Endovascular Aortic Repair in Patients of Advanced Age

2021 ◽  
pp. 152660282110493
Author(s):  
Mitri K. Khoury ◽  
Micah A. Thornton ◽  
Christopher A. Heid ◽  
Jacqueline Babb ◽  
Bala Ramanan ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Survival Benefit ◽  
Elective Surgery ◽  
Endovascular Aneurysm Repair ◽  
The Elderly ◽  
Mortality Rates ◽  
Current Data ◽  
Aortic Aneurysms ◽  
Advanced Age ◽  
The Impact

Purpose: Treatment decisions for the elderly with abdominal aortic aneurysms (AAAs) are challenging. With advancing age, the risk of endovascular aneurysm repair (EVAR) increases while life expectancy decreases, which may nullify the benefit of EVAR. The purpose of this study was to quantify the impact of EVAR on 1-year mortality in patients of advanced age. Materials and Methods: The 2003–2020 Vascular Quality Initiative Database was utilized to identify patients who underwent EVAR for AAAs. Patients were included if they were 80 years of age or older. Exclusions included non-elective surgery or missing aortic diameter data. Predicted 1-year mortality of untreated AAAs was calculated based on a validated comorbidity score that predicts 1-year mortality (Gagne Index, excluding the component associated with AAAs) plus the 1-year aneurysm-related mortality without repair. The primary outcome for the study was 1-year mortality. Results: A total of 11 829 patients met study criteria. The median age was 84 years [81, 86] with 9014 (76.2%) being male. Maximal AAA diameters were apportioned as follows: 39.6% were <5.5 cm, 28.6% were 5.5–5.9 cm, 21.3% were 6.0–6.9 cm, and 10.6% were ≥7.0 cm. The predicted 1-year mortality rate without EVAR was 11.9%, which was significantly higher than the actual 1-year mortality rate with EVAR (8.2%; p<0.001). The overall rate of perioperative MACE was 4.4% (n = 516). Patients with an aneurysm diameter <5.5cm had worse actual 1-year mortality rates with EVAR compared to predicted 1-year mortality rates without EVAR. In contrast, those with larger aneurysms (≥5.5cm) had better actual 1-year mortality rates with EVAR. The benefit from EVAR for those with Gagne Indices 2–5 was largely restricted to those with AAAs ≥ 7.0cm; whereas those with Gagne Indices 0–1 experience a survival benefit for AAAs larger than 5.5 cm. Conclusion: The current data suggest that EVAR decreases 1-year mortality rates for patients of advanced age compared to non-operative management in the elderly. However, the survival benefit is largely limited to those with Gagne Indices 0–1 with AAAs ≥ 5.5 cm and Gagne Indices 2–5 with AAAs ≥ 7.0 cm. Those of advanced age may benefit from EVAR, but realizing this benefit requires careful patient selection.

scholarly journals Proximity to the Treating Centre and Outcomes Following Subarachnoid Hemorrhage

2011 ◽  
Vol 38 (1) ◽  
pp. 36-40 ◽  
Author(s):  
Cian J. O'Kelly ◽  
Julian Spears ◽  
David Urbach ◽  
M. Christopher Wallace
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Survival Benefit ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Mortality Rates ◽  
Limited Resources ◽  
Early Complications ◽  
The Impact ◽  
The Relationship

Abstract:Background:In the management of subarachnoid hemorrhage (SAH), the potential for early complications and the centralization of limited resources often challenge the delivery of timely neurosurgical care. We sought to determine the impact of proximity to the accepting neurosurgical centre on outcomes following aneurysmal SAH.Methods:Using administrative data, we analyzed patients undergoing treatment for aneurysmal subarachnoid hemorrhage at neurosurgical centres in Ontario between 1995 and 2004. We compared mortality for patients receiving treatment at a centre in their county (in-county) versus those treated from outside counties (out-of-county). We also examined the impact of distance from the patient's residence to the treating centre.Results:The mortality rates were significantly lower for in-county versus out-of-county patients (23.5% vs. 27.6%, p=0.009). This advantage remained significant after adjusting for potential confounders (HR=0.84, p=0.01). The relationship between distance from the treating centre and mortality was biphasic. Under 300km, mortality increased with increasing distance. Over 300km, a survival benefit was observed.Conclusions:Proximity to the treating neurosurgical centre impacts survival after aneurysmal SAH. These results have significant implications for the triage of these critically ill patients.

