Abstract TP353: Long-term Outcomes in Patients With Intracerebral Hemorrhage and Delayed Hospital Presentation

Background: Delays in medical care are known to be associated with worse outcomes in ischemic stroke, but outcomes in patients with intracerebral hemorrhage (ICH) and delayed presentation are unclear. We aimed to determine factors associated with prolonged delays from ICH symptom onset to hospital presentation and implications for long-term outcomes. Methods: We performed a single-center cohort study using data from consecutive ICH patients over 12 months. ICH characteristics and outcomes were prospectively collected, while time of symptom onset (or last-known-well) and emergency department arrival were retrospectively abstracted. We calculated time-to-arrival and defined prolonged delay as >24 hours. Using multivariable logistic regression, we determined factors associated with prolonged delays to presentation, then determined associations with unfavorable 3-month outcomes (modified Rankin Scale [mRS] 4-6) after adjusting for demographics and ICH severity. Results: Of 299 patients with out-of-hospital ICH, 21% (n=62) presented >24 hours from symptom onset; median time-to-arrival was 5.5 hours (IQR 1.2-17.8). There were not significant differences in age (mean 71.9±14.0 vs. 70.4±16.0, p=0.50), sex (48% vs. 50% male, p=0.80), race (89% vs. 82% white, p=0.22), or ICH size (mean 15.5±23.2 vs. 20.5±27.4cc, p=0.19) between patients presenting >24 hours and <24 hours from symptom onset, though patients with prolonged delays were less likely to have initial GCS <13 (16% vs. 34%, p=0.02) and therefore had modestly lower ICH scores (median 1 [0-2] vs. 1 [1-2], p=0.02). Patients with prolonged delays had lower 3-month mRS scores than patients who presented earlier (median 3 [1.5-4] vs. 4 [3-6], p=0.002), and lower odds of unfavorable 3-month outcome in adjusted models (OR 0.46, 95% CI 0.22-0.97). Conclusions: Outcomes in ICH patients with prolonged delays to presentation differ from those who present earlier. ICH severity in such patients may not be accurately captured by established predictors, and prognostication models should therefore account for inherent survivorship bias.

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Abstract WP302: Transferring Patients with Primary Intracerebral Hemorrhage to Comprehensive Stroke Centers

Stroke ◽

10.1161/str.48.suppl_1.wp302 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Farhaan Vahidy ◽

Liang Zhu ◽

Nancy J Edwards

Keyword(s):

Intracerebral Hemorrhage ◽

Patient Characteristics ◽

Hospital Treatment ◽

Stroke Severity ◽

Long Term Outcomes ◽

Similar Treatment ◽

Euroqol 5D ◽

Transferred Patients

Introduction: The American Heart Association’s updated guidelines for management of patients with primary intracerebral hemorrhage (ICH) recommend monitoring and early care at centers with advanced nursing and neuro-critical care expertise. This entails frequent transfer of ICH patients to certified Comprehensive Stroke Centers (CSC) for higher level of care. We hypothesized that transferred patients (TP) to a CSC will differ from directly admitted patients (DAP) in terms of patient characteristics, treatment factors, and functional and quality of life (QOL) outcomes. Methods: We analyzed data from a prospectively collected ICH registry at our CSC. Patients with traumatic or secondary causes of ICH were excluded. We collected data on demographics, comorbidities, presentation lab values, clinical characteristics, radiological parameters, in-hospital treatment variables, and discharge and long term outcomes. Functional outcomes were captured as modified Rankin Scale (mRS) and EuroQol 5D (EQ-5D) was used to assess QOL indices. Results: Out of a total 192 primary ICH patients, 114 (59.4%) were transferred-in. TP were significantly older, had lower diastolic blood pressure, lower arrival National Institutes of Health Stroke Scale (NIHSS) score, and smaller hematoma volumes as compared to DAP. A higher proportion of TP had a good discharge functional outcome (mRS score 0 - 3) as compared to DAP (29.8% vs. 15.4%, p = 0.02), this trend was also observed for Day-90 mRS (34.2% vs. 24.4%, p = 0.09). TP also reported significantly better QOL indices at Day-90; EQ-5D total median (Q1, Q3) score [10 (6,16) vs. 15 (9.5,18), p = 0.02] and self-reported median (Q1,Q3) score [75 (50,88) vs. 62.5(40,70)], p < 0.01]. Day-90 data are complete for approximately 50% patients. After adjusting for initial stroke severity, the discharge mRS was however not significantly different between TP and DAP. Conclusions: A larger proportion of ICH patients were transferred-in. Our data suggest that TP have lower disease severity, and better discharge and long term outcomes. However, they had similar treatment intensity as DAP at the CSC. We continue to capture day-90, 6 and 12-month functional and QOL data, which will be presented.

