Tobacco Use Is Associated With Increased 90-Day Readmission Among Patients Undergoing Surgery for Degenerative Spine Disease

Study Design: Retrospective database study. Objective: Tobacco use is associated with complications after surgical procedures, including poor wound healing, surgical site infections, and cardiovascular events. We used the Nationwide Readmissions Database (NRD) to determine if tobacco use is associated with increased 30- and 90-day readmission among patients undergoing surgery for degenerative spine disorders. Methods: Patients who underwent elective spine surgery were identified in the NRD from 2010 to 2014. The study population included patients with degenerative spine disorders treated with discectomy, fusion, or decompression. Descriptive and multivariate logistic regression analyses were performed to identify patient and hospital factors associated with 30- and 90-day readmission, with significance set at P value <.001. Results: Within 30 days, 4.8% of patients were readmitted at a median time of 9 days. The most common reasons for 30-day readmission were postoperative infection (12.5%), septicemia (3.5%), and postoperative pain (3.0%). Within 90 days, 7.3% were readmitted at a median time of 18 days. The most common reasons for 90-day readmission were postoperative infection (9.6%), septicemia (3.5%), and pneumonia (2.3%). After adjustment for patient and hospital characteristics, tobacco use was independently associated with readmission at 90 days (odds ratio 1.05, 95% confidence interval 1.03-1.07, P < .0001) but not 30 days (odds ratio 1.02, 95% confidence interval 1.00-1.05, P = .045). Conclusions: Tobacco use is associated with readmission within 90 days after cervical and thoracolumbar spine surgery for degenerative disease. Tobacco use is a known risk factor for adverse health events and therefore should be considered when selecting patients for spine surgery.

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Hypoxic Status Is Associated With The Intensity Of Hypoxia Inducible Factor (Hif)-1α Expression In A Premature Placenta

Saintika Medika ◽

10.22219/sm.vol17.smumm1.11685 ◽

2021 ◽

Vol 17 (1) ◽

pp. 1-11

Author(s):

Kartini Edwin

Keyword(s):

Confidence Interval ◽

Premature Birth ◽

Odds Ratio ◽

Critical Role ◽

Hypoxia Inducible Factor ◽

Biological Materials ◽

P Value ◽

Live Births ◽

Infant Morbidity ◽

The Relationship

Prematurity refers to live births before 37 weeks of gestation and associated with infant morbidity/mortality. Activation of HIF during the final pregnancy phase is believed to play a critical role in the pathogenesis of premature birth and other pregnancy disorders. This study aimed to analyze the relationship between hypoxicstatus and the intensity of HIF-1α expression in a premature placenta.Stored biological materials premature placenta (paraffin blocks) was used in this study. Thirtyone samples of placental hypoxia (H) and 28 samples of premature placental non-hypoxia (N) as controls, were selected non-random consecutively. Subsequently, immunohistochemistry was performed to analyze HIF-1α expression. TheChi-square testwas used to analyze the data and a p-value <0.05 was considered statistically significant.Moderate to strong intensity of HIF-1α expressionwas observed in 58% of hypoxic placenta samples, whereas most of non-hypoxic placental samples(86%) did not expressed or expressed weaklyHIF-1α.There was a significant correlation between the intensity of HIF-1α expression and placental hypoxia (p <0.05) and Odds Ratio (OR) value was 8.31 with a 95% confidence interval (2.32-29.77). The conclusion shows that hypoxic status is associated with intensity of hypoxia inducible factor (HIF)-1α expression in a premature placenta.

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Latrine availability and associated factors among Religious institution in Northern Ethiopia, 2018

10.21203/rs.2.13250/v1 ◽

2019 ◽

Author(s):

Mulugeta Woldu Abrha ◽

Kiros Demoz Ghebremedhin ◽

Tesfay Teklemariam Weldeslasie

Keyword(s):

