scholarly journals Extubation in the operating room results in fewer composite mechanical ventilation-related adverse outcomes in patients after liver transplantation: a retrospective cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yan Xu ◽  
Yiding Zuo ◽  
Li Zhou ◽  
Xuechao Hao ◽  
Xiao Xiao ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Liver Transplantation ◽  
Kidney Injury ◽  
Infectious Complications ◽  
Pulmonary Complications ◽  
Adverse Outcomes ◽  
Total Hospital Cost ◽  
Total Hospital ◽  
Acute Kidney Injury Stage ◽  
All Cause Mortality

Abstract Background To investigate the effect of extubation in the operating room (OR) on mechanical ventilation-related adverse outcomes in patients who undergo liver transplantation. Methods Patients who underwent liver transplantation between January 2016 and December 2019 were included. According to the timing of extubation, patients were divided into OR extubation group and intensive care unit (ICU) extubation group. The propensity score was used to match OR extubation group and ICU extubation group at a 1:2 ratio by demographical and clinical covariates. The primary outcome was a composite of mechanical ventilation-related adverse outcomes, including 30-day all-cause mortality, in-hospital acute kidney injury (stage 2 or 3), and in-hospital moderate to severe pulmonary complications. Secondary outcomes included in-hospital moderate to severe infectious complications, unplanned reintubation rates, ICU and postoperative hospital lengths of stay, and total hospital cost. Results A total of 438 patients were enrolled. After propensity score matching, 94 patients were in OR extubation group and 148 patients were in ICU extubation group. Incidence of the composite mechanical ventilation-related adverse outcomes was significantly lower in OR extubation group than ICU extubation group, even after adjusting for confounding factors (19.1% vs. 31.8%; Odds Ratio, 0.509; 95% Confidence Index [CI], 0.274-0.946; P=0.031). The duration of ICU stay was much shorter in OR extubation group than ICU extubation group (median 4, Interquartile range [IQR] (3 ~ 6) vs. median 6, IQR (4 ~ 8); P<0.001). Meanwhile, extubation in the OR led to a significant reduction of total hospital cost compared with extubation in the ICU (median 3.9, IQR (3.5 ~ 4.6) 10000 US dollars vs. median 4.1, IQR (3.8 ~ 5.1) 10000 US dollars; P=0.021). However, there were no statistically significant differences in moderate to severe infectious complications, unplanned reintubation rates, and the length of postoperative hospital stay between groups. Conclusions Among patients who underwent liver transplantation, extubation in the OR compared with extubation in the ICU, significantly reduced the primary composite outcome of 30-day all-cause mortality, in-hospital acute kidney injury (stage 2 or 3), or in-hospital moderate to severe pulmonary complications. Trial registration The trial was registered at www.clinicaltrials.gov with registration number NCT04261816. Retrospectively registered on 1st February 2020.

Inpatient epidemiology and economic burden of granulomatosis with polyangiitis: a 10-year study of the national inpatient sample

Rheumatology ◽  
2020 ◽  
Vol 59 (12) ◽  
pp. 3685-3689 ◽  
Author(s):  
Patompong Ungprasert ◽  
Matthew J Koster ◽  
Wisit Cheungpasitporn ◽  
Karn Wijarnpreecha ◽  
Charat Thongprayoon ◽  
...  
Keyword(s):  
Economic Burden ◽  
Nationwide Inpatient Sample ◽  
Granulomatosis With Polyangiitis ◽  
Kidney Injury ◽  
Total Hospital Cost ◽  
National Inpatient Sample ◽  
Total Hospital ◽  
All Cause Mortality ◽  
The Usa ◽  
Inpatient Database

Abstract Objective To characterize inpatient epidemiology and economic burden of granulomatosis with polyangiitis (GPA). Methods Patients with GPA were identified from the Nationwide Inpatient Sample (NIS), the largest inpatient database in the USA consisting of over 4000 non-federal acute care hospitals, using the ICD-9 CM code. A cohort of comparators without GPA was also constructed from the same database. Data on demographics, procedures, length of stay, mortality, morbidity and total hospitalization charges were extracted. All analysed data were extracted from the database for the years 2005–2014. Results The inpatient prevalence of GPA was 32.6 cases per 100 000 admissions. GPA itself (38.3%), pneumonia (13.7%) and sepsis (8.4%) were the most common reasons for admission. After adjusting for potential confounders, the all-cause mortality adjusted odds ratio (aOR) of patients with GPA was significantly higher than that of patients without GPA (aOR 1.20; 95% CI: 1.41, 1.61). This was also true for several morbidities, including acute kidney injury, multi-organ failure, shock and need for intensive care unit admission. Hospitalizations of patients with GPA were associated with higher cost as demonstrated by an adjusted additional mean of $5125 (95% CI: $4719, $5531) for total hospital cost and an adjusted additional mean of $16 841 (95% CI: $15 280, $18 403) for total hospitalization charges when compared with patients without GPA. Conclusion Inpatient prevalence of GPA was higher than what would be expected from prevalence in the general population. Hospitalizations of patients with GPA were associated with higher morbidity, mortality and cost.

