scholarly journals The cumulative duration of bispectral index less than 40 concurrent with hypotension is associated with 90-day postoperative mortality: a retrospective study

2020 ◽  
Author(s):  
Soohyuk Yoon ◽  
Seokha Yoo ◽  
Min Hur ◽  
Sun-Kyung Park ◽  
Hyung-Chul Lee ◽  
...  
Keyword(s):  
Risk Factors ◽  
Retrospective Study ◽  
Bispectral Index ◽  
Odds Ratio ◽  
Postoperative Mortality ◽  
Anesthetic Depth ◽  
Intraoperative Hypotension ◽  
Cumulative Duration ◽  
The Relationship ◽  
Cumulative Time

Abstract Background The relationship between intraoperative low bispectral index (BIS) values and poor clinical outcomes has been controversial. Intraoperative hypotension is associated with postoperative complication. The purpose of this study was to investigate the influence of intraoperative low BIS values and hypotension on postoperative mortality in patients undergoing major abdominal surgery. Methods This retrospective study analyzed 1,862 cases of general anesthesia. We collected the cumulative time of BIS values below 20 and 40 as well as electroencephalographic suppression and documented the incidences in which these states were maintained for at least 5 minutes. Durations of intraoperative mean arterial pressures (MAP) less than 50 mmHg were also recorded. Multivariable logistic regression was used to evaluate the association between suspected risk factors and postoperative mortality. Results Ninety-day mortality and 180-day mortality were 1.5% and 3.2% respectively. The cumulative time in minutes for BIS values falling below 40 coupled with MAP falling below 50 mmHg was associated with 90-day mortality (odds ratio, 1.26; 95% confidence interval, 1.04-1.53; P = .019). We found no association between BIS related values and 180-day mortality. Conclusions Delicate adjustment of anesthetic depth is important to avoid excessive brain suppression and hypotension, which could be associated with postoperative mortality.

scholarly journals The cumulative duration of bispectral index less than 40 concurrent with hypotension is associated with 90-day postoperative mortality: a retrospective study

2020 ◽  
Author(s):  
Soohyuk Yoon ◽  
Seokha Yoo ◽  
Min Hur ◽  
Sun-Kyung Park ◽  
Hyung-Chul Lee ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Retrospective Study ◽  
Abdominal Surgery ◽  
Bispectral Index ◽  
Odds Ratio ◽  
Postoperative Mortality ◽  
Anesthetic Depth ◽  
Cumulative Duration ◽  
Cumulative Time

Abstract Background The influence of intraoperative low bispectral index (BIS) values and hypotension on poor clinical outcomes has been controversial. The purpose of this study was to investigate the influence of intraoperative low BIS values and hypotension on postoperative mortality in patients undergoing major abdominal surgery. Methods This retrospective study analyzed 1,862 cases of general anesthesia. We collected the cumulative time of BIS values below 20 and 40 as well as electroencephalographic suppression and documented the incidences in which these states were maintained for at least 5 minutes. Durations of intraoperative mean arterial pressures (MAP) less than 50 mmHg were also recorded. Multivariable logistic regression was used to evaluate the association between suspected risk factors and postoperative mortality. Results Ninety-day mortality and 180-day mortality were 1.5% and 3.2% respectively. The cumulative time in minutes for BIS values falling below 40 coupled with MAP falling below 50 mmHg was associated with 90-day mortality (odds ratio, 1.26; 95% confidence interval, 1.04-1.53; P = .019). We found no association between BIS related values and 180-day mortality. Conclusions Delicate adjustment of anesthetic depth is important to avoid excessive brain suppression and hypotension, which could be associated with postoperative mortality.

scholarly journals Bispectral Index Monitoring, Duration of Bispectral Index Below 45, Patient Risk Factors, and Intermediate-term Mortality after Noncardiac Surgery in the B-Unaware Trial

