scholarly journals Does Identifying Frailty from ICD-10 Coded Data on Hospital Admission Improve Prediction of Adverse Outcomes in Older Surgical Patients

2020 ◽  
Vol 5 (5) ◽  
Author(s):  
Lara Harvey ◽  
Barbara Toson ◽  
Ian Harris ◽  
Robert Gandy ◽  
Jacqueline Close
Keyword(s):  
External Validation ◽  
Age Groups ◽  
Information Criterion ◽  
Population Based ◽  
Adverse Outcomes ◽  
Unplanned Readmission ◽  
Surgical Specialty ◽  
Prolonged Length ◽  
Logistic Regression Models ◽  
Poor Outcomes

IntroductionAs the population ages, increasing numbers of older adults are undergoing surgery. Outcomes for older people are known to be worse than younger people following surgical procedures, and identifying which patients stand to benefit from surgery can be challenging. Frailty is recognised as a major contributor to poor outcomes, however assessing frailty clinically is time-consuming and not routinely undertaken. Using data available from electronic medical records can potentially provide the opportunity to routinely screen for frailty electronically at time of admission. Objectives and ApproachThis population-based external validation study aimed to: 1. assess the performance of the Hospital Frailty Risk Score (HFRS) in the prediction of adverse outcomes (mortality, prolonged length of stay (LOS) and 28-day readmission), 2. to determine optimal age-groups and lookback periods and 3. compare HFRS performance against the Charlson Comorbidity Index (CCI). Hospital and death data for individuals (n=487,197) aged >50 years admitted under a surgical specialty to all public/private hospitals in NSW, Australia, 2013-2017 were linked. Logistic regression models were tested for each outcome of interest. Area under receiving operator curve (AUC) and Akaike information criterion (AIC) were assessed for each model. ResultsFor prediction of 30-day, all models performed better than age and sex alone; however adjusting for CCI (AUC 0.76) provided marginally better prediction than adjusting for HFRS (AUC 0.75). Models consistently performed better in the younger age-group (50-65), providing excellent discrimination (AUC 0.82). In contrast, all models had poor ability to predict prolonged-LOS (AUC range 0.62- 0.63) or readmission (AUC range 0.62-0.65). Using a 5-year lookback period did not improve model discrimination over using a 2-year period. Conclusion / ImplicationsAdjusting for frailty using the HFRS did not improve prediction of 30-mortality over that achieved by the CCI. Neither HFRS nor CCI were useful for predicting prolonged-LOS r 28-day unplanned readmission.

Does identifying frailty from ICD-10 coded data on hospital admission improve prediction of adverse outcomes in older surgical patients? A population-based study

2020 ◽  
Author(s):  
Lara A Harvey ◽  
Barbara Toson ◽  
Christina Norris ◽  
Ian A Harris ◽  
Robert C Gandy ◽  
...  
Keyword(s):  
Information Criterion ◽  
International Classification Of Diseases ◽  
Population Based ◽  
Adverse Outcomes ◽  
Unplanned Readmission ◽  
Model Discrimination ◽  
Prolonged Length ◽  
Logistic Regression Models ◽  
Explanatory Variables ◽  
Classification Of Diseases

Abstract Background frailty is a major contributor to poor health outcomes in older people, separate from age, sex and comorbidities. This population-based validation study evaluated the performance of the International Classification of Diseases, 10th revision, coded Hospital Frailty Risk Score (HFRS) in the prediction of adverse outcomes in an older surgical population and compared its performance against the commonly used Charlson Comorbidity Index (CCI). Methods hospitalisation and death data for all individuals aged ≥50 admitted for surgery to New South Wales hospitals (2013–17) were linked. HFRS and CCI scores were calculated using both 2- and 5-year lookback periods. To determine the influence of individual explanatory variables, several logistic regression models were fitted for each outcome of interest (30-day mortality, prolonged length of stay (LOS) and 28-day readmission). Area under the receiving operator curve (AUC) and Akaike information criterion (AIC) were assessed. Results of the 487,197 patients, 6.8% were classified as high HFRS, and 18.3% as high CCI. Although all models performed better than base model (age and sex) for prediction of 30-day mortality, there was little difference between CCI and HFRS in model discrimination (AUC 0.76 versus 0.75), although CCI provided better model fit (AIC 79,020 versus 79,910). All models had poor ability to predict prolonged LOS (AUC range 0.62–0.63) or readmission (AUC range 0.62–0.65). Using a 5-year lookback period did not improve model discrimination over the 2-year period. Conclusions adjusting for HFRS did not improve prediction of 30-mortality over that achieved by the CCI. Neither HFRS nor CCI were useful for predicting prolonged LOS or 28-day unplanned readmission.

