Effects of surgical treatment on 24465 patients with intestinal perforation complicated with septic shock in tertiary hospitals in China from 2017 to 2020: a systematic review

2021 ◽  
Author(s):  
Lu Wang ◽  
Xudong Ma ◽  
Huaiwu He ◽  
Longxiang Su ◽  
Yanhong Guo ◽  
...  
Keyword(s):  
Septic Shock ◽  
Surgical Treatment ◽  
Mortality Rate ◽  
Intestinal Perforation ◽  
Significant Proportion ◽  
Care Quality ◽  
Medical Advice ◽  
Hospitalization Cost ◽  
Tertiary Hospitals ◽  
Per Capita

Abstract Background Intestinal perforation often leads to abdominal infection and is one of the main causes of septic shock. Prompt surgical treatment is an important treatment for this disease. We designed this study to investigate the effects of surgical treatment on patients with intestinal perforation complicated with septic shock in China. Methods Tertiary hospitals were enrolled from the China National Critical Care Quality Control Center (China-NCCQC). The data were collected between January 1, 2017 and December 31, 2020. Intestinal perforation includes duodenal perforation, jejunal perforation, ileal perforation, colonic perforation, and rectal perforation. Sepsis 3.0 criteria were used for the diagnosis of septic shock. According to the above criteria, 26747 patients from 247915897 patients were selected. After excluding the missing data of gender, age and discharge mode, 24465 patients were remained. Results Patients with intestinal perforation complicated with septic shock in tertiary hospitals in China are more male and older patients. A significant proportion of patients were hospitalized for more than one month. The hospitalization cost per capita of these patients far exceeds the overall hospitalization cost per capita. In the operative group, the hospitalization days were longer. The operative group spent more. However, the incidence of complications was lower in the operative group. Patients with coronary heart disease (CHD) tended to be treated nonoperatively, and patients with systemic lupus erythematosus (SLE) tended to be treated surgically. 20% of the patients discharged against medical advice, 12% of the patients died. The operative group had a higher rate discharging with medical advice and a lower mortality rate. Conclusions For intestinal perforation complicated with septic shock in tertiary hospitals in China, patients who had surgery stayed longer and cost more. However, the incidence of complications was lower in the patients who had surgery. At the same time, the rate of discharging with medical advice was higher and the mortality rate was lower in the patients who had surgery.

Empirical analysis of factors influencing the public health expenditure in Malaysia

2018 ◽  
Vol 6 (3) ◽  
pp. 1
Author(s):  
Kok Wooi Yap ◽  
Doris Padmini Selvaratnam
Keyword(s):  
Public Health ◽  
Mortality Rate ◽  
Infant Mortality ◽  
Health Expenditure ◽  
Price Index ◽  
Infant Mortality Rate ◽  
Public Health Expenditure ◽  
The Public ◽  
Empirical Results ◽  
Per Capita

This study aims to investigate the determinants of public health expenditure in Malaysia. An Autoregressive Distributed Lag (ARDL) approach proposed by Pesaran & Shin (1999) and Pesaran et al. (2001) is applied to analyse annual time series data during the period from 1970 to 2017. The study focused on four explanatory variables, namely per capita gross domestic product (GDP), healthcare price index, population aged 65 years and above, as well as infant mortality rate. The bounds test results showed that the public health expenditure and its determinants are cointegrated. The empirical results revealed that the elasticity of government health expenditure with respect to national income is less than unity, indicating that public health expenditure in Malaysia is a necessity good and thus the Wagner’s law does not exist to explain the relationship between public health expenditure and economic growth in Malaysia. In the long run, per capita GDP, healthcare price index, population aged more than 65 years, and infant mortality rate are the important variables in explaining the behaviour of public health expenditure in Malaysia. The empirical results also prove that infant mortality rate is significant in influencing public health spending in the short run. It is noted that macroeconomic and health status factors assume an important role in determining the public health expenditure in Malaysia and thus government policies and strategies should be made by taking into account of these aspects.