2011 ◽  
Vol 114 (3) ◽  
pp. 545-556 ◽  
Author(s):  
Miklos D. Kertai ◽  
Ben J. A. Palanca ◽  
Nirvik Pal ◽  
Beth A. Burnside ◽  
Lini Zhang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Bispectral Index ◽  
Cox Regression ◽  
Postoperative Mortality ◽  
Noncardiac Surgery ◽  
Volatile Agent ◽  
Discriminative Ability ◽  
Cox Regression Analysis ◽  
Cumulative Duration ◽  
End Tidal

Background Postoperative mortality has been associated with cumulative anesthetic duration below an arbitrary processed electroencephalographic threshold (bispectral index [BIS] <45). This substudy of the B-Unaware Trial tested whether cumulative duration of BIS values lower than 45, cumulative anesthetic dose, comorbidities, or intraoperative events were independently associated with postoperative mortality. Methods The authors studied 1,473 patients (mean ± SD age, 57.9 ± 14.4 yr; 749 men) who underwent noncardiac surgery at Barnes-Jewish Hospital in St. Louis, Missouri. Multivariable Cox regression analysis was used to determine whether perioperative factors were independently associated with all-cause mortality. Results A total of 358 patients (24.3%) died during a follow-up of 3.2 ± 1.1 yr. There were statistically significant associations among various perioperative risk factors, including malignancy and intermediate-term mortality. BIS-monitored patients did not have lower mortality than unmonitored patients (24.9 vs. 23.7%; difference = 1.2%, 95% CI, -3.3 to 5.6%). Cumulative duration of BIS values less than 45 was not associated with mortality (multivariable hazard ratio, 1.03; 95% CI, 0.93-1.14). Increasing mean and cumulative end-tidal anesthetic concentrations were not associated with mortality. The multivariable Cox regression model showed a good discriminative ability (c-index = 0.795). Conclusions This study found no evidence that either cumulative BIS values below a threshold of 40 or 45 or cumulative inhalational anesthetic dose is injurious to patients. These results do not support the hypothesis that limiting depth of anesthesia either by titration to a specific BIS threshold or by limiting end-tidal volatile agent concentrations will decrease postoperative mortality.

THE RELATIONSHIP BETWEEN PREECLAMPSIA AND PARITY IN MATERNAL BIRTH IN RSUD MUHAMMAD SANI KARIMUN

2021 ◽  
Vol 10 (2) ◽  
pp. 39-44
Author(s):  
Bratasena Bratasena ◽  
Junita Henriette
Keyword(s):  
Risk Factors ◽  
Odds Ratio ◽  
Risk Group ◽  
Case Control ◽  
Exposure Risk ◽  
Prevalence Odds Ratio ◽  
High Parity ◽  
A Value ◽  
Not At Risk ◽  
The Relationship

Background : In Indonesia, eclampsia in addition to bleeding and infection is still the main cause of maternal mortality and a high cause of perinatal mortality. Therefore, early diagnosis of preeclampsia, which is a preliminary level of eclampsia, and its handling need to be implemented immediately to reduce maternal and child mortality (Prawiroharjo, 2012). Method : The research design used was case control. Population is the whole object of research. The population in this study were all women who gave birth at Muhammad Sani Karimun Hospital, namely 218 people with the number of preeclampsia incidents of 30 people. The number of cases to be used is 2 (two) times the number of cases, namely 60 people. The analysis used was the Ods Ratio (OR), which is a measure of the association of exposure (risk factors) with the incidence of disease in the risk group (exposed to risk factors) compared to the incidence of disease in the group that is not at risk (not exposed to risk factors). Result : The results of the study, the value of the Prevalence Odds Ratio (POR) = 6,875 with a value of 95% Confidence Interval (CI) = 3,318-12,410. Congclusions : The conclusion of this research is that respondents with high parity are 6.8 times more likely to experience preeclampsia than respondents with little parity.

scholarly journals Preoperative Risk and the Association between Hypotension and Postoperative Acute Kidney Injury

2020 ◽  
Vol 132 (3) ◽  
pp. 461-475 ◽  
Author(s):  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Validation Cohort ◽  
Kidney Injury ◽  
Preoperative Risk ◽  
Intraoperative Hypotension