Withdrawal of Care in a Trauma Intensive Care Unit: The Impact on Mortality Rate

2014 ◽  
Vol 80 (8) ◽  
pp. 764-767 ◽  
Author(s):  
Leonard J. Weireter ◽  
Jay N. Collins ◽  
Rebecca C. Britt ◽  
T. J. Novosel ◽  
L. D. Britt
Keyword(s):  
Intensive Care Unit ◽  
Decision Making ◽  
Mortality Rate ◽  
Trauma Center ◽  
Mortality Rates ◽  
Active Aging ◽  
Neurologic Injury ◽  
Trauma Service ◽  
The Impact ◽  
Overall Mortality

Withdrawal of care has increased in recent years as the population older than 65 years of age has increased. We sought to investigate the impact of this decision on our mortality rate. We retrospectively reviewed a prospectively collected database to determine the percentage of cases in which care was actively withdrawn. Neurologic injury as the cause for withdrawal, age of the patient, number of days to death, number of cases thought to be treatment failures, and the reason for failure were analyzed. Between January 2008 and December 2012, there were 536 trauma service deaths; 158 (29.5%) had care withdrawn. These patients were 67 (6 18.5) years old and neurologic injury was responsible in 63 per cent (6 5.29%). Fifty-two per cent of the patients died by Day 3; 65 per cent by Day 5; and 74 per cent Day 7. A total of 22.7 per cent (6 7.9%) could be considered a treatment failure. Accounting for cases in which care was withdrawn for futility would decrease the overall mortality rate by approximately 23 per cent. Trauma center mortality calculation does not account for care withdrawn. Treating an active, aging population, with advance directives, requires methodologies that account for such decision-making when determining mortality rates.

scholarly journals Glioblastoma in the Elderly: The Impact of Advanced Age on Treatment and Survival

2014 ◽  
Vol 75 (04) ◽  
pp. 276-281 ◽  
Author(s):  
Carmela Peca ◽  
Marialaura De Caro ◽  
Arcangelo Giamundo ◽  
Renato Donzelli ◽  
Francesco Maiuri ◽  
...  
Keyword(s):  
The Elderly ◽  
Advanced Age ◽  
The Impact

The role of surgical resection for hepatocellular carcinoma in octogenarians: A population-based analysis.

2014 ◽  
Vol 32 (3_suppl) ◽  
pp. 202-202
Author(s):  
Takintope Akinbiyi ◽  
Atuhani S. Burnett ◽  
Philip Ernst ◽  
Marisa Cevasco ◽  
Donald A. McCain ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Surgical Resection ◽  
Survival Benefit ◽  
The Elderly ◽  
Population Based ◽  
Seer Database ◽  
Significant Difference ◽  
Disease Stages ◽  
The Impact

202 Background: Hepatocellular carcinoma (HCC) is a significant source of morbidity and mortality amongst the elderly population. In appropriately selected patients, surgery is known to confer a survival advantage. Octagenarians, however, given their remaining life expectancy may receive limited benefit from surgery. Nevertheless, insufficient information is available in the literature on the survival benefit of surgery in octagenarians with HCC. Methods: Octogenarians with HCC were selected from the Surveillance, Epidemiology, and End Results (SEER) database between 1998 and 2009. We evaluated patients who underwent surgical resection and those that declined to assess the impact surgery has on overall survival in this population. Results: A total of 8,614 with HCC were identified in the SEER database, of which surgery was recommended for 3,529 (41%). A total of 1,002 patients (28%) underwent surgery and 2,497 (71%) declined. Although there was a trend towards improved survival in the surgery group (7.91 months) vs the non-surgical group (7.03 months), there was no statistically significant difference in survival between the two groups (p = 0.09). Conclusions: Our study demonstrates that octagenarians as a whole do not experience a survival benefit from surgical resection for HCC. Subgroup analysis, however, may ultimately identify benefit in specific disease stages or patients with fewer comorbidities.

scholarly journals COVID-19 mortality across selected states in India: the role of age structure.

