scholarly journals COVID-19 hospital activity and in-hospital mortality during the first and second waves of the pandemic in England: an observational study

Thorax ◽  
2021 ◽  
pp. thoraxjnl-2021-218025
Author(s):  
William K Gray ◽  
Annakan V Navaratnam ◽  
Jamie Day ◽  
Julia Wendon ◽  
Tim W R Briggs
Keyword(s):  
Hospital Mortality ◽  
Hospital Stay ◽  
Ethnic Groups ◽  
Mortality Rates ◽  
Data Set ◽  
Black African ◽  
Substantial Decline ◽  
The Relationship ◽  
Second Wave

IntroductionWe aimed to examine the profile of, and outcomes for, all people hospitalised with COVID-19 across the first and second waves of the pandemic in England.MethodsThis was an exploratory retrospective analysis of observational data from the Hospital Episode Statistics data set for England. All patients aged ≥18 years in England with a diagnosis of COVID-19 who had a hospital stay that was completed between 1 March 2020 and 31 March 2021 were included. In-hospital mortality was the primary outcome of interest. The second wave was identified as starting on 1 September 2020. Multilevel logistic regression modelling was used to investigate the relationship between mortality and demographic, comorbidity and temporal covariates.ResultsOver the 13 months, 374 244 unique patients had a diagnosis of COVID-19 during a hospital stay, of whom 93 701 (25%) died in hospital. Adjusted mortality rates fell from 40%–50% in March 2020 to 11% in August 2020 before rising to 21% in January 2021 and declining steadily to March 2021. Improvements in mortality rates were less apparent in older and comorbid patients. Although mortality rates fell for all ethnic groups from the first to the second wave, declines were less pronounced for Bangladeshi, Indian, Pakistani, other Asian and black African ethnic groups.ConclusionsThere was a substantial decline in adjusted mortality rates during the early part of the first wave which was largely maintained during the second wave. The underlying reasons for consistently higher mortality risk in some ethnic groups merits further study.

scholarly journals In-Hospital Mortality and Complication Rates According to Health Insurance Data in Patients Undergoing Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Surface Malignancies in Germany

2020 ◽  
Author(s):  
Lisa Überrück ◽  
Giorgi Nadiradze ◽  
Can Yurttas ◽  
Alfred Königsrainer ◽  
Ingmar Königsrainer ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Hospital Stay ◽  
Intraperitoneal Chemotherapy ◽  
Cytoreductive Surgery ◽  
Hyperthermic Intraperitoneal Chemotherapy ◽  
Diagnosis Related Groups ◽  
Mortality Rates ◽  
Complication Rates ◽  
Billing Data ◽  
Health Insurance Data

Abstract Background Morbidity and in-hospital mortality rates of patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in Germany are not known. Methods From 2009 to 2018 all patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in Germany were retrospectively analyzed regarding morbidity and in-hospital mortality rates according to nationwide hospital billing data based on diagnosis-related groups (DRG). The “failure to rescue” (FTR) index, characterizing patients who died after severe but potentially manageable complications, was calculated. Results In total, 8463 patients were included and analyzed. Female sex predominated (1.5:1). Colonic origin of peritoneal metastasis was highest throughout all years, reaching its highest level in 2017 (55%; n = 563) and its lowest level in 2012 (40%; n = 349). Median length of hospital stay reached its maximum in 2017 at 23.9 days and its minimum in 2010 at 22.0 days. Analysis of the total FTR index showed a noticeable improvement over the years, reaching its lowest values in 2017 (9.8%) and 2018 (8.8%). The FTR index for sepsis, peritonitis, and pulmonary complications significantly improved over time. Of the 8463 included patients, 290 died during hospital stay, reflecting an in-hospital mortality rate of 3.4%. Conclusion In-hospital mortality after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy is reasonably low compared with other surgical procedures. The improvement in the FTR index reflects efforts to centralize treatment at specialized high-volume centers.

scholarly journals Frailty, delirium and hospital mortality of older adults admitted to intensive care, a mediation analysis: the Delirium (Deli) in ICU study.

