Long-Term Survival and Medical Costs of Patients with Prolonged Mechanical Ventilation and Tracheostomy: A Nationwide Cohort Study

Few large-scale studies have focused on tracheostomy in patients with prolonged mechanical ventilation. This retrospective population-based study extracted data from the longitudinal National Health Insurance Research Database in Taiwan to compare long-term mortality between patients on prolonged mechanical ventilation with and without tracheostomy and their related medical expenditures. Data on newly developed respiratory failure in patients on ventilator support were extracted from 1 January 2002 to 31 December 2008. Of 10,705 patients included, 1372 underwent tracheostomy (n = 563) or translaryngeal intubation (n = 779). Overall survival of the patients with tracheostomy was followed for 5 years. Average survival was 4.98 years for the patients with tracheostomy and 5.48 years for the patients with translaryngeal intubation (not significant). Sex, age, premium-based monthly salary difference, occupation, urbanization level, chronic obstructive pulmonary disease, chronic heart failure, chronic renal disease, and cerebrovascular diseases were significantly associated with mortality for endotracheal intubation. Male sex, chronic heart failure, chronic renal disease, age ≥45 years, and low income were associated with significantly higher mortality. Although total medical expenditures were higher for the patients with tracheostomy, annual medical expenditures were not significantly different. There were no differences in long-term mortality between the two groups.

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644 Depletion in more than one endocrine anabolic axis identifies men with chronic heart failure of particularly high long-term mortality

European Journal of Heart Failure Supplements ◽

10.1016/s1567-4215(06)80432-7 ◽

2006 ◽

Vol 5 (1) ◽

pp. 150-151

Author(s):

E JANKOWSKA ◽

B BIEL ◽

J MAJDA ◽

J PETRUKKOWALCZYK ◽

S ANKER ◽

...

Keyword(s):

Heart Failure ◽

Chronic Heart Failure ◽

Long Term Mortality

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Epidemiology of Major Lower Extremity Amputations in Individuals With Diabetes in Austria, 2014-2017: A Retrospective Analysis of Health Insurance Database

10.21203/rs.3.rs-36835/v1 ◽

2020 ◽

Author(s):

Faisal Aziz ◽

Berthold Reichardt ◽

Caren Sourij ◽

Hans-Peter Dimai ◽

Daniela Reichart ◽

...

Keyword(s):

Risk Factors ◽

Heart Failure ◽

Health Insurance ◽

Lower Extremity ◽

Renal Disease ◽

Mortality Rates ◽

Short And Long Term ◽

Male Sex ◽

Long Term Mortality

Abstract Background: Previous data show a high incidence of major lower extremity amputations (LEA) in Austria. Moreover, recent data on the epidemiology of major LEA are sparse in the Country. This study estimated the incidence and mortality rates of major LEA and assessed risk factors of post major LEA mortality in individuals with diabetes.Methods: A retrospective cohort analysis of 507,180 individuals with diabetes enrolled in the Austrian Health Insurance between 2014 and 2017 was performed. Crude and age-standardized rates of major LEA (hip, femur, knee, lower leg) were estimated by extracting their procedure codes from the database. Short- (30-day, 90-day) and long-term (1-year, 5-year) all-cause cumulative mortality after major LEA was estimated from the date of amputation till the date of death. Poisson regression was performed to compare rates by characteristics and assess the annual trend. The Cox-regression was performed to identify significant risk factors of all-cause mortality after major LEA.Results: A total of 2,165 individuals with diabetes underwent major LEA between 2014 and 2017. The mean age was amputees was 73.0 ±11.3 years, 62.7% were males, and 87.3% had a peripheral vascular disease (PVD). The overall age-standardized rate was 6.44 per 100,000 population. The rate increased with age (p<0.001) and was higher (p<0.001) in males (9.38) than females (5.66). The rate was 5.71 in 2014, 6.86 in 2015, 6.71 in 2016, and 6.66 in 2017, with an insignificant annual change of 3% (p=0.825). The cumulative 30-day mortality was 13.5%, 90-day was 22.0%, 1-year was 34.4%, and 5-year was 66.7%. Age, male sex, above-knee amputation, Charlson index, and heart failure were significantly associated with both short- and long-term mortality. Cancer, dementia, heart failure, PVD, and renal disease were only associated with long-term mortality.Conclusions: The rate of major LEA remained stable between 2014 and 2017 in Austria. Short and long-term mortality rates were considerably high after major LEA. Old age, male sex, above-knee amputations, heart failure, and Charlson Index were significant predictors of both short- and long-term mortality, whereas, comorbidities such as cancer, dementia, PVD, and renal disease were significant predictors of long-term mortality only.

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Low hematocrit levels: a risk factor for long-term outcomes in patients requiring prolonged mechanical ventilation after cardiovascular surgery. A retrospective study

Journal of Investigative Medicine ◽

10.1136/jim-2019-001122 ◽

2019 ◽

Vol 68 (2) ◽

pp. 392-396 ◽

Cited By ~ 1

Author(s):

Akito Tsukinaga ◽

Shunsuke Takaki ◽

Takahiro Mihara ◽

Kenta Okamura ◽

Susumu Isoda ◽

...

