the nearest HVH (allP< 0.05). Patients who travel 50 miles or more to the treating hospital are more likely to have surgery at a HVH (odds ratio, 6.03; 95% confidence interval, 4.67–7.79) In contrast, patients, who reside ≥50 miles from a HVH, are less likely to have their surgery at an HVH. (odds ratio, 0.37; 95% confidence interval, 0.32–0.42).ConclusionIn Maryland, 50 miles or more from residence to the nearest HVH is a barrier to high-volume care. However, patients who travel 50 miles or more seem to do so to receive care by a high-volume surgeon at an HVH. In Maryland, Nonwhites are more likely to live closer to an HVH and more likely to use these services.

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Comparing Telephone Counseling With Reminding to Promote On-Time Repeated Mammography: A Randomized Trial in a Cohort With 4 Years Follow-Up

Health Education & Behavior ◽

10.1177/1090198119886347 ◽

2019 ◽

Vol 47 (1) ◽

pp. 37-46

Author(s):

Mary E. Costanza ◽

Roger Luckmann ◽

Christine Frisard ◽

Mary Jo White ◽

Caroline Cranos

Keyword(s):

Confidence Interval ◽

Randomized Trial ◽

Odds Ratio ◽

Multivariable Analysis ◽

Telephone Counseling ◽

Long Term Effects ◽

Time Points ◽

Reminder Call ◽

Screening Mammograms

Background. Long-term continuous adherence to biennial screening mammograms as guidelines recommend remains low. Limited evidence suggests that reminder calls may increase short-term adherence as much as telephone counseling, but research is needed comparing the long-term effects of these two approaches. Purpose. To compare the impacts of two telephone outreach interventions and mailed reminders on 4-year continuous mammography adherence. Method. A cohort of 3,215 women, age 50 to 81 years, was selected from 30,160 women from a 4-year randomized trial of three interventions to promote biennial mammography: reminder letter only (LO), letter plus reminder call (RC), and two letters plus educational material and a counseling call (CC). Women selected remained eligible for the trial all 4 years and received annual interventions as needed. The proportion with a mammogram in the last 24 months was determined at baseline and four annual time points. Results. Continuous adherence at all four time points was higher in the RC (78.8%) and CC arms (78.8%) than in the LO arm (75.1%; p < .001). Multivariable analysis confirmed this finding: CC (odds ratio = 1.27; 95% confidence interval = [1.01, 1.61]) and RC (odds ratio = 1.23; 95% confidence interval = [0.98, 1.56]). Only 27.8% of women eligible for an initial counseling call actually received counseling. Conclusions. Compared with letters alone, outreach calls can modestly increase continuous mammography adherence among insured women with consistent primary care. Telephone counseling was no more effective than a reminder call, possibly due to limited acceptance of counseling calls by women who may find them unwelcome or unnecessary.

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Clinical and socio-economic predictors of work participation in adult CHD patients

Cardiology in the Young ◽

10.1017/s1047951120001572 ◽

2020 ◽

Vol 30 (8) ◽

pp. 1081-1085

Author(s):

Lauren A. Sarno ◽

Lindsay Cortright ◽

Tiara Stanley ◽

Dmitry Tumin ◽

Jennifer S. Li ◽

...

Keyword(s):

