scholarly journals Respiratory risk factors in development of postoperative complications after the lung resection

2004 ◽  
Vol 4 (3) ◽  
pp. 55-58
Author(s):  
Goran Krdžalić ◽  
Emir Kabil ◽  
Urnid Salaka ◽  
Mirna Sijerčić ◽  
Alisa Krdžalić
Keyword(s):  
Risk Factors ◽  
Postoperative Complications ◽  
Lung Diseases ◽  
Lung Resection ◽  
Univariate Analysis ◽  
Advanced Age ◽  
Malignant Neoplasms ◽  
Factors Associated ◽  
Lung Resections

The objectives of the study were to identify possible associated respiratory risk factors and to assess incidence of overall postoperative complications after the lung resection. We reviewed 110 patients who underwent lung resections due to malignant neoplasms or benign lung diseases. The risk of postoperative complications was evaluated using the univariate analysis. Results confirmed that low FEV1, postoperative high PaCO2, ASA-status and advanced age were factors associated with development of postoperative complications.

scholarly journals Early Outcomes After Surgical Management of Geriatric Patella Fractures

2021 ◽  
Vol 12 ◽  
pp. 215145932098769
Author(s):  
Jaclyn Kapilow ◽  
Junho Ahn ◽  
Kathryn Gallaway ◽  
Megan Sorich
Keyword(s):  
Risk Factors ◽  
Postoperative Complications ◽  
Length Of Stay ◽  
Geriatric Patients ◽  
The United States ◽  
Unplanned Readmission ◽  
Patella Fracture ◽  
Factors Associated ◽  
Prolonged Hospitalization ◽  
Patella Fractures

Objectives: To report the incidence and risk factors for prolonged hospitalization, discharge to a facility, and postoperative complications in geriatric patients who underwent surgery for patella fracture. Design: Retrospective database review. Setting: The American College of Surgeons—National Surgical Quality Improvement Program (NSQIP) collects data from 600 hospitals across the United States. Patients/Participants: NSQIP patients over 65 years of age with patella fractures. Intervention: Surgical fixation of patella fracture including extensor mechanism repair. Main Outcome Measurements: Prolonged hospitalization, discharge to a facility, and 30-day post-operative complications. Results: 1721 patients were included in the study. The average age was 74.9 years. 358 (20.8%) patients were male. 122 (7.1%) patients had a length of stay greater than 7 days. Factors associated with prolonged length of stay include pre-existing renal failure, need for emergent surgery, and time to surgery greater than 24 hours from admission. 640 patients (37.2%) of patients were discharged to a facility after surgery. Discharge to facility was associated with age >77 years, obesity, anemia, thrombocytopenia, pre-operative SIRS, and CCI > 0.5. Admission from home decreased the odds of discharge to a facility. The most common postoperative complications in this population were unplanned readmission (3.4%), unplanned reoperation (2.7%), surgical site infection (1.1%), mortality (1.0%), venous thromboembolism (0.8%), and wound dehiscence (0.2%). Complication rates increased with anemia and ASA class IV-V. Conclusions: Geriatric patients undergoing operative intervention for patella fractures are at high risk for prolonged hospitalization, discharge to facility, unplanned readmission or reoperation, and surgical site complications in the first 30 days following surgery. This study highlights modifiable and non-modifiable risk factors associated with adverse events. Early recognition of these factors can allow for close monitoring and multidisciplinary intervention in the perioperative period to improve outcomes. Level of Evidence: Prognostic level III.

Higher-Than-Expected Rates of Distal Radioulnar Joint Fixation in Radial Shaft Fractures: Location of Fracture Matters

Hand ◽  
2021 ◽  
pp. 155894472110068
Author(s):  
Joanne Y. Zhang ◽  
Aneesh V. Samineni ◽  
David C. Sing ◽  
Alyssa Rothman ◽  
Andrew B. Stein
Keyword(s):  
Risk Factors ◽  
Postoperative Complications ◽  
Patient Characteristics ◽  
Distal Radioulnar Joint ◽  
Older Age ◽  
Radioulnar Joint ◽  
Factors Associated ◽  
Shaft Fractures ◽  
Male Sex ◽  
Preoperative Patient