Confidence Interval ◽

Odds Ratio ◽

Associated Factors ◽

P Value ◽

Northern Ethiopia ◽

Religious Institutions ◽

Religious Institution ◽

Tigray Region ◽

Availability Analysis ◽

Sanitation And Hygiene

Abstract Background Religious institutions found at the community, not only uphold belief and cultural values but also as a force for positive change and development. Improved sanitation and hygiene is crucial in these institutions to decrease preventable infections due to unsanitary conditions. However, there are no studies among religious institution on availability of latrine. So this study was conducted to assess the latrine availability and associated factors among religious institution in Tigray Region, Ethiopia.Method Institution based cross – sectional study design was conducted in Tigray Region, Northern Ethiopia. Multi-stage sampling was used to sample 385 religious institutions. Data was collected using pre tested, structured questionnaire and observation checklist. Logistic regression was fitted and odds ratio with 95% confidence interval (CI) with p-value less than 0.05 was used to determine the predictors of latrine availability. Analysis was carried out using SPSS 20 TM - software package.Results In this study latrine availability was 32.8%. And was significantly affected by currently saved money towards having a latrine (Adjusted Odds ratio (AOR): 0.32, 95% confidence interval (CI) [0.25, 0.42]), any messages seen, heard or received on sanitation and hygiene (AOR: 0.43, 95% CI [0.38, 0.51]) and place where messages seen, heard, received (AOR: 2.95, 95% CI [1.11, 5.55]).Conclusion Availability of latrine was very low when compared to the national target of 100% among the religious institution and was affected by the currently saved money towards having a latrine, any messages seen, heard or received on sanitation and hygiene and place where the messages receive. Information regarding latrine availability should be provided to the community visiting religious institutions through available channels and practical models promotion.

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Maximizing the potential of minimally invasive spine surgery in complex spinal disorders

Neurosurgical FOCUS ◽

10.3171/foc/2008/25/8/e19 ◽

2008 ◽

Vol 25 (2) ◽

pp. E19 ◽

Cited By ~ 45

Author(s):

Patrick C. Hsieh ◽

Tyler R. Koski ◽

Daniel M. Sciubba ◽

Dave J. Moller ◽

Brian A. O'shaughnessy ◽

...

Keyword(s):

Minimally Invasive ◽

Spine Surgery ◽

Spinal Diseases ◽

Spinal Deformities ◽

Degenerative Spine ◽

Spinal Disorders ◽

The Past ◽

Prolonged Recovery ◽

Minimally Invasive Spine ◽

Spine Disorders

Minimally invasive surgery (MIS) in the spine was primarily developed to reduce approach-related morbidity and to improve clinical outcomes compared with those following conventional open spine surgery. Over the past several years, minimally invasive spinal procedures have gained recognition and their utilization has increased. In particular, MIS is now routinely used in the treatment of degenerative spine disorders and has been shown to be as effective as conventional open spine surgeries. Although the procedures are not yet widely recognized in the context of complex spine surgery, the true potential in minimizing approach-related morbidity is far greater in the treatment of complex spinal diseases such as spinal trauma, spinal deformities, and spinal oncology. Conventional open spine surgeries for complex spinal disorders are often associated with significant soft tissue disruption, blood loss, prolonged recovery time, and postsurgical pain. In this article the authors review numerous cases of complex spine disorders managed with MIS techniques and discuss the current and future implications of these approaches for complex spinal pathologies.

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Treatment with Epinephrine (Adrenaline) in Suspected Anaphylaxis during Anesthesia in Denmark

Anesthesiology ◽

10.1097/aln.0b013e318218119d ◽

2011 ◽

Vol 115 (1) ◽

pp. 111-116 ◽

Cited By ~ 37

Author(s):

Lene H. Garvey ◽

Bo Belhage ◽

Mogens Krøigaard ◽

Bent Husum ◽

Hans-Jørgen Malling ◽

...

Keyword(s):