2021 ◽  
Author(s):  
Mohamed Jainul Azarudeen ◽  
Tanzin Dikid ◽  
Karishma Kurup ◽  
Khyati Aroskar ◽  
Himanshu Chauhan ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Age Structure ◽  
Disease Surveillance ◽  
Economic Status ◽  
Age Groups ◽  
The Elderly ◽  
Mortality Rates ◽  
Health System Intervention ◽  
Indirect Standardization ◽  
Standardized Mortality Rate

Background Mortality rates provide an opportunity to identify and act on the health system intervention for preventing deaths. Hence, it is essential to appreciate the influence of age structure while reporting mortality for a better summary of the magnitude of the epidemic. Objectives We described and compared the pattern of COVID-19 mortality standardized by age between selected states and India from January to November 2020. Methods We initially estimated the Indian population for 2020 using the decadal growth rate from the previous census (2011). This was followed by estimations of crude and age-adjusted mortality rate per million for India and the selected states. We used this information to perform indirect standardization and derive the age-standardized mortality rates for the states for comparison. In addition, we derived a ratio for age-standardized mortality to compare across age groups within the state. We extracted information regarding COVID-19 deaths from the Integrated Disease Surveillance Programme special surveillance portal up to November 16, 2020. Results The crude mortality rate of India stands at 88.9 per million population(118,883/1,337,328,910). Age-adjusted mortality rate (per million) was highest for Delhi (300.5) and lowest for Kerala (35.9).The age-standardized mortality rate (per million) for India is (<15 years=1.6, 15-29 years=6.3, 30-44 years=35.9, 45-59 years=198.8, 60-74 years=571.2, & ≥75 years=931.6). The ratios for age-standardized mortality increase proportionately from 45-59 years age group across all the states. Conclusion There is high COVID-19 mortality not only among the elderly ages, but we also identified heavy impact of COVID-19 on the working population. Therefore, we recommend further evaluation of age-adjusted mortality for all States and inclusion of variables like gender, socio-economic status for standardization while identifying at-risk populations and implementing priority public health actions. Keywords COVID-19, Mortality, Age Standardized Mortality Rate, Indirect Standardization.

scholarly journals Disability and the risk of subsequent mortality in elderly: a 12-year longitudinal population-based study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yang Yang ◽  
Zhaohui Du ◽  
Yafei Liu ◽  
Jiahui Lao ◽  
Xiaoru Sun ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Proportional Hazards ◽  
Survey Design ◽  
Age Groups ◽  
The Elderly ◽  
Cox Proportional Hazards ◽  
Cumulative Mortality ◽  
Hazard Ratios ◽  
The Impact ◽  
Young Old

