Anaesthetic choice for hip or knee arthroplasty in New Zealand: Risk of postoperative death and variations in use

2021 ◽  
pp. 0310057X2110509
Author(s):  
Jason K Gurney ◽  
Melissa A McLeod ◽  
Douglas Campbell ◽  
Elizabeth Dennett ◽  
Sarah Jackson ◽  
...  
Keyword(s):  
New Zealand ◽  
Hip Replacement ◽  
Regional Anaesthesia ◽  
Postoperative Mortality ◽  
National Study ◽  
Increased Risk ◽  
Large Joint ◽  
The Impact ◽  
Partial Hip Replacement ◽  
Over Time

Anaesthetic choice for large joint surgery can impact postoperative outcomes, including mortality. The extent to which the impact of anaesthetic choice on postoperative mortality varies within patient populations and the extent to which anaesthetic choice is changing over time remain under-explored both internationally and in the diverse New Zealand context. In a national study of 199,211 hip and knee replacement procedures conducted between 2005 and 2017, we compared postoperative mortality among those receiving general, regional or general plus regional anaesthesia. Focusing on unilateral ( n=86,467) and partial ( n=13,889) hip replacements, we assessed whether some groups within the population are more likely to receive general, regional or general plus regional anaesthesia than others, and whether mortality risk varies depending on anaesthetic choice. We also examined temporal changes in anaesthetic choice over time. Those receiving regional alone or general plus regional for unilateral hip replacement appeared at increased risk of 30-day mortality compared to general anaesthesia alone, even after adjusting for differences in terms of age, ethnicity, deprivation, rurality, comorbidity, American Society of Anesthesiologists physical status score and admission type (e.g. general plus regional: adjusted hazard ratio (adj. HR)=1.94, 95% confidence intervals (CI) 1.32 to 2.84). By contrast, we observed lower 30-day mortality among those receiving regional anaesthesia alone compared to general alone for partial hip replacement (adj. HR=0.86, 95% CI 0.75 to 0.97). The latter observation contrasts with declining temporal trends in the use of regional anaesthesia alone for partial hip replacement procedures. However, we recognise that postoperative mortality is one perioperative factor that drives anaesthetic choice.

The Role of Vascular Aging in Atherosclerotic Plaque Development and Vulnerability

2019 ◽  
Vol 25 (29) ◽  
pp. 3098-3111 ◽  
Author(s):  
Luca Liberale ◽  
Giovanni G. Camici
Keyword(s):  
Atherosclerotic Plaque ◽  
Molecular Mechanisms ◽  
Driving Forces ◽  
Plaque Burden ◽  
Vascular Aging ◽  
Age Related ◽  
Plaque Development ◽  
Increased Risk ◽  
The Impact ◽  
Over Time

Background: The ongoing demographical shift is leading to an unprecedented aging of the population. As a consequence, the prevalence of age-related diseases, such as atherosclerosis and its thrombotic complications is set to increase in the near future. Endothelial dysfunction and vascular stiffening characterize arterial aging and set the stage for the development of cardiovascular diseases. Atherosclerotic plaques evolve over time, the extent to which these changes might affect their stability and predispose to sudden complications remains to be determined. Recent advances in imaging technology will allow for longitudinal prospective studies following the progression of plaque burden aimed at better characterizing changes over time associated with plaque stability or rupture. Oxidative stress and inflammation, firmly established driving forces of age-related CV dysfunction, also play an important role in atherosclerotic plaque destabilization and rupture. Several genes involved in lifespan determination are known regulator of redox cellular balance and pre-clinical evidence underlines their pathophysiological roles in age-related cardiovascular dysfunction and atherosclerosis. Objective: The aim of this narrative review is to examine the impact of aging on arterial function and atherosclerotic plaque development. Furthermore, we report how molecular mechanisms of vascular aging might regulate age-related plaque modifications and how this may help to identify novel therapeutic targets to attenuate the increased risk of CV disease in elderly people.

Elevated Hematocrit Concentration and the Risk of Mortality and Vascular Events in Patients Undergoing Major Surgery.

