scholarly journals Mortality risk estimation in acute calculous cholecystitis: beyond the Tokyo Guidelines

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Ana María González-Castillo ◽  
Juan Sancho-Insenser ◽  
Maite De Miguel-Palacio ◽  
Josep-Ricard Morera-Casaponsa ◽  
Estela Membrilla-Fernández ◽  
...  
Keyword(s):  
Risk Factors ◽  
Surgical Treatment ◽  
Propensity Score ◽  
Mortality Risk ◽  
Characteristic Curve ◽  
Chronic Obstructive ◽  
Tokyo Guidelines ◽  
Acute Calculous Cholecystitis ◽  
Calculous Cholecystitis ◽  
Non Surgical Treatment

Abstract Background Acute calculous cholecystitis (ACC) is the second most frequent surgical condition in emergency departments. The recommended treatment is the early laparoscopic cholecystectomy; however, the Tokyo Guidelines (TG) advocate for different initial treatments in some subgroups of patients without a strong evidence that all patients will benefit from them. There is no clear consensus in the literature about who is the unfit patient for surgical treatment. The primary aim of the study is to identify the risk factors for mortality in ACC and compare them with Tokyo Guidelines (TG) classification. Methods Retrospective unicentric cohort study of patients emergently admitted with and ACC during 1 January 2011 to 31 December 2016. The study comprised 963 patients. Primary outcome was the mortality after the diagnosis. A propensity score method was used to avoid confounding factors comparing surgical treatment and non-surgical treatment. Results The overall mortality was 3.6%. Mortality was associated with older age (68 + IQR 27 vs. 83 + IQR 5.5; P = 0.001) and higher Charlson Comorbidity Index (3.5 + 5.3 vs. 0+2; P = 0.001). A logistic regression model isolated four mortality risk factors (ACME): chronic obstructive pulmonary disease (OR 4.66 95% CI 1.7–12.8 P = 0.001), dementia (OR 4.12; 95% CI 1.34–12.7, P = 0.001), age > 80 years (OR 1.12: 95% CI 1.02–1.21, P = 0.001) and the need of preoperative vasoactive amines (OR 9.9: 95% CI 3.5–28.3, P = 0.001) which predicted the mortality in a 92% of the patients. The receiver operating characteristic curve yielded an area of 88% significantly higher that 68% (P = 0.003) from the TG classification. When comparing subgroups selected using propensity score matching with the same morbidity and severity of ACC, mortality was higher in the non-surgical treatment group. (26.2% vs. 10.5%). Conclusions Mortality was higher in ACC patients treated with non-surgical treatment. ACME identifies high-risk patients. The validation to ACME with a prospective multicenter study population could allow us to create a new alternative guideline to TG for treating ACC. Trial registration Retrospectively registered and recorded in Clinical Trials. NCT04744441

Mortality Risk Estimation in Acute Calculous Cholecystitis: Beyond the Tokyo Guidelines

2021 ◽  
Author(s):  
Ana-María González-Castillo ◽  
Juan Sancho-Insenser ◽  
Maite De Miguel-Palacio ◽  
Josep-Ricard Morera-Casaponsa ◽  
Estela Membrilla-Fernández ◽  
...  
Keyword(s):  
Risk Factors ◽  
Surgical Treatment ◽  
Propensity Score ◽  
Mortality Risk ◽  
Characteristic Curve ◽  
Chronic Obstructive ◽  
Tokyo Guidelines ◽  
Acute Calculous Cholecystitis ◽  
Calculous Cholecystitis ◽  
Non Surgical Treatment