Abstract Background Despite the significant healthcare impact of acute kidney injury, little is known regarding prevention. Single-center data have implicated hypotension in developing postoperative acute kidney injury. The generalizability of this finding and the interaction between hypotension and baseline patient disease burden remain unknown. The authors sought to determine whether the association between intraoperative hypotension and acute kidney injury varies by preoperative risk. Methods Major noncardiac surgical procedures performed on adult patients across eight hospitals between 2008 and 2015 were reviewed. Derivation and validation cohorts were used, and cases were stratified into preoperative risk quartiles based upon comorbidities and surgical procedure. After preoperative risk stratification, associations between intraoperative hypotension and acute kidney injury were analyzed. Hypotension was defined as the lowest mean arterial pressure range achieved for more than 10 min; ranges were defined as absolute (mmHg) or relative (percentage of decrease from baseline). Results Among 138,021 cases reviewed, 12,431 (9.0%) developed postoperative acute kidney injury. Major risk factors included anemia, estimated glomerular filtration rate, surgery type, American Society of Anesthesiologists Physical Status, and expected anesthesia duration. Using such factors and others for risk stratification, patients with low baseline risk demonstrated no associations between intraoperative hypotension and acute kidney injury. Patients with medium risk demonstrated associations between severe-range intraoperative hypotension (mean arterial pressure less than 50 mmHg) and acute kidney injury (adjusted odds ratio, 2.62; 95% CI, 1.65 to 4.16 in validation cohort). In patients with the highest risk, mild hypotension ranges (mean arterial pressure 55 to 59 mmHg) were associated with acute kidney injury (adjusted odds ratio, 1.34; 95% CI, 1.16 to 1.56). Compared with absolute hypotension, relative hypotension demonstrated weak associations with acute kidney injury not replicable in the validation cohort. Conclusions Adult patients undergoing noncardiac surgery demonstrate varying associations with distinct levels of hypotension when stratified by preoperative risk factors. Specific levels of absolute hypotension, but not relative hypotension, are an important independent risk factor for acute kidney injury. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

scholarly journals Assessment of Breast Cancer Risk Based on Mammary Gland Volume Measured with CT

2010 ◽  
Vol 4 ◽  
pp. BCBCR.S5248 ◽  
Author(s):  
Megumi Kuchiki ◽  
Takaaki Hosoya ◽  
Akira Fukao
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
Breast Cancer Risk ◽  
Cancer Risk ◽  
Cancer Patients ◽  
Odds Ratio ◽  
Premenopausal Women ◽  
Breast Cancer Patients ◽  
History Of ◽  
The Relationship

We investigated the relationship between mammary gland volume (MGV) of the breast as measured with three-dimensional chest computed tomography (CT) and breast cancer risk. Univariate analysis was used to assess the relationship between MGV and known risk factors in 427 healthy women. A case control study (97 cases and 194 controls) was conducted to assess breast cancer risk. MGV was significantly smaller for postmenopausal women than for premenopausal women, and was significantly larger for women with a family history of breast cancer than for women without. MGV, body mass index (BMI), and rate of family history of breast cancer were significantly higher among breast cancer patients than among healthy women, and number of deliveries was significantly lower among breast cancer patients. In postmenopausal women, age at menarche was significantly younger for breast cancer patients. MGV correlated well with breast cancer risk factors. The highest odds ratio was 4.9 for premenopausal women with the largest MGV. Regardless of menopausal status, the greater the MGV, the higher the odds ratio. Our results constitute the first reliable data on the relationship between MGV and breast cancer obtained through exact volume analysis.

scholarly journals The clinical importance of microscopic hematuria and hydronephrosis in urolithiasis

2021 ◽  
Author(s):  
Kamil Kokulu ◽  
ekrem taha sert
Keyword(s):  
Risk Factors ◽  
Odds Ratio ◽  
Clinical Importance ◽  
Microscopic Hematuria ◽  
Ureteral Stones ◽  
Stone Size ◽  
Factors Associated ◽  
Radiology Reports ◽  
Contrast Ct ◽  
The Relationship

