scholarly journals Anastomotic leakage after intrathoracic versus cervical oesophagogastric anastomosis for oesophageal carcinoma in Chinese population: a retrospective cohort study

BMJ Open ◽  
2018 ◽  
Vol 8 (9) ◽  
pp. e021025 ◽  
Author(s):  
Yin-jiang Liu ◽  
Jun Fan ◽  
Huang-he He ◽  
Shu-sheng Zhu ◽  
Qiu-lan Chen ◽  
...  
Keyword(s):  
Cohort Study ◽  
Anastomotic Leakage ◽  
Oesophageal Cancer ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Primary Outcome ◽  
Oesophageal Carcinoma ◽  
Secondary Outcome ◽  
Anastomotic Site ◽  
Confounding Factors

ObjectiveTo investigate the characteristics and predictors for anastomotic leakage after oesophagectomy for oesophageal carcinoma from the perspective of anastomotic level.DesignRetrospective cohort study.SettingsA single tertiary medical centre in China.ParticipantsFrom January 2010 to December 2016, all patients with oesophageal cancer of the distal oesophagus or gastro-oesophageal junction undergoing elective oesophagectomy with a curative intent for oesophageal carcinoma with intrathoracic oesophagogastric anastomosis (IOA) versus cervical oesophagogastric anastomosis (COA) were included. We investigated anastomotic level and perioperative confounding factors as potential risk factors for postoperative leakage by univariate and multivariate logistic regression.Primary outcome measuresThe primary outcome was the odds of anastomotic leakage by different confounding factors. Secondary outcome was the association of IOA versus COA with other postoperative outcomes.ResultsOf 458 patients included, 126 underwent cervical anastomosis and 332 underwent intrathoracic anastomosis. Anastomotic leakage developed in 55 patients (12.0%), with no statistical differences between COA and IOA (16.6% vs 10.2%; p=0.058). Multivariable analysis identified active diabetes mellitus (OR 2.001, p=0.047), surgical procedure (open: reference; minimally invasive: OR 1.770, p=0.049) and anastomotic method (semimechanical: reference; stapled: OR 1.821; handsewn: OR 2.271, p=0.048) rather than anastomotic level (IOA: reference; COA: OR 1.622, p=0.110) were independent predictors of leakage.ConclusionsSurgical and anastomotic techniques rather than the level of anastomotic site were independent predictors of postoperative anastomotic leakage in patients undergoing oesophageal cancer surgery.

ECMO Transport without Physicians or Additional Clinicians

2020 ◽  
pp. 1-7
Author(s):  
Anna Condella ◽  
Jeremy B. Richards ◽  
Michael A. Frakes ◽  
Christian J. Grant ◽  
Jason E. Cohen ◽  
...  
Keyword(s):  
Cohort Study ◽  
Adverse Events ◽  
Nurse Practitioner ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Primary Outcome ◽  
Secondary Outcome ◽  
Hub And Spoke ◽  
Current Guidelines ◽  
Major Adverse Events

Abstract Background: Extracorporeal membrane oxygenation (ECMO) has accelerated rapidly for patients in severe cardiac or respiratory failure. As a result, ECMO networks are being developed across the world using a “hub and spoke” model. Current guidelines call for all patients transported on ECMO to be accompanied by a physician during transport. However, as ECMO centers and networks grow, the increasing number of transports will be limited by this mandate. Objectives: The aim of this study was to compare rates of adverse events occurring during transport of ECMO patients with and without an additional clinician, defined as a physician, nurse practitioner (NP), or physician assistant (PA). Methods: This is a retrospective cohort study of all adults transported while cannulated on ECMO from 2011-2018 via ground and air between 21 hospitals in the northeastern United States, comparing transports with and without additional clinicians. The primary outcome was the rate of major adverse events, and the secondary outcome was minor adverse events. Results: Over the seven-year study period, 93 patients on ECMO were transported. Twenty-three transports (24.7%) were accompanied by a physician or other additional clinician. Major adverse events occurred in 21.5% of all transports. There was no difference in the total rate of major adverse events between accompanied and unaccompanied transports (P = .91). Multivariate analysis did not demonstrate any parameter as being predictive of major adverse events. Conclusions: In a retrospective cohort study of transports of ECMO patients, there was no association between the overall rate of major adverse events in transport and the accompaniment of an additional clinician. No variables were associated with major adverse events in either cohort.

scholarly journals P067: Missed opportunities for prehospital management of anaphylactic reactions