Confidence Interval ◽

Odds Ratio ◽

Employment Status ◽

Heart Defects ◽

Multivariable Analysis ◽

Population Based ◽

Work Participation ◽

Surveillance Network ◽

The North ◽

Economic Predictors

AbstractBackground:Adults with CHD have reduced work participation rates compared to adults without CHD. We aimed to quantify employment rate among adult CHD patients in a population-based registry and to describe factors and barriers associated with work participation.Methods:We retrospectively identified adults with employment information in the North Carolina Congenital Heart Defects Surveillance Network. Employment was defined as any paid work in a given year. Logistic regression was used to examine patients’ employment status during each year.Results:The registry included 1,208 adult CHD patients with a health care encounter between 2009 and 2013, of whom 1,078 had ≥1 year of data with known employment status. Overall, 401 patients (37%) were employed in their most recent registry year. On multivariable analysis, the odds of employment decreased with older age and were lower for Black as compared to White patients (odds ratio = 0.78; 95% confidence interval: 0.62, 0.98; p = 0.030), and single as compared to married patients (odds ratio = 0.50; 95% confidence interval: 0.39, 0.63; p < 0.001).Conclusion:In a registry where employment status was routinely captured, only 37% of adult CHD patients aged 18–64 years were employed, with older patients, Black patients, and single patients being less likely to be employed. Further work is needed to consider how enhancing cardiology follow-up for adults with CHD can integrate support for employment.

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Association between Abdominal Free Fluid and Postoperative Complications and Mortality in Patients with Small-Bowel Obstruction

Scandinavian Journal of Surgery ◽

10.1177/1457496918772372 ◽

2018 ◽

Vol 108 (1) ◽

pp. 36-41

Author(s):

I. Pinar ◽

W. Abdul-Wahid ◽

T. Fransgaard ◽

I. Gögenur

Keyword(s):

Postoperative Complications ◽

Small Bowel ◽

Confidence Interval ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Odds Ratio ◽

Hounsfield Unit ◽

Free Fluid ◽

Computed Tomography Scans ◽

Complications And Mortality

Background and Aims: Small-bowel obstruction is a frequent cause of hospitalization. The condition is potentially life-threatening, causing many admission days and is a heavy burden socioeconomically. Patients with small-bowel obstruction may develop abdominal free fluid and the quality of this fluid may be predictive of worse outcomes. Our aim was to examine whether the presence of free fluid and its density, measured on computed tomography scans, was associated with severe complications and mortality postoperatively. Materials and Methods: Patients admitted to the Department of Surgery, Zealand University Hospital with a diagnosis of small-bowel obstruction between January 2010 and December 2015 were included. Medical records were reviewed and preoperative computed tomography scans were examined. A radiologist blinded to the outcomes reviewed all Hounsfield unit values of the free fluid. The primary outcomes evaluated were odds ratios of the severity of complications and hazard ratios of 30- and 90-day mortality postoperatively. Results: A total of 289 patients were included. Analyses revealed an adjusted odds ratio of 1.03 (95%confidence interval = 0.93–1.15) between the presence of free fluid and postoperative complications and an adjusted hazard ratio of 1.28 (95% confidence interval = 0.80–2.05, p = 0.30) of the 30-day mortality in this patient group. Furthermore, the analyses revealed an adjusted odds ratio of 1.22 (95% confidence interval 0.98–1.52) between the density of the free fluid > 20 Hounsfield unit and postoperative complications and an adjusted hazard ratio of 0.85 (95% confidence interval = 0.28–2.63, p = 0.78) of the 30-day mortality. Conclusion: No significant correlation was found between the presence of free fluid nor its density in regard to postoperative complications or mortality in patients with small-bowel obstruction.

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Association of hemoglobin with incidence of in-hospital cardiac arrest in patients with acute coronary syndrome complicated by cardiogenic shock

Journal of International Medical Research ◽

10.1177/0300060519857021 ◽

2019 ◽

Vol 47 (9) ◽

pp. 4151-4162

Author(s):