Background: The purpose of this study was to evaluate rates of distal radioulnar joint (DRUJ) fixation based on location of the radial shaft fracture and risk factors associated with postoperative complications following radial shaft open reduction internal fixation (ORIF). Methods: Adult patients who underwent isolated radial shaft ORIF from 2014 to 2018 were identified from American College of Surgeons National Surgical Quality Improvement Program database and stratified by fracture location and by the presence or absence of DRUJ fixation. Preoperative patient characteristics and postoperative complications were compared to determine risk factors associated with DRUJ fixation. Results: We identified 1517 patients who underwent isolated radial shaft ORIF, of which 396 (26.1%) underwent DRUJ fixation. Preoperative patient characteristics and postoperative complications were similar between cohorts. Distal radioulnar joint fixation was performed in 50 (30.7%) of 163 distal radial shaft fractures, 191 (21.8%) of 875 midshaft fractures, and 3 (13.0%) of 23 proximal shaft fractures ( P = .025). Risk factors for patients readmitted include male sex (odds ratio [OR] = 12.76, P = .009) and older age (OR = 4.99, P = .035). Risk factors for patients with any postoperative complication include dependent functional status (OR = 6.78, P = .02), older age (50-69 vs <50) (OR = 2.73, P = .05), and American Society of Anesthesiologists (ASA) ≥3 (OR = 2.45, P = .047). Conclusions: The rate of DRUJ fixation in radial shaft ORIF exceeded previously reported rates of concomitant DRUJ injury, especially among distal radial shaft fractures. More distally located radial shaft fractures are significantly associated with higher rates of DRUJ fixation. Male sex is a risk factor for readmission, whereas dependent functional status, older age, and ASA ≥3 are risk factors for postoperative complications.

scholarly journals Risk Factors for Community Acquired Extended-Spectrum Β-lactamase (ESBL) Producing Enterobacteriaceae Urinary Tract Infections (UTIs)

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S345-S345
Author(s):  
Dheeraj Goyal ◽  
Kristin Dascomb ◽  
Peter S Jones ◽  
Bert K Lopansri
Keyword(s):  
Risk Factors ◽  
Urinary Tract ◽  
Urinary Catheter ◽  
Univariate Analysis ◽  
Prior History ◽  
Factors Associated ◽  
Extended Spectrum ◽  
History Of ◽  
Enterobacteriaceae Infections ◽  
Tract Infections

Abstract Background Community-acquired extended-spectrum β-lactamase (ESBL) producing Enterobacteriaceae infections pose unique treatment challenges. Identifying risk factors associated with ESBL Enterobacteriaceae infections outside of prior colonization is important for empiric management in an era of antimicrobial stewardship. Methods We randomly selected 251 adult inpatients admitted to an Intermountain healthcare facility in Utah with an ESBL Enterobacteriaceae urinary tract infection (UTI) between January 1, 2001 and January 1, 2016. 1:1 matched controls had UTI at admission with Enterobacteriaceae but did not produce ESBL. UTI at admission was defined as urine culture positive for &gt; 100,000 colony forming units per milliliter (cfu/mL) of Enterobacteriaceae and positive symptoms within 7 days prior or 2 days after admission. Repeated UTI was defined as more than 3 episodes of UTI within 12 months preceding index hospitalization. Cases with prior history of ESBL Enterobacteriaceae UTIs or another hospitalization three months preceding the index admission were excluded. Univariate and multiple logistic regression techniques were used to identify the risk factors associated with first episode of ESBL Enterobacteriaceae UTI at the time of hospitalization. Results In univariate analysis, history of repeated UTIs, neurogenic bladder, presence of a urinary catheter at time of admission, and prior exposure to outpatient antibiotics within past one month were found to be significantly associated with ESBL Enterobacteriaceae UTIs. When controlling for age differences, severity of illness and co-morbid conditions, history of repeated UTIs (adjusted odds ratio (AOR) 6.76, 95% confidence interval (CI) 3.60–13.41), presence of a urinary catheter at admission (AOR 2.75, 95% CI 1.25 – 6.24) and prior antibiotic exposure (AOR: 8.50, 95% CI: 3.09 – 30.13) remained significantly associated with development of new ESBL Enterobacteriaceae UTIs. Conclusion Patients in the community with urinary catheters, history of recurrent UTIs, or recent antimicrobial use can develop de novo ESBL Enterobacteriaceae UTIs. Disclosures All authors: No reported disclosures.