scholarly journals Correlates of Adverse Outcomes in Abdominally Obese Individuals: Findings from the Five-Year Followup of the Population-Based Study of Health in Pomerania

2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
Nele Friedrich ◽  
Harald J. Schneider ◽  
Ulrich John ◽  
Marcus Dörr ◽  
Sebastian E. Baumeister ◽  
...  
Keyword(s):  
Abdominal Obesity ◽  
Regression Models ◽  
Kidney Diseases ◽  
Premature Death ◽  
Population Based ◽  
Serum Glucose ◽  
Adverse Outcomes ◽  
Population Based Study ◽  
Logistic Regression Models ◽  
Increased Risk

Background. Abdominal obesity is a major risk factor of cardiovascular disease (CVD), type 2 diabetes (T2DM), and premature death. However, it has not been resolved which factors predispose for the development of these adverse obesity-related outcomes in otherwise healthy individuals with abdominal obesity.Methods. We studied 1,506 abdominal obese individuals (waist-to-height ratio (WHtR) ≥ 0.5) free of CVD or T2DM from the population-based Study of Health in Pomerania and assessed the incidence of CVD or T2DM after a five-year followup. Logistic regression models were adjusted for major cardiovascular risk factors and liver, kidney diseases, and sociodemographic status.Results. During follow-up time, we observed 114 and 136 new T2DM and CVD cases, respectively. Regression models identified age, waist circumference, serum glucose, and liver disease as predictors of T2DM. Regarding CVD, only age, unemployment, and a divorced or widowed marital status were significantly associated with incident CVD. In this subgroup of obese individuals blood pressure, serum glucose, or lipids did not influence incidence of T2DM or CVD.Conclusion. We identified various factors associated with an increased risk of incident T2DM and CVD among abdominally obese individuals. These findings may improve the detection of high-risk individuals and help to advance prevention strategies in abdominal obesity.

scholarly journals Mild anemia and 11- to 15-year mortality risk in young-old and old-old: Results from two population-based cohort studies

PLoS ONE ◽  
2021 ◽  
Vol 16 (12) ◽  
pp. e0261899
Author(s):  
Alessia A. Galbussera ◽  
Sara Mandelli ◽  
Stefano Rosso ◽  
Roberto Zanetti ◽  
Marianna Rossi ◽  
...  
Keyword(s):  
Sex Education ◽  
Mortality Risk ◽  
Age Groups ◽  
Population Based ◽  
Adverse Outcomes ◽  
Smoking History ◽  
Time Varying ◽  
Mild Anemia ◽  
Time Varying Covariates ◽  
Young Old

Background Mild anemia is a frequent although often overlooked finding in old age. Nevertheless, in recent years anemia has been linked to several adverse outcomes in the elderly population. Objective of the study was to investigate the association of mild anemia (hemoglobin concentrations: 10.0–11.9/12.9 g/dL in women/men) with all-cause mortality over 11–15 years and the effect of change in anemia status on mortality in young-old (65–84 years) and old-old (80+ years). Methods The Health and Anemia and Monzino 80-plus are two door-to-door, prospective population-based studies that included residents aged 65-plus years in Biella municipality and 80-plus years in Varese province, Italy. No exclusion criteria were used. Results Among 4,494 young-old and 1,842 old-old, mortality risk over 15/11 years was significantly higher in individuals with mild anemia compared with those without (young-old: fully-adjusted HR: 1.35, 95%CI, 1.15–1.58; old-old: fully-adjusted HR: 1.28, 95%CI, 1.14–1.44). Results were similar in the disease-free subpopulation (age, sex, education, smoking history, and alcohol consumption adjusted HR: 1.54, 95%CI, 1.02–2.34). Both age groups showed a dose-response relationship between anemia severity and mortality (P for trend <0.0001). Mortality risk was significantly associated with chronic disease and chronic kidney disease mild anemia in both age groups, and with vitamin B12/folate deficiency and unexplained mild anemia in young-old. In participants with two hemoglobin determinations, seven-year mortality risk was significantly higher in incident and persistent anemic cases compared to constant non-anemic individuals in both age groups. In participants without anemia at baseline also hemoglobin decline was significantly associated with an increased mortality risk over seven years in both young-old and old-old. Limited to the Monzino 80-plus study, the association remained significant also when the risk was further adjusted also for time-varying covariates and time-varying anemia status over time. Conclusions Findings from these two large prospective population-based studies consistently suggest an independent, long-term impact of mild anemia on survival at older ages.