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S101-S101
Author(s):  
T. Kawano ◽  
B.E. Grunau ◽  
F.X. Scheuermeyer ◽  
R. Stenstrom
Keyword(s):  
Cohort Study ◽  
Emergency Medical Services ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Primary Outcome ◽  
Secondary Outcome ◽  
Allergic Reactions ◽  
Missed Opportunities ◽  
Prehospital Management ◽  
Explicit Criteria

Introduction: Emergency medical services (EMS) have the opportunity to treat allergic reactions anaphylactic reactions rapidly. However, the rate of recognition and treatment is unknown. Methods: This was a retrospective cohort study conducted at two urban emergency departments from 2007 to 2012 including adult patients with allergy and anaphylaxis, both of which were predefined by explicit criteria. The patients of interest were those attended by EMS and transported to hospital. The primary outcome was the proportion of patients who met anaphylaxis criteria in the prehospital setting, but who did not have epinephrine administered. The secondary outcome was the proportion of patients who did not meet anaphylaxis criteria, yet had epinephrine administered. Results: Of 2819 overall patients, 491 (17.4%) arrived by EMS. The median age was 38 (IQR 27 to 49) and 60.9% were female. For the 151 (30.8%) patients with anaphylaxis, 55 received ephinephrine, (36.4%, 95% CI 27.4 to 47.4%). For the 340 (69.2%) patients without anaphylaxis, 28 received ephinephrine (8.2%, 95% CI 5.5 to 11.9%). Conclusion: For patients with anaphylaxis and allergic reactions who are managed by EMS, there may be a mismatch between illness severity and treatment.

scholarly journals Perforated appendicitis in patients with schizophrenia: a retrospective cohort study

BMJ Open ◽  
2017 ◽  
Vol 7 (9) ◽  
pp. e017150 ◽  
Author(s):  
Yoshimasa Nishihira ◽  
Rita L McGill ◽  
Mitsuyo Kinjo
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Pain Sensitivity ◽  
Primary Outcome ◽  
Perforated Appendicitis ◽  
Secondary Outcome ◽  
Delayed Presentation ◽  
Schizophrenic Patients ◽  
Appendiceal Perforation

ObjectiveAltered pain sensitivity may affect the outcome of appendicitis in patients with schizophrenia. We aimed to compare the prevalence of perforation in appendicitis between patients with and without schizophrenia.DesignRetrospective cohort study with random matching.SettingA single tertiary medical centre in Japan.ParticipantsFrom 1985 to 2013, 1821 cases of appendicitis requiring appendectomy were collected. Patients with schizophrenia and a cohort of randomly selected control subjects without schizophrenia who underwent appendectomy were identified.Primary and secondary outcome measuresThe primary outcome was the rate of perforated appendicitis in patients with and without schizophrenia. Secondary outcome was the odds of perforated appendicitis by different clinical factors.Results62 patients with schizophrenia and randomly sampled 200 non-schizophrenic patients were compared. The prevalence of perforation was 53% in patients with schizophrenia versus 17% in controls (p<0.0001). The adjusted OR for perforation were 4.87 (95% CI: 2.33 to 10.2) for schizophrenia, 3.35 (95% CI 1.51 to 7.45) for age >55 years and 2.18 (95% CI: 1.12 to 4.27) for delayed presentation.ConclusionAppendiceal perforation was more frequent in patients with schizophrenia than controls, which may be partly attributable to delayed presentation and altered responses to pain.

scholarly journals Characteristics, outcomes and risk factors for mortality of 522 167 patients hospitalised with COVID-19 in Brazil: a retrospective cohort study

BMJ Open ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. e049089
Author(s):  
Marcia C Castro ◽  
Susie Gurzenda ◽  
Eduardo Marques Macário ◽  
Giovanny Vinícius A França
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Cox Proportional Hazards ◽  
Secondary Outcome ◽  
Hospital Death ◽  
Factors Associated ◽  
Icu Admission ◽  
Hospitalised Patients

