Risk Factors for Postoperative Unplanned Intubation: Analysis of a National Database

2015 ◽  
Vol 81 (8) ◽  
pp. 820-825 ◽  
Author(s):  
Martin P. Alvarez ◽  
Andres X. Samayoa-Mendez ◽  
Mary C. Naglak ◽  
James V. Yuschak ◽  
Kenric M. Murayama

Postoperative unplanned intubation (PUI) is a significant complication and is associated with severe adverse events and mortality. By participating in the National Surgical Quality Improvement Program (NSQIP), we learned that PUI occurred more frequently than expected at our institution. The aim of this study was to identify risk factors that are predictors of PUI at our institution. We reviewed the NSQIP data from our institution and the NSQIP national database for surgery patients from 2010 through 2013. The rate of PUI at our institution was 1.54 per cent compared with the national rate of 1.03 per cent. Perioperative risk factors were analyzed by multivariate logistic regression. Analysis of the national NSQIP database identified 14 independent risk factors for PUI. Analysis of the NSQIP data at our institution demonstrated that emergent cases, preoperative ventilator status, smoking, chronic obstructive pulmonary disease, and older age were independent risk factors. In conclusion, patients at our institution with these five risk factors were at higher risk of requiring PUI. These risk factors could be used to help identify patients at high risk and possibly help prevent postoperative respiratory failure and unplanned intubation.

2006 ◽  
Vol 27 (12) ◽  
pp. 1397-1400 ◽  
Author(s):  
M. J. López Gude ◽  
R. San Juan ◽  
J. M. Aguado ◽  
L. Maroto ◽  
F. López-Medrano ◽  
...  

We report results of a case-control study in which we evaluated 41 risk factors potentially associated with the development of post-surgical mediastinitis. There were 163 case patients and 326 control patients. Independent risk factors kept in the final multivariate logistic regression model were obesity (defined as a body mass index of greater than 30), diabetes mellitus, chronic obstructive pulmonary disease, preoperative stay longer than 1 week, pulmonary hypertension, perioperative myocardial infarction, and reoperation.


2006 ◽  
Vol 27 (12) ◽  
pp. 1397-1400 ◽  
Author(s):  
M. J. López Gude ◽  
R. San Juan ◽  
J. M. Aguado ◽  
L. Maroto ◽  
F. López-Medrano ◽  
...  

We report results of a case-control study in which we evaluated 41 risk factors potentially associated with the development of post-surgical mediastinitis. There were 163 case patients and 326 control patients. Independent risk factors kept in the final multivariate logistic regression model were obesity (defined as a body mass index of greater than 30), diabetes mellitus, chronic obstructive pulmonary disease, preoperative stay longer than 1 week, pulmonary hypertension, perioperative myocardial infarction, and reoperation.


2021 ◽  
Vol 12 ◽  
Author(s):  
Manyun Tang ◽  
Yidan Wang ◽  
Mengjie Wang ◽  
Rui Tong ◽  
Tao Shi

Background: Patients with chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSAS) overlap syndrome (OS) are thought to be at increased risk for cardiovascular diseases.Objective: To evaluate the burden of cardiovascular diseases and long-term outcomes in patients with OS.Methods: This was a retrospective cohort study. The prevalence of cardiovascular diseases and 1-year mortality were compared among patients diagnosed with OS (OS group), COPD alone (COPD group) and OSAS alone (OSAS group), and Cox proportional hazards models were used to assess independent risk factors for all-cause mortality.Results: Overall, patients with OS were at higher risk for pulmonary hypertension (PH), heart failure and all-cause mortality than patients with COPD or OSAS (all p < 0.05). In multivariate Cox regression analysis, the Charlson comorbidity index (CCI) score [adjusted hazard ratio (aHR): 1.273 (1.050–1.543); p = 0.014], hypertension [aHR: 2.006 (1.005–4.004); p = 0.048], pulmonary thromboembolism (PTE) [aHR: 4.774 (1.335–17.079); p = 0.016] and heart failure [aHR: 3.067 (1.521–6.185); p = 0.002] were found to be independent risk factors for 1-year all-cause mortality.Conclusion: Patients with OS had an increased risk for cardiovascular diseases and 1-year mortality. More efforts are needed to identify the causal relationship between OS and cardiovascular diseases, promoting risk stratification and the management of these patients.