scholarly journals Language Delay Is Not Predictable from Available Risk Factors

2013 ◽  
Vol 2013 ◽  
pp. 1-8 ◽  
Author(s):  
Philip Wilson ◽  
Fiona McQuaige ◽  
Lucy Thompson ◽  
Alex McConnachie
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Positive Predictive Value ◽  
Predictive Value ◽  
Univariate Analysis ◽  
Male Gender ◽  
Language Delay ◽  
Predictive Capacity ◽  
Factors Associated ◽  
Health Visitors

Aims. To investigate factors associated with language delay in a cohort of 30-month-old children and determine if identification of language delay requires active contact with families.Methods. Data were collected at a pilot universal 30-month health contact. Health visitors used a simple two-item language screen. Data were obtained for 315 children; language delay was found in 33. The predictive capacity of 13 variables which could realistically be known before the 30-month contact was analysed.Results. Seven variables were significantly associated with language delay in univariate analysis, but in logistic regression only five of these variables remained significant.Conclusion. The presence of one or more risk factors had a sensitivity of 89% and specificity of 45%, but a positive predictive value of only 15%. The presence of one or more of these risk factors thus can not reliably be used to identify language delayed children, nor is it possible to define an “at risk” population because male gender was the only significant demographic factor and it had an unacceptably low specificity (52.5%). It is not possible to predict which children will have language delay at 30 months. Identification of this important ESSENCE disorder requires direct clinical contact with all families.

scholarly journals Prevalence and associated factors for Pterygium in Han and Mongolian adults: across-sectional study in inner Mongolian, China

2019 ◽  
Author(s):  
Yuhan Wang ◽  
Guangliang Shan ◽  
Linyang Gan ◽  
Yonggang Qian ◽  
Ting Chen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Protective Factors ◽  
Rural Areas ◽  
Inner Mongolia ◽  
Univariate Analysis ◽  
Education Level ◽  
Study Cohort ◽  
Sectional Study ◽  
Factors Associated ◽  
Significant Difference

Abstract Background: To investigate the prevalence of and factors associated with pterygium in Han and Mongolian adults at four survey sites in Inner Mongolia, China. Methods: A population-based, cross-sectional study was conducted. Using a stratified sampling method, we eventually included 2,651 participants of at least30 years of age from a total of 3,468 eligible residents. Factors associated with pterygium were analysed using univariate analysis and logistic regression models. Results: There were 1,910 Han adults and 741 Mongolian adults included in this study. The mean± standard deviation of age for individuals in the study cohort was 48.93±11.06 years. The overall prevalence of pterygium was 6.4% (n=169), and the prevalences of bilateral and unilateral pterygium were 1.4% (n=38) and 4.8% (n=128), respectively. The most common grade of pterygium was Grade 2. After univariate analysis, eleven factors were considered in a multivariate analysis. The results indicated that age (P<0.001), education level (P<0.001), outdoor occupation (P=0.026), and time spent in rural areas (P<0.001) were significantly associated with pterygium, whereas gender and ethnicity were not risk factors. In subgroup analysis, BMI≥28 was a protective factor for Han individuals (OR 0.42, 95% CI 0.21-0.81, P=0.01), but a risk factor for Mongolian individuals (OR 2.39, 95% CI 1.02-5.58, P=0.044). The BF% in Han and Mongolian individuals had significant difference (P<0.001). Conclusions: Our results indicated that an outdoor occupation, old age and time spent in rural areas are risk factors for pterygium in Inner Mongolia. Living near an urban survey site (Hohhot and Tsining District) and having a higher education level are protective factors for pterygium. Ethnicity, gender, smoking, diabetes and high blood pressure are not associated with pterygium. Different dietary structures in Han and Mongolian adults may lead to different fat content of body and therefore contributes to the prevalence of pterygium. Keywords: Pterygium, prevalence, Han and Mongolian, risk factors, protective factors

scholarly journals 547. Risk Factors Associated with 30-Day Mortality in a Large Cohort of Patients who Received Remdesivir and Corticosteroids for Severe COVID-19

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S375-S376
Author(s):  
Kartik Gupta ◽  
Lea Monday ◽  
Milan Kaushik ◽  
George J Alangaden ◽  
Indira Brar
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Health System ◽  
Drug Administration ◽  
Food And Drug Administration ◽  
Antiviral Agent ◽  
Advanced Age ◽  
Event Analysis ◽  
Time To Event ◽  
Factors Associated