Cardiac Arrest ◽

Retrospective Study ◽

Confidence Interval ◽

Median Time ◽

Odds Ratio ◽

Anaphylactic Shock ◽

Route Of Administration ◽

Epinephrine Administration ◽

Timing Of Treatment

Background Literature on the use of epinephrine in the treatment of anaphylaxis during anesthesia is very limited. The objective of this study was to investigate how often epinephrine is used in the treatment of suspected anaphylaxis during anesthesia in Denmark and whether timing of treatment is important. Methods A retrospective study of 270 patients investigated at the Danish Anaesthesia Allergy Centre after referral due to suspected anaphylaxis during anesthesia was performed. Reactions had been graded by severity: C1, mild reactions; C2, moderate reactions; C3, anaphylactic shock with circulatory instability; C4, cardiac arrest. Use of epinephrine, dosage, route of administration, and time between onset of circulatory instability and epinephrine administration were noted. Results A total of 122 (45.2%) of referred patients had C3 or C4 reactions; of those, 101 (82.8%) received epinephrine. Route of administration was intravenous in 95 (94%) patients. Median time from onset of reported hypotension to treatment with epinephrine was 10 min (range, 1-70 min). Defining epinephrine treatment less than or equal to 10 min after onset of hypotension as early, and more than 10 min as late, infusion was needed in 12 of 60 patients (20%) treated early versus 12 of 35 patients (34%) treated late (odds ratio, 2.09) (95% confidence interval, 0.81-5.35). Conclusion Anaphylaxis may be difficult to diagnose during anesthesia, and treatment with epinephrine can be delayed as a consequence. Anaphylaxis should be considered and treated in patients with circulatory instability during anesthesia of no apparent cause who do not respond to the usual treatments.

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The occurrence of urinary tract infection and determinant factors among diabetic patients at Dessie Referral Hospital, South Wollo, Northeast Ethiopia

SAGE Open Medicine ◽

10.1177/20503121211060614 ◽

2021 ◽

Vol 9 ◽

pp. 205031212110606

Author(s):

Betelhem Walelgn ◽

Mehd Abdu ◽

Prem Kumar

Keyword(s):

Diabetes Mellitus ◽

Urinary Tract ◽

Confidence Interval ◽

Urinary Tract Infections ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

P Value ◽

Diabetic Patients ◽

Tract Infections ◽

Khat Chewer

Introduction: Diabetic patients have a higher tendency of developing all infections, especially infections of the genitourinary tract. Urinary tract infections cause considerable disorders in diabetic patients, and if complicated, can cause renal failure. In Ethiopia, the magnitude of diabetes mellitus-associated urinary tract infections increased from 7.1% in 2005 to 33.9% in 2019. The successful management of patients suffering from urinary tract infections in diabetic patients depends upon the identification of risk factors. This study aimed to determine the magnitude and factors affecting the urinary tract infections among diabetic patients which enable professionals to prevent infections and manage them effectively. Methods: Hospital-based cross-sectional study was conducted with 365 diabetic patients selected by systematic sampling technique from March to April 2020. Data were collected by trained BSc nurses via face-to-face interview and patient chart review. Urine microscopy was done to diagnose urinary tract infections. Data were coded and entered using Epi data version 3.1 and exported to Statistical Package of Social Sciences version 26 for analysis. Variables with p-value < 0.25 in bivariable logistic regression were included multivariable logistic regression and variables with a p-value < 0.05 were considered statistically significant. Results: The magnitude of urinary tract infections was 22.3% (95% confidence interval: 18–27). The odds of being infected by urinary tract infections were significantly higher in diabetic females (adjusted odds ratio: 2.46; 95% confidence interval: 1.40–4.32), duration of diabetes mellitus diagnosis of ⩾5 years (adjusted odds ratio: 1.98; 95% confidence interval: 1.05–3.72), with comorbidity (adjusted odds ratio: 4.87; 95% confidence interval: 2.76–8.59) and khat chewer (adjusted odds ratio: 1.84; 95% confidence interval: 1.04–3.24) compared with their counter. Conclusion and recommendation: Urinary tract infections were high among diabetic patients. Predictors like sex, duration of diagnosis, comorbidity, and khat chewer were found to be associated with urinary tract infections. Improvement of the regular screening of patients with diabetes mellitus for urinary tract infections will provide more effective measures in prevention and management.

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Venous Thromboembolism and Preoperative Steroid Use, a Retrospective Cohort Study from the ACS-NSQIP Database: Are Surgical Patients at Risk?