scholarly journals Age-Specific Predictive Models of the Upper Quintile of Periodontal Attachment Loss

2019 ◽  
Vol 99 (1) ◽  
pp. 44-50
Author(s):  
J.A. Shariff ◽  
B. Cheng ◽  
P.N. Papapanou
Keyword(s):  
Predictive Models ◽  
Diagnostic Performance ◽  
Propensity Scores ◽  
External Validation ◽  
Age Groups ◽  
Area Under The Curve ◽  
Practical Method ◽  
Clinical Attachment Loss ◽  
Attachment Loss ◽  
Logistic Regression Models

A practical method to identify people who are most affected by periodontitis in their age group is currently unavailable. We focused on individuals with mean clinical attachment loss (CAL) above the 80th percentile within each of 10 age groups (5-y intervals between 30 and 74 y as well as ≥75 y). We developed predictive models using combined data from 2 cohorts (2009 to 2010 and 2011 to 2012) from the NHANES (National Health and Nutrition Examination Survey; development cohort [DC], n = 6,757), and we carried out external validation using data from a third NHANES cohort (2013 to 2014; validation cohort [VC], n = 3,447). We used 1) age-specific logistic regression models with stepwise selection to identify significant demographic variables, habits, medical conditions, and selected clinical periodontal parameters (proportion of teeth with probing depth ≥4 mm at incisors and molars and with visible [≥2 mm] recession) and to calculate propensity scores (PSs); 2) Youden’s J statistic to select optimum PS cutoffs to maximize diagnostic performance using receiver operating characteristic curves; and 3) bootstrap resampling with 1,000 replicates to validate the age-specific models and adjust the PS and optimal PS cutoffs for overfitting. The bootstrap-adjusted PSs were used as single predictors of mean CAL over the 80th percentile in the VC. The age-specific upper quintiles of mean CAL ranged between 1.63 and 3.24 mm in the DC and between 1.87 and 3.20 mm in the VC. The area under the curve of the models exceeded 0.85 in all age groups in the DC and 0.84 in the VC, indicating well-validated diagnostic performance. In the DC, sensitivity values ranged between 0.75 and 0.97 and exceeded 0.83 in 8 of 10 age groups. Corresponding values in the VC ranged between 0.56 and 0.89 and exceeded 0.68 in 8 of 10 age groups. We conclude that modeling that incorporates readily obtainable variables through a brief patient interview and an abbreviated periodontal examination accurately identifies individuals who are most affected by periodontitis in different ages.

scholarly journals Comparison of Labor and Delivery Complications and Delivery Methods Between Physicians and White-Collar Workers

2020 ◽  
Vol 17 (14) ◽  
pp. 5212
Author(s):  
Chun-Che Huang ◽  
Wen-Feng Lee ◽  
Ching-Hsueh Yeh ◽  
Chiang-Hsing Yang ◽  
Yu-Tung Huang
Keyword(s):  
Placenta Previa ◽  
Age Groups ◽  
White Collar ◽  
Population Based ◽  
Research Database ◽  
Labor And Delivery ◽  
Delivery Complications ◽  
Logistic Regression Models ◽  
Occupational Risks ◽  
White Collar Workers