ObjectiveTo provide a comprehensive description of demographic, clinical and radiographic characteristics; treatment and case outcomes; and risk factors associated with in-hospital death of patients hospitalised with COVID-19 in Brazil.DesignRetrospective cohort study of hospitalised patients diagnosed with COVID-19.SettingData from all hospitals across Brazil.Participants522 167 hospitalised patients in Brazil by 14 December 2020 with severe acute respiratory illness, and a confirmed diagnosis for COVID-19.Primary and secondary outcome measuresPrevalence of symptoms and comorbidities was compared by clinical outcomes and intensive care unit (ICU) admission status. Survival was assessed using Kaplan Meier survival estimates. Risk factors associated with in-hospital death were evaluated with multivariable Cox proportional hazards regression.ResultsOf the 522 167 patients included in this study, 56.7% were discharged, 0.002% died of other causes, 30.7% died of causes associated with COVID-19 and 10.2% remained hospitalised. The median age of patients was 61 years (IQR, 47–73), and of non-survivors 71 years (IQR, 60–80); 292 570 patients (56.0%) were men. At least one comorbidity was present in 64.5% of patients and in 76.8% of non-survivors. From illness onset, the median times to hospital and ICU admission were 6 days (IQR, 3–9) and 7 days (IQR, 3–10), respectively; 15 days (IQR, 9–24) to death and 15 days (IQR, 11–20) to hospital discharge. Risk factors for in-hospital death included old age, Black/Brown ethnoracial self-classification, ICU admission, being male, living in the North and Northeast regions and various comorbidities. Age had the highest HRs of 5.51 (95% CI: 4.91 to 6.18) for patients≥80, compared with those ≤20.ConclusionsCharacteristics of patients and risk factors for in-hospital mortality highlight inequities of COVID-19 outcomes in Brazil. As the pandemic continues to unfold, targeted policies that address those inequities are needed to mitigate the unequal burden of COVID-19.

The effects of propofol on extracorporeal membrane oxygenation oxygenator exchange

2021 ◽  
pp. 039139882110160
Author(s):  
Kelsey L Browder ◽  
Ayesha Ather ◽  
Komal A Pandya
Keyword(s):  
Cohort Study ◽  
Extracorporeal Membrane Oxygenation ◽  
Cumulative Dose ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Primary Outcome ◽  
Ecmo Support ◽  
Single Center ◽  
Membrane Oxygenation ◽  
Vv Ecmo

The objective of this study was to determine if propofol administration to veno-venous (VV) extracorporeal membrane oxygenation (ECMO) patients was associated with more incidents of oxygenator failure when compared to patients who did not receive propofol. This was a single center, retrospective cohort study. The primary outcome of the study is oxygenator exchanges per ECMO day in patients who received propofol versus those who did not receive propofol. Patients were 18 years or older on VV-ECMO support between January 1, 2015 and January 31, 2018. Patients were excluded if they required ECMO support for less than 48 h or greater than 21 days. There were five patients in the propofol arm that required oxygenator exchanges and seven patients in the control arm. The total number of oxygenator exchanges per ECMO day was not significantly different between groups ( p = 0.50). When comparing those who required an oxygenator exchange and those who did not, there was no difference in the cumulative dose of propofol received per ECMO hour (0.64 mg/kg/h vs 0.96 mg/kg/h; p = 0.16). Propofol use in patients on VV-ECMO does not appear to increase the number of oxygenator exchanges.

scholarly journals Selective Decontamination of the Digestive Tract to Prevent Postoperative Pneumonia and Anastomotic Leakage after Esophagectomy: A Retrospective Cohort Study

Antibiotics ◽  
2021 ◽  
Vol 10 (1) ◽  
pp. 43
Author(s):  
Robin Janssen ◽  
Frans Van Workum ◽  
Nikolaj Baranov ◽  
Harmen Blok ◽  
Jaap ten Oever ◽  
...  
Keyword(s):  
Cohort Study ◽  
Anastomotic Leakage ◽  
Digestive Tract ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Protective Factor ◽  
Gastrointestinal Surgery ◽  
Surgical Site Infections ◽  
Selective Decontamination ◽  
Postoperative Pneumonia

Infectious complications occur frequently after esophagectomy. Selective decontamination of the digestive tract (SDD) has been shown to reduce postoperative infections and anastomotic leakage in gastrointestinal surgery, but robust evidence for esophageal surgery is lacking. The aim was to evaluate the association between SDD and pneumonia, surgical-site infections (SSIs), anastomotic leakage, and 1-year mortality after esophagectomy. A retrospective cohort study was conducted in patients undergoing Ivor Lewis esophagectomy in four Dutch hospitals between 2012 and 2018. Two hospitals used SDD perioperatively and two did not. SDD consisted of an oral paste and suspension (containing amphotericin B, colistin, and tobramycin). The primary outcomes were 30-day postoperative pneumonia and SSIs. Secondary outcomes were anastomotic leakage and 1-year mortality. Logistic regression analyses were performed to determine the association between SDD and the relevant outcomes (odds ratio (OR)). A total of 496 patients were included, of whom 179 received SDD perioperatively and the other 317 patients did not receive SDD. Patients who received SDD were less likely to develop postoperative pneumonia (20.1% vs. 36.9%, p < 0.001) and anastomotic leakage (10.6% vs. 19.9%, p = 0.008). Multivariate analysis showed that SDD is an independent protective factor for postoperative pneumonia (OR 0.40, 95% CI 0.23–0.67, p < 0.001) and anastomotic leakage (OR 0.46, 95% CI 0.26–0.84, p = 0.011). Use of perioperative SDD seems to be associated with a lower risk of pneumonia and anastomotic leakage after esophagectomy.