Keyword(s):

Mechanical Ventilation ◽

Risk Factor ◽

Cardiovascular Surgery ◽

Cox Regression ◽

Prolonged Mechanical Ventilation ◽

Cox Regression Analysis ◽

Icu Admission ◽

Risk Patients ◽

Long Term Mortality

While low-risk patients who undergo elective surgery can tolerate low hematocrit levels, the benefits of higher hematocrit levels might outweigh the risk of transfusion in high-risk patients. Therefore, this study aimed to evaluate the effects of perioperative hematocrit levels on mortality in patients requiring prolonged mechanical ventilation (PMV) after a cardiovascular surgery. This single-center retrospective cohort study was conducted on 172 patients who underwent cardiovascular surgery with cardiopulmonary bypass or off-pump coronary artery bypass grafting and required PMV for ≥72 hours in the intensive care unit (ICU) from 2008 to 2012 at the Yokohama City University Medical Center in Yokohama, Japan. Patients were classified according to hematocrit levels on ICU admission: high (≥30%) and low (<30%) groups. Of 172 patients, 86 were included to each of the low-hematocrit and high-hematocrit groups, with median hematocrit levels (first to third quartiles) of 27.4% (25.4%–28.7%) and 33.0% (31.3%–35.5%), respectively. The difference in survival rates was significant between the two groups using the log-rank test (HR 0.55, 95% CI 0.32 to 0.95, p=0.033). Cox regression analysis revealed that ≥30% increase in hematocrit levels on ICU admission was significantly associated with decreased long-term mortality (HR 0.40, 95% CI 0.20 to 0.80, p=0.0095). Lower hematocrit levels on ICU admission was a risk factor for increased long-term mortality, and higher hematocrit levels might outweigh the risk of transfusion in patients requiring PMV after a cardiovascular surgery.

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Quality of life and long-term mortality in patients with advanced chronic heart failure treated with intermittent low-dose intravenous inotropes in an outpatient setting

ESC Heart Failure ◽

10.1002/ehf2.12114 ◽

2016 ◽

Vol 4 (2) ◽

pp. 122-129 ◽

Cited By ~ 5

Author(s):

Fernando Chernomordik ◽

Dov Freimark ◽

Michael Arad ◽

Michael Shechter ◽

Shlomi Matetzky ◽

...

Keyword(s):

Quality Of Life ◽

Heart Failure ◽

Chronic Heart Failure ◽

Low Dose ◽

Outpatient Setting ◽

Long Term Mortality

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Charlson Comorbidity Index does not predict long-term mortality in elderly subjects with chronic heart failure

Age and Ageing ◽

10.1093/ageing/afp165 ◽

2009 ◽

Vol 38 (6) ◽

pp. 734-740 ◽

Cited By ~ 39

Author(s):

G. Testa ◽

F. Cacciatore ◽

G. Galizia ◽

D. Della-Morte ◽

F. Mazzella ◽

...

Keyword(s):

Heart Failure ◽

Chronic Heart Failure ◽

Charlson Comorbidity Index ◽

Elderly Subjects ◽

Comorbidity Index ◽

Long Term Mortality

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Mortality after Critical Illness

10.1093/med/9780199653461.003.0003 ◽

2014 ◽

Author(s):

Matthew Baldwin ◽

Hannah Wunsch

Keyword(s):

Mechanical Ventilation ◽

Intensive Care ◽

Critical Illness ◽

Prolonged Mechanical Ventilation ◽

Risk Of Death ◽

Increased Risk ◽

Poor Nutrition ◽

Long Term Mortality

Many critically ill patients now survive what were previously fatal illnesses, but long-term mortality after critical illness remains high. While study populations vary by country, age, intervention, or specific diagnosis, investigations demonstrate that the majority of additional deaths occur in the first 6 to 12 months after hospital discharge. Patients with diagnoses of cancer, respiratory failure, and neurological disorders leading to the need for intensive care have the highest long-term mortality, while those with trauma and cardiovascular diseases have much lower long-term mortality. Use of mechanical ventilation, older age, and a need for care in a facility after the acute hospitalization are associated with particularly high 1-year mortality among survivors of critical illnesses. Due to challenges of follow-up, less is known about causes of delayed mortality following critical illness. Longitudinal studies of survivors of pneumonia, stroke, and patients who require prolonged mechanical ventilation suggest that most debilitated survivors die from recurrent infections and sepsis. Potential biologic mechanisms for increased risk of death after a critical illness include sepsis-induced immunoparalysis, intensive care unit-acquired weakness, neuroendocrine changes, poor nutrition, and genetic variance. Studies are needed to fully understand how the severity of the acute critical illness interacts with comorbid disease, pre-illness disability, and pre-existing and acquired frailty to affect long-term mortality. Such studies will be fundamental to improve targeting of rehabilitative, therapeutic, and palliative interventions to improve both survival and quality of life after critical illness.

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