2020 ◽  
Author(s):  
David Sanchez ◽  
Kathleen Brennan ◽  
Masar El Safye ◽  
Sharon-Ann Shunker ◽  
Tony Bogdanoski ◽  
...  
Keyword(s):  
Older Adults ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Hospital Stay ◽  
Mediation Analysis ◽  
Baseline Period ◽  
Acute Episode ◽  
Hospital Death ◽  
Frail Patients ◽  
The Relationship

Abstract Background As the population ages clinical frailty among older adults admitted to intensive care has been proposed as an important determinant of patient outcomes. Among this group of frail patients an acute episode of delirium is also common, and both frailty and delirium increase the risk of mortality. However, the complex relationship between frailty, delirium and mortality has not been extensively explored in the intensive care setting. Therefore, the aim of this study was to explore the relationship between clinical frailty, acute delirium and hospital mortality of older adults admitted to intensive care. Methods This study is part of a Delirium in Intensive Care (Deli) study that is being conducted across the South Western Sydney Local Health District, between May 2019 and April 2020. During the initial 6-month baseline period, clinical frailty status on admission to ICU, among adults aged 50-years or more, acute episodes of delirium, and the outcomes of ICU and hospital stay will be described. Mediation analysis was used to assess the relationship between frailty, delirium and risk of hospital death. Results During the 6-month baseline period 997 patients, aged 50-years or more, were included in this study. The average age was 71-years (IQR, 63–79), 55% were male (n = 537). Among these patients 39.2% (95% CI 36.1–42.3%, n = 396) had a Clinical Frailty Score (CFS) of 5 or more, and 13.0% (n = 127) had at least one acute episode of delirium. Frail patients were at greater risk of an episode of delirium (17% versus 10%, adjusted Rate Ratio (adjRR) = 1.61, 95% Confidence Interval (CI) 1.14–2.28, p = 0.007), had a longer hospital stay (2.6 days, 95% CI 1–7 days, p = 0.009), and higher risk of hospital mortality (19% versus 7%, adjRR = 2.43, 95% CI 1.68–3.57, p < 0.001), when compared to non-frail patients. Patients who were frail and experienced an acute episode of delirium in the ICU had a 35% rate of hospital mortality, versus 10% among non-frail patients who also experienced delirium in the ICU (p = 0.034, for interaction between frailty, delirium and hospital mortality). The proportion of the effect of frailty and risk of hospital mortality mediated by an acute episode of delirium in the ICU was estimated to 9.4% (95% CI 2–24%). Conclusion This study has been able to show that clinical frailty on admission increases the risk of delirium by approximately 60%, and both increase the risk of hospital mortality. One in three frail patients who experienced an acute episode of delirium during their stay in the ICU did not survive to hospital discharge. These results suggest the importance of recognising clinical frailty in the ICU setting, not just to improve the prediction of outcomes from critical illness, but to identify patients at the greatest risk of adverse events such as delirium, and institute measures to reduce risk, and, importantly to discuss these issues in an open and empathetic way with the patient and their families.

Union De-Recognition and Declining Union Density in Britain

ILR Review ◽  
1995 ◽  
Vol 48 (3) ◽  
pp. 389-402 ◽  
Author(s):  
Phillip B. Beaumont ◽  
Richard I. D. Harris
Keyword(s):  
Panel Data ◽  
Industrial Relations ◽  
Union Density ◽  
Company Size ◽  
Organizational Changes ◽  
Data Set ◽  
Union Status ◽  
The Individual ◽  
Substantial Decline ◽  
The Relationship

In Britain, where there are no representation elections and management's recognition of unions is entirely voluntary, a substantial decline in union density since 1979 has been in part attributed to increased instances of union de-recognition by management. This study examines the relationship between union density and union de-recognition at the individual establishment level through an analysis of the panel data set contained in the 1990 national Workplace Industrial Relations Survey. The results indicate that between 1984 and 1990, union recognition was lost in less than 10% of establishments in the sample; changes in union status were closely related to changes in union density; and changes in union density, in turn, resulted from extrinsic and organizational changes, such as increased competition and changes in company size.

scholarly journals COVID-19 in-patient hospital mortality by ethnicity

2020 ◽  
Vol 5 ◽  
pp. 86 ◽  
Author(s):  
Gillian Santorelli ◽  
Trevor Sheldon ◽  
Jane West ◽  
Chris Cartwright ◽  
John Wright
Keyword(s):  
Hospital Mortality ◽  
Ethnic Group ◽  
Ethnic Groups ◽  
South Asian ◽  
Mortality Rates ◽  
Test Results ◽  
Adjusted Risk

There is debate about the extent to which COVID-19 affects ethnic groups differently. We explored if there was variation in hospital mortality in patients with COVID. Mortality rates in 1,276 inpatients in Bradford with test results for COVID-19 were analysed by ethnic group. The age-adjusted risk of dying from COVID-19 was slightly lower in South Asian compared to White British patients. (RR =0.87, 95% CI: 0.41 to 1.84).