Abstract Background Assessment the impact of disability on mortality among the elderly is vital to healthy ageing. The present study aimed to assess the long-term influence of disability on death in the elderly based on a longitudinal study. Method This study used the Chinese Longitudinal Healthy Longevity Study (CLHLS) data from 2002 to 2014, including 13,666 participants aged 65 years and older in analyses. The Katz ADL index was used to assess disability status and levels. Cumulative mortality rates were estimated by the Kaplan-Meier method. Cox proportional hazards models were conducted to estimate associations between disability and all-cause mortality for overall participants, two age groups as well as specific chronic disease groups. All reported results were adjusted by survey weights to account for the complex survey design. Results During the 12-year follow-up, the death density was 6.01 per 100 person-years. The 3-years’ cumulative mortality rate of nondisabled elderly was 11.9% (95%CI: 10.9, 12.9%). As the level of disability increased, the cumulative mortality rate was from 28.1% (95%CI: 23.0, 33.1%) to 77.6% (95%CI: 63.8, 91.4%). Compared with non-disabled elderly, the multiple-adjusted hazard ratio of death due to disability was 1.68 (95% CI: 1.48, 1.90). The hazard ratios varied from 1.44 (95%CI: 1.23, 1.67) to 4.45 (95%CI: 2.69, 7.38) after classifying the disability levels. The hazard ratios of death in the young-old group (65–79 years) were higher than the old-old group (80 years and over) in both level B (HR = 1.58, 95%CI: 1.25, 2.00 vs. HR = 1.22, 95%CI: 1.06, 1.39, P = 0.029) and level G (HR = 24.09, 95%CI: 10.83, 53.60 vs. HR = 2.56, 95%CI: 1.75, 3.74, P < 0.001). For patients with hypertension, diabetes, heart disease, cerebrovascular disease as well as dementia, disability increases their relative risk of mortality by 1.64 (95%CI: 1.40, 1.93), 2.85 (95%CI: 1.46, 5.58), 1.45 (95%CI: 1.02, 2.05), 2.13 (95%CI: 1.54, 2.93) and 3.56 (95%CI: 1.22, 10.38) times, respectively. Conclusions Disability increases the risk of all-cause death in the elderly, especially those with chronic diseases and the young-old group. Further studies are needed to better understand how to effectively prevent disability in the older population.

scholarly journals A Comprehensive Analysis of COVID-19 Transmission and Fatality Rates at the County level in the United States considering Socio-Demographics, Health Indicators, Mobility Trends and Health Care Infrastructure Attributes

2020 ◽  
Author(s):  
Tanmoy Bhowmik ◽  
Sudipta Dey Tirtha ◽  
Naveen Chandra Iraganaboina ◽  
Naveen Eluru
Keyword(s):  
Health Care ◽  
Mortality Rate ◽  
Health Indicators ◽  
Mortality Rates ◽  
County Level ◽  
Model Framework ◽  
Transmission Rates ◽  
Health Care Infrastructure ◽  
The Impact ◽  
At Home

Background: Several research efforts have evaluated the impact of various factors including a) socio-demographics, (b) health indicators, (c) mobility trends, and (d) health care infrastructure attributes on COVID-19 transmission and mortality rate. However, earlier research focused only on a subset of variable groups (predominantly one or two) that can contribute to the COVID-19 transmission/mortality rate. The current study effort is designed to remedy this by analyzing COVID-19 transmission/mortality rates considering a comprehensive set of factors in a unified framework. Method: We study two per capita dependent variables: (1) daily COVID-19 transmission rates and (2) total COVID-19 mortality rates. The first variable is modeled using a linear mixed model while the later dimension is analyzed using a linear regression approach. The model results are augmented with a sensitivity analysis to predict the impact of mobility restrictions at a county level. Findings: Several county level factors including proportion of African-Americans, income inequality, health indicators associated with Asthma, Cancer, HIV and heart disease, percentage of stay at home individuals, testing infrastructure and Intensive Care Unit capacity impact transmission and/or mortality rates. From the policy analysis, we find that enforcing a stay at home order that can ensure a 50% stay at home rate can result in a potential reduction of about 30% in daily cases. Interpretation: The model framework developed can be employed by government agencies to evaluate the influence of reduced mobility on transmission rates at a county level while accommodating for various county specific factors. Based on our policy analysis, the study findings support a county level stay at home order for regions currently experiencing a surge in transmission. The model framework can also be employed to identify vulnerable counties that need to be prioritized based on health indicators for current support and/or preferential vaccination plans (when available). Funding: None.