Tiancheng Xu ◽

Dongjie Liang ◽

Shengjie Wu ◽

Xiaodong Zhou ◽

Ruiyu Shi ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Cardiac Arrest ◽

Confidence Interval ◽

Cardiogenic Shock ◽

Odds Ratio ◽

Protective Factor ◽

Multivariable Analysis ◽

Hemoglobin Concentration ◽

Coronary Syndrome ◽

Hospital Cardiac Arrest

Objective This study was performed to investigate the association of the admission hemoglobin level with the incidence of in-hospital cardiac arrest (IHCA) in patients with acute coronary syndrome (ACS) complicated by cardiogenic shock (CS). Methods In this retrospective study, we reviewed the medical records of consecutive patients with ACS complicated by CS admitted to the coronary care unit from January 2014 to October 2017. Logistic regression models were carried out to evaluate the association between hemoglobin and the incidence of IHCA. Interaction and subgroup analyses were also performed. Results In total, 211 patients were included in the study, and 61 (28.9%) patients developed IHCA. In the multivariable analysis, hemoglobin was a strong independent predictor of IHCA (odds ratio, 0.971; 95% confidence interval, 0.954–0.989). In the fully adjusted model, patients in the higher hemoglobin tertile were less likely to develop IHCA than patients in the lowest hemoglobin tertile (odds ratio, 0.194; 95% confidence interval, 0.071–0.530). The relationship remained stable in most subgroups except patients aged ≥70 years. Conclusion In patients with ACS complicated by CS, the incidence of IHCA is related to the hemoglobin concentration, and a high hemoglobin concentration is a protective factor against the development of IHCA.

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Gastroenteritis in older people living in the community: results of two Australian surveys

Epidemiology and Infection ◽

10.1017/s0950268811002834 ◽

2012 ◽

Vol 140 (11) ◽

pp. 2028-2036 ◽

Cited By ~ 8

Author(s):

M. D. KIRK ◽

G. V. HALL ◽

N. BECKER

Keyword(s):

Food Safety ◽

Confidence Interval ◽

Older People ◽

Elderly People ◽

Odds Ratio ◽

Multivariable Analysis ◽

The Elderly ◽

The State ◽

National Surveys

SUMMARYWe analysed two large national surveys conducted in 2001 and 2008 to examine incidence and outcomes of gastroenteritis in older Australians. A case was someone reporting ⩾3 loose stools or ⩾1 episode of vomiting in 24 h, excluding non-infectious causes. We compared cases arising in the elderly (⩾65 years) and in other adults (20–64 years). Elderly people experienced 0·33 [95% confidence interval (CI) 0·24–0·42] episodes of gastroenteritis/person per year, compared to 0·95 (95% CI 0·74–1·15) in other adults. Elderly cases reported less stomach cramps, fever and myalgia than younger cases, and were more likely to be hospitalized, although this was not statistically significant. In multivariable analysis, gastroenteritis in elderly people was associated with travelling within the state (odds ratio 1·35, 95% CI 1·07–1·71). Elderly people were less concerned about food safety than other adults. Older Australians were less likely to report gastroenteritis and experienced different symptoms and outcomes from other adults.

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Development and Validation of a Simple and Easy-to-Employ Electronic Algorithm for Identifying Clinical Methicillin-Resistant Staphylococcus aureus Infection

Infection Control and Hospital Epidemiology ◽

10.1086/676437 ◽

2014 ◽

Vol 35 (6) ◽

pp. 692-698 ◽

Cited By ~ 13

Author(s):

Westyn Branch-Elliman ◽

Judith Strymish ◽

Kalpana Gupta

Keyword(s):