STUDY OF CLINICAL PROFILE OF COMMUNITY-ACOUIRED ACUTE KIDNEY INJURY DEFINED USING RIFLE CRITERIA IN IGIMS PATNA

2021 ◽  
pp. 34-36
Author(s):  
Farogh Haidry ◽  
Arshad Ahmad ◽  
Debarshi Jana
Keyword(s):  
Acute Kidney Injury ◽  
Hospital Mortality ◽  
Hospital Stay ◽  
Urine Output ◽  
Kidney Injury ◽  
Mortality Rates ◽  
Class I ◽  
Rifle Criteria ◽  
Classi Cation ◽  
Class F

Aim: To examine the progression between stages of the classication, and to relate this classication to the length of stay and mortality in a large cohort of critically ill patients. Material and methods:A total of 5,383 patients was evaluated. We classied patients according to the maximum RIFLE class (class R, class I or class F) reached during their hospital stay. The RIFLE class was determined based on the worst of either glomerular ltration rate criteria or urine output criteria. We used the change in serum creatinine level and urine output to classify patients according to the RIFLE criteria. Result:Increasing severity of acute kidney injury was associated with an increasing length of ICU stay and hospital stay, and higher mortality. Patients with maximum RIFLE class R, class I and class F had hospital mortality rates of 8.6%, 11.7% and 26.8%, respectively, compared with 5.5% for patients without acute kidney injury. Conclusion:ICU population, newly developed RIFLE classication was associated with increased hospital mortality.

scholarly journals Clipping aneurysms improves outcomes for patients undergoing coiling

2019 ◽  
Vol 130 (5) ◽  
pp. 1491-1497 ◽  
Author(s):  
Ian A. Anderson ◽  
Ahilan Kailaya-Vasan ◽  
Richard J. Nelson ◽  
Christos M. Tolias
Keyword(s):  
Endovascular Procedures ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Statistical Significance ◽  
Mortality Rates ◽  
Endovascular Techniques ◽  
Data Set ◽  
Case Selection ◽  
The One ◽  
The Relationship ◽  
One Way Anova

OBJECTIVEMost intracranial aneurysms are now treated by endovascular rather than by microsurgical procedures. There is evidence to demonstrate superior outcomes for patients with aneurysmal subarachnoid hemorrhage (aSAH) treated by endovascular techniques. However, some cases continue to require microsurgery. The authors have examined the relationship between the number of aneurysms treated by microsurgery and outcome for patients undergoing treatment for aSAH at neurosurgical centers in England.METHODSThe Neurosurgical National Audit Programme (NNAP) database was used to identify aSAH cases and to provide associated 30-day mortality rates for each of the 24 neurosurgical centers in England. Data were compared for association by regression analysis using the Pearson product-moment correlation coefficient and any associations were tested for statistical significance using the one-way ANOVA test. The NNAP data were validated utilizing a second, independent registry: the British Neurovascular Group’s (BNVG) National Subarachnoid Haemorrhage Database.RESULTSIncreasing numbers of microsurgical cases in a center are associated with lower 30-day mortality rates for all patients treated for aSAH, irrespective of treatment modality (Pearson r = 0.42, p = 0.04), and for patients treated for aSAH by endovascular procedures (Pearson r = 0.42, p = 0.04). The correlations are stronger if all (elective and acute) microsurgical cases are compared with outcome. The BNVG data validated the NNAP data set for patients with aSAH.CONCLUSIONSThere is a statistically significant association between local microsurgical activity and center outcomes for patients with aSAH, even for patients treated endovascularly. The authors postulate that the number of microsurgical cases performed may be a surrogate indicator of closer neurosurgical involvement in the overall management of neurovascular patients and of optimal case selection.

scholarly journals Perinatal Mortality in Term and Preterm Twin and Singleton Births

Twin Research ◽  
2002 ◽  
Vol 5 (4) ◽  
pp. 260-264 ◽  
Author(s):  
Jennifer C. Payne ◽  
M. Karen Campbell ◽  
Orlando DaSilva ◽  
John Koval
Keyword(s):  
Perinatal Mortality ◽  
Gestational Age ◽  
Age Distribution ◽  
Mortality Rates ◽  
Large Sample Size ◽  
Data Set ◽  
Perinatal Center ◽  
Mother’S Age ◽  
Definition Of ◽  
The Relationship

AbstractAlthough, in general, twins have higher perinatal mortality rates than singletons, preterm twins have lower perinatal mortality rates than singletons of the same birth weight or gestational age. This study investigated the hypotheses that this paradoxical twin advantage: 1) is due to gestational age distribution differences between the singleton and twin populations, and 2) is due to increased likelihood of birth having occurred in a tertiary perinatal center. A pre-existing, time-limited data set of all births in the province of Ontario in odd years between 1979 and 1985 was chosen for this study because of the large sample size (n = 618,579). Multivariable logistic regression of the relationship between perinatal mortality and twin status was controlled for mother’s age, hospital level and gestational age. Findings confirm the lower mortality of preterm twins. After controlling for level of hospital of birth this difference remained, suggesting that level of hospital of birth was not a major factor responsible for the twin advantage. Analyses in which gestational age was standardized indicate that, for those whose gestational age was less than 2 SD below the mean for their particular group (twin or singleton), twins were actually at higher risk than singletons. These results support hypothesis 1 and do not strongly support hypothesis 2. The results also support earlier authors’ suggestions that the definition of term birth should be different for twins and singletons

scholarly journals COMMUNITY-ACQUIRED PNEUMONIA IN ST. PETERSBURG: MAIN RESULTS AND TRENDS IN 2009-2016