Blood ◽

10.1182/blood.v124.21.2865.2865 ◽

2014 ◽

Vol 124 (21) ◽

pp. 2865-2865

Author(s):

Anthony Haddad ◽

Rami Kantar ◽

Hani Tamim ◽

Faek R Jamali ◽

Ali Taher

Keyword(s):

Venous Thromboembolism ◽

Urinary Tract ◽

Adverse Events ◽

Confidence Interval ◽

Odds Ratio ◽

Surgical Patients ◽

P Value ◽

Steroid Use ◽

Increased Risk ◽

History Of

Abstract Background : Despite early ambulation, use of anticoagulation and several other strategies, postoperative venous thromboembolism (VTE) remains a major cause of morbidity and mortality. Therefore, the search for modifiable preoperative risk factors is crucial. Few reports in the literature mention an increased risk of VTE with exogenous steroid use and endogenous hypercortisolism. To date however, the direct relationship between steroid use and VTE remains unexplored. Objective: To assess if an association between preoperative steroid use and postoperative venous thromboembolism exists. Methods: Using data from the American College of Surgeons’ National Surgical Quality Improvement Program (NSQIP), which is a prospective validated outcomes registry including around 548 hospitals in the United States and around the world, we identified patients with no history of thrombotic events. We excluded patients with a history of one or more deep venous thrombosis (DVT), and patients with sepsis. After analyzing patient characteristics, we used multivariate logistic regression to assess the crude and adjusted effect of steroids on VTE, our primary outcome. Results: We obtained data for 1 921 901 patients, 58 667 of whom were on steroids for at least 30 days before operative intervention. Amongst those, 1241 patients had a postoperative VTE. After adjustment for different variables, VTE was higher in patients on steroids with an adjusted odds ratio of 1.54, 95% confidence interval (CI) 1.45-1.64. Secondary assessed outcomes included mortality, urinary tract infection (UTI), wound occurrences, sepsis, cardiac and respiratory adverse events. Adjusted odds ratios for the latter were 1.42 (CI 1.35-1.49), 1.40 (CI 1.30-1.50), 1.58 (CI 1.51-1.66), 1.51 (CI 1.42-1.60), 1.19(CI 1.11-1.29) and 1.302 (CI 1.301-1.303) respectively. Discussion: Our results suggest that surgical patients with prolonged preoperative steroid intake are at a higher risk of developing postoperative VTE. This is an important finding since preoperative steroid use is a modifiable factor. Furthermore, our data also shows that the exposure of interest is associated with a number of secondary outcomes considered including: all-cause mortality, UTI, sepsis, wound occurrences, cardiac and respiratory adverse events. Association with wound occurrences, sepsis and UTI is concordant with the well-known inhibitory effect of prolonged steroid use on wound healing and immune functions. The association with mortality, cardiac and respiratory events might in fact be due to the association between preoperative steroid use and our main outcome Future perspectives include investigating the mechanism by which steroid use might lead to an increased risk of postoperative VTE with a particular emphasis on the coagulation cascade and potential interference with its normal physiologic function. Abstract 2865. Table 1. Various outcomes and steroid use Steroid intake No Steroid ORcrude CI p-value ORadj CI P-value Venous Thromboembolic Event 1241 14544 2.74 2.59-2.91 <.0001 1.54 1.45-1.64 <.0001 Mortality 2525 21868 3.78 3.63-3.94 <.0001 1.42 1.35-1.49 <.0001 Cardiac 852 11665 2.33 2.18-2.50 <.0001 1.19 1.11-1.29 <.0001 Respiratory 4094 44220 3.08 2.98-3.18 <.0001 1.302 1.301-1.303 <.0001 Urinary Tract 937 10752 2.79 2.61-2.99 <.0001 1.40 1.30-1.50 <.0001 Wound 2135 29221 2.37 2.26-2.47 <.0001 1.58 1.51-1.66 <.0001 Sepsis 1515 13286 3.69 3.49-3.89 <.0001 1.51 1.42-1.60 <.0001 Abbreviations: OR: Odds ratio, CI: confidence interval, adj: adjusted. Disclosures No relevant conflicts of interest to declare.