Measuring Effectiveness Of Economic Growth On Reducing Infant Mortality Rate In Tamilnadu

2019 ◽  
Vol 118 (4) ◽  
pp. 129-141
Author(s):  
Mr. Y. EBENEZER
Keyword(s):  
Economic Growth ◽  
Mortality Rate ◽  
Infant Mortality ◽  
Negative Relationship ◽  
Infant Mortality Rate ◽  
Domestic Product ◽  
Per Capita ◽  
The Impact ◽  
Adf Test ◽  
Bound Test

                   This paper deals with economic growth and infant mortality rate in Tamilnadu. The objects of this paper are to test the relationship between Per capita Net State Domestic Product and infant mortality rate and also to measure the impact of Per capita Net State Domestic Product on infant mortality rate in Tamil Nadu. This analysis has employed the ADF test and ARDL approach. The result of the study shows that IMR got reduced and Per capita Net State Domestic Product increased during the study period. This analysis also revealed that there is a negative relationship between IMR and the economic growth of Tamilnadu. In addition, ARDL bound test result has concluded that per capita Net State Domestic Product of Tamilnadu has long run association with IMR.

scholarly journals COVID-19 Mortality Rate and Its Incidence in Latin America: Dependence on Demographic and Economic Variables

2021 ◽  
Vol 18 (13) ◽  
pp. 6900
Author(s):  
Javier Cifuentes-Faura
Keyword(s):  
Latin America ◽  
Mortality Rate ◽  
Population Density ◽  
Life Expectancy ◽  
Latin American ◽  
Positive Influence ◽  
Death Rates ◽  
Per Capita ◽  
Latin American Countries ◽  
Quality Infrastructure

The pandemic caused by COVID-19 has left millions infected and dead around the world, with Latin America being one of the most affected areas. In this work, we have sought to determine, by means of a multiple regression analysis and a study of correlations, the influence of population density, life expectancy, and proportion of the population in vulnerable employment, together with GDP per capita, on the mortality rate due to COVID-19 in Latin American countries. The results indicated that countries with higher population density had lower numbers of deaths. Population in vulnerable employment and GDP showed a positive influence, while life expectancy did not appear to significantly affect the number of COVID-19 deaths. In addition, the influence of these variables on the number of confirmed cases of COVID-19 was analyzed. It can be concluded that the lack of resources can be a major burden for the vulnerable population in combating COVID-19 and that population density can ensure better designed institutions and quality infrastructure to achieve social distancing and, together with effective measures, lower death rates.

scholarly journals Early Surgery Does Not Improve Outcomes for Patients with Periprosthetic Femoral Fractures—Results from the Registry for Geriatric Trauma of the German Trauma Society

Medicina ◽  
2021 ◽  
Vol 57 (6) ◽  
pp. 517
Author(s):  
Christopher Bliemel ◽  
Katherine Rascher ◽  
Tom Knauf ◽  
Juliana Hack ◽  
Daphne Eschbach ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Mortality Rate ◽  
Femoral Fractures ◽  
Geriatric Trauma ◽  
Outcome Parameters ◽  
Periprosthetic Femoral Fractures ◽  
Trauma Society ◽  
Eq5d Index ◽  
Early Surgical Treatment

Background and Objectives: Appropriate timing of surgery for periprosthetic femoral fractures (PFFs) in geriatric patients remains unclear. Data from a large international geriatric trauma register were analyzed to examine the outcome of patients with PFF with respect to the timing of surgical stabilization. Materials and Methods: The Registry for Geriatric Trauma of the German Trauma Society (Deutsche Gesellschaft für Unfallchirurgie (DGU)) (ATR-DGU) was analyzed. Patients treated surgically for PFF were included in this analysis. As outcome parameters, in-house mortality rate and mortality at the 120-day follow-up as well as mobility, the EQ5D index score and reoperation rate were analyzed in relation to early (<48 h) or delayed (≥48 h) surgical stabilization. Results: A total of 1178 datasets met the inclusion criteria; 665 fractures were treated with osteosynthesis (56.4%), and 513 fractures were treated by implant change (43.5%). In contrast to the osteosynthesis group, the group with implant changes underwent delayed surgical treatment more often. Multivariate logistic regression analysis of mortality rate (p = 0.310), walking ability (p = 0.239) and EQ5D index after seven days (p = 0.812) revealed no significant differences between early (<48 h) and delayed (≥48 h) surgical stabilization. These items remained insignificant at the follow-up as well. However, the odds of requiring a reoperation within 120 days were significantly higher for delayed surgical treatment (OR: 1.86; p = 0.003). Conclusions: Early surgical treatment did not lead to decreased mortality rates in the acute phase or in the midterm. Except for the rate of reoperation, all other outcome parameters remained unaffected. Nevertheless, for most patients, early surgical treatment should be the goal, so as to achieve early mobilization and avoid secondary nonsurgical complications. If early stabilization is not possible, it can be assumed that orthogeriatric co-management will help protect these patients from further harm.

