scholarly journals Complications in the 90-day postoperative period following kidney transplant and the relationship of the Charlson Comorbidity Index

2017 ◽  
Vol 11 (12) ◽  
pp. 388-93 ◽  
Author(s):  
Max A. Levine ◽  
Trevor Schuler ◽  
Sita Gourishankar
Keyword(s):  
Logistic Regression ◽  
Postoperative Complications ◽  
Renal Transplant ◽  
Postoperative Period ◽  
Charlson Comorbidity Index ◽  
Significant Risk ◽  
Patient Counselling ◽  
Increased Risk ◽  
Comorbidity Index ◽  
Relationship Of

Introduction: Renal transplant experiences widespread success, but little is published regarding the postoperative complications. The Charlson Comorbidity Index (CCI) is a system of mortality risk assessment. Our purpose is to assess the 90-day postoperative complications after renal transplantation. The secondary objective is to clarify whether CCI predicts complications. We hypothesized increased CCI corresponds to worse complication on the Clavien scale.Methods: This is a retrospective analysis of renal recipients at our institution (2011‒2013) who were ≥18 years old and received complete follow up. CCI, age, gender, body mass index (BMI), and graft type were extracted from the electronic medical records. Complications were scored using the Clavien scale. Descriptive statistics and logistic regression were used to analyze 198 patients.Results: The mean age was 53 (standard deviation [SD] 14), mean BMI 27.4 (SD 14), median CCI 1. Grade 2 or higher (significant) complications occurred in 60% of patients and Grade 3b or higher (severe) in 15% of patients in the 90-day postoperative period. Sixty-eight different complications were identified, the most common being blood transfusion (19%). Logistic regression suggests a predictive value of CCI (odds ratio [OR] 1.70; 95% confidence interval [CI] 1.3‒2.3) for severe complications, with diabetes mellitus and peripheral vascular disease conferring increased risk. Conclusions: Renal transplant carries significant risk. This data can be used to improve patient counselling on the likely postoperative course. Study limitations include the retrospective design, predisposing to potential bias in data capture.

Risk factors and outcomes of postoperative emergency response team activation: a matched case-control study

2020 ◽  
Vol 22 (1) ◽  
pp. 6-14
Author(s):  
Matthew I Hardman ◽  
◽  
S Chandralekha Kruthiventi ◽  
Michelle R Schmugge ◽  
Alexandre N Cavalcante ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Postoperative Complications ◽  
Emergency Response ◽  
Case Control Study ◽  
Case Control ◽  
Multiple Logistic Regression ◽  
Increased Risk ◽  
Response Team ◽  
Control Study

OBJECTIVE: To determine patient and perioperative characteristics associated with unexpected postoperative clinical deterioration as determined for the need of a postoperative emergency response team (ERT) activation. DESIGN: Retrospective case–control study. SETTING: Tertiary academic hospital. PARTICIPANTS: Patients who underwent general anaesthesia discharged to regular wards between 1 January 2013 and 31 December 2015 and required ERT activation within 48 postoperative hours. Controls were matched based on age, sex and procedure. MAIN OUTCOME MEASURES: Baseline patient and perioperative characteristics were abstracted to develop a multiple logistic regression model to assess for potential associations for increased risk for postoperative ERT. RESULTS: Among 105 345 patients, 797 had ERT calls, with a rate of 7.6 (95% CI, 7.1–8.1) calls per 1000 anaesthetics (0.76%). Multiple logistic regression analysis showed the following risk factors for postoperative ERT: cardiovascular disease (odds ratio [OR], 1.61; 95% CI, 1.18–2.18), neurological disease (OR, 1.57; 95% CI, 1.11–2.22), preoperative gabapentin (OR, 1.60; 95% CI, 1.17–2.20), longer surgical duration (OR, 1.06; 95% CI, 1.02–1.11, per 30 min), emergency procedure (OR, 1.54; 95% CI, 1.09–2.18), and intraoperative use of colloids (OR, 1.50; 95% CI, 1.17–1.92). Compared with control participants, ERT patients had a longer hospital stay, a higher rate of admissions to critical care (55.5%), increased postoperative complications, and a higher 30-day mortality rate (OR, 3.36; 95% CI, 1.73–6.54). CONCLUSION: We identified several patient and procedural characteristics associated with increased likelihood of postoperative ERT activation. ERT intervention is a marker for increased rates of postoperative complications and death.