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Postoperative Spinal Subdural Lesions Following Lumbar Spine Surgery: Prevalence and Risk Factors

Asian Spine Journal ◽

10.4184/asj.2017.11.5.793 ◽

2017 ◽

Vol 11 (5) ◽

pp. 793-803 ◽

Cited By ~ 2

Author(s):

Yukitaka Nagamoto ◽

Shota Takenaka ◽

Hiroyuki Aono

Keyword(s):

Risk Factors ◽

Lumbar Spine ◽

Confidence Interval ◽

Spine Surgery ◽

Odds Ratio ◽

Protective Factor ◽

Multivariate Logistic Regression Analysis ◽

Lumbar Spine Surgery ◽

Decompression Surgery ◽

Mr Images

<sec><title>Study Design</title>Retrospective case–control study</sec><sec><title>Purpose</title>To clarify the prevalence and risk factors for spinal subdural lesions (SSDLs) following lumbar spine surgery.</sec><sec><title>Overview of Literature</title>Because SSDLs, including arachnoid cyst and subdural hematoma, that develop following spinal surgery are seldom symptomatic and require reoperation, there are few reports on these pathologies. No study has addressed the prevalence and risk factors for SSDLs following lumbar spine surgery.</sec><sec><title>Methods</title>We conducted a retrospective analysis of the magnetic resonance (MR) images and medical records of 410 patients who underwent lumbar decompression surgery with or without instrumented fusion for degenerative disorders. SSDLs were classified into three grades: grade 0, no obvious lesion; grade 1, cystic lesion; and grade 2, lesions other than a cyst. Grading was based on the examination of preoperative and postoperative MR images. The prevalence of SSDLs per grade was calculated and risk factors were evaluated using multivariate logistic regression analysis.</sec><sec><title>Results</title>Postoperative SSDLs were identified in 123 patients (30.0%), with 50 (12.2%) and 73 (17.8%) patients being classified with grade 1 and 2 SSDLs, respectively. Among these, one patient was symptomatic, requiring hematoma evacuation because of the development of incomplete paraplegia. Bilateral partial laminectomy was a significantly independent risk factor for SSDLs (odds ratio, 1.52; 95% confidence interval, 1.20–1.92; <italic>p</italic><0.001). In contrast, a unilateral partial laminectomy was a protective factor (odds ratio, 0.11; 95% confidence interval, 0.03–0.46; <italic>p</italic>=0.002).</sec><sec><title>Conclusions</title>The prevalence rate of grade 1 SSDLs was 30%, with no associated clinical symptoms observed in all but one patient. Bilateral partial laminectomy increases the risk for SSDLs, whereas unilateral partial laminectomy is a protective factor.</sec>

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Comparative feasibility of two World Health Organization partographs to predict prolonged labour: a randomized control trial

International Journal of Clinical Trials ◽

10.18203/2349-3259.ijct20193674 ◽

2019 ◽

Vol 6 (4) ◽

pp. 167

Author(s):

Mohini Rajoriya ◽

Ruchi Kalra

Keyword(s):

Confidence Interval ◽

Odds Ratio ◽

Randomized Control Trial ◽

Controlled Trial ◽

World Health ◽

P Value ◽

Obstructed Labor ◽

Prolonged Labor ◽

Randomized Control ◽

Latent Phase

Background: One of the major causes of maternal mortality is obstructed labor. Identification of abnormal labor at earliest and timely management can prevent prolonged labor and significantly reduce its sequel. Partograph is a useful tool in hands of labor care givers to monitor labor course. The study was done to compare feasibility of two WHO partographs a composite partograph including the latent phase with a simplified one without the latent phase to predict prolonged labor in randomized control trial.Methods: A randomized controlled trial, with parallel arm design was conducted. Sample size was calculated as 404 pregnant women .They were randomly categorized in two groups, each group having 202 participants.Results: labor had crossed the alert line in 108 (53.4%) cases monitored by composite partograph and 38(18.8%) cases monitored with simplified partograph. The calculated P value was <0.0001. The odds ratio calculate was 4.95 and 95% confidence interval was 3.16 to 7.76. Labor crossing the action line was found in 16 (7.9%) in composite partograph whereas in simplified partograph, labor had crossed the action line in 18 cases in simplified group. Calculated P value was 0.72 (>0.05). The odds ratio was 0.8793 and 95% confidence interval 0.43 to 1.77 which was not significant statistically .Most participants (70%) experienced difficulty with the composite partograph, but no participant reported difficulty while plotting the simplified partograph.Conclusions: WHO simplified partograph was found to be as good as WHO composite partograph in identifying maternal and perinatal outcomes and was more user friendly.