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 2088-2088 ◽  
Author(s):  
Khaled M Musallam ◽  
John B Porter ◽  
Assaad Soweid ◽  
Jamal J Hoballah ◽  
Pierre M Sfeir ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Postoperative Mortality ◽  
Major Surgery ◽  
Vascular Events ◽  
Improvement Program ◽  
Vein Thrombosis ◽  
Increased Risk ◽  
Deep Vein ◽  
The Impact

Abstract Abstract 2088 Background: Preoperative anemia is associated with adverse outcomes after major surgery. This study evaluates the effect of elevated hematocrit concentration on 30-day postoperative mortality and vascular events in patients undergoing major surgery. Methods: We conducted a cohort study using the American College of Surgeons National Surgical Quality Improvement Program database. Thirty-day mortality and vascular events, demographic, and perioperative risk factors were obtained for 197,469 adult patients undergoing major surgery in nonveteran's administration hospitals across the US, Canada, Lebanon, and the UAE during 2008 and 2009. We assessed the adjusted effect of elevated (>0.50) compared to normal preoperative hematocrit concentration (≥0.41–0.50, American Medical Association reference-range) on postoperative outcomes. Separate sex-specific analysis using hematocrit concentration thresholds commonly used in the diagnosis and management of patients with apparent or absolute erythrocytosis was also done. Results: A total of 3,961 patients (2.0%) had elevated hematocrit concentration preoperatively. After adjustment, postoperative mortality at 30 days was higher in patients with elevated hematocrit concentration than in those without (odds ratio [OR]: 2.23, 95% CI: 1.77–2.80). 30-day deep vein thrombosis (OR: 1.95, 95% CI: 1.44–2.64) and pulmonary embolism (OR: 1.79, 95% CI: 1.17–2.73), but not myocardial infarction or cerebrovascular events, were also higher in patients with elevated hematocrit concentration than in those without. Similar evaluation of various clinically relevant hematocrit concentrations revealed the following: an effect on mortality was noted beyond the thresholds of 0.48 in women and 0.52 in men, with the effect estimates becoming considerably high for values >0.54. Values between 0.41–0.45 were not associated with increased odds mortality. Similar observations were noted for deep vein thrombosis, although with higher variation and uncertainty especially in women; while the effects on pulmonary embolism were restricted to men. Conclusion: Elevated hematocrit concentration is associated with an increased risk of 30-day mortality and venous thrombosis following major surgery. Further investigation of the impact of elevated hematocrit concentration and its reduction on surgical outcomes is warranted. Disclosures: No relevant conflicts of interest to declare.

Comorbidities Impact Survival in Multiple Myeloma: Analysis of the Veterans Health Administration National Database

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 760-760
Author(s):  
Tanya Wildes ◽  
Suhong Luo ◽  
Graham A Colditz ◽  
Kenneth R. Carson
Keyword(s):  
Cardiovascular Disease ◽  
Multiple Myeloma ◽  
Renal Impairment ◽  
Proportional Hazards ◽  
First Year ◽  
Risk Of Death ◽  
Increased Risk ◽  
Comorbidity Index ◽  
The Impact ◽  
Over Time