To evaluate labor and delivery complications and delivery modes between physicians and white-collar workers in Taiwan, this retrospective population-based study used data from Taiwan’s National Health Insurance Research Database. We compared 1530 physicians aged 25 to 50 years old who worked and had singleton births between 2007 and 2013 with 3060 white-collar workers matched by age groups, groups of monthly insured payroll-related premiums, previous cesarean delivery, perinatal history anemia, and gestational diabetes mellitus. The logistic regression models were used to assess the labor and delivery complications between the two groups. Multivariate analysis revealed that physicians had a significantly higher risk of placenta previa (odds ratio (OR) 1.35, 95% confidence interval (CI) 1.08–1.69) and other malpresentation (OR 1.86, 95% CI 1.45–2.39) than white-collar workers, whereas they had a significantly lower risk of placental abruption (OR 0.53, 95% CI 0.40–0.71), preterm delivery (OR 0.75, 95% CI 0.61–0.92), and premature rupture of membranes (OR 0.72, 95% CI 0.59–0.88). Increased risks of some adverse labor and delivery complications were observed among physicians, when compared to white-collar workers. These findings suggest that working women should take preventative action to manage occupational risks during pregnancy.

scholarly journals Discharge against medical advice after hospitalisation for acute myocardial infarction

Heart ◽  
2018 ◽  
Vol 105 (4) ◽  
pp. 315-321 ◽  
Author(s):  
Chun Shing Kwok ◽  
Mary Norine Walsh ◽  
Annabelle Volgman ◽  
Mirvat Alasnag ◽  
Glen Philip Martin ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Risk Groups ◽  
Medical Advice ◽  
Adverse Outcomes ◽  
Unplanned Readmission ◽  
Crude Rate ◽  
Against Medical Advice ◽  
Discharge Against Medical Advice ◽  
Poor Outcomes

BackgroundDischarge against medical advice (AMA) occurs infrequently but is associated with poor outcomes. There are limited descriptions of discharges AMA in national cohorts of patients with acute myocardial infarction (AMI). This study aims to evaluate discharge AMA in AMI and how it affects readmissions.MethodsWe conducted a cohort study of patients with AMI in USA in the Nationwide Readmission Database who were admitted between the years 2010 and 2014. Descriptive statistics were presented for variables according to discharge home or AMA. The primary end point was all-cause 30-day unplanned readmissions and their causes.Results2663 019 patients were admitted with AMI of which 10.3% (n=162 070) of 1569 325 patients had an unplanned readmission within 30 days. The crude rate of discharge AMA remained stable between 2010 and 2014 at 1.5%. Discharge AMA was an independent predictor of unplanned all-cause readmissions (OR 2.27 95% CI 2.14 to 2.40); patients who discharged AMA had >twofold increased crude rate of readmission for AMI (30.4% vs 13.4%) and higher crude rate of admissions for neuropsychiatric reasons (3.2% vs 1.3%). After adjustment, discharge AMA was associated with increased odds of readmissions for AMI (OR 3.65 95% CI 3.31 to 4.03, p<0.001). We estimate that there are 1420 excess cases of AMI among patients who discharged AMA.ConclusionsDischarge AMA occurs in 1.5% of the population with AMI and these patients are at higher risk of early readmissions for re-infarction. Interventions should be developed to reduce discharge AMA in high-risk groups and initiate interventions to avoid adverse outcomes and readmission.

scholarly journals Practice Patterns and Real-Life Outcomes for Patients with Acute Promyelocytic Leukemia in the United States

2021 ◽  
Author(s):  
Jan Philipp Bewersdorf ◽  
Stephanie Prozora ◽  
Nikolai A. Podoltsev ◽  
Rory Michael Shallis ◽  
Scott F Huntington ◽  
...  
Keyword(s):  
Acute Promyelocytic Leukemia ◽  
Adverse Outcome ◽  
Real Life ◽  
The United States ◽  
Population Based ◽  
Promyelocytic Leukemia ◽  
Adverse Outcomes ◽  
Hospital Death ◽  
Newly Diagnosed ◽  
Logistic Regression Models