Abstract Background: Acute Calculous Cholecystitis (ACC) is the second most frequent surgical condition in Emergency Departments. The recommended treatment is the Early Laparoscopic Cholecystectomy, however, the Tokyo Guidelines (TG) advocate for different initial treatments in some subgroups of patients without a strong evidence that all patients will benefit from them. There is no clear consensus in the literature about who is the unfit patients for surgical treatment. The objective of the study is to identify the risk factors for mortality in ACC and compare them with Tokyo Guidelines (TG) classification.Methods: retrospective unicentric cohort study of patients emergently admitted with and ACC during January 1, 2011 to December 31, 2016. The study comprised 963 patients. Primary outcome was the mortality after the diagnosis. A propensity score method was used to avoid confunding factors comparing surgical treatment and non-surgical treatment.Results: the overall mortality was 3.6%. Mortality was associated with older age (68 + IQR 27 vs. 83 + IQR 5.5; P 0.001) and higher Charlson Comorbidity Index (3.5 + 5.3 vs. 0+2; P 0.001). A logistic regression model isolated four mortality risk factors (ACME): chronic obstructive pulmonary disease (OR 4.66:95%CI: 1.7-12.8 P=0.001), dementia (OR 4.12;95%CI: 1.34-12.7 P=0.001), age > 80 years (OR 1.12:95% CI: 1.02-1.21 P=0.001) and the need of preoperative vasoactive amines (OR 9.9:95%CI: 3.5-28.3 P=0.001) which predicted the mortality in a 92% of the patients. The receiver operating characteristic curve yielded an area of 88% significantly higher that 68% (P=0.003) from the TG classification. When comparing subgroups selected using propensity score matching with the same morbidity and severity of ACC, mortality was higher in the non-surgical treatment group. (26.2% vs. 10.5%).Conclusions: mortality was higher in ACC patients treated with non-surgical treatment. ACME identifies high-risk patients. The validation to ACME could allow us to create a new alternative guideline to TG for treating ACC.Trial Registration: retrospectively registered and recorded in Clinical Trials (NTC 0474441).

scholarly journals The pattern of Comorbidities and Associated Risk Factors among Colorectal Cancer Patients in Spain: CoMCoR study

2019 ◽  
Author(s):  
Miguel Angel Luque-Fernandez ◽  
Daniel Redondo-Sánchez ◽  
Miguel Rodríguez-Barranco ◽  
Ma Carmen Carmona-García ◽  
Rafael Marcos-Gragera ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Risk Factors ◽  
Surgical Treatment ◽  
Cancer Patients ◽  
Cancer Diagnosis ◽  
Web Application ◽  
Stage Iv ◽  
Chronic Obstructive ◽  
Limited Information ◽  
Colorectal Cancer Patients

AbstractColorectal cancer is the second most frequently diagnosed cancer in Spain. Cancer treatment and outcomes can be influenced by tumor characteristics, patient general health status and comorbidities. Numerous studies have analyzed the influence of comorbidity on cancer outcomes, but limited information is available regarding the frequency and distribution of comorbidities in colorectal cancer patients, particularly elderly ones, in the Spanish population. We developed a population-based high-resolution cohort study of all incident colorectal cancer cases diagnosed in Spain in 2011 to describe the frequency and distribution of comorbidities, as well as tumor and healthcare factors. We then characterized risk factors associated with the most prevalent comorbidities, as well as dementia and multimorbidity, and developed an interactive web application to visualize our findings. The most common comorbidities were diabetes (23.6%), chronic obstructive pulmonary disease (17.2%), and congestive heart failure (14.5%). Dementia was the most common comorbidity among patients aged ≥75 years. Patients with dementia had a 30% higher prevalence of being diagnosed at stage IV and the highest prevalence of emergency hospital admission after colorectal cancer diagnosis (33%). Colorectal cancer patients with dementia were nearly three times more likely to not be offered surgical treatment. Age ≥75 years, obesity, male sex, being a current smoker, having surgery more than 60 days after cancer diagnosis, and not being offered surgical treatment were associated with a higher risk of multimorbidity. Patients with multimorbidity aged ≥75 years showed a higher prevalence of hospital emergency admission followed by surgery the same day of the admission (37%). We found a consistent pattern in the distribution and frequency of comorbidities and multimorbidity among colorectal cancer patients. The high frequency of stage IV diagnosis among patients with dementia and the high proportion of older patients not being offered surgical treatment are significant findings that require policy actions.

Surgical treatment of acute calculous cholecystitis followed by one-day discharge of patients

2019 ◽  
pp. 32
Author(s):  
F. S. Kurbanov ◽  
M. A. Chinikov ◽  
Yu. G. Aliev ◽  
R. Kh. Azimov ◽  
L. R. Alvendova ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Acute Calculous Cholecystitis ◽  
Calculous Cholecystitis

scholarly journals Maximum chest CT score predicts progression to severe illness in patients with COVID-19: a retrospective study from Wuhan, China

2020 ◽  
Author(s):  
Jianwei Xiao ◽  
Xiang Li ◽  
Yuanliang Xie ◽  
Zengfa Huang ◽  
Yi Ding ◽  
...  
Keyword(s):  
Risk Factors ◽  
Disease Progression ◽  
Clinical Laboratory ◽  
Characteristic Curve ◽  
Severe Illness ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Factors Associated ◽  
Radiological Data ◽  
Symptom Progression

