scholarly journals Early Failures After Lumbar Discectomy Surgery: An Analysis of 62 690 Patients

2020 ◽  
pp. 219256822093540
Author(s):  
Andre M. Samuel ◽  
Kyle Morse ◽  
Francis Lovecchio ◽  
Noor Maza ◽  
Avani S. Vaishnav ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Lumbar Fusion ◽  
Lumbar Discectomy ◽  
Neurological Symptoms ◽  
Improvement Program ◽  
Increased Risk ◽  
Early Failures

Study Design: Retrospective cohort study. Objective: To determine the rate of early failures (readmission or reoperation for new or recurrent pain/neurological symptoms) within 30 days after lumbar discectomy and identify associated risk factors. Methods: A retrospective cohort study was conducted of patients undergoing lumbar discectomy in the National Surgical Quality Improvement Program database between 2013 and 2017. Rates of readmission for new or recurrent symptoms or reoperation for revision discectomy or fusion within 30 days postoperatively were measured and correlated with risk factors. Results: In total 62 690 patients were identified; overall rate of readmission within 30 days was 3.3%, including 1.2% for pain or neurological symptoms. Populations at increased risk of readmission were those with 3 or more levels of treatment (2.0%, odds ratio [OR] 2.8%, P < .01), age >70 years (1.8%, OR 1.6, P < .01), class 3 obesity (1.5%, OR 1.4, P = .04), and female gender (1.4%, OR 1.2, P = .02). The overall rate of reoperation within 30 days was 2.2%, including 1.2% for revision decompression or lumbar fusion surgery. Populations at increased risk of reoperation were revision discectomies (1.4%, OR 1.7, P < .01) and females (1.1%, OR 1.4, P < 0.01). Extraforaminal discectomies were associated with lower rates of readmission (0.7%, OR 0.6, P = 0.02) and reoperation (0.4%, OR 0.4, P = .01). Conclusions: Early failures after lumbar discectomy surgery are rare. However, certain subpopulations are associated with increased rates of early failure: obesity, multilevel surgery, females, and revision discectomies.

scholarly journals Proton pump inhibitors versus histamine-2 receptor blockers for stress ulcer prophylaxis in patients with sepsis: a retrospective cohort study

2021 ◽  
Vol 49 (6) ◽  
pp. 030006052110251
Author(s):  
Minqiang Huang ◽  
Ming Han ◽  
Wei Han ◽  
Lei Kuang
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Hospital Mortality ◽  
Critically Ill ◽  
Proton Pump ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Stress Ulcer ◽  
Increased Risk ◽  
Ulcer Prophylaxis

Objective We aimed to compare the efficacy and risks of proton pump inhibitor (PPI) versus histamine-2 receptor blocker (H2B) use for stress ulcer prophylaxis (SUP) in critically ill patients with sepsis and risk factors for gastrointestinal bleeding (GIB). Methods In this retrospective cohort study, we used the Medical Information Mart for Intensive Care III Clinical Database to identify critically ill adult patients with sepsis who had at least one risk factor for GIB and received either an H2B or PPI for ≥48 hours. Propensity score matching (PSM) was conducted to balance baseline characteristics. The primary outcome was in-hospital mortality. Results After 1:1 PSM, 1056 patients were included in the H2B and PPI groups. The PPI group had higher in-hospital mortality (23.8% vs. 17.5%), GIB (8.9% vs. 1.6%), and pneumonia (49.6% vs. 41.6%) rates than the H2B group. After adjusting for risk factors of GIB and pneumonia, PPI use was associated with a 1.28-times increased risk of in-hospital mortality, 5.89-times increased risk of GIB, and 1.32-times increased risk of pneumonia. Conclusions Among critically ill adult patients with sepsis at risk for GIB, SUP with PPIs was associated with higher in-hospital mortality and higher risk of GIB and pneumonia than H2Bs.

scholarly journals Parvovirus Enteritis and Other Risk Factors Associated With Persistent Gastrointestinal Signs in Dogs Later in Life: a Retrospective Cohort Study

2021 ◽  
Author(s):  
Kanae Takada ◽  
Anne M. Flemming ◽  
Maarten J. Voordouw ◽  
Anthony P. Carr
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Health Problems ◽  
Organ Systems ◽  
Increased Risk