Acute Kidney Injury before Dialysis Initiation Predicts Adverse Outcomes in Hemodialysis Patients

2018 ◽  
Vol 47 (6) ◽  
pp. 427-434 ◽  
Author(s):  
Timmy Lee ◽  
Silvi Shah ◽  
Anthony C. Leonard ◽  
Pratik Parikh ◽  
Charuhas V. Thakar
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Injury ◽  
The United States ◽  
Hemodialysis Patients ◽  
Adverse Outcomes ◽  
Study Cohort ◽  
All Cause Mortality ◽  
Arteriovenous Access ◽  
The Impact ◽  
Esrd Patients

Background: Acute kidney injury (AKI) is associated with increased morbidity and mortality. Mortality in end-stage renal disease (ESRD) patients is highest during the first year of dialysis. The impact of pre-ESRD AKI events on long-term outcomes in incident ESRD patients remains unknown. Methods: We evaluated a retrospective cohort of 47,341 incident hemodialysis patients from the United States Renal Data System with linked Medicare data for at least 2 years prior to hemodialysis initiation. We examined the impact of pre-ESRD AKI events in the 2-year pre-ESRD period on the type of vascular access used at hemodialysis initiation (central venous catheter (CVC) versus arteriovenous access), and 1-year all-cause mortality after initiating hemodialysis. Results: The mean age was 72 ± 11 years. Of the study cohort, 18% initiated hemodialysis with arteriovenous access, and 54% of patients had at least one pre-ESRD AKI event. One-year, all-cause mortality was 32%. Compared to 75% for patients without a pre-ESRD AKI event, 89% of patients with a pre-ESRD AKI event initiated hemodialysis with CVC than arteriovenous access (p < 0.001). A pre-ESRD AKI event was associated with lower adjusted odds of starting hemodialysis with an arteriovenous access (OR 0.47; 95% CI 0.44–0.50, p < 0.001), and higher adjusted odds of 1-year mortality (OR 1.36; 95% CI 1.30–1.42, p < 0.001). Conclusion: An AKI event prior to initiating hemodialysis independently increases the risk of CVC use and predicts 1-year mortality. Improving processes of care after AKI events may improve dialysis outcomes in patients who progress to ESRD.

Perioperative use of renin-angiotensin system inhibitors and short-term outcomes in patients undergoing cardiac surgery

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
R.M Vieira De Melo ◽  
D.C Azevedo ◽  
L.N Danziato ◽  
M.T.C.F Fernandes ◽  
L.F.C Alcantara ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Multivariate Regression ◽  
Enzyme Inhibitor ◽  
Kidney Injury ◽  
Adverse Outcomes ◽  
Icu Mortality ◽  
Short Term ◽  
Icu Stay