Abstract Abstract 760 Introduction: The incidence of multiple myeloma (MM) increases with age, and the prognosis worsens. Comorbidities increase in prevalence with age, yet little is known about the impact of comorbid medical conditions on outcomes in MM. Methods: In a retrospectively-assembled cohort study, all patients with MM diagnosed between 1998 and 2009 at a Veterans' Administration (VA) hospital were identified in the VA central cancer registry. Patients who received no treatment within 6 months of diagnosis were excluded, eliminating those with smoldering myeloma or who received supportive care only. Comorbidities were ascertained from ICD-9 codes present prior to the diagnosis of MM, and categorized using the Romano adaptation of the Charlson Comorbidity Index (CCI). The independent effects of age, race and comorbidities were examined using Cox proportional hazards modeling. The impact of individual comorbidities on survival was also examined, controlling for age and race. Results: A total of 2,968 patients were identified. The median age was 69 (range 27–92). The vast majority of patients (98%) were male; 28.6% of the patients were black. The median Charlson Comorbidity Index score was 2 (range 0–13). The frequencies of selected comorbidities were: diabetes (31%), renal impairment (23.8%), cardiovascular comorbidities (38.8%) and pulmonary (26.6%). The median overall survival (OS) for the entire cohort was 28.6 months at a median follow up of 26.8 months (range 0–137 months). On multivariate analysis, age was significantly associated with mortality [Hazard Ratio (HR) 1.03 per year (95% confidence intervals (CI) 1.03–1.04), p<0.0001]. Race was not significantly associated with survival [HR 0.99 (95% CI 0.90–1.09), p=0.81]. The median OS, adjusted for age and race, was 36.5 months for patients with no comorbidities, 33.9 months for patients with a CCI score of 1–2, 25.6 months for patients with a CCI score of 3–4 and 20.2 months for patients with a CCI score ≥5. The impact of comorbidities on survival violated the proportional hazards assumption, with a cut-point at 1 year, indicating that the influence of comorbidities varied over time. Relative to those with no comorbidities, the HR for death among those with a CCI score 1–2 was 1.20 (0.97–1.48) in the first year, and 1.03 (95% CI 0.89–1.18) subsequent to the first year; among those with a CCI score 3–4, the HR for death was 1.67 (95% CI 1.34–2.08) in the first year and 1.23 (95% CI 1.05–1.45) subsequently; among those with a CCI score ≥5, the risk of death in the first year doubled [HR 2.15 (95% CI 1.73–2.67)] and was increased 40% subsequently [HR 1.42 (95% CI 1.19–1.69)]. Individual prevalent comorbidities were then examined. Cardiovascular disease, renal impairment, and pulmonary disease were all significantly associated with mortality. In the first year after diagnosis, cardiovascular disease was associated with a 55% increase in mortality [HR 1.55 (95% CI 1.35–1.78)] while, subsequent to the first year, the risk was only increased about 20% [HR 1.19 (95% CI 1.07–1.39)]. The impact of renal impairment and pulmonary impairment did not vary over time; both were associated with a 25% increased risk of death [renal impairment HR 1.26 (95% CI 1.14–1.38); pulmonary disease HR 1.24 (95% CI 1.13–1.37)]. Diabetes was not associated with survival (HR 1.02, p=0.64) after controlling for age, race and cardiovascular, pulmonary or renal impairment. Conclusion: Age and comorbidities are independently associated with increased risk of mortality in MM. The influence of comorbidities varies over time, with the greatest impact noted in the first year after diagnosis of MM among those with a CCI score ≥3 and with cardiovascular disease. Further study is needed to determine whether this increased early mortality is related to increased risk of toxicity of therapy, inadequate MM therapy or both. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Trends in survival from myeloma, 1990–2015: a competing risks analysis

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Mary Jane Sneyd ◽  
Andrew R. Gray ◽  
Ian M. Morison
Keyword(s):  
New Zealand ◽  
Competing Risks ◽  
Proportional Hazards ◽  
Chemotherapeutic Agents ◽  
Mortality Data ◽  
Proportional Hazards Regression ◽  
Competing Risks Analysis ◽  
Increased Risk ◽  
Regional Health Authorities ◽  
Over Time

Abstract Background Myeloma survival has greatly increased over past decades. We investigated trends in survival over time in New Zealand by age, ethnicity, and geography and thus examined potential inequalities among these population subgroups. Methods From data supplied by the New Zealand Ministry of Health, all new diagnoses of multiple myeloma (ICD-10 code C90) between 1990 and 2016 were extracted, as well as their matched mortality data. Cox’s proportional hazards regression and competing risks regression were used to estimate multivariable survival functions. Results Between 1 January 1990 and 1 December 2015, 6642 myeloma cases were registered by the New Zealand Cancer Registry. Although survival from myeloma increased substantially from 1990–1994 to 2010–2015, 5-year survival was still only about 60% in 2010–2015. The greatest improvement in survival was for people aged 60–69 years at diagnosis. Using Cox’s proportional hazards regression, Māori showed an increased risk of myeloma death but this was predominantly due to differences in competing risks among ethnic groups. Competing risks analysis found the greatest improvement in myeloma survival in Pacific Islanders, and in 2010–2015 Māori had better survival than other ethnicities. Myeloma survival improved significantly over time in all regional health authorities but in all time periods the Central and Southern regions had significantly poorer survival than the Midland region. Conclusions Improvements in myeloma survival have been unequal across subgroups and regions in New Zealand. Detailed information about utilization of chemotherapeutic agents and transplantation in New Zealand is not available. This information, as well as more detailed hematological data, is essential to further explore the relationships and reasons for differing myeloma survival in population subgroups of New Zealand.