Staphylococcus Aureus ◽

Confidence Interval ◽

Odds Ratio ◽

Multivariable Analysis ◽

Simple Algorithm ◽

Electronic System ◽

Surveillance Systems ◽

Methicillin Resistant ◽

Sterile Site ◽

Mrsa Infection

Background.With growing demands to track and publicly report and compare infection rates, efforts to utilize automated surveillance systems are increasing. We developed and validated a simple algorithm for identifying patients with clinical methicillin-resistant Staphylococcus aureus (MRSA) infection using microbiologic and antimicrobial variables. We also estimated resource savings.Methods.Patients who had a culture positive for MRSA at any of 5 acute care Veterans Affairs hospitals were eligible. Clinical infection was defined on the basis of manual chart review. The electronic algorithm defined clinical MRSA infection as a positive non-sterile-site culture with receipt of MRSA-active antibiotics during the 5 days prior to or after the culture.Results.In total, 246 unique non-sterile-site cultures were included, of which 168 represented infection. The sensitivity (43.4%–95.8%) and specificity (34.6%–84.6%) of the electronic algorithm varied depending on the combination of antimicrobials included. On multivariable analysis, predictors of algorithm failure were outpatient status (odds ratio, 0.23 [95% confidence interval, 0.10–0.56]) and respiratory culture (odds ratio, 0.29 [95% confidence interval, 0.13–0.65]). The median cost was $2.43 per chart given 4.6 minutes of review time per chart.Conclusions.Our simple electronic algorithm for detecting clinical MRSA infections has excellent sensitivity and good specificity. Implementation of this electronic system may streamline and standardize surveillance and reporting efforts.Infect Control Hosp Epidemiol 2014;35(6):692–698

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Risk assessment for postoperative outcomes in a mixed hospitalized gynecological population by the Dutch safety management system (Veiligheidsmanagementsysteem, VMS) screening tool ‘frail elderly’

Archives of Gynecology and Obstetrics ◽

10.1007/s00404-021-06073-z ◽

2021 ◽

Author(s):

Vera van der Zanden ◽

K. Marieke Paarlberg ◽

Hester J. van der Zaag-Loonen ◽

Wouter J. Meijer ◽

Marian J. E. Mourits ◽

...

Keyword(s):

Postoperative Complications ◽

Frail Elderly ◽

Odds Ratio ◽

Management System ◽

Screening Tool ◽

Safety Management ◽

Multivariable Analysis ◽

Postoperative Outcomes ◽

Gynecological Surgery ◽

Safety Management System

Abstract Purpose Frailty is associated with a higher risk for negative postoperative outcomes. This study aimed to determine the association between the screening tool of the Dutch safety management system, Veiligheidsmanagementsysteem (VMS) ‘frail elderly’ and postoperative complications in a gynecological population. Methods This cohort study included women aged 70 years or older, who were scheduled for any kind of gynecological surgery. VMS screening data (including risk for delirium, falling, malnutrition, and functional impairment) were extracted from the electronic patient records. VMS score could range between 0 and 4 patients with a VMS score of one or more were considered frail. Data on possible confounding factors and complications within 30 days after surgery, classified with the Clavien–Dindo classification, were collected. Regression analysis was performed. Results 157 women were included with a median age of 74 years (inter quartile range 71–79). Most patients underwent prolapse surgery (52%) or hysterectomy (31%). Forty-one patients (26%) experienced any postoperative complication. Sixty-two patients (39%) were considered frail preoperatively by the VMS screening tool. Frailty measured with the VMS screening tool was not independently associated with postoperative complications in multivariable analysis (Odds ratio 1.18; 95% CI 0.49–2.82). However, a recent fall in the last 6 months (n = 208) was associated with postoperative complications (Odds ratio 3.90; 95% CI 1.57–9.66). Conclusion An independent association between frailty, determined by the VMS screening tool ‘Frail elderly’, and postoperative complications in gynecological surgery patients could not be confirmed. A recent fall in the last 6 months seems associated with postoperative complications.

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Predictors of Early Neurological Deterioration in Stroke Due to Vertebrobasilar Occlusion

Frontiers in Neurology ◽

10.3389/fneur.2021.696042 ◽

2021 ◽

Vol 12 ◽

Author(s):

Seungyon Koh ◽

Sung Eun Lee ◽

Woo Sang Jung ◽

Jin Wook Choi ◽

Jin Soo Lee ◽

...