Hypercoagulability in Septic Shock Patients With Thrombocytopenia

2021 ◽  
pp. 088506662110241
Author(s):  
Sang-Min Kim ◽  
Sang-Il Kim ◽  
Gina Yu ◽  
June-Sung Kim ◽  
Seok In Hong ◽  
...  
Keyword(s):  
Emergency Department ◽  
Septic Shock ◽  
Multivariate Analysis ◽  
Platelet Count ◽  
Mortality Rate ◽  
Confidence Interval ◽  
Sofa Score ◽  
Odds Ratio ◽  
Fibrinogen Level ◽  
Limited Information

Background: Despite thrombocytopenia, patients with sepsis often experience hypercoagulability. However, limited information is available on the prevalence and effect of hypercoagulability in patients with sepsis-induced thrombocytopenia. Hence, we evaluated the prevalence of hypercoagulability and the association between hypercoagulability and clinical outcomes in septic shock patients with thrombocytopenia. Methods: Thromboelastography (TEG) was performed prospectively in 1294 patients with septic shock at the emergency department (ED) between January 2016 and December 2019. After excluding 405 patients who did not require resuscitation, refused enrollment, or developed septic shock after ED presentation, 889 patients were included. We defined thrombocytopenia as an admission platelet count lower than 150,000/µl according to SOFA score. We defined hypocoagulability and hypercoagulability as coagulation index (CI)< −3 and >3 on TEG, respectively. Results: Of the 889 septic shock patients (mean age 65.6 ± 12.7 years, 58.6% male), 473 (53.2%) had thrombocytopenia. Eighty-five (18.0%) patients showed hypercoagulable TEG and73 (15.4%) patients showed hypocoagulable TEG. The hypercoagulable TEG group had a significantly higher fibrinogen level and a lower 28-day mortality rate than the normal and hypocoagulable TEG groups (518 vs. 347 and 315 mg/dL; 7.1% vs. 21.1% and 36.8%, P < 0.01, respectively). In multivariate analysis, hypercoagulable TEG was associated with a decreased mortality rate (odds ratio: 0.395; 95% confidence interval, 0.162-0.965). Conclusions: In septic shock patients with thrombocytopenia, hypercoagulability was not uncommon. TEG can quickly distinguish the hypercoagulability and hypocoagulability states and serve as a valuable tool for evaluating the degree and risk in septic shock patients with thrombocytopenia.

A disease-based evaluation of lung cancer care quality in a community healthcare system.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 251-251
Author(s):  
Meghan Brooke Taylor ◽  
Meredith Ray ◽  
Nicholas Faris ◽  
Matthew Smeltzer ◽  
Carrie Fehnel ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Quality Improvement ◽  
Surgical Treatment ◽  
Healthcare System ◽  
Cancer Care ◽  
Care Quality ◽  
Nodal Points ◽  
Diagnostic Biopsy ◽  
Pre Treatment ◽  
Non Surgical Treatment

251 Background: Lung cancer care is complex, but, for quality improvement, can be simplified into five ‘nodal points’: lesion detection, diagnostic biopsy, radiologic staging, invasive staging, and treatment. We previously demonstrated great heterogeneity in passage through these nodal points in patients who received surgical resection for lung cancer in our healthcare system. However, examining only surgical patients may underestimate the enormity of the opportunity for quality improvement. With the aim of identifying quality gaps in pre-treatment evaluation for lung cancer, we evaluated the flow of care through these nodal points within a community-based healthcare system. Methods: We classified lung cancer care procedures received by all suspected lung cancer patients treated within the Multidisciplinary Thoracic Oncology Program at Baptist Cancer Center, Memphis TN between 2014 and 2019, into five nodal points. We compared the frequency of, and time intervals between, nodal points among patients receiving surgical, nonsurgical (chemotherapy/radiation), or no definitive treatment, using Chi-square or Kruskal Wallis tests, where appropriate. Results: Of 1304 eligible patients: 11% had no pre-treatment diagnostic procedure, 20% no PET/CT, and 39% no invasive staging. 39% of patients underwent surgical resection, 51% received non-surgical treatment, and 10% received no treatment. Patients who had surgery were less likely than those who had non-surgical treatment to get a diagnostic test, radiologic staging, and invasive staging (Table). Patients who had non-surgical treatment were more likely to pass through all five nodal points (50% v 68%, p<0.0001). The median (IQR) duration from initial lesion identification to treatment (n=1126) was 77 days (45-190); 27 days (10-90) from lesion identification to diagnostic biopsy (n=1115); and 38 days (26-63) from diagnostic biopsy to treatment (n=1041). Patients who had surgery received less timely care than those who had non-surgical or no treatment: median 122 v 66 v 68 days from lesion identification to treatment; 40 v 21 v 29 days from lesion identification to diagnostic biopsy; 46 v 38 v 31 days from diagnostic biopsy to treatment (p<0.0001 all comparisons). Conclusions: Quality improvement initiatives within our healthcare system, such as the establishment of a coordinated multidisciplinary program, enhanced care quality over previous benchmarks. Despite improvements, lung cancer patients who had surgery received less frequent and less timely pre-treatment evaluation than those without surgery. Implementing a standardized cancer care pathway from diagnosis to surgery could help to reduce variations in optimal care delivery.[Table: see text]