scholarly journals The relationship of Charlson comorbidity index with stent restenosis and extent of coronary artery disease

2018 ◽  
Vol 10 (2) ◽  
pp. 70-75 ◽  
Author(s):  
Turgut Karabağ ◽  
Emіne Altuntaş ◽  
Belma Kalaycı ◽  
Bahar Şahіn ◽  
Mustafa Umut Somuncu ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Charlson Comorbidity Index ◽  
Stent Restenosis ◽  
Comorbidity Index ◽  
Artery Disease ◽  
Relationship Of ◽  
The Relationship

scholarly journals Charlson Comorbidity Index Is Predictive of Postoperative Clinical Outcome After Single Level Posterior Lumbar Interbody Fusion Surgery: a Single-center Study

2021 ◽  
Author(s):  
Kensuke Shinohara ◽  
Ryo Ugawa ◽  
Shinya Arataki ◽  
Shinnosuke Nakahara ◽  
Kazuhiro Takeuchi
Keyword(s):  
Postoperative Complications ◽  
Clinical Outcome ◽  
Direct Cost ◽  
Charlson Comorbidity Index ◽  
Japanese Orthopaedic Association ◽  
Negative Relationship ◽  
Improvement Rate ◽  
Single Level ◽  
Comorbidity Index ◽  
Group 2

Abstract Background. In several previous studies Charlson comorbidity Index (CCI) score was associated with postoperative complications, mortality and re-admission. There are few reports about the influence of CCI score on postoperative clinical outcome. The purpose of this study was to investigate the influence of comorbidities as calculated with CCI on postoperative clinical outcomes after PLIF.Methods. 366 patients who underwent an elective primary single level PLIF were included. Postoperative clinical outcome was evaluated with the Japanese Orthopaedic Association lumbar score (JOA score). The correlation coefficient between the CCI score and postoperative improvement in JOA score was investigated. Patients were divided into three groups according to their CCI score (0, 1 and 2+). JOA improvement rate, length of stay (LOS) and direct cost were compared between each group. Postoperative complications were also investigated.Results. There was a weak negative relationship between CCI score and JOA improvement rate (r = -0.20). LOS and direct cost had almost no correlation with CCI score. The JOA improvement rate of Group 0 and Group 1 was significantly higher than Group 2+. LOS and direct cost were also significantly different etween Group 0 and Group 2+. There were 14 postoperative complications. Adverse postoperative complications were equivalently distributed in each group, and not associated with the number of comorbidities.Conclusions. A higher CCI score leads to a poor postoperative outcome. The recovery rate of patients with two or more comorbidities was significantly higher than in patients without comorbidities. However, the CCI score did not influence LOS and increased direct costs. The surgeon must take into consideration the patient’s comorbidities when planning a surgical intervention in order to achieve a good clinical outcome.

scholarly journals Frailty Assessed by Administrative Tools and Mortality in Patients With Pneumonia Admitted to the Hospital and ICU: a Population-based Data-linkage Study

2021 ◽  
Author(s):  
Tamas Szakmany ◽  
Joe Hollinghurst ◽  
Richard Pugh ◽  
Ashley Akbari ◽  
Rowena Griffiths ◽  
...  
Keyword(s):  
Data Linkage ◽  
Social Deprivation ◽  
Frailty Index ◽  
Significant Risk ◽  
Population Based ◽  
Linkage Study ◽  
Increased Risk ◽  
Comorbidity Index ◽  
Population Scale

Abstract Background: The ideal method of identifying frailty is uncertain, and data on long-term outcomes is relatively limited. We examined frailty indices derived from population-scale linked data on Intensive Care Unit (ICU) and hospitalised non-ICU patients with pneumonia to elucidate the influence of frailty on mortality.Methods: Longitudinal cohort study between 2010-2018 using population-scale anonymised data linkage of healthcare records for adults admitted to hospital with pneumonia in Wales. Primary outcome was in-patient mortality. Age, hospital frailty risk score (HFRS), electronic frailty index (eFI), Charlson comorbidity index (CCI), and social deprivation index were entered in the multivariate regression models.Results: Of the 107,188 patients, mean (SD) age was 72.6 (16.6) years, 50% were men. The two frailty indices and the comorbidity index had an increased risk of mortality for individuals with an ICU admission. Advancing age, increased frailty and comorbidity affected short- and long-term mortality. For predicting inpatient deaths, the CCI and HFRS based models were similar, however for longer term outcomes the CCI based model was superior. Discussion: Frailty and comorbidity are significant risk factors for patients admitted to hospital with pneumonia. Frailty and comorbidity scores based on administrative data have only moderate ability to predict outcome.