Acute promyelocytic leukemia (APL) is associated with a favorable long-term prognosis if appropriate treatment is initiated promptly. Outcomes in clinical trials and population-based registries vary; potential explanations include a delay in treatment and lower adherence to guideline-recommended therapy in real-world practice. We used the Vizient Clinical Data Base (CDB) to describe demographics, baseline clinical characteristics, and treatment patterns in newly diagnosed APL patients during the study period of April 2017 - March 2020. Baseline white blood cell count (WBC) was used to assign risk status and assess treatment concordance with National Comprehensive Cancer Network guidelines. Logistic regression models examined adjusted associations between patient, hospital, disease characteristics, and adverse outcomes (in-hospital death or discharge to hospice). Among 1,464 APL patients, 205 (14.0%) experienced an adverse outcome. A substantial subset (20.6%) of patients did not receive guideline-concordant regimens. Odds of adverse outcomes increased with failure to receive guideline-concordant treatment (OR: 2.31 [95% CI: 1.43 - 3.75]; p=0.001), high-risk disease (OR: 2.48 [1.53 - 4.00]; p&lt;0.001) and increasing age (≥60 years: OR: 11.13 [95% CI: 4.55 - 27.22]; p&lt;0.001). Higher hospital AML patient volume was associated with lower odds of adverse outcome (OR: 0.44 [0.20 - 0.99] for ≤ 50 vs. &gt;200 AML patients/year; p=0.046). In conclusion, in this large database analysis, 14.0% of newly diagnosed APL patients died or were discharged to hospice. A substantial proportion of patients did not receive guideline-concordant therapy, potentially contributing to adverse outcomes.

Abstract P254: Health-Related Internet Use in Patients with Hypertension: A Population-Based Analysis

2011 ◽  
Vol 4 (suppl_2) ◽  
Author(s):  
Joseph Finkelstein ◽  
Eunme Cha
Keyword(s):  
Health Status ◽  
Statistical Significance ◽  
Age Groups ◽  
Population Based ◽  
Sampling Weights ◽  
Logistic Regression Models ◽  
Income Ratio ◽  
Health Related ◽  
The Difference ◽  
The Impact

Background: With widely available web-based information about hypertension, internet has the potential to improve health literacy and to affect clinical outcomes. In this study we assessed the prevalence of health-related internet (HRI) usage by patients with hypertension and its association with health outcomes. Methods: Hypertension was defined by the question, “Have you ever been told by a doctor or health profession that you have high blood pressure?” Participants who answered “Yes” were included in the sample. If the participants stated that they accessed the Internet to look up health information, to learn about health topics in chat groups, to refill prescriptions, to schedule appointments, or to communicate with their provider, they were included in ‘HRI user’ group. Two logistic regression models were run to assess predictors of HRI usage and to explore the impact of HRI use on health status among hypertension patients. All models were controlled by age, gender, marital status, race, education, and poverty income ratio (PIR). Sampling weights were utilized to produce population-based results. Results: The prevalence of HRI use in hypertension patients was: 57% (40-55 yrs), 50% (56-65 yrs) and 26% (>65 yrs). In comparison, 58% (40-55 yrs), 56% (56-65 years) and 29% (>65 yrs) of population without hypertension used HRI. The difference between two groups was not statistically significant. Younger age (OR 4.0, p <.0001 for 40-55 group, and OR 2.6, p=0.001 for 50-65 group), women (OR 1.4, p <.0001), higher education (OR 3.8, p <.0001 for 12+ years of education), or higher PIR (OR 1.3, p=0.02 for PIR=2, and OR=3.1, p <.0001 for PIR>=3) were predictors of using HRI with statistical significance. Compared to Caucasians, Africans Americans (OR 0.5, p=0.04) were less likely to use the HRI. After adjusting for socio-demographic variables, patients who used HRI in the last 12 months were 1.3 time more likely to report improvement in health status (p=0.04). Conclusions: HRI usage between the hypertension patients and general population did not differ significantly in different age groups. Age, gender, education, PIR, and race were significant predictors of HRI usage pattern. HRI use was associated with improvement in health status within 12 months of using internet.

scholarly journals Safety of parathyroidectomy in older vs. younger patients with primary hyperparathyroidism