Abstract Background: We investigated the clinical course and imaging findings of hospitalized patients who were initially diagnosed with moderate COVID-19 symptoms to identify risk factors associated with progression to severe/critical symptoms.Methods: This study was a retrospective single-center study at The Central Hospital of Wuhan. 243 patients with confirmed COVID­19 pneumonia were enrolled in the analysis, of which 40 patients progressed from moderate to severe/critical symptoms during follow up. Demographic, clinical, laboratory and radiological data were extracted from electronic medical records and compared between moderate and severe/critical symptom types. Univariable and multivariable logistic regressions were used to identify the risk factors associated with symptom progression.Results: Patients with severe/critical symptoms were older (p＜0.001) and more often male (p=0.046). We found that the combination of chronic obstructive pulmonary disease and high maximum CT scores was associated with disease progression. Maximum CT scores (≥11) had the greatest predictive value for disease progression. The area under the receiver operating characteristic curve (ROC) was 0.861 (95% CI: 0.811-0.902).Conclusions: Maximum CT scores and COPD are associated with patient deterioration. Maximum CT scores (≥11) are associated with severe illness.

THE PRINCIPLES OF DIAGNOSIS AND SURGICAL TREATMENT OF COMPLICATED FORMS OF GALLSTONE DISEASE

Vestnik ◽  
2021 ◽  
pp. 391-394
Author(s):  
В.М. Мадьяров ◽  
М.М. Сахипов ◽  
Г.Р. Жапаркулова
Keyword(s):  
Surgical Treatment ◽  
Gallstone Disease ◽  
Pathological Process ◽  
Abdominal Complications ◽  
Acute Calculous Cholecystitis ◽  
Results Of Treatment ◽  
Calculous Cholecystitis

Проанализированы за последние три года результаты оперативного лечения 200 больных с осложненными формами желчнокаменной болезни. Доказано, что риск возникновения гнойно-деструктивных форм острого калькулезного холецистита зависит от характера патологического процесса в желчном пузыре. По поводу гнойно-деструктивных форм заболевания при острого калькулезного холецистита оперировано 79,7% больных и 38,9% при необструктивной форме холецистита. Риск интраабдоминальных осложнений зависит от наличия обструкции, выявленное у 18,1% больных с обтурационнной и 5,6% у пациентов с необтурационнной формой. Госпитализация при гнойно-деструктивных формах 63,5% пациентов в первые 2 часа и 85,7% в первые 6 часов от момента заболевания, дает возможность своевременно оперировать больных до развития его интраабдоминальных осложнений. The results of treatment of 200 patients with complicated forms of gallstone disease were analyzed. It is proved that the risk of purulent-destructive forms of acute calculous cholecystitis depends on the nature of the pathological process in the gallbladder. For purulent-destructive forms of the disease in acute calculous cholecystitis, 79.7% of patients and 38.9% of patients with non-obstructive form of cholecystitis were operated on. The risk of intra-abdominal complications depends on the presence of obstruction, identified in 18.1% of patients with obstructive and 5.6% in patients with non-obstructive form. Hospitalization with purulent-destructive forms of 63.5% of patients in the first 2 hours and 85.7% in the first 6 hours from the time of the disease makes it possible to timely operate patients before the development of its intra-abdominal complications.

scholarly journals Optimal Treatment and Management of Proximal Fifth Metatarsal Fractures

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0006
Author(s):  
Reinout Heijboer ◽  
Sofie Breuking ◽  
Noortje Hagemeijer ◽  
Daniel Guss ◽  
Christopher DiGiovanni
Keyword(s):  
Risk Factors ◽  
Surgical Treatment ◽  
Propensity Score ◽  
Conservative Treatment ◽  
Propensity Score Matching ◽  
Avulsion Fracture ◽  
Diaphyseal Fracture ◽  
Factors Associated ◽  
Metatarsal Fractures ◽  
Diaphyseal Fractures