Aim: The aim of this study was to investigate the relationship between the degree of hydronephrosis and the presence of microscopic hematuria in patients that presented to the emergency department (ED) with ureteral stones. Methods: The records of patients who presented to our ED due to urolithiasis between January 2017 and December 2020 were retrospectively analyzed. Patients aged 18 years or older who underwent non-contrast computed tomography (CT abdomen/pelvis) and urinalysis (UA) and were diagnosed with ureteral stones were included in the study. Radiology reports were reviewed for stone size, localization, and degree of hydronephrosis. Patients with and without microscopic hematuria and the degree of hydronephrosis were compared. Results: A total of 476 patients were included, which consisted of 391 with microscopic hematuria and 85 without microscopic hematuria. The median stone size was 4.1 mm in the presence of microscopic hematuria and 5.5 mm in the absence of microscopic hematuria. Logistic regression analysis was performed to determine the factors associated with the development of hydronephrosis. Stone size [odds ratio (OR):2.15, 95% confidence interval (CI):1.12-4.16, p<0.001), presence of pyuria (OR: 2.58, 95%CI: 1.78-3.48, p<0.001), and absence of microscopic hematuria (OR: 1.31, 95%CI 1.04-2.89, p=0.017) were identified as risk factors for moderate and severe hydronephrosis. Conclusion: We consider that non-contrast CT imaging is necessary for the diagnosis and treatment of emergency cases in which microscopic hematuria is not detected in urinalysis since their stone size may be larger and degree of hydronephrosis may be more severe.

scholarly journals Snowfall reduces the risk of chronic subdural hematoma onset: Analysis of an administrative database in Japan

2021 ◽  
Vol 12 ◽  
pp. 69
Author(s):  
Kazunori Oda ◽  
Shotaro Aso ◽  
Yujiro Hattori ◽  
Fumio Yamaguchi ◽  
Hiroki Matsui ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Subdural Hematoma ◽  
Odds Ratio ◽  
Chronic Subdural Hematoma ◽  
Japan Meteorological Agency ◽  
Administrative Database ◽  
Diagnosis Procedure Combination ◽  
Binomial Approximation ◽  
The Relationship ◽  
Inpatient Database

Background: Chronic subdural hematoma (CSDH) is a frequently observed disease in neurosurgical practice. Although first snowfall has been considered to increase the onset of CSDH, few reports have assessed the relationship between snowfall and CSDH. In this study, we aimed to investigate the relationship between CSDH onset and first snowfall events. Methods: This retrospective study was based on the Japanese Diagnosis Procedure Combination inpatient database from July 1, 2010, to March 31, 2016, and on the global observation of snowfall events in Japan obtained from the Japan Meteorological Agency. We used a binomial approximation to evaluate the average number of CSDH patients after first snowfall events compared with that before first snowfall events. We calculated the odds ratio of CSDH onset on the first snowfall. Results: We identified 8526 CSDH patients from the database. A total of 5573 (65.4%) were observed before first snowfall events, and 2953 (34.6%) after first snowfall events. The first snowfall of winter was significantly associated with a reduction in the occurrence of CSDH (odds ratio, 0.53; 95% confidence interval; 0.51–0.55). In subgroup analysis, only the first snowfall in October was not associated with reduction in the occurrence of CSDH. Conclusion: First snowfall events did not affect the onset of CSDH in Japan.

The Effect of Seromuscular-Dermal and All Layer-Dermal Suturing on the Rate of Early Stomal Mucocutaneous Separation: A Retrospective Study

2021 ◽  
Vol 67 (3) ◽  
pp. 21-28
Author(s):  
Yusuke Ohara ◽  
Tsuyoshi Enomoto ◽  
Yohei Owada ◽  
Daichi Kitaguchi ◽  
Katsuji Hisakura ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Retrospective Study ◽  
Odds Ratio ◽  
Suture Technique ◽  
Short Term ◽  
Steroid Use ◽  
Surgical History ◽  
History Of ◽  
Independent Risk Factors