2019 ◽  
Vol 62 (5) ◽  
pp. 228-233
Author(s):  
O. N. Titova ◽  
N. A. Kuzubova ◽  
T. E. Gembitskaya ◽  
M. A. Petrova ◽  
Andrey G. Kozyrev ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Russian Federation ◽  
Medical Records ◽  
Federal District ◽  
Mortality Rates ◽  
Community Acquired Pneumonia ◽  
Prognostic Impact ◽  
Incidence And Mortality ◽  
Epidemiological Characteristics ◽  
The Relationship

The article considers the incidence, mortality and in-hospital mortality rates from community-acquired pneumonia in St. Petersburg, 2009-2016. Epidemiological characteristics were studied in comparison with values in Russian Federation, as well as levels in Moscow and the Northwestern Federal District. The relationship between incidence and mortality rates from community-acquired pneumonia and epidemics of influenza was demonstrated. After the analysis of the medical records of patients who died of community-acquired pneumonia, defects in the organization of medical care, which had a negative prognostic impact, were indicated. A series of measures was proposed to improve the situation with community-acquired pneumonia in St. Petersburg.

scholarly journals Frailty, delirium and hospital mortality of older adults admitted to intensive care: the Delirium (Deli) in ICU study.

2020 ◽  
Author(s):  
David Sanchez ◽  
Kathleen Brennan ◽  
Masar El Safye ◽  
Sharon-Ann Shunker ◽  
Tony Bogdanoski ◽  
...  
Keyword(s):  
Older Adults ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Hospital Stay ◽  
Baseline Period ◽  
Acute Episode ◽  
Hospital Death ◽  
Frail Patients ◽  
Increased Risk ◽  
The Relationship

Abstract Background: As the population ages clinical frailty among older adults admitted to intensive care has been proposed as an important determinant of patient outcomes. Among this group of patients an acute episode of delirium is also common, but its relationship to frailty and increased risk of mortality has not been extensively explored. Therefore, the aim of this study was to explore the relationship between clinical frailty, delirium and hospital mortality of older adults admitted to intensive care.Methods: This study is part of a Delirium in Intensive Care (Deli) study that is being conducted across the SWSLHD between May 1st 2019 and the end of April 2020. During the initial 6-month baseline period, clinical frailty status on admission to intensive care, among adults aged 50-years or more, acute episodes of delirium, and the outcomes of intensive care and hospital stay will be described. Mediation analysis was used to assess the relationship between frailty and increased risk of hospital death and delirium.Results: During the 6-month baseline period 997 patients, aged 50-years or more, were included in this study. The average age was 71-years (IQR, 63-79), 55% were male (n = 537). Among these patients 39.2% (95% CI 36.1 – 42.3%, n = 396) had a Clinical Frailty Score (CFS) of 5 or more, and 13.0% (n=127) had at least one acute episode of delirium. Frail patients were at greater risk of an episode of delirium (17% versus 10%, adjusted Rate Ratio (adjRR) = 1.61, 95% Confidence Interval (CI) 1.14 – 2.28, p = 0.007), had a longer hospital stay (2.6 days, 95% CI 1-7 days, p = 0.009), and higher risk of hospital mortality (19% versus 7%, adjRR = 2.43, 95% CI 1.68 – 3.57, p < 0.001), when compared to non-frail patients. Patients who were frail and experienced an acute episode of delirium in the intensive care had a 35% rate of hospital mortality, versus 10% among non-frail patients who also experienced delirium in the ICU (p = 0.034, for interaction between frailty, delirium and hospital mortality). The proportion of the effect of frailty and risk of hospital mortality mediated by an acute episode of delirium in the ICU was estimated to 9.4% (95% CI 2 – 24%).Conclusion: This study among adults, aged 50-years or more, admitted to intensive care has been able to show that clinical frailty on admission increases the risk of delirium by approximately 60%, and both increase the risk of hospital mortality. One in three frail patients who experienced an acute episode of delirium during their stay in the intensive care did not survive to hospital discharge. These results suggest the importance of recognising clinical frailty in the intensive care setting, not just to improve the prediction of outcomes from critical illness, but to identify patients at the greatest risk of adverse events such as delirium, and institute measures to reduce risk, and, importantly to discuss these issues in an open and empathetic way with the patient and their families.

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