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Risk factors associated with long-term outcomes after active and supporting periodontal treatments: impact of various compliance definitions on tooth loss

Clinical Oral Investigations ◽

10.1007/s00784-019-02851-x ◽

2019 ◽

Vol 23 (11) ◽

pp. 4123-4131 ◽

Cited By ~ 2

Author(s):

Catherine Petit ◽

Sylvie Schmeltz ◽

Alexandre Burgy ◽

Henri Tenenbaum ◽

Olivier Huck ◽

...

Keyword(s):

Risk Factors ◽

Tooth Loss ◽

Long Term Outcomes ◽

Factors Associated

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FTY720 attenuates iron deposition and glial responses in improving delayed lesion and long-term outcomes of collagenase-induced intracerebral hemorrhage

Brain Research ◽

10.1016/j.brainres.2019.04.031 ◽

2019 ◽

Vol 1718 ◽

pp. 91-102 ◽

Cited By ~ 4

Author(s):

Zhiyong Yang ◽

Sisi Dong ◽

Qiuyue Zheng ◽

Lingling Zhang ◽

Xinmei Tan ◽

...

Keyword(s):

Intracerebral Hemorrhage ◽

Iron Deposition ◽

Long Term Outcomes

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Is there a measurable association of epidural use at cystectomy and postoperative outcomes? A population-based study

Canadian Urological Association Journal ◽

10.5489/cuaj.3856 ◽

2016 ◽

Vol 10 (9-10) ◽

pp. 321 ◽

Cited By ~ 7

Author(s):

R. Christopher Doiron ◽

Melanie Jaeger ◽

Christopher M. Booth ◽

Xuejiao Wei ◽

D. Robert Siemens

Keyword(s):

Proportional Hazards ◽

Proportional Hazards Model ◽

Multivariable Analysis ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Long Term Outcomes ◽

Cancer Specific Survival ◽

Factors Associated ◽

Provider Volume

Introduction: Thoracic epidural analgesia (TEA) is commonly used to manage postoperative pain and facilitate early mobilization after major intra-abdominal surgery. Evidence also suggests that regional anesthesia/analgesia may be associated with improved survival after cancer surgery. Here, we describe factors associated with TEA at the time of radical cystectomy (RC) for bladder cancer and its association with both short- and long-term outcomes in routine clinical practice.Methods: All patients undergoing RC in the province of Ontario between 2004 and 2008 were identified using the Ontario Cancer Registry (OCR). Modified Poisson regression was used to describe factors associated with epidural use, while a Cox proportional hazards model describes associations between survival and TEA use.Results: Over the five-year study period, 1628 patients were identified as receiving RC, 54% (n=887) of whom received TEA. Greater anesthesiologist volume (lowest volume providers relative risk [RR] 0.85, 95% confidence interval [CI] 0.75‒0.96) and male sex (female sex RR 0.89, 95% CI 0.79‒0.99) were independently associated with greater use of TEA. TEA use was not associated with improved short-term outcomes. In multivariable analysis, TEA was not associated with cancer-specific survival (hazard ratio [HR] 1.02, 95% CI 0.87‒1.19; p=0.804) or overall survival (HR 0.91, 95% CI 0.80‒1.03; p=0.136).Conclusions: In routine clinical practice, 54% of RC patients received TEA and its use was associated with anesthesiologist provider volume. After controlling for patient, disease and provider variables, we were unable to demonstrate any effect on either short- or long-term outcomes at the time of RC.

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Clinical outcomes and Prognostic factors in children with B-Lymphoblastic Lymphoma (pB-LBL) treated on Modified BFM-90 protocol: experience from a tertiary cancer care center in India

10.22541/au.161159447.73724891/v1 ◽

2021 ◽

Author(s):

Kalasekhar Vijayasekharan ◽

Anand KC ◽

Maya Prasad ◽

Chetan Dhamne ◽

Nirmalya Roy Moulik ◽

...