The impact of national context on future care planning for Korean parents in Korea and in New Zealand caring for their children living with disabilities: A cross-national study

2020 ◽  
pp. 002087282094962
Author(s):  
Clara Choi ◽  
Mike O’Brien
Keyword(s):  
New Zealand ◽  
Planning Process ◽  
National Study ◽  
Care Planning ◽  
Care Provision ◽  
Structured Interviews ◽  
Korean Parents ◽  
Future Care ◽  
Cross National Study ◽  
The Impact

An increasing concern of families caring for children living with disabilities is related to planning for their future care. This qualitative study explores how the country contexts shape the plans for future care provision of Korean parents in New Zealand and Korea. Data were collected using semi-structured interviews with parents ( n = 18) and professionals ( n = 18). The study revealed that there are differences and similarities regarding the social reality of future care planning among Koreans in different national contexts. Recommendations are made In support of future care planning process taking its place as a conventional phase of care provision for people living with disabilities.

scholarly journals Recurrent delirium over 12 months predicts dementia: results of the Delirium and Cognitive Impact in Dementia (DECIDE) study

2020 ◽  
Author(s):  
Sarah J Richardson ◽  
Daniel H J Davis ◽  
Blossom C M Stephan ◽  
Louise Robinson ◽  
Carol Brayne ◽  
...  
Keyword(s):  
Cognitive Function ◽  
Cognitive Decline ◽  
Hospital Admissions ◽  
Outcome Data ◽  
Illness Severity ◽  
Cognitive Outcomes ◽  
Dementia Diagnosis ◽  
Increased Risk ◽  
The Impact ◽  
Over Time

Abstract Background Delirium is common, distressing and associated with poor outcomes. Previous studies investigating the impact of delirium on cognitive outcomes have been limited by incomplete ascertainment of baseline cognition or lack of prospective delirium assessments. This study quantified the association between delirium and cognitive function over time by prospectively ascertaining delirium in a cohort aged ≥ 65 years in whom baseline cognition had previously been established. Methods For 12 months, we assessed participants from the Cognitive Function and Ageing Study II-Newcastle for delirium daily during hospital admissions. At 1-year, we assessed cognitive decline and dementia in those with and without delirium. We evaluated the effect of delirium (including its duration and number of episodes) on cognitive function over time, independently of baseline cognition and illness severity. Results Eighty two of 205 participants recruited developed delirium in hospital (40%). One-year outcome data were available for 173 participants: 18 had a new dementia diagnosis, 38 had died. Delirium was associated with cognitive decline (−1.8 Mini-Mental State Examination points [95% CI –3.5 to –0.2]) and an increased risk of new dementia diagnosis at follow up (OR 8.8 [95% CI 1.9–41.4]). More than one episode and more days with delirium (&gt;5 days) were associated with worse cognitive outcomes. Conclusions Delirium increases risk of future cognitive decline and dementia, independent of illness severity and baseline cognition, with more episodes associated with worse cognitive outcomes. Given that delirium has been shown to be preventable in some cases, we propose that delirium is a potentially modifiable risk factor for dementia.