scholarly journals Impact of federal transfers upon US infant mortality rates: a secondary analysis using a fixed effects regression approach

BMJ Open ◽  
2018 ◽  
Vol 8 (9) ◽  
pp. e021533
Author(s):  
Michael McLaughlin ◽  
Mark R Rank
Keyword(s):  
Mortality Rate ◽  
Infant Mortality ◽  
Fixed Effects ◽  
State Level ◽  
Well Being ◽  
Mortality Rates ◽  
Postneonatal Mortality ◽  
Per Capita ◽  
Fixed Effects Regression ◽  
The Impact

ObjectivesIn order to improve health outcomes, the federal government allocates hundreds of billions of annual dollars to individual states in order to further the well-being of its citizens. This study examines the impact of such federal intergovernmental transfers on reducing state-level infant mortality rates.SettingAnnual data are collected from all 50 US states between 2004 and 2013.ParticipantsEntire US population under the age of 1 year between 2004 and 2013.Primary and secondary outcome measuresState-level infant mortality rate, neonatal mortality rate and postneonatal mortality rate.ResultsUsing a fixed effects regression model to control for unmeasurable differences between states, the impact of federal transfers on state-level infant mortality rates is estimated. After controlling for differences across states, increases in per capita federal transfers are significantly associated with lower infant, neonatal and postneonatal mortality rates. Holding all other variables constant, a $200 increase in the amount of federal transfers per capita would save one child’s life for every 10 000 live births.ConclusionsConsiderable debate exists regarding the role of federal transfers in improving the well-being of children and families. These findings indicate that increases in federal transfers are strongly associated with reductions in infant mortality rates. Such benefits should be carefully considered when state officials are deciding whether to accept or reject federal funds.

The Impact of BMI on Adult Blunt Trauma Outcomes

2019 ◽  
Vol 85 (12) ◽  
pp. 1354-1362
Author(s):  
Rahman Barry ◽  
Milad Modarresi ◽  
Rodrigo Aguilar ◽  
Jacqueline Sanabria ◽  
Thao Wolbert ◽  
...  
Keyword(s):  
United States ◽  
Mortality Rate ◽  
Length Of Stay ◽  
Blunt Trauma ◽  
Nationwide Inpatient Sample ◽  
The United States ◽  
Mortality Rates ◽  
Hospital Length Of Stay ◽  
Obese Patients ◽  
The Impact

Traumatic injuries account for 10% of all mortalities in the United States. Globally, it is estimated that by the year 2030, 2.2 billion people will be overweight (BMI ≥ 25) and 1.1 billion people will be obese (BMI ≥ 30). Obesity is a known risk factor for suboptimal outcomes in trauma; however, the extent of this impact after blunt trauma remains to be determined. The incidence, prevalence, and mortality rates from blunt trauma by age, gender, cause, BMI, year, and geography were abstracted using datasets from 1) the Global Burden of Disease group 2) the United States Nationwide Inpatient Sample databank 3) two regional Level II trauma centers. Statistical analyses, correlations, and comparisons were made on a global, national, and state level using these databases to determine the impact of BMI on blunt trauma. The incidence of blunt trauma secondary to falls increased at global, national, and state levels during our study period from 1990 to 2015, with a corresponding increase in BMI at all levels ( P < 0.05). Mortality due to fall injuries was higher in obese patients at all levels ( P < 0.05). Analysis from Nationwide Inpatient Sample database demonstrated higher mortality rates for obese patients nationally, both after motor vehicle collisions and mechanical falls ( P < 0.05). In obese and nonobese patients, regional data demonstrated a higher blunt trauma mortality rate of 2.4% versus 1.2%, respectively ( P < 0.05) and a longer hospital length of stay of 4.13 versus 3.26 days, respectively ( P = 0.018). The obesity rate and incidence of blunt trauma secondary to falls are increasing, with a higher mortality rate and longer length of stay in obese blunt trauma patients.

Sign in / Sign up

Export Citation Format

Share Document