Keyword(s):

Overall Survival ◽

Prognostic Factors ◽

Lymphoblastic Lymphoma ◽

Delayed Presentation ◽

Event Free Survival ◽

Long Term Outcomes ◽

Free Survival ◽

Post Induction ◽

B Lymphoblastic Lymphoma

Background: Pediatric B-Lymphoblastic lymphoma(pB-LBL) is a rare entity, and appropriate treatment for pB-LBL is not well defined. While intensive Acute Lymphoblastic leukemia(ALL) type regimens achieve long term event free survival of 90% across western co-operative group trials, published data from Asian studies on long term outcomes in pB-LBL are scarce. We evaluated the outcomes and prognostic factors of pediatric B-LBL patients treated at our center. Methods: We retrospectively analyzed the data of pediatric B-LBL patients treated between January 2010 and December 2017 on a uniform protocol(modified BFM 90). Patients were evaluated for early response post-induction and monitored for toxicity and long term outcomes. Kaplan-Meier method was used to estimate the event free survival(EFS) and overall survival(OS). Cox regression models were performed to identify prognostic factors. Results: Of 21 patients who received treatment on the modified BFM 90 protocol, 17(81%) were alive in remission, 3(14%) had relapse, and 1(4%) had treatment-related mortality(TRM) while in remission. Two of 3 relapsed patients subsequently expired. With a median follow-up of 66 months(range 6–114), 5-year Event free survival(EFS) and overall survival(OS) were 80%(95% CI:71–89%) and 91% (95% CI:85–97%), respectively. While delayed presentation (≥3 months) had inferior EFS(p-0.030), patients with elevated baseline Lactate Dehydrogenase(LDH) had a worse OS(p-0.037). Age, gender, site of origin, stage, and post-induction response had no bearing on outcome. Conclusions: Outcomes of pB-LBL patients treated on modified BFM 90 protocol are excellent. Higher disease burden manifested by elevated baseline LDH and delayed presentation(≥3 months) portend poorer survival.

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Survival and risk of recurrence of takotsubo syndrome

Heart ◽

10.1136/heartjnl-2020-318028 ◽

2021 ◽

pp. heartjnl-2020-318028

Author(s):

Christopher Lau ◽

Sarah Chiu ◽

Rohith Nayak ◽

Bryan Lin ◽

Ming-Sum Lee

Keyword(s):

Cox Regression ◽

Beta Blockers ◽

Angiotensin Receptor Blockers ◽

Population Based ◽

Takotsubo Syndrome ◽

Long Term Outcomes ◽

Risk Of Recurrence ◽

Factors Associated ◽

A Minor

ObjectiveThe goal of this study is to evaluate the long-term outcomes of patients with takotsubo syndrome and assess factors associated with death or recurrence.MethodsThis is a retrospective population-based cohort study of consecutive patients who presented to an integrated health system in Southern California with takotsubo syndrome between 2006 and 2016. Medical records were manually reviewed to confirm diagnosis and to identify predisposing factors, medication treatment and long-term outcomes. Factors associated with death or recurrent takotsubo syndrome were tested using Cox regression models.ResultsBetween 2006 and 2016, there were 519 patients with a confirmed diagnosis of takotsubo syndrome. Patients were followed for 5.2 years (IQR 3.0–7.2). During the follow-up period, 39 (7.5%) had recurrent takotsubo syndrome and 84 (16.2%) died. In multivariate modelling, factors associated with higher risk of recurrence or death were age (HR 1.56 per 10-year increase, 95% CI 1.29 to 1.87), male sex (HR 2.52, 95% CI 1.38 to 4.60), diabetes (HR 1.6, 95% CI 1.06 to 2.43), pulmonary disease (HR 2.0, 95% CI 1.37 to 2.91) and chronic kidney disease (HR 1.58, 95% CI 1.01 to 2.47). Treatment with beta-blockers were associated with lower risk of recurrence or death (HR 0.46, 95% CI 0.29 to 0.72). No association was observed between treatment with ACE inhibitors or angiotensin-receptor blockers and recurrence or death (HR 0.92, 95% CI 0.59 to 1.42).ConclusionsRecurrent takotsubo syndrome occurred in a minor subset of patients. Treatment with beta-blocker was associated with higher event-free survival.

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T stage and venous invasion are crucial prognostic factors for long-term survival of patients with remnant gastric cancer: a cohort study

World Journal of Surgical Oncology ◽

10.1186/s12957-021-02400-5 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Kentaro Matsuo ◽

Sang-Woong Lee ◽

Ryo Tanaka ◽

Yoshiro Imai ◽

Kotaro Honda ◽

...