scholarly journals Mortality rates in pediatric septic shock

2017 ◽  
Vol 56 (5) ◽  
pp. 304 ◽  
Author(s):  
Desy Rusmawatiningtyas ◽  
Nurnaningsih Nurnaningsih
Keyword(s):  
Intensive Care Unit ◽  
Septic Shock ◽  
Intensive Care ◽  
Mortality Rate ◽  
Fluid Overload ◽  
Pediatric Intensive Care ◽  
Developed Countries ◽  
Mortality Rates ◽  
Study Cohort ◽  
Survival Group

Background Septic shock remains a major cause of morbidity and mortality in children admitted to the intensive care unit. Recent investigations from developed countries have reported mortality rates of 20-30%. Few studies have reported mortality rates from pediatric septic shock in intensive care settings in developing countries with limited resources.  Objective  To determine the current mortality rates for pediatric patients with septic shock in a developing country.Methods A retrospective study was conducted in the Pediatric Intensive Care Unit (PICU) at DR. Sardjito General Hospital. Medical records and charts were reviewed and recorded for diagnoses of septic shock, from November 1st, 2011 to June 30th, 2014. Results  A database of all PICU admissions was assembled, and cases with diagnoses of septic shock were reviewed. The final data consisted of 136 patients diagnosed with septic shock. Septic shock was defined as a clinical suspicion of sepsis, manifested by hyperthermia or hypothermia, and accompanied by hypoperfusion  The overall mortality rate for the study cohort was 88.2%.  The median age of patients was 16 months, with 52.2% males. Median initial PRISM III and PELOD scores were 10 and 22, respectively. The median length of PICU stay was 4 days. A total of 48.5% of the subjects were in need of crystalloid and colloid fluid at a median amount of 40 mL/kg. The median time required to complete the initial resuscitation was 60 minutes. Mechanical ventilator support in the first 24 hours was required in 79.4% of the cases. Fluid overload of > 10% (FO>10%) was found in 58.8% of the subjects.Conclusion The mortality rate in pediatric septic shock in our hospital is very high. There is a higher incidence of fluid overload in the non-survival group .

scholarly journals Iatrogenic Teratoma Rupture during TVOR Complicated with Peritonitis, Pleuritis, and Septic Shock

2018 ◽  
Vol 2018 ◽  
pp. 1-4
Author(s):  
Pei-Yi Wang ◽  
Yi-En Chang ◽  
Yu-Chieh Lee ◽  
Chii Ruey Tzeng
Keyword(s):  
Septic Shock ◽  
Surgical Treatment ◽  
Rare Case ◽  
Clinical Course ◽  
Oocyte Retrieval ◽  
Chemical Irritation ◽  
Chemical Peritonitis ◽  
Purulent Fluid ◽  
Exploratory Laparoscopy ◽  
Transvaginal Oocyte Retrieval

Objective. To obtain a better understanding of the clinical course and the subsequent complications of teratoma rupture. Case. We report a rare case of chemical peritonitis and pleuritis caused by teratoma rupture during ultrasonographically guided transvaginal oocyte retrieval (TVOR). The patient initially presented with nonspecific and digestive symptoms after TVOR, but the condition deteriorated rapidly after three weeks with peritonitis and septic shock. Thus, exploratory laparoscopy was performed with the findings of a ruptured teratoma at left adnexa, severe adhesions, and purulent fluid in her peritoneal cavity. Bilateral pleuritis was also noted after the operation, which was suspected to be caused by chemical irritation of the spilled contents of the teratoma. The patient’s condition improved after surgical treatment and was discharged 28 days after admission. Conclusion. Our case showed that the timing of peritoneal irritation caused by teratoma rupture converting to severe chemical peritonitis was approximately 3 weeks. Physicians should avoid cyst puncture during TVOR and closely observe or even perform surgical treatment when iatrogenic teratoma ruptures are suspected.

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