Keyword(s):

Blood Pressure ◽

Confidence Interval ◽

Endovascular Therapy ◽

Odds Ratio ◽

Multivariate Analyses ◽

Multivariable Analysis ◽

Posterior Circulation ◽

Neurological Deterioration ◽

Early Neurological Deterioration ◽

Basilar Occlusion

Background and Aims: This study explores the predictors of early neurological deterioration (END) in patients with vertebrobasilar occlusion (VBO) in both primary endovascular therapy (EVT) and medical management (MM) groups.Methods: Patients diagnosed with VBO from 2010 to 2018 were included. Comparative and multivariate analyses were used to identify predictors of all-cause END in the EVT group, and END due to ischemia progression (END-IP) in the MM group.Results: In 174 patients with VBO, 43 had END. In the primary EVT group (N = 66), 17 all-cause END occurred. Distal basilar occlusion (odds ratio (OR), 14.5 [95% confidence interval (CI), 1.4–154.4]) and reperfusion failure (eTICI < 2b67 (OR, 5.0 [95% CI, 1.3–19.9]) were predictive of END in multivariable analysis. In the MM group (N=108), 17 END-IP occurred. Higher systolic blood pressure (SBP) at presentation (per 10 mmHg increase, OR, 1.5 [95% CI, 1.1–2.0]), stroke onset-to-door time <24 h (OR, 5.3 [95% CI, 1.1–2.0]), near-total occlusions (OR, 4.9 [95% CI, 1.2–19.6]), lower posterior circulation-Alberta Stroke Program Early CT scores (OR, 1.6 [95% CI, 1.0–2.5]), and lower BATMAN collateral scores (OR, 1.6 [95% CI, 1.1–2.2]) were predictive of END-IP.Conclusions: In patients with stroke due to VBO, potential predictors of END can be identified. In the primary EVT group, failure to achieve reperfusion and distal basilar occlusion were associated with all-cause END. In the MM group, higher SBP at presentation, onset-to-door time less than 24 h, incomplete occlusions, larger infarct cores, and poorer collaterals were associated with END-IP.

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The Role of Intraoperative Fluid Optimization Using the Esophageal Doppler in Advanced Gynecological Cancer: Early Postoperative Recovery and Fitness for Discharge

International Journal of Gynecological Cancer ◽

10.1097/igc.0b013e3182752372 ◽

2013 ◽

Vol 23 (1) ◽

pp. 199-207 ◽

Cited By ~ 8

Author(s):

Supratik Chattopadhyay ◽

Shilpi Mittal ◽

Steven Christian ◽

Andries Lourens Terblanche ◽

Amit Patel ◽

...

Keyword(s):

Postoperative Complications ◽

Confidence Interval ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Gynecological Cancer ◽

Postoperative Recovery ◽

Fluid Replacement ◽

Esophageal Doppler ◽

Stage Disease ◽

Fluid Optimization

ObjectiveTo determine the effect of fluid optimization using esophageal Doppler monitoring (EDM) when compared to standard fluid management in women who undergo major gynecological cancer surgery and whether its use is associated with reduced postoperative morbidity.MethodsFrom January 2009 to December 2010, women undergoing laparotomy for pelvic masses or uterine cancer had either fluid optimization using intraoperative EDM or standard fluid replacement without using EDM. Cases were selected from 2 surgeons to control for variability in surgical practice. Demographic and surgical details were collected prospectively. Univariate and multivariate analyses were performed to quantify the association between the use of EDM with “early postoperative recovery” and “early fitness for discharge.”ResultsA total of 198 women were operated by the 2 prespecified surgeons; 79 women had fluid optimization with EDM, whereas 119 women had standard anesthetic care. The use of ODM was associated with earlier postoperative recovery (adjusted odds ratio, 2.83; 95% confidence interval, 1.20–6.68; P = 0.02) and earlier fitness for discharge (adjusted odds ratio, 2.81; 95% confidence interval, 1.01–7.78; P = 0.05). Women with advanced-stage disease in the “EDM” group resumed oral diet earlier than women in the “no EDM” group (median, 1 day vs 2 days; P = 0.02). These benefits with EDM did not extend to women with early-stage disease/benign/borderline tumors. No significant difference in postoperative complications was noted.ConclusionsIntraoperative fluid optimization with EDM in women with advanced gynecological cancer may be associated with improved postoperative recovery and early fitness for discharge. Studies with adequate power are needed to investigate its role in reducing postoperative complications.

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