2021 ◽  
Author(s):  
Marlena Mueller ◽  
Fahim Ebrahimi ◽  
Emanuel Christ ◽  
Christian Andreas Nebiker ◽  
Philipp Schuetz ◽  
...  
Keyword(s):  
Primary Hyperparathyroidism ◽  
Older Patients ◽  
Large Population ◽  
Age Groups ◽  
Length Of Hospital Stay ◽  
Population Based ◽  
Old Patients ◽  
Prolonged Length ◽  
Icu Admission ◽  
Increased Risk

Background: Primary hyperparathyroidism is a prevalent endocrinopathy for which surgery is the only curative option. Parathyroidectomy is primarily recommended in younger and symptomatic patients, while there are still concerns regarding surgical complications in older patients. We therefore assessed the association of age with surgical outcomes in patients undergoing parathyroidectomy in a large population in Switzerland. Methods: Population-based cohort study of adult patients with primary hyperparathyroidism undergoing parathyroidectomy in Switzerland between 2012 and 2018. The cohort was divided into four age groups (<50 years, 50-64 years, 65-74 years, ≥75 years). The primary outcome was a composite of in-hospital postoperative complications. Secondary outcomes were intensive care unit (ICU) admission, unplanned 30-day-readmission, and prolonged length of hospital stay. Results: We studied 2642 patients with a median (IQR) age of 62 (53 – 71) years. Overall, 111 patients had complications including surgical re-intervention, hypocalcemia, and vocal cord paresis. As compared to <50 year-old patients, older patients had no increased risk for in-hospital complications after surgery (50-64 years: OR 0.51 [95% CI 0.28 to 0.92]; 65-74 years: OR 0.72 [95% CI 0.39 to 1.33]; ≥75 years: OR 1.03 [95% CI 0.54 to 1.95]), respectively. There was also no association of age and rates of ICU-admission and unplanned 30-day-readmission, but oldest patients had longer hospital stays (OR 2.38 [95% CI 1.57 – 3.60]). Conclusion: ≥50 year-old patients undergoing parathyroidectomy had comparable risk of in-hospital complications as compared with younger ones. These data support parathyroidectomy in even older patients with primary hyperparathyroidism as performed in clinical routine.

scholarly journals Age-Specific Changes in Virulence Associated with SARS-CoV-2 Variants of Concern

2021 ◽  
Author(s):  
David N. Fisman ◽  
Ashleigh R. Tuite
Keyword(s):  
Age Groups ◽  
Relative Increase ◽  
Adverse Outcomes ◽  
Older Individuals ◽  
Term Care ◽  
Logistic Regression Models ◽  
Icu Admission ◽  
Risk Of Death ◽  
Novel Variants ◽  
Increase In Risk

AbstractBackgroundNovel variants of concern (VOCs) have been associated with both increased infectivity and virulence of SARS-CoV-2. The virulence of SARS-CoV-2 is closely linked to age. Whether relative increases in virulence of novel VOCs is similar across the age spectrum, or is limited to some age groups, is unknown.MethodsWe created a retrospective cohort of people in Ontario, Canada testing positive for SARS-CoV-2 and screened for VOCs, with dates of test report between February 7 and August 30, 2021 (n=233,799). Cases were classified as N501Y-positive VOC, probable Delta VOC, or VOC undetected. We constructed age-specific logistic regression models to evaluate the effects of N501Y-postive or Delta VOC infections on infection severity, using hospitalization, intensive care unit (ICU) admission, and death as outcome variables. Models were adjusted for sex, time, health unit, vaccination status, comorbidities, immune compromise, long-term care residence, healthcare worker status, and pregnancy.ResultsInfection with either N501Y-positive or Delta VOCs was associated with significant elevations in risk of hospitalization, ICU admission, and death in younger and older adults, compared to infections where a VOC was not detected. Delta VOC increased hospitalization risk in children under 10 by a factor of 2.5 (adjusted odds ratio, 95% confidence interval: 1.2 to 5.1) compared to non-VOC. For most VOC-outcome combinations there was no heterogeneity in adverse outcomes by age. However, there was an inverse relationship between age and relative increase in risk of death with delta VOC, with younger age groups showing a greater relative increase in risk of death than older individuals.InterpretationSARS-CoV-2 VOCs appear to be associated with increased relative virulence of infection in all age groups, though low absolute numbers of outcomes in younger individuals make estimates in these groups imprecise.

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