Factors associated with loss to follow-up after occupational HIV exposure in Cape Town, South Africa: a retrospective cohort study

Abstract Background: Although stroke is an uncommon but life-threatening complication among spinal surgery patients, the recognition of this adverse event is critical given the aging population undergoing surgical procedures. The objective of this study was to estimate the incidence of stroke among adults undergoing elective posterior lumbar fusion (PLF) during post-operative risk windows and among different subgroups. Methods: A retrospective cohort study using a longitudinal electronic healthcare record (EHR) database was conducted from January 1, 2007 to June 30, 2018. Elective PLF, stroke, and select clinical characteristics were defined based on International Classification of Disease codes. Patients aged 18 to 85 years with ≥ 183 days of enrollment in the database prior to undergoing elective PLF were followed from the index date until the occurrence of stroke, death, loss to follow-up, or end of study period, whichever occurred first. Incidence proportions (IPs) and rates (IRs) of stroke were estimated in the following risk windows: index hospitalization, ≤ 30 days, ≤ 90 days, ≤ 180 days, and ≤ 365 days post-operation Results: A total of 43,063 patients were eligible for the study. The IP of stroke following elective PLF ranged from 0.29% (95% confidence interval [CI]: 0.25%, 0.35%) during index hospitalization to 1.12% (95% CI: 1.03%, 1.23%) ≤ 365 days post-operation; the IR of stroke following elective PLF per 1000 person-years decreased consistently from 229.08 (95% CI: 192.38, 272.78) during index hospitalization to 13.68 (95% CI: 12.51, 14.96) ≤ 365 days post-operation. Stratified analyses revealed that older patients had a higher incidence of stroke. Additionally, black patients had higher stroke incidences than white, Asian, or other patients. Furthermore, the incidence of post-operative stroke was higher among patients with a history of type 2 diabetes than among patients without such history. Conclusions: The incidence of stroke following elective PLF found here using an EHR database is slightly higher than that reported in the literature; however, the discrepancy is due to differences in the variable definitions, study populations, follow-up periods, and data sources between our study and those in the literature.

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P3131Evolution of subclinical rheumatic heart disease: a multi-centre retrospective cohort study

European Heart Journal ◽

10.1093/eurheartj/ehz745.0206 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

A Sanyahumbi ◽

G Karthikeyan ◽

T Aliku ◽

A Beaton ◽

J Carapetis ◽

...

Keyword(s):

Cohort Study ◽

Heart Disease ◽

Rheumatic Heart Disease ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Multivariable Analysis ◽

Subtype C ◽

Factors Associated ◽

Rheumatic Heart

Abstract Background Screening echocardiography (echo) detects subclinical rheumatic heart disease (RHD) which is categorised as definite or borderline. The natural history of subclinical RHD is not known. Follow up single centre studies have included a relatively small number of participants, and have shown variable progression rates. Aim To determine incidence of and factors associated with progression and regression among a cohort of children with baseline subclinical RHD across multiple countries and regions. Methods This is a retrospective cohort study of RHD evolution in children with subclinical RHD. Study sites were Australia, Fiji, Malawi, New Zealand, and Uganda. Progression or regression was determined from echos obtained at baseline and most recent follow-up. Factors associated with echo progression or regression were identified using multivariable logistic regression. Results 482 participants (131 with definite, 351 with borderline subclinical RHD) from 5 countries were included (mean age 11.5 years, range 5–19 years). Mean follow up was 3.4 yrs (range 0.4–9.5 yrs). Of 482 participating children, 204 (42%) regressed. Among 131 children with definite lesions, 48 (37%) regressed to borderline or normal, and 83 (63%) remained definite. Among 351 children with borderline lesions, 39 (11.1%) progressed, 156 (44.4%) remained borderline, and 156 (44.4%) regressed to normal. World Heart Federation defines subcategories based on characteristics of affected valves. By subcategory, children with definite C (pathological aortic regurgitation and 2 morphologic characteristics of the aortic valve) and borderline A (at least 2 morphologic features of the mitral valve without pathologic mitral regurgitation or stenosis) were less likely to regress, and borderline A was more likely to progress. In univariable analysis, good adherence (>80%) to penicillin prophylaxis (BPG) was associated with more regression among all patients (definite + borderline) (OR 1.9, CI 1, 3.5; p=0.04) but this association did not remain significant after adjustment. With multivariable analysis, borderlines prescribed BPG was the only factor related to progression from borderline to definite (OR 4.1, CI 1.8, 9.3, p<0.01). Conclusion This is the largest reported subclinical RHD cohort followed to report outcomes. 42% of definite RHD regressed with subtype C more likely to regress. 11% of borderline RHD progressed. Borderline A was more likely to progress and less likely to regress. We have also identified that being prescribed BPG is associated with borderline progression. This is likely because children with more advanced borderline disease may be more likely to be prescribed BPG. This study highlights that RHD evolution is variable out to 3–4 years post echo detection. While borderline disease is likely, in some cases, to reflect the earliest change of RHD, how this should be monitored and whether it should be treated with BPG should be a priority for future prospective evaluation.

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