Abstract 17765: Mild Preoperative Anemia is an Independent Predictor of Mortality and Cardiovascular Events in Patients Undergoing Elective Major Noncardiac Surgery

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Jesús álvarez-García ◽  
Miquel Vives-Borrás ◽  
Joan I Llao ◽  
Andreu Ferrero-Gregori ◽  
Marc Bausili ◽  
...  
Keyword(s):  
Risk Factor ◽  
Cardiovascular Events ◽  
Postoperative Mortality ◽  
Postoperative Outcome ◽  
Primary Outcome Measure ◽  
Noncardiac Surgery ◽  
Concomitant Treatment ◽  
Preoperative Anemia ◽  
Increased Risk ◽  
The Impact

Background: Preoperative anemia has been recognized as an important risk factor for perioperative red blood cell transfusions and adverse events in patients undergoing noncardiac surgery. Mild anemia has not unequivocally shown to be a risk factor for death, unless cardiac disease is present or major blood loss occurs. Objective: To evaluate the prevalence of preoperative anemia and its effect on 30-day postoperative outcome in subjects undergoing elective major noncardiac surgery. Methods: A retrospective cohort study was performed in 1630 patients, 40 years and older, who underwent major noncardiac surgery.Based on preoperative hemoglobin levels and gender, we stratified patients into the next categories of anemia: mild (11-12 g/dl), moderate (10-11 g/dl) and severe (<10 g/dl) for female; mild (12-13 g/dl), moderate (11-12 g/dl) and severe (<11 g/dl) for male. Age, risk factors, previous chronic heart or lung disease, renal function and concomitant treatment were used in a binary logistic regression to determine the impact of anemia in prognosis. The primary outcome measure was a composite of 30-day postoperative mortality or cardiovascular events (cardiac arrest, myocardial infarction, stroke or pulmonary embolism). Results: The overall prevalence of anemia was 18.8%. Thirty-day mortality and cardiac event rate increased with the presence of anemia (table). Mild, moderate and severe anemia were associated with a two-fold (OR 2.07; CI 95%: 1.04-4.11), three-fold (OR 2.93; CI 95%: 1.45-5.94) and four-fold (OR 4.09; CI 95%:1.87-8.95) increases in the risk of MACCE respectively. Conclusions: Anemia is a prevalent risk factor in patients undergoing major noncardiac surgery. Even mild degrees of preoperative anemia are associated with an increased risk of 30-day postoperative mortality and cardiovascular events. Further studies are needed in order to evaluate whether treatment of preoperative anemia could reduce postoperative mortality.

Behavioral Outcomes in Children With an Orofacial Cleft in a National Study in New Zealand

2020 ◽  
pp. 105566562097286
Author(s):  
John M. D. Thompson ◽  
S. Louise Ayrey ◽  
Rebecca F. Slykerman ◽  
Peter R. Stone ◽  
Peter V. Fowler
Keyword(s):  
Quality Of Life ◽  
New Zealand ◽  
Peer Relationships ◽  
Behavioral Problems ◽  
Life Support ◽  
National Study ◽  
Orofacial Cleft ◽  
Prosocial Skills ◽  
Increased Risk

Objective: To determine whether children with an orofacial cleft have higher levels of behavioral problems than the general population and whether this differs by cleft phenotype. Design: A cohort of children with cleft lip and/or palate (CL/P) born in New Zealand from January 1, 2000. Setting: Cleft clinics in New Zealand participating in a larger outcomes study between 2014 and 2017. Participants: Children (N = 378) aged 5 to 12 years of age and their parents. Main Outcomes: The Strengths and Difficulties Questionnaire (SDQ) and Pediatric Quality of Life Inventory (PedsQL) Generic Core Scales 4.0 and Family Impact Module 2.0. Results: Compared to standardized norms, children with a cleft had higher than expected (defined as 20%) levels of abnormal/borderline SDQ scores for conduct problems (27.4%, P = .0003) and peer relationship problems (31.6%, P < .0001) but lower than expected levels of problems with pro-social skills (6.3%, P < .0001). There were no significant differences by age-group and or cleft phenotype other than an increased risk of hyperactivity in children with CP compared to children with CL. Total difficulties SDQ scores had moderate correlations with the PedsQL. Conclusions: While over 90% of children with CL/P had normal prosocial skills, they may not be easily accepted by their peers which may result in behavioral problems. These concerns were moderately related to lower quality of life. Support for establishment and maintenance of peer relationships is important to address externalizing and peer difficulties in children with CL/P. Community knowledge and understanding of CL/P needs to continue to be promoted.