Abstract Background: Parvoviral enteritis is a viral gastrointestinal (GI) infection of dogs. Recovery from PE has been associated with persistent GI signs. The objectives of this study were: (i) To determine whether dogs that have recovered from PE (post-parvo dogs) had an increased risk of persistent GI signs compared to uninfected controls. (ii) To investigate the lifestyle and clinicopathologic factors that are associated with persistent GI signs in post-parvo dogs. Methods: Eighty-six post-parvo dogs and 52 age-matched control dogs were enrolled in this retrospective cohort study. The owners were interviewed about the health and habits of their dogs using a questionnaire. We used logistic regression to test whether parvovirus enteritis and other risk factors are associated with general health problems in all dogs and with persistent GI signs in post-parvo dogs.Results: The prevalence of persistent GI signs was significantly higher in post-parvo dogs compared to control dogs (57% vs 25%, P < 0.001). Markers of disease severity such as neutropenia, low body temperature, and treatment with an antiemetic medication (metoclopramide) were significant risk factors for persistent GI signs in post-parvo dogs. Persistent GI signs in post-parvo dogs was a risk factor for health problems in other organ systems.Conclusions: Parvovirus enteritis is a significant risk factor for persistent GI signs in dogs highlighting the importance of prevention. The risk factors identified in the present study may guide future investigations on the mechanisms that link parvovirus enteritis to chronic health problems in dogs.

scholarly journals Association of Rosacea With Cardiovascular Disease: A Retrospective Cohort Study

2021 ◽  
Author(s):  
Daein Choi ◽  
Sungjun Choi ◽  
Seulggie Choi ◽  
Sang Min Park ◽  
Hyun‐Sun Yoon
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Coronary Heart Disease ◽  
Cohort Study ◽  
Heart Disease ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Cox Regression ◽  
Hazard Ratios ◽  
Increased Risk

Background There is emerging evidence that rosacea, a chronic cutaneous inflammatory disease, is associated with various systemic diseases. However, its association with cardiovascular disease (CVD) remains controversial. We aimed to investigate whether patients with rosacea are at increased risk of developing CVD. Methods and Results This retrospective cohort study from the Korean National Health Insurance Service‐Health Screening Cohort included patients with newly diagnosed rosacea (n=2681) and age‐, sex‐, and index year–matched reference populations without rosacea (n=26 810) between 2003 and 2014. The primary outcome was subsequent CVD including coronary heart disease and stroke. Multivariable Cox regression analyses were used to evaluate adjusted hazard ratios for subsequent CVD adjusted for major risk factors of CVD. Compared with the reference population (13 410 women; mean [SD] age, 57.7 [9.2] years), patients with rosacea (1341 women; mean [SD] age, 57.7 [9.2] years) displayed an increased risk for CVD (adjusted hazard ratios, 1.20; 95% CI, 1.03–1.40) and coronary heart disease (adjusted hazard ratios, 1.29; 95% CI, 1.05–1.60). The risk for stroke was not significantly elevated (adjusted hazard ratios, 1.12; 95% CI, 0.91–1.37). Conclusions This study suggests that patients with rosacea are more likely to develop subsequent CVD. Proper education for patients with rosacea to manage other modifiable risk factors of CVD along with rosacea is needed.

scholarly journals Associations Between Malignancy and Cardiovascular Complications Following Emergency Laparotomy – a Retrospective Cohort Study

2020 ◽  
Author(s):  
Rasmus Peuliche Vogelsang ◽  
Jacob Hartmann Søby ◽  
Mai-Britt Tolstrup ◽  
Jakob Burcharth ◽  
Sarah Ekeløf ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Malignant Disease ◽  
Multivariate Logistic Regression Analysis ◽  
Cardiovascular Complications ◽  
Emergency Laparotomy ◽  
Asa Score ◽  
Increased Risk

Abstract Background Several studies have shown a possible causal relationship between the occurrence of systemic inflammation in patients with malignant disease and increased risk of cardiovascular events. Our objective was to estimate the association between malignant disease and postoperative cardiovascular complications. Secondarily, we aimed to identify risk factors for postoperative cardiovascular complications. Methods We conducted a retrospective cohort study of all patients ≥ 18 years undergoing emergency laparotomy between 2010 and 2016 at the Department of Surgery at Zealand University Hospital, Denmark. Complications were graded according to the Clavien-Dindo (CD) classification of surgical complications. A multivariate logistic regression analysis was performed to estimate the association between malignant disease and cardiovascular complications within 30 days of emergency laparotomy and to identify other risk factors for postoperative cardiovascular complications after emergency laparotomy. Results We identified 1188 patients ≥ 18 years undergoing emergency laparotomy between 2010 and 2016, in which 254 (21%) had malignant disease. Within 30 days of emergency laparotomy, 89 (9.5%) of patients without malignancy died, as compared with 45 (18%) of patients with malignancy (p < 0.001). Severe cardiovascular complication graded CD 3–5 occurred in 93 (8%) of all patients within 30 days of emergency laparotomy. We found no association between malignancy and postoperative cardiovascular complications. Increasing age and ASA physical status classification system (ASA) score ≥ III were the only independent risk factors of cardiovascular complications graded CD 3–5. Conclusions Malignancy was not associated with postoperative cardiovascular complications after emergency laparotomy. Risk factors for major cardiovascular complications after emergency abdominal surgery were age and ASA score ≥ III.