Abstract Background Remdesivir (RDV), an antiviral agent, is approved by Food and Drug Administration (FDA) for the treatment of patients (pts) admitted with SARS-COV-2 infection (COVID-19). Earlier RDV studies (such as ACCT-1) prior to widespread use of corticosteroids (CS), showed a 30-day mortality of 11%. Advanced age, obesity, and certain comorbidities are known risk factors for death in COVID-19, but whether these risks vary in pts treated with RDV and CS is unknown. As of March 20, 2020 CS were routinely used for the treatment of pts admitted with COVID19 in our health care system. The objective of this study was to identify risk factors associated with 30 -Day mortality in a cohort of pts admitted with COVID-19 and who received RDV and CS. Methods This retrospective cohort study evaluated pts admitted to a health system in South East Michigan with COVID-19 between March and November 2020 who received ≥1 dose RDV. Demographics, comorbidities, and characteristics including quick sequential organ failure assessment (qSOFA) score were collected and compared between patients who died versus survived. Primary outcome was 30 day mortality. Secondary outcomes were risk factors for death using logistic regression and time-to-event analysis. Results A total of 1,591 pts received RDV and were included in the study; median age 67 years, 56% male and 18% Black. RDV use increased after emergency use authorization and FDA approval (Fig 1). Death within 30 days occurred in 15.3%. Patients who died were older males with higher rates of hypertension, kidney disease, diabetes, and were more likely to have qSOFA ≥2 on arrival (Table 1). In a multivariable logistic model, advanced age, male gender, pulmonary disease, CKD, obesity, and qSOFA≥2 were independent predictors of death (Figure 2). Among these, age and qSOFA≥2 were the most important risk factors (Figure 2). Patients receiving remdesivir (red) were included in the study. Routine use of corticosteroids was adopted on all patients in our health system beginning March 20, 2020. System-wide use of remdesivir increased following Food and Drug Administration approval in fall 2020. On both logistic regression and time-to-event analysis, advanced age and qSOFA ≥ 2 had the highest predictive value for mortality. Others comorbidities were similar and comparable in importance. Conclusion The population in our Real-world study was older with more comorbidities as compared to ACCT-1, and the 30 day mortality was 15%. Despite the use of CS and RDV advanced age and qSOFA were the most important drivers of mortality. Future, therapeutic strategies need to focus on this group which is at the highest risk of dying from COVID-19 infection. Disclosures All Authors: No reported disclosures

Patient-Related Risk Factors Associated With Surgical Site Complications After Elective Hand Surgery

Hand ◽  
2020 ◽  
pp. 155894472094426
Author(s):  
Tyler Youngman ◽  
Michael Del Core ◽  
Timothy Benage ◽  
Daniel Koehler ◽  
Douglas Sammer ◽  
...  
Keyword(s):  
Risk Factors ◽  
Regression Analysis ◽  
Surgical Complications ◽  
Multivariate Regression ◽  
Univariate Analysis ◽  
Hand Surgery ◽  
Multivariate Regression Analysis ◽  
Class Iii ◽  
Factors Associated ◽  
Surgical Site Complications

Background: The purpose of this study was to identify independent risk factors associated with an increased rate of surgical site complications after elective hand surgery. Methods: This study is a retrospective review of all patients who underwent elective hand, wrist, forearm, and elbow surgery over a 10-year period at a single institution. Electronic medical records were reviewed, and information regarding patient demographics, past medical and social history, perioperative laboratory values, procedures performed, and surgical complications was collected. Surgical site complications included surgical site infections, seromas or hematomas, and delayed wound healing or wound dehiscence. A univariate analysis was then performed to identify potential risk factors, which were then included in a multivariate regression analysis. Results: A total of 3261 patients who underwent elective hand surgery and met the above inclusion and exclusion criteria were included in this study. The mean age was 57 years, with 65% female and 35% male patients. The overall surgical complication rate was 2.2%. Univariate analysis of patient factors identified male sex; number of procedures >1; history of drug, alcohol, or smoking use; American Society of Anesthesiologists (ASA) class III and IV; and serum albumin <3.5 mg/dL to be significantly associated with complications. However, multivariate regression analysis identified that only ASA class III and IV (odds ratio = 3.27) was significantly associated with surgical complications. Conclusions: Patients classified as ASA class III or IV were identified to be at a significantly increased risk of complications following elective hand surgery. Health factors which triage patients into these 2 groups may represent potentially modifiable factors to mitigate perioperative risk in the elective hand surgery population.