Abstract Background Controversy exists about whether preoperative angiotensin-converting enzyme inhibitor (ACEi) or an angiotensin receptor blocker (ARB) therapy is associated with adverse outcomes after cardiac surgery. Current guidelines stated that it is uncertain about the safety of the preoperative administration of this medications because of the potential deleterious consequences of perioperative hypotension Purpose To determine the effect of preoperative therapy with ACEi or ARB on short-term outcome after cardiac surgery. Methods Single-center prospective cohort between January 2018 and December 2019. Patients were eligible if they were submitted to elective on-pump cardiac surgery and aged ≥18 years. Patients were divided into two groups according to previous use of ACEi or ARB. All preoperative demographic, clinical, and intraoperative surgical variables were collected prospectively. Outcomes of interests were intensive care unit (ICU) mortality, incidence and duration (hours) of postoperative shock (defined as the need for intravenous vasopressors or inopressors), postoperative acute kidney injury (AKI), defined as a doubling of serum creatinine, duration of mechanical ventilation (hours) and length of stay in the ICU (days). A multivariate regression was performed for categorical outcomes and Kruskal-Wallis test for non-parametric continuous variables. Results 353 patients were evaluated in the period, 182 (51.6%) of male sex, with a mean age of 54.5 (±14.7) and STS mortality and EURO scores of 1.93 (±1.81) and 1.89 (±1.9), respectively. Coronary artery bypass grafting was the common procedure, 168 (47.6%). After multivariate regression, use of ACEi or ARB preoperatively was associated with postoperative shock: RR: 2.03, CI 1.25–3.30, p=0.004; incidence of AKI: RR: 2.84, CI 1.01–7.98, increased length of ICU stay: 4 (3–6) vs 3 (2–5), p=0.03; and increased duration of shock: 10 (0–39) vs 0 (0–24), p&lt;0.01. There was no association with the duration of mechanical ventilation: 10.5 (6–20) vs 11.0 (5–18), p=0.31 or ICU mortality: 14 (7.3%) vs 16 (10.0%), p=0,44. Conclusions The use of preoperative ACEi or ARBs was associated with increased incidence and duration of postoperative shock, incidence of acute kidney injury, and durations of mechanical ventilation and ICU stay. Funding Acknowledgement Type of funding source: None

scholarly journals Urine Alpha-1-Microglobulin Levels and Acute Kidney Injury, Mortality, and Cardiovascular Events following Cardiac Surgery

2021 ◽  
pp. 1-11
Author(s):  
Jonathan G. Amatruda ◽  
Michelle M. Estrella ◽  
Amit X. Garg ◽  
Heather Thiessen-Philbrook ◽  
Eric McArthur ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Proportional Hazards ◽  
Kidney Injury ◽  
Cox Proportional Hazards ◽  
Adverse Outcomes ◽  
Ckd Progression ◽  
Urine Albumin ◽  
All Cause Mortality

<b><i>Introduction:</i></b> Urine alpha-1-microglobulin (Uα1m) elevations signal proximal tubule dysfunction. In ambulatory settings, higher Uα1m is associated with acute kidney injury (AKI), progressive chronic kidney disease (CKD), cardiovascular (CV) events, and mortality. We investigated the associations of pre- and postoperative Uα1m concentrations with adverse outcomes after cardiac surgery. <b><i>Methods:</i></b> In 1,464 adults undergoing cardiac surgery in the prospective multicenter Translational Research Investigating Biomarker Endpoints for Acute Kidney Injury (TRIBE-AKI) cohort, we measured the pre-and postoperative Uα1m concentrations and calculated the changes from pre- to postoperative concentrations. Outcomes were postoperative AKI during index hospitalization and longitudinal risks for CKD incidence and progression, CV events, and all-cause mortality after discharge. We analyzed Uα1m continuously and categorically by tertiles using multivariable logistic regression and Cox proportional hazards regression adjusted for demographics, surgery characteristics, comorbidities, baseline estimated glomerular filtration rate, urine albumin, and urine creatinine. <b><i>Results:</i></b> There were 230 AKI events during cardiac surgery hospitalization; during median 6.7 years of follow-up, there were 212 cases of incident CKD, 54 cases of CKD progression, 269 CV events, and 459 deaths. Each 2-fold higher concentration of preoperative Uα1m was independently associated with AKI (adjusted odds ratio [aOR] = 1.36, 95% confidence interval 1.14–1.62), CKD progression (adjusted hazard ratio [aHR] = 1.46, 1.04–2.05), and all-cause mortality (aHR = 1.19, 1.06–1.33) but not with incident CKD (aHR = 1.21, 0.96–1.51) or CV events (aHR = 1.01, 0.86–1.19). Postoperative Uα1m was not associated with AKI (aOR per 2-fold higher = 1.07, 0.93–1.22), CKD incidence (aHR = 0.90, 0.79–1.03) or progression (aHR = 0.79, 0.56–1.11), CV events (aHR = 1.06, 0.94–1.19), and mortality (aHR = 1.01, 0.92–1.11). <b><i>Conclusion:</i></b> Preoperative Uα1m concentrations may identify patients at high risk of AKI and other adverse events after cardiac surgery, but postoperative Uα1m concentrations do not appear to be informative.