scholarly journals Pioglitazone use and Parkinson’s disease: a retrospective cohort study in Taiwan

BMJ Open ◽  
2018 ◽  
Vol 8 (8) ◽  
pp. e023302 ◽  
Author(s):  
Hsiu-Feng Wu ◽  
Li-Ting Kao ◽  
Jui-Hu Shih ◽  
Hui-Han Kao ◽  
Yu-Ching Chou ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Asian Population ◽  
Secondary Outcome ◽  
Study Cohort ◽  
Patients With Diabetes

ObjectivesMany researchers have expected pioglitazone to serve as an effective neuroprotective agent against Parkinson’s disease (PD). Therefore, we conducted this cohort study to investigate the association between pioglitazone use and PD by using a large Asian population-based dataset in Taiwan.DesignRetrospective cohort study.SettingTaiwan.Participants7906 patients with diabetes who had received pioglitazone were defined as the study cohort, and 7906 matched patients with diabetes who had not received pioglitazone were defined as the comparison cohort.Primary and secondary outcome measuresWe tracked each patient individually over a 5-year follow-up period to identify those diagnosed as having PD during this period. We performed Cox proportional hazard regression analyses to evaluate the HRs for PD between the study and comparison cohorts.ResultsThe findings indicated that among the sampled patients, PD occurred in 257 (1.63%): 119 (1.51%) pioglitazone users and 138 (1.75%) non-users. The adjusted HR for PD within the follow-up period was 0.90 (95% CI: 0.68 to 1.18) in the patients who had received pioglitazone compared with the matched patients who had not received pioglitazone. Moreover, this study revealed that pioglitazone use was not associated with PD incidence in men (HR: 1.06, 95% CI: 0.71 to 1.59) or women (HR: 0.84, 95% CI: 0.61 to 1.15).ConclusionsThis study did not find the relationship between pioglitazone use and PD incidence, regardless of sex, among an Asian population of patients with diabetes.

scholarly journals Sex differences in type and occurrence of adverse reactions to opioid analgesics: a retrospective cohort study

BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e044157
Author(s):  
Guilherme S Lopes ◽  
Suzette Bielinski ◽  
Ann M Moyer ◽  
Debra J Jacobson ◽  
Liwei Wang ◽  
...  
Keyword(s):  
Nervous System ◽  
Sex Differences ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Adverse Reactions ◽  
Secondary Outcome ◽  
Opioid Prescription ◽  
Biological Variable ◽  
The Right

ObjectivesSex as a biological variable affects response to opioids. However, few reports describe the prevalence of specific adverse reactions to commonly prescribed opioids in men and women separately. A large cohort was used to investigate sex differences in type and occurrence of adverse reactions associated with use of codeine, tramadol, oxycodone and hydrocodone.DesignRetrospective cohort study.SettingParticipants in the Right Drug, Right Dose, Right Time (RIGHT) Study.ParticipantsThe medical records of 8457 participants in the RIGHT Study who received an opioid prescription between 1 January 2004 and 31 December 2017 were reviewed 61% women, 94% white, median age (Q1–Q3)=58 (47–66).Primary and secondary outcome measuresAdverse reactions including gastrointestinal, skin, psychiatric and nervous system issues were collected from the allergy section of each patient’s medical record. Sex differences in the risk of adverse reactions due to prescribed opioids were modelled using logistic regression adjusted for age, body mass index, race and ethnicity.ResultsFrom 8457 participants (of which 449 (5.3%) reported adverse reactions), more women (6.5%) than men (3.4%) reported adverse reactions to at least one opioid (OR (95% CI)=2.3 (1.8 to 2.8), p<0.001). Women were more likely to report adverse reactions to tramadol (OR (95% CI)=2.8 (1.8 to 4.4), p<0.001) and oxycodone (OR (95% CI)=2.2 (1.7 to 2.9), p<0.001). Women were more likely to report gastrointestinal (OR (95% CI)=3.1 (2.3 to 4.3), p<0.001), skin (OR (95% CI)=2.1 (1.4 to 3.3), p=0.001) and nervous system issues (OR (95% CI)=2.3 (1.3 to 4.2), p=0.004).ConclusionsThese findings support the importance of sex as a biological variable to be factored into pain management studies.

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