Life ◽  
2021 ◽  
Vol 11 (10) ◽  
pp. 1030
Author(s):  
Abu Sadat Mohammad Sayeem Bin Shahid ◽  
Tahmina Alam ◽  
Lubaba Shahrin ◽  
K. M. Shahunja ◽  
Md. Tanveer Faruk ◽  
...  

Hospital acquired pneumonia (HAP) is common and often associated with high mortality in children aged five or less. We sought to evaluate the risk factors and outcome of HAP in such children. We compared demographic, clinical, and laboratory characteristics in children <5 years using a case control design during the period of August 2013 and December 2017, where children with HAP were constituted as cases (n = 281) and twice as many randomly selected children without HAP were constituted as controls (n = 562). HAP was defined as a child developing a new episode of pneumonia both clinically and radiologically after at least 48 h of hospitalization. A total of 4101 children were treated during the study period. The mortality was significantly higher among the cases than the controls (8% vs. 4%, p = 0.014). In multivariate logistic regression analysis, after adjusting for potential confounders, it was found that persistent diarrhea (95% CI = 1.32–5.79; p = 0.007), severe acute malnutrition (95% CI = 1.46–3.27; p < 0.001), bacteremia (95% CI = 1.16–3.49; p = 0.013), and prolonged hospitalization of >5 days (95% CI = 3.01–8.02; p < 0.001) were identified as independent risk factors for HAP. Early identification of these risk factors and their prompt management may help to reduce HAP-related fatal consequences, especially in resource limited settings.


2020 ◽  
Author(s):  
Zhongzhong Liu ◽  
Wenjuan Lin ◽  
Qingli Lu ◽  
Jing Wang ◽  
Pei Liu ◽  
...  

Abstract Background: The incidences of stroke recurrence, disability, and all-cause death of patients with minor ischemic stroke (MIS) remain problematic. The aim of the present was to identify risk factors associated with adverse outcomes at 1-year after MIS in the Xi’an region of China. Methods: The cohort of this prospective cohort study included MIS patients aged 18–97 years with a National Institutes of Health Stroke Scale (NIHSS) score of ≤ 3 who were treated in any of four hospitals in Xi’an region of China between January and December 2015. The 1-year percentage of stroke recurrence, disability, and all-cause death were evaluated. Multivariate logistic regression analysis was performed to assess the association between the identified risk factors and clinical outcomes. Results: Among the 1,121 patients included for analysis, the percentage of stroke recurrence, disability, and all-cause death at 1 year after MIS were 3.4% (38/1121), 9.3% (104/1121), and 3.3% (37/1121), respectively. Multivariate logistic regression analysis identified age, current smoking, and pneumonia as independent risk factors for stroke recurrence. Age, pneumonia, and alkaline phosphatase were independent risk factors for all-cause death. Independent risk factors for disability were age, pneumonia, NIHSS score on admission, and leukocyte count. Conclusions: The 1-year outcomes of MIS is not optimistic in the Xi’an region of China, especially high percentage of disability. In this study, we found the risk factors affecting 1-year stroke recurrence, disability and, all-cause death which need further verification in the subsequent studies.


2013 ◽  
Vol 109 (02) ◽  
pp. 207-213 ◽  
Author(s):  
Savino Sciascia ◽  
Veronica Murru ◽  
Cesar Garcia-Fernandez ◽  
Giovanni Sanna ◽  
Munther Khamashta ◽  
...  