scholarly journals Comparison of postoperative complications between segmentectomy and lobectomy by video-assisted thoracic surgery: a multicenter study

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Benoît Bédat ◽  
Etienne Abdelnour-Berchtold ◽  
Thomas Perneger ◽  
Marc-Joseph Licker ◽  
Alexandra Stefani ◽  
...  
Keyword(s):  
Risk Factors ◽  
Postoperative Complications ◽  
Thoracic Surgery ◽  
Benign Lesion ◽  
Lung Resection ◽  
Primary Lung Cancer ◽  
Forced Expiratory Volume ◽  
University Hospitals ◽  
Video Assisted Thoracic Surgery ◽  
Video Assisted

Abstract Background Compared to lobectomy by video-assisted thoracic surgery (VATS), segmentectomy by VATS has a potential higher risk of postoperative atelectasis and air leakage. We compared postoperative complications between these two procedures, and analyzed their risk factors. Methods We reviewed the records of all patients who underwent anatomical pulmonary resections by VATS from January 2014 to March 2018 in two Swiss university hospitals. All complications were reported. A logistic regression model was used to compare the risks of complications for the two interventions. Adjustment for patient characteristics was performed using a propensity score, and by including risk factors separately. Results Among 690 patients reviewed, the major indication for lung resection was primary lung cancer (86.4%) followed by metastasis resection (5.8%), benign lesion (3.9%), infection (3.2%) and emphysema (0.7%). Postoperatively, there were 80 instances (33.3%) of complications in 240 segmentectomies, and 171 instances (38.0%) of complications in 450 lobectomies (P = 0.73). After adjustment for the patient’s propensity to be treated by segmentectomy rather than lobectomy, the risks of a complication remained comparable for the two techniques (odds ratio for segmentectomy 0.91 (0.61–1.30), p = 0.59). Length of hospital stay and drainage duration were shorter after segmentectomy. On multivariate analysis, an American Society of Anesthesiologists score above 2 and a forced expiratory volume in one second below 80% of predicted value were significantly associated with the occurrence of complications. Conclusions The rate of complications and their grade were similar between segmentectomy and lobectomy by VATS.

Risk factors for postoperative systemic complications in elderly patients with brain tumors

2009 ◽  
Vol 111 (2) ◽  
pp. 258-264 ◽  
Author(s):  
Kenichiro Asano ◽  
Takahiro Nakano ◽  
Tetsuji Takeda ◽  
Hiroki Ohkuma
Keyword(s):  
Risk Factors ◽  
Postoperative Complications ◽  
Brain Tumors ◽  
Blood Loss ◽  
Elderly Patients ◽  
Univariate Analysis ◽  
Intraoperative Blood Loss ◽  
Systemic Complications ◽  
Level Difference ◽  
Cutoff Values

Object In elderly patients with brain tumors, the prevention of postoperative systemic complications is extremely important, and identification of the risk factors would be useful for planning therapy. The authors investigated ways to avoid postoperative complications by identifying risk factors. Methods The study population included 84 patients, 70 years of age or older, who underwent surgical brain tumor removal. The following independent factors were assessed by univariate and multivariate analyses: sex, age, preoperative underlying diseases and complications, histopathological findings, preoperative Karnofsky Performance Scale (KPS) score, preoperative whole blood hemoglobin (Hb) level, preoperative serum total protein (TP) level, operation time, intraoperative blood loss, change in Hb level (difference between pre- and postoperative values), and change in TP level (difference between pre- and postoperative values). The cutoff values for significant independent factors were also determined. Results Overall, 35 (41.7%) of the 84 patients had a total of 56 postoperative systemic complications. Univariate analysis identified the preoperative KPS score, intraoperative blood loss, change in Hb level, and change in TP level as risk factors for postoperative complications, and multivariate analysis extracted the following risk factors: the preoperative KPS score (p = 0.0450, OR 4.020), intraoperative blood loss (p = 0.0104, OR 6.571), and change in Hb levels (p = 0.0023, OR 9.301). The cutoff values were: KPS score < 80%, intraoperative blood loss ≥ 350 ml, and change in Hb level ≥ 2.0 g/dl. Conclusions In elderly patients with brain tumors, low preoperative KPS score, high intraoperative blood loss, and a large difference between pre- and postoperative Hb levels are significant risk factors for postoperative systemic complications.

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