Keyword(s):

Gastric Cancer ◽

Survival Rate ◽

Venous Invasion ◽

Long Term Outcomes ◽

Term Survival ◽

Long Term Survival ◽

Factors Associated ◽

T Stage ◽

History Of

Abstract Background The incidence of remnant gastric cancer (RGC) after distal gastrectomy is 1–5%. However, as the survival rate of patients with gastric cancer improves due to early detection and treatment, more patients may develop RGC. There is no consensus on the surgical and postoperative management of RGC, and the clinicopathological characteristics correlated with the long-term outcomes remain unclear. Therefore, we investigated the clinicopathological factors associated with the long-term outcomes of RGC. Methods We included 65 consecutive patients who underwent gastrectomy for RGC from January 2000 to December 2015 at the Osaka Medical and Pharmaceutical University Hospital, Japan. The Kaplan–Meier method was used to create survival curves, and differences in survival were compared between the groups (clinical factors, pathological factors, and surgical factors) using the log-rank test. Multivariate analyses using the Cox proportional hazard model were used to identify factors associated with long-term survival. Results No significant differences were noted in the survival rate based on clinical factors (age, body mass index, diabetes mellitus, hypertension, cardiovascular disease, pulmonary complications, liver disease, diet, history of alcohol drinking, and history of smoking) or the type of remnant gastrectomy. Significant differences were noted in the survival rate based on pathological factors and surgical characteristics (intraoperative blood loss, operation time, and the number of positive lymph nodes). Multivariate analysis revealed that the T stage (hazard ratio, 5.593; 95% confidence interval [CI], 1.183–26.452; p = 0.030) and venous invasion (hazard ratio, 3.351; 95% CI, 1.030–10.903; p = 0.045) were significant independent risk factors for long-term survival in patients who underwent radical resection for RGC. Conclusions T stage and venous invasion are important prognostic factors of long-term survival after remnant gastrectomy for RGC and may be keys to managing and identifying therapeutic strategies for improving prognosis in RGC.

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Arthroscopic Bone Marrow Stimulation for the Treatment of Osteochondral Lesions of the Talus Shows Promising Clinical Outcomes Over 10 Years

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00068 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0006

Author(s):

Jae Han Park ◽

Jin Woo Lee ◽

Kwang Hwan Park ◽

Sang B. Kim ◽

Yoo Jung Park ◽

...

Keyword(s):

Bone Marrow ◽

Clinical Outcomes ◽

Osteochondral Lesions ◽

Line Treatment ◽

Long Term Outcomes ◽

Bone Marrow Stimulation ◽

Factors Associated ◽

Marrow Stimulation

Category: Arthroscopy; Ankle Introduction/Purpose: Arthroscopic bone marrow stimulation (BMS) has been considered as the 1st-line treatment for osteochondral lesions of the talus (OLT) with its simplicity, cost-effectiveness, low complication rate and successful clinical results in numerous studies. However, there were few studies which had investigated long-term clinical outcomes about the arthroscopic BMS. The purpose of this study is to evaluate the long-term outcomes of arthroscopic BMS for OLT and to identify prognostic factors that affect the outcomes. Methods: A retrospective analysis was performed for 202 ankles (189 patients) who underwent arthroscopic BMS as a primary surgery for the OLT between January 2001 and December 2008 with more than 10 years of follow-up. Visual analog scale (VAS) and American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scales, Foot and Ankle Outcome Score (FAOS) were assessed as clinical outcomes and re-operation data were collected. The clinical scores were compared along the stream of time. Kaplan-Meier plot and log rank test showed survival outcomes of OLT in the long-term follow-up. Factors associated with revision surgery were evaluated with multivariate Cox proportional hazard regression model. Results: The VAS scales were improved from 7.11 +- 1.73 (preoperatively) to 1.51 +- 1.61 (3 to 6 years after BMS), and 2.00 +- 1.67 (over 10 years after BMS) (P < 0.001). Also the AOFAS ankle-hindfoot scale were also improved from 58.39 +- 13.7373 (preoperatively) to 85.85 +- 10.31 (3 to 6 years after BMS), and 82.56 +- 11.62 (over 10 years after BMS) (P < 0.001). FAOS at final follow-up was compatible with those of other literatures with short- and mid-term follow-up. Re-operation rate was 5.94 % (12 / 202 ankles). According to multivariate regression analysis, significant factors associated with the revision surgery were large- size (greater than 150mm2) OLT (P = 0.009) and body mass index greater than 25 kg/m2 (P = 0.014). Conclusion:: Arthroscopic bone marrow stimulation is an effective and reliable operative procedure for the primary treatment of osteochondral lesions of the talus with favorable long-term outcomes at a mean follow-up of 13.9 years. Therefore, we recommend this procedure for the 1st-line treatment of the OLT. Success of arthroscopic BMS depends on the size of the OLT and the body mass index of patients.

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