SummaryAntibodies to prothrombin in solid phase (aPT) and those to phosphatidiyserine- prothrombin complex (aPS/PT) have been suggested to strongly correlate with the presence of lupus anticoagulant (LA). As their clinical diagnostic value and true relationship with the LA remains elusive, we designed this study to evaluate the prevalence and significance of aPT and aPS/PT in a large cohort of patients with and without LA. Samples from 257 patients were included. aPT and aPS/PT were tested by ELISA. LA was tested as per the current criteria from the ISTH Subcommittee on LA-Phospholipid-dependent antibodies. aPS/PT and aPT were found in 51% and 32% of LA-positive (LA+ve) patients and in 22% and 28% of LA-negative (LA-ve) patients, respectively. Thrombosis, particularly venous thrombosis was associated with IgG aPT in the LA+ve group (p=0.0006) and in the LA-ve group (p=0.017). Antibodies to phosphatidylserine-prothrombin, either IgG and IgM were associated with thrombosis in general (p=0.0003) in particularly with venous thrombosis in the LA+ve group (p<0.0001 for IgG and p=0.025 for IgM; respectively) and the LA-ve group (p=0.028, 0.02 and 0.001, respectively). Further multivariate logistic regression analysis showed that LA and of IgG and/or IgM aPS/PT were independent risk factors for thrombosis and pregnancy loss. In conclusion, aPS/PT, but not aPT, are more frequently found in patients with LA. Their association with thrombosis seems to be independent of the presence of LA.


2022 ◽  
Author(s):  
Chengcheng Sheng ◽  
Zongxu Xu ◽  
Jun Wang

Abstract Background: Acute pancreatitis in pregnancy (APIP) with persistent organ failure (POF) poses a high risk of death for mother and fetus. This study sought to create a nomogram model for early prediction of POF with APIP patients.Methods: We conducted a cross-sectional study on APIP patients with organ failure (OF) between January 2012 and March 2021 in a university hospital. 131 patients were collected. Their clinical courses and pregnancy outcomes were obtained. Risk factors for POF were identified by univariate and multivariate logistic regression analysis. Prediction models with POF were built and nomogram was plotted. The performance of the nomogram was evaluated by using a bootstrapped-concordance index and calibration plots.Results: Hypertriglyceridemia was the most common etiology in this group of APIP patients, which accounted for 50% of transient organ failure (TOF) and 72.3% of POF. All in-hospital maternal death was in the POF group (P<0.05), which also had a significantly higher perinatal mortality rate than the TOF group (P<0.05). Univariate and multivariate logistic regression analysis determined that lactate dehydrogenase, triglycerides, serum creatinine, and procalcitonin were independent risk factors for predicting POF in APIP. A nomogram for POF was created by using the four indicators. The area under the curve was 0.875 (95% confidence interval 0.80–0.95). The nomogram had a bootstrapped-concordance index of 0.85 and was well-calibrated.Conclusions: Hypertriglyceridemia was the leading cause of organ failure-related APIP. Lactate dehydrogenase, triglycerides, serum creatinine, and procalcitonin were the independent risk factors of POF in APIP. Our nomogram model showed an effective prediction of POF with the four indicators in APIP patients.


2020 ◽  
Author(s):  
Zhongzhong Liu ◽  
Wenjuan Lin ◽  
Qingli Lu ◽  
Jing Wang ◽  
Pei Liu ◽  
...  

Abstract Background: The incidences of stroke recurrence, disability, and all-cause mortality of patients with minor ischemic stroke (MIS) remain problematic. The aim of the present was to identify risk factors associated with adverse outcomes at 1-year after MIS in the Xi’an region of China. Methods: The cohort of this prospective cohort study included MIS patients aged 18–97 years with a National Institutes of Health Stroke Scale (NIHSS) score of ≤ 3 who were treated in any of four hospitals in Xi’an region of China between January and December 2015. The 1-year rates of stroke recurrence, disability, and all-cause mortality were evaluated. Multivariate logistic regression analysis was performed to assess the association between the identified risk factors and clinical outcomes. Results: Among the 1,121 patients included for analysis, the rates of stroke recurrence, disability, and all-cause mortality at 1 year after MIS were 3.4% (38/1121), 9.3% (104/1121), and 3.3% (37/1121), respectively. Multivariate logistic regression analysis identified age, current smoking, and pneumonia as independent risk factors for stroke recurrence. Age, pneumonia, and alkaline phosphatase were independent risk factors for all-cause mortality. Independent risk factors for disability were age, pneumonia, NIHSS score on admission, and leukocyte count. Conclusions: The 1-year outcomes of MIS is not optimistic in the Xi’an region of China. Early identification of risk factors for poor clinical outcomes, attention to high risk populations, and targeted interventions contribute to reducing the risk for poor clinical outcomes of patients at 1 year after onset of MIS.


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