scholarly journals Risk factors for death among children aged 5–14 years hospitalised with pneumonia: a retrospective cohort study in Kenya

2019 ◽  
Vol 4 (5) ◽  
pp. e001715 ◽  
Author(s):  
Liana Macpherson ◽  
Morris Ogero ◽  
Samuel Akech ◽  
Jalemba Aluvaala ◽  
David Gathara ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Clinical Characteristics ◽  
Univariate Analysis ◽  
Older Age ◽  
Who Criteria ◽  
Risk Of Death ◽  
Increased Risk

IntroductionThere were almost 1 million deaths in children aged between 5 and 14 years in 2017, and pneumonia accounted for 11%. However, there are no validated guidelines for pneumonia management in older children and data to support their development are limited. We sought to understand risk factors for mortality among children aged 5–14 years hospitalised with pneumonia in district-level health facilities in Kenya.MethodsWe did a retrospective cohort study using data collected from an established clinical information network of 13 hospitals. We reviewed records for children aged 5–14 years admitted with pneumonia between 1 March 2014 and 28 February 2018. Individual clinical signs were examined for association with inpatient mortality using logistic regression. We used existing WHO criteria (intended for under 5s) to define levels of severity and examined their performance in identifying those at increased risk of death.Results1832 children were diagnosed with pneumonia and 145 (7.9%) died. Severe pallor was strongly associated with mortality (adjusted OR (aOR) 8.06, 95% CI 4.72 to 13.75) as were reduced consciousness, mild/moderate pallor, central cyanosis and older age (>9 years) (aOR >2). Comorbidities HIV and severe acute malnutrition were also associated with death (aOR 2.31, 95% CI 1.39 to 3.84 and aOR 1.89, 95% CI 1.12 to 3.21, respectively). The presence of clinical characteristics used by WHO to define severe pneumonia was associated with death in univariate analysis (OR 2.69). However, this combination of clinical characteristics was poor in discriminating those at risk of death (sensitivity: 0.56, specificity: 0.68, and area under the curve: 0.62).ConclusionChildren >5 years have high inpatient pneumonia mortality. These findings also suggest that the WHO criteria for classification of severity for children under 5 years do not appear to be a valid tool for risk assessment in this older age group, indicating the urgent need for evidence-based clinical guidelines for this neglected population.

Risk factors of venous thromboembolism in patients with nephrotic syndrome: a retrospective cohort study

2020 ◽  
Author(s):  
Kanna Shinkawa ◽  
Satomi Yoshida ◽  
Tomotsugu Seki ◽  
Motoko Yanagita ◽  
Koji Kawakami
Keyword(s):  
Risk Factors ◽  
Nephrotic Syndrome ◽  
Cohort Study ◽  
Venous Thromboembolism ◽  
Lupus Nephritis ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Vein Thrombosis ◽  
Female Sex ◽  
Increased Risk

Abstract Background Nephrotic syndrome is associated with an increased risk of venous thromboembolism (VTE). However, the risk factors of VTE in nephrotic syndrome, other than hypoalbuminemia and severe proteinuria, are not well established. Therefore we aimed to investigate the risk factors of VTE in patients with nephrotic syndrome. Methods This retrospective cohort study used data from a Japanese nationwide claims database. We identified patients ≥18 years of age hospitalized with nephrotic syndrome. Through multivariable logistic regression, we determined the risk factors of VTE in patients with nephrotic syndrome during hospitalization. Results Of the 7473 hospitalized patients with nephrotic syndrome without VTE, 221 (3.0%) developed VTE. In the VTE group, 14 (6.3%), 11 (5.0%) and 198 (89.6%) patients developed pulmonary embolism, renal vein thrombosis and deep vein thrombosis, respectively. We found that female sex {odds ratio [OR] 1.39 [95% confidence interval (CI) 1.05–1.85]}, body mass index (BMI) ≥30 [OR 2.01 (95% CI 1.35–2.99)], acute kidney injury [AKI; OR 1.67 (95% CI 1.07–2.62)], sepsis [OR 2.85 (95% CI 1.37–5.93)], lupus nephritis [OR 3.64 (95% CI 1.58–8.37)] and intravenous corticosteroids use [OR 2.40 (95% CI 1.52–3.80)] were associated with a significantly higher risk of developing VTE. Conclusions In patients with nephrotic syndrome, female sex, BMI ≥30, AKI, sepsis, lupus nephritis and intravenous corticosteroid use may help evaluate the risk of VTE.