scholarly journals Nutrient Dense, Low-Cost Foods Can Improve the Affordability and Quality of the New Zealand Diet—A Substitution Modeling Study

2021 ◽  
Vol 18 (15) ◽  
pp. 7950
Author(s):  
Carlene S. Starck ◽  
Michelle Blumfield ◽  
Tim Keighley ◽  
Skye Marshall ◽  
Peter Petocz ◽  
...  
Keyword(s):  
New Zealand ◽  
Diet Quality ◽  
Communicable Disease ◽  
Low Cost ◽  
Cost Ratio ◽  
Processing Level ◽  
Nutrient Density ◽  
Increased Risk ◽  
Adults And Children ◽  
The Impact

The high prevalence of non-communicable disease in New Zealand (NZ) is driven in part by unhealthy diet selections, with food costs contributing to an increased risk for vulnerable population groups. This study aimed to: (i) identify the nutrient density-to-cost ratio of NZ foods; (ii) model the impact of substituting foods with a lower nutrient density-to-cost ratio with those with a higher nutrient density-to-cost ratio on diet quality and affordability in representative NZ population samples for low and medium socioeconomic status (SES) households by ethnicity; and (iii) evaluate food processing level. Foods were categorized, coded for processing level and discretionary status, analyzed for nutrient density and cost, and ranked by nutrient density-to-cost ratio. The top quartile of nutrient dense, low-cost foods were 56% unprocessed (vegetables, fruit, porridge, pasta, rice, nuts/seeds), 31% ultra-processed (vegetable dishes, fortified bread, breakfast cereals unfortified <15 g sugars/100 g and fortified 15–30 g sugars/100 g), 6% processed (fruit juice), and 6% culinary processed (oils). Using substitution modeling, diet quality improved by 59% and 71% for adults and children, respectively, and affordability increased by 20–24%, depending on ethnicity and SES. The NZ diet can be made healthier and more affordable when nutritious, low-cost foods are selected. Processing levels in the healthier, modeled diet suggest that some non-discretionary ultra-processed foods may provide a valuable source of low-cost nutrition for food insecure populations.

scholarly journals Association between institutional case volume and mortality following thoracic aorta replacement: A nationwide Korean cohort study

2020 ◽  
Author(s):  
Karam Nam ◽  
Eun Jin Jang ◽  
Jun Woo Jo ◽  
Jae Woong Choi ◽  
Minkyoo Lee ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Thoracic Aorta ◽  
Postoperative Mortality ◽  
Administrative Database ◽  
Case Volume ◽  
Replacement Surgery ◽  
Increased Risk ◽  
Aorta Replacement ◽  
Low Volume ◽  
The Impact

Abstract Background The inverse relationship between case volume and postoperative mortality following high-risk surgical procedures have been reported. Thoracic aorta surgery is associated with one of the highest postoperative mortality. The relationship between institutional case volume and postoperative mortality in patients undergoing thoracic aorta replacement surgery was evaluated. Methods All thoracic aorta replacement surgeries performed in Korea between 2009 and 2016 in adult patients were analyzed using an administrative database. Hospitals were divided into low (<30 cases/year), medium (30–60 cases/year), or high (>60 cases/year) volume centers depending on the annual average number of thoracic aorta replacement surgeries performed. The impact of case volume on in-hospital mortality was assessed using the logistic regression. Results Across 83 hospitals, 4867 cases of thoracic aorta replacement were performed. In-hospital mortality was 8.6% (191/2222), 10.7% (77/717), and 21.9% (422/1928) in high, medium, and low volume centers, respectively. The adjusted risk of in-hospital mortality was significantly higher in medium (odds ratio [OR], 1.56; 95% confidence interval [CI], 1.16–2.11, P = 0.004) and low volume centers (OR, 3.12; 95% CI, 2.54–3.85, P <0.001) compared to high volume centers. Conclusions Patients who had underwent thoracic aorta replacement surgery in lower volume centers had increased risk of in-hospital mortality after surgery compared to those in higher volume centers. Our results may provide the basis for minimum case volume requirement or regionalization in thoracic aorta replacement surgery for optimal patient outcome.

Sign in / Sign up

Export Citation Format

Share Document