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Is Isotretinoin Innocent from Causing Inflammatory Bowel Disease?

Saudi Journal of Internal Medicine ◽

10.32790/sjim.2016.6.2.4 ◽

2016 ◽

Vol 6 (2) ◽

pp. 21-33

Author(s):

Saad M. Alrajhi

Keyword(s):

Ulcerative Colitis ◽

Inflammatory Bowel Disease ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Confidence Interval ◽

Bowel Disease ◽

Odds Ratio ◽

Random Model ◽

P Value ◽

Inflammatory Bowel

Objectives: Multiple case reports suggesting isotretinoin causes inflammatory bowel disease leading to compensations reaching millions of dollars. New larger studies question this effect. This is a meta-analysis to study the association. Methods: We searched PubMed, Cochrane, Google Scholar, and WorldCat. We extracted six articles measuring drug exposure and disease incidence. We measured the effects of isotretinoin on inflammatory bowel disease, Crohn’s disease and ulcerative colitis, using pooled odds ratio. The effect can be measured using the fixed or the random model. The fixed effect assumes studies have the same effect in the same population, while the random assumes heterogeneity. The correct model is chosen based on a Q-heterogeneity test. Results: Sample size was 9723864. Inflammatory bowel disease in isotretinoin exposed had an odds ratio of {1.075, 95% confidence interval (0.78, 1.49)}, Crohn’s disease{0.97, 95% confidence interval (0.65, 1.43)} and ulcerative colitis {1.28, 95% confidence interval (0.88, 1.86)}. All odds ratios had a p-value > 0.05 using the random-model which was chosen due to significant Q and I-squared score p value < 0.05. There was significant heterogeneity of the six studies, which lack consistency in adjusting for important co-variables (dose, family history, smoking, etc.)

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Factors associated with non-vaccination against measles among 12-23 months old children in Yirgachefe district of SNNPR, Ethiopia, 2016

10.21203/rs.2.10399/v2 ◽

2020 ◽

Author(s):

Luna Habtamu Degife ◽

Yoseph Worku ◽

Muse Tadesse

Keyword(s):

Confidence Interval ◽

Odds Ratio ◽

Statistical Significance ◽

Southern Ethiopia ◽

Effective Vaccine ◽

P Value ◽

Age Group ◽

Factors Associated ◽

Measles Vaccination

Abstract Immunization is an effective and proven tool for controlling and eliminating life-threatening vaccine preventable infectious diseases. In Ethiopia 5% of childhood mortalities are due to measles. Despite the availability of a safe and effective vaccine, measles outbreaks secondary to non-vaccination are occurring in southern Ethiopia especially in Yirgachefe district. This study was done to assess the risk factors associated with non-vaccination against measles. A Community-based unmatched case control study was conducted in Yirgachefe district from December 1-31, 2016.Cases were children in the age group of 12- 23 months of age who did not take measles vaccination and controls were children in the same age group who took at least one dose of measles vaccine. The study was done in 6 randomly selected kebeles and cases and controls were selected randomly by probability proportional to size sampling. A structured questionnaire was used for data collection. Statistical significance was interpreted using Odds ratio with 95% confidence interval and P value <0.05.A total of 320 individuals (107 cases and 214 controls) were approached for interview with a response rate of 93.75%. Of the cases, 57% were males and more than half fall in the 12-18 months age group. Knowledge regarding measles vaccination was also asked and among cases 72% heard about measles, 26% knew that all children should be vaccinated, 31% had awareness about the right age of vaccination, 60% agrees that measles is vaccine preventable and 65% knew that it is contagious. In multivariable logistic regression, Lack of Ante Natal Care follow up(ANC) (Adjusted Odds Ratio (AOR) =3.57; 95% Confidence Interval (CI): 1.22-10.44), lack of knowledge on the importance of vaccination, who should be vaccinated and if measles is contagious with an AOR and CI of (AOR=6.81; 95% CI: 1.56-29.64), (AOR=4.29; 95% CI: 1.83-10.04) and (AOR=8.97; 95%CI: 3.15-25.58) respectively were independent risk factors.Education and awareness about measles and its immunization should be given to the community. Additionally, ANC follow up should also be strengthened.

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