scholarly journals Dexmedetomidine-Associated Hyperthermia: A Retrospective Cohort Study of Intensive Care Unit Admissions between 2009 and 2016

2017 ◽  
Vol 45 (6) ◽  
pp. 727-736 ◽  
Author(s):  
K. E. D. Grayson ◽  
A. E. Tobin ◽  
D. T. K. Lim ◽  
D. E. Reid ◽  
M. Ghani
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Cohort Study ◽  
Intensive Care ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Open Heart ◽  
Increased Risk

Dexmedetomidine-associated hyperthermia has not been previously studied. Analysis is warranted to determine whether this potentially dangerous complication is more prevalent than previously realised. We aimed to examine the association between dexmedetomidine and temperature ≥39.5°C, including patient characteristics, temporality and potential risk factors. We conducted a retrospective cohort study of all intensive care unit (ICU) admissions between 1 July 2009 and 31 May 2016 in a tertiary ICU in Australia. Temperature data was available for 9,782 ICU admissions. Dexmedetomidine was given intravenously to 611 (6.3%) patients at a dose of 0 to 1.5 g/kg/hour. Temperatures ≥39.5°C were recorded in 341 (3.5%) patients. Overall hospital mortality was 10.8% for all admissions and 29.3% for patients with temperatures ≥39.5°C. Dexmedetomidine exposure was more frequent in patients with temperature recordings ≥39.5°C compared to those with temperatures <39.5°C, 11.94% versus 2.94% (odds ratio [OR] 4.49; 95% confidence intervals [CI] 3.37, 5.92; P <0.001). The association was stronger for patients post-open heart surgery (OHS) with temperatures ≥39.5°C (OR 12.9; 95% CI 5.01, 31.62; P <0.001). Multivariate analysis showed an independent association between dexmedetomidine and a temperature ≥39.5°C in two particular patient groups: OHS (OR 2.72; 95% CI 1.1, 6.9; P <0.001), and obesity (OR 3.44; 95% CI 1.5, 7.9; P <0.001). Dexmedetomidine exposure is associated with an increased risk of hyperthermia. Possible risk factors are open heart surgery and obesity.

scholarly journals Factors associated with thrombocytopenia in patients with dengue fever: a retrospective cohort study

BMJ Open ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. e035120
Author(s):  
Bruna M Castilho ◽  
Marcus T Silva ◽  
André R R Freitas ◽  
Izabela Fulone ◽  
Luciane Cruz Lopes
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Dengue Fever ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Dengue Infection ◽  
Factors Associated ◽  
Increased Risk ◽  
Haematological Changes ◽  
Male Sex

ObjectiveSome patients with dengue fever tend to develop thrombocytopenia during the course of infection and are thus vulnerable to haemorrhagic manifestations and other complications. However, the factors associated with the development of thrombocytopenia are unknown. We aimed to identify factors associated with an increased risk of thrombocytopenia and haematological changes in patients with confirmed dengue fever.DesignRetrospective cohort study.SettingBrazilian multicentre primary care databases.Participants387 patients had positive laboratory serological confirmation of dengue infection during 2014. The data were identified from two databases: Notification of Injury Information System (SINAN) and Municipal Laboratory.Main outcome measureThe presence of thrombocytopenia (platelet count <1 50×109/L). The associations of factors that predisposed patients to thrombocytopenia and haematological changes were analysed using logistic regression. ORs and 95% CIs were calculated.ResultsAmong 387 patients, 156 had both dengue and thrombocytopenia. The risk factors associated with thrombocytopenia included male sex (OR: 1.77, 95% CI: 1.16 to 2.71, p=0.007), age of 46–64 years (OR: 2.20, 95% CI: 1.15 to 4.21, p=0.009) or ≥65 years (OR: 3.02, 95% CI: 1.40 to 6.50, p=0.002), presence of leucopenia (OR: 6.85, 95% CI: 4.27 to 10.99, p<0.001) and high mean corpuscular haemoglobin (MCH) levels (OR: 2.00, 95% CI: 1.29 to 3.12, p=0.005).ConclusionOlder age, male sex, presence of leucopenia and high MCH levels were identified as risk factors associated with the development of thrombocytopenia in this population.

scholarly journals Prevalence, associated factors, and outcomes for labor induction at a tertiary hospital in Northern Tanzania: A retrospective cohort study 2000 - 2015