BACKGROUND: Stomal mucocutaneous separation (SMS) is a serious and common short-term and long-term complication of ostomy surgery, but optimal methods to help prevent it have not been established. The authors hypothesized that seromuscular-dermal (SM-D) suturing may be better than all layer-dermal (AL-D) suturing to help prevent SMS. METHODS: This retrospective study evaluated the short-term SMS rate of patients who underwent colostomy or ileostomy surgery between 2015 and 2019. Patient demographics, medical and surgical history variables, as well as SMS outcomes were abstracted. Postoperative SMS severity was categorized by extent as follows: grade A (mild), grade B (moderate), and grade C (severe). RESULTS: In total, 105 patients (AL-D group, 45 patients; SM-D group, 60 patients) were enrolled in the study. SMS occurred in 24 patients (23%). The overall SMS rate was 18% (n = 11) in the SM-D group and 29% (n = 13) in the AL-D group (P = .202). The occurrence of severe (grade C) or moderate and severe SMS (grades B + C) in the SM-D compared with the AL-D group was significantly different (2% vs 16% [P = .011] and 10% vs 24% [P = .047], respectively). A history of steroid use was a risk factor for moderate and severe SMS (P = .016, odds ratio 5.694). Stomal height ≤1 cm was a a risk factor for all cases of SMS (P = .037, odds ratio 2.650). AL-D suture technique and a history of steroid use were independent risk factors for severe and moderate plus severe SMS (P = .021, odds ratio 12.844 and P = .027, odds ratio 4.808, respectively). CONCLUSION: In this study, use of the AL-D suturing technique and a history of steroid use were independent risk factors for the short-term development of moderate or severe SMS. Patients whose stoma was secured using the SM-D technique had a significantly lower rate of moderate or severe SMS.

Association between Intraoperative Hypotension and Hypertension and 30-day Postoperative Mortality in Noncardiac Surgery

2015 ◽  
Vol 123 (2) ◽  
pp. 307-319 ◽  
Author(s):  
Terri G. Monk ◽  
Michael R. Bronsert ◽  
William G. Henderson ◽  
Michael P. Mangione ◽  
S. T. John Sum-Ping ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Odds Ratio ◽  
Absolute Threshold ◽  
Postoperative Mortality ◽  
Percent Change ◽  
Medical Centers ◽  
Intraoperative Hypotension ◽  
Increased Risk ◽  
Blood Pressure Data ◽  
Veterans Affairs Medical Centers

Abstract Background Although deviations in intraoperative blood pressure are assumed to be associated with postoperative mortality, critical blood pressure thresholds remain undefined. Therefore, the authors estimated the intraoperative thresholds of systolic blood pressure (SBP), mean blood pressure (MAP), and diastolic blood pressure (DBP) associated with increased risk-adjusted 30-day mortality. Methods This retrospective cohort study combined intraoperative blood pressure data from six Veterans Affairs medical centers with 30-day outcomes to determine the risk-adjusted associations between intraoperative blood pressure and 30-day mortality. Deviations in blood pressure were assessed using three methods: (1) population thresholds (individual patient sum of area under threshold [AUT] or area over threshold 2 SDs from the mean of the population intraoperative blood pressure values), (2). absolute thresholds, and (3) percent change from baseline blood pressure. Results Thirty-day mortality was associated with (1) population threshold: systolic AUT (odds ratio, 3.3; 95% CI, 2.2 to 4.8), mean AUT (2.8; 1.9 to 4.3), and diastolic AUT (2.4; 1.6 to 3.8). Approximate conversions of AUT into its separate components of pressure and time were SBP &lt; 67 mmHg for more than 8.2 min, MAP &lt; 49 mmHg for more than 3.9 min, DBP &lt; 33 mmHg for more than 4.4 min. (2) Absolute threshold: SBP &lt; 70 mmHg for more than or equal to 5 min (odds ratio, 2.9; 95% CI, 1.7 to 4.9), MAP &lt; 49 mmHg for more than or equal to 5 min (2.4; 1.3 to 4.6), and DBP &lt; 30 mmHg for more than or equal to 5 min (3.2; 1.8 to 5.5). (3) Percent change: MAP decreases to more than 50% from baseline for more than or equal to 5 min (2.7; 1.5 to 5.0). Intraoperative hypertension was not associated with 30-day mortality with any of these techniques. Conclusion Intraoperative hypotension, but not hypertension, is associated with increased 30-day operative mortality.

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