Category: Midfoot/Forefoot Introduction/Purpose: Proximal fifth metatarsal fractures (PFMF) are among the most common fractures of the foot, and may be subdivided into tuberosity avulsion fracture, Jones fracture, and proximal diaphyseal fracture. However, for Jones fractures and proximal diaphyseal fractures optimal treatment is still debated in literature. The Torg criteria are used in deciding to treat surgically or conservative, whereby Torg type I and II indicates conservative treatment, and type III indicates surgical treatment. Yet failure rates of both management options vary and derive from small study groups. The aim of this study was to compare failure rates after surgical- and conservative treatment of Jones fractures and proximal diaphyseal fractures, to evaluate the incidence of treatment failure, and to assess factors associated with healing difficulties of PFMF. Methods: A total of 1,133 adult patients that were diagnosed and treated for PFMF between 2005 and 2015 in a tertiary care foot and ankle referral center were included. Retrospective chart review recorded patient demographics, suspected risk factors for impaired healing of PFMF (rheumatoid arthritis, diabetes mellitus, osteoporosis, nutritional and hormonal disorders, foot deformities, (neuropathic) arthropathy of the foot and/or ankle and peripheral neuropathy of the lower extremity), and treatment indication. Multivariable logistic regression analysis was used to determine factors associated with healing difficulties. Propensity score matching was used to minimize selection bias between treatments in Jones fractures and proximal diaphyseal fractures. Results: In total, 489(43.2%) patients were diagnosed with a tuberosity avulsion fracture, 391(34.5%) patients with a Jones fracture and 253(22.3%) patients with a proximal diaphyseal fracture. In the tuberosity fracture group, a nonunion was found in 5.3%(25/473) of the patients treated conservatively and in 0%(0/16) treated operatively. For the Jones fractures and proximal diaphyseal fractures the non-union rate for conservative treatment was 10%(35/337) and 5.9%(14/238), and for surgical treatment 11%(6/54) and 0%(0/15), respectively. No independent risk factors for complicating the healing process of PFMF were identified. With propensity score matching, 37 patients treated operatively were matched to 37 patients undergoing conservative treatment. The risk for a nonunion was lower in the operative group compared to the conservative treatment group (relative risk 0.8, P=0.006). Conclusion: In this propensity-matched cohort, surgical treatment for Jones fractures and proximal diaphyseal fractures were associated with better fracture healing compared to conservative treatment. In addition, no factors were found to be associated with healing difficulties of proximal fifth metatarsal fractures.

scholarly journals Risk Factors and Mortality Associated with Multimorbidity in People with Stroke or Transient Ischaemic Attack: A Study of 8,751 UK Biobank Participants

2018 ◽  
Vol 8 (1) ◽  
pp. 1-8 ◽  
Author(s):  
Katie I. Gallacher ◽  
Ross McQueenie ◽  
Barbara Nicholl ◽  
Bhautesh D. Jani ◽  
Duncan Lee ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mortality Risk ◽  
Transient Ischaemic Attack ◽  
Alcohol Intake ◽  
Mortality Data ◽  
Chronic Obstructive ◽  
Uk Biobank ◽  
Lifestyle Risk Factors ◽  
All Cause Mortality ◽  
Ischaemic Attack

Background Multimorbidity is common in stroke, but the risk factors and effects on mortality remain poorly understood. Objective To examine multimorbidity and its associations with sociodemographic/lifestyle risk factors and all-cause mortality in UK Biobank participants with stroke or transient ischaemic attack (TIA). Design Data were obtained from an anonymized community cohort aged 40–72 years. Overall, 42 comorbidities were self-reported by those with stroke or TIA. Relative risk ratios demonstrated associations between participant characteristics and number of comorbidities. Hazard ratios demonstrated associations between the number and type of comorbidities and all-cause mortality. Results were adjusted for age, sex, socioeconomic status, smoking, and alcohol intake. Data were linked to national mortality data. Median follow-up was 7 years. Results Of 8,751 participants (mean age 60.9±6.7 years) with stroke or TIA, the all-cause mortality rate over 7 years was 8.4%. Over 85% reported ≥1 comorbidities. Age, socioeconomic deprivation, smoking and less frequent alcohol intake were associated with higher levels of multimorbidity. Increasing multimorbidity was associated with higher all-cause mortality. Mortality risk was double for those with ≥5 comorbidities compared to those with none. Having cancer, coronary heart disease, diabetes, or chronic obstructive pulmonary disease significantly increased mortality risk. Presence of any cardiometabolic comorbidity significantly increased mortality risk, as did any non-cardiometabolic comorbidity. Conclusions In stroke survivors, the number of comorbidities may be a more helpful predictor of mortality than type of condition. Stroke guidelines should take greater account of comorbidities, and interventions are needed that improve outcomes for people with multimorbidity and stroke.

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