2020 ◽  
Author(s):  
Clifford Silver Tarimo ◽  
Jian Wu ◽  
Joseph Obure ◽  
Michael Johnson Mahande
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Associated Factors ◽  
Neonatal Intensive Care ◽  
Variance Estimation ◽  
Tertiary Hospital ◽  
Labor Induction ◽  
Increased Risk

Abstract Background Labor induction (IOL) refers to an obstetric intervention which include artificial stimulation of uterine contraction aiming at vaginal delivery of a fetus before the onset of spontaneous labor. Despite undisputed importance of this intervention in improving pregnancy outcomes, data on its utilization and outcomes in Tanzania is limited. The aim of this study was to determine the prevalence, associated factors and outcomes for labor induction among women who were attended at a tertiary hospital in north-Tanzania. Methods We designed a retrospective cohort study and analyzed 53338 deliveries at the Kilimanjaro Christian Medical Centre (KCMC) between the year 2000 to 2015. We enrolled singleton deliveries with vertex presentation and excluded observations with missing information on induction status. Relative risk and 95% Confidence Interval for risk factors and outcomes of labor induction were estimated using log-binomial regression models. Robust variance estimation was used to account for repeated deliveries from the same subject. Results 53,338 deliveries were analyzed. Prevalence of labor induction was 21.63%. Independent risk factors for labor induction were; postdates (RR = 1.21; 95% CI: 1.15–1.28), fetal macrosomia (RR = 1.27; 95% CI: 1.18–1.36) and obesity (RR = 1.12; 95% CI: 1.06–1.18). Labor induction was associated with an increased risk of uterine rapture (RR = 1.84; 95% CI: 1.62–2.09) and low (< 7) Apgar score (RR = 1.27; 95% CI: 1.17–1.37). Labor induction offered protective effect against cesarean delivery (RR = 0.56; 95% CI: 0.53–0.58) and admission to neonatal intensive care unit (RR = 0.94; 95% CI: 0.89–0.99). Conclusion Efforts aimed at achieving the health-related sustainable development goals should focus on increasing access to effective interventions as well as improving quality of health care while being cautioned on likelihood of adverse maternal and fetal outcomes.

scholarly journals Chronic hypersensitivity pneumonitis is associated with an increased risk of venous thromboembolism: a retrospective cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Małgorzata Sobiecka ◽  
Monika Szturmowicz ◽  
Katarzyna Lewandowska ◽  
Agata Kowalik ◽  
Ewa Łyżwa ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Venous Thromboembolism ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Hypersensitivity Pneumonitis ◽  
Significant Risk ◽  
Increased Risk ◽  
Chronic Hypersensitivity Pneumonitis ◽  
Incident Cases

Abstract Background Idiopathic pulmonary fibrosis (IPF) and chronic hypersensitivity pneumonitis share commonalities in pathogenesis shifting haemostasis balance towards the procoagulant and antifibrinolytic activity. Several studies have suggested an increased risk of venous thromboembolism in IPF. The association between venous thromboembolism and chronic hypersensitivity pneumonitis has not been studied yet. Methods A retrospective cohort study of IPF and chronic hypersensitivity pneumonitis patients diagnosed in single tertiary referral center between 2005 and 2018 was conducted. The incidence of symptomatic venous thromboembolism was evaluated. Risk factors for venous thromboembolism and survival among those with and without venous thromboembolism were assessed. Results A total of 411 (259 IPF and 152 chronic hypersensitivity) patients were included (mean age 66.7 ± 8.4 vs 51.0 ± 13.3 years, respectively). There were 12 (4.6%) incident cases of venous thromboembolism in IPF and 5 (3.3%) in chronic hypersensitivity pneumonitis cohort. The relative risk (RR) of venous thromboembolism in chronic hypersensitivity pneumonitis was not significantly different to that found in patients with IPF (7.1 vs 11.8/1000 person-years, RR 1.661 95% CI 0.545–6.019, respectively). The treatment with systemic steroids (OR 5.38; 95% CI 1.65–18.8, p = 0.006) and GAP stage 3 (OR 7.85; 95% CI 1.49–34.9; p = 0.037) were significant risk factors for venous thromboembolism in IPF. Arterial hypertension and pulmonary hypertension significantly increased risk of venous thromboembolism in chronic hypersensitivity pneumonitis. There were no significant differences in survival between patients with and without venous thromboembolism. Conclusions The patients with chronic hypersensitivity pneumonitis have a marked increase in the risk of venous thromboembolism, similar to the patients with IPF. Venous thromboembolism does not affect the survival of patients with IPF and chronic hypersensitivity pneumonitis.

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