Total Hospital Costs and Readmission Rate of Patient-Specific Instrument in Total Knee Arthroplasty Patients

2020 ◽  
Author(s):  
Stephen Thomas ◽  
Ankur Patel ◽  
Corey Patrick ◽  
Gary Delhougne
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Hospital Cost ◽  
Readmission Rate ◽  
Hospital Costs ◽  
Patient Specific ◽  
P Value ◽  
Total Hospital Cost ◽  
Total Hospital ◽  
Total Knee

AbstractDespite advancements in surgical technique and component design, implant loosening, stiffness, and instability remain leading causes of total knee arthroplasty (TKA) failure. Patient-specific instruments (PSI) aid in surgical precision and in implant positioning and ultimately reduce readmissions and revisions in TKA. The objective of the study was to evaluate total hospital cost and readmission rate at 30, 60, 90, and 365 days in PSI-guided TKA patients. We retrospectively reviewed patients who underwent a primary TKA for osteoarthritis from the Premier Perspective Database between 2014 and 2017 Q2. TKA with PSI patients were identified using appropriate keywords from billing records and compared against patients without PSI. Patients were excluded if they were < 21 years of age; outpatient hospital discharges; evidence of revision TKA; bilateral TKA in same discharge or different discharges. 1:1 propensity score matching was used to control patients, hospital, and clinical characteristics. Generalized Estimating Equation model with appropriate distribution and link function were used to estimate hospital related cost while logistic regression models were used to estimate 30, 60, and 90 days and 1-year readmission rate. The study matched 3,358 TKAs with PSI with TKA without PSI patients. Mean total hospital costs were statistically significantly (p < 0.0001) lower for TKA with PSI ($14,910; 95% confidence interval [CI]: $14,735–$15,087) than TKA without PSI patients ($16,018; 95% CI: $15,826–$16,212). TKA with PSI patients were 31% (odds ratio [OR]: 0.69; 95% CI: 0.51–0.95; p-value = 0.0218) less likely to be readmitted at 30 days; 35% (OR: 0.65; 95% CI: 0.50–0.86; p-value = 0.0022) less likely to be readmitted at 60 days; 32% (OR: 0.68; 95% CI: 0.53–0.88; p-value = 0.0031) less likely to be readmitted at 90 days; 28% (OR: 0.72; 95% CI: 0.60–0.86; p-value = 0.0004) less likely to be readmitted at 365 days than TKA without PSI patients. Hospitals and health care professionals can use retrospective real-world data to make informed decisions on using PSI to reduce hospital cost and readmission rate, and improve outcomes in TKA patients.

Analysis of Nosocomial Infections in Post–Cardiac Surgery Extracorporeal Membrane Oxygenation Support Therapy

2018 ◽  
Vol 21 (5) ◽  
pp. E387-E391 ◽  
Author(s):  
Binfei Li ◽  
Geqin Sun ◽  
Zhou Cheng ◽  
Chuangchuang Mei ◽  
Xiaozu Liao ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Cardiac Surgery ◽  
Extracorporeal Membrane Oxygenation ◽  
Hospital Stay ◽  
Nosocomial Infections ◽  
Total Hospital ◽  
Secondary Infections ◽  
Total Hospital Stay ◽  
Mechanical Ventilation Time ◽  
Post Cardiac Surgery

Objectives: This study aims to analyze the nosocomial infection factors in post–cardiac surgery extracorporeal membrane oxygenation (ECMO) supportive treatment (pCS-ECMO). Methods: The clinical data of the pCS-ECMO patients who obtained nosocomial infections (NI) were collected and analyzed retrospectively. Among the 74 pCS-ECMO patients, 30 occurred with NI, accounting for 40.5%; a total of 38 pathogens were isolated, including 22 strains of Gram-negative bacteria (57.9%), 15 strains of Gram-positive bacteria (39.5%), and 1 fungus (2.6%). Results: Multidrug-resistant strains were highly concentrated, among which Acinetobacter baumannii and various coagulase-negative staphylococci were the main types; NI was related to mechanical ventilation time, intensive care unit (ICU) residence, ECMO duration, and total hospital stay, and the differences were statistically significant (P < .05). The binary logistic regression analysis indicated that ECMO duration was a potential independent risk factor (OR = 0.992, P = .045, 95.0% CI = 0.984-1.000). Conclusions: There existed significant correlations between the secondary infections of pCS-ECMO and mechanical ventilation time, ICU residence, ECMO duration, and total hospital stay; therefore, hospitals should prepare appropriate preventive measures to reduce the incidence of ECMO secondary infections.

Sign in / Sign up

Export Citation Format

Share Document