The Charleston Comorbidity Index

2010 ◽  
pp. 153-201
Author(s):  
Patricia Cerrito
Keyword(s):  
Logistic Regression ◽  
Regression Model ◽  
Risk Adjustment ◽  
Charlson Comorbidity Index ◽  
Logistic Regression Model ◽  
Charlson Index ◽  
Comorbidity Index

In this chapter, we consider the Charlson Comorbidity Index (CCI). This index is published, and the weights used to define risk adjustment in the logistic regression model are clearly identified as well. (Sundararajan et al., 2004) Therefore, we are able to examine this index in detail, and to see if the index is meaningful in terms of adjusting risk based upon patient condition. We will suggest an alternative to the Charlson Index in Chapter 8 that gives improvements in terms of its relationship to outcomes.

scholarly journals Prognostic Risk Factors for Complications Associated with Below the Knee Amputations

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0037
Author(s):  
Jason Ni ◽  
Eric Lukosius ◽  
Kaitlin Saloky ◽  
Kempland Walley ◽  
Leanne Ludwick ◽  
...  
Keyword(s):  
Risk Factors ◽  
Postoperative Complications ◽  
Charlson Comorbidity Index ◽  
High Rate ◽  
Tourniquet Time ◽  
Ambulatory Status ◽  
Asa Classification ◽  
Below The Knee ◽  
Comorbidity Index ◽  
Prognostic Risk Factors

Category: Other Introduction/Purpose: Below the knee amputation (BKA) is an effective surgical procedure for individuals with severe injury or infection to their lower extremities. However, patients who receive these procedures are subject to significant morbidity and a high rate of postoperative complications due to the presence of multiple concomitant comorbidities. Despite the wide practice of this intervention, prognostic risk factors aiding in predicting surgical outcomes in these patients are poorly understood. The purpose of this study is to evaluate risk factors that may contribute to the outcomes of BKA procedures. Methods: The clinical and radiographic outcomes for 89 patients ages 19-90 who underwent BKA were retrospectively evaluated from 2012-2017. Postoperative complications of mortality, infection, and reoperation were evaluated with patient and surgical variables. Patient variables included: age, ambulatory status, obesity, diabetes, HbA1C2 levels, neuropathy, smoking, Charlson Comorbidity Index (CCI), and American Society of Anesthesiologists (ASA) classification. Surgical variables evaluated included: presence of pre-op infection, pre-op ambulatory status, tourniquet time, tourniquet pressure, and usage of prophylactic antibiotics. Results: Of the patients evaluated there was an overall complication rate of 49% (44/89) and a mortality rate of 19% (17/89). Patients with diabetes (p=.035), a greater score on the Charlson Comorbidity Index (p=.001), and an ASA classification =3 (p=.005) were associated with a greater risk of mortality. Operative values (i.e. tourniquet time, tourniquet pressure etc.) did not affect patient mortality rates in a significant way, but there was a higher incidence of complications (i.e. mortality, post-op infections, and reoperations) with patients with pre-operative infections. Conclusion: Diabetes, a higher CCI score and a greater ASA value were found to be significant predictors of patient mortality after BKA (p<0.05). Future perioperative optimization in these patients identified as high risk may improve patient outcomes in the future.

Severe Complications of the Anterior Cricoid Split Operation and Single-Stage Laryngotracheoplasty

1994 ◽  
Vol 103 (9) ◽  
pp. 723-725 ◽  
Author(s):  
Anthony G. Zeitouni ◽  
John Manoukian
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Postoperative Complications ◽  
Postoperative Period ◽  
Intensive Care Unit Setting ◽  
Single Stage ◽  
Successful Outcome ◽  
Increased Risk ◽  
Split Operation

The management of congenital and acquired subglottic stenosis has been considerably facilitated with the introduction of the anterior cricoid split operation and, more recently, the single-stage laryngotracheoplasty. These procedures are followed by a 1- to 2-week period of sedation, during which the patient is paralyzed and completely dependent on mechanical ventilation. Although these procedures have proven very successful at achieving decannulation, the postoperative period can be the source of significant complications. This is illustrated with 4 cases of severe postoperative complications. The possible pathophysiologic causes are discussed, and the literature concerning the postoperative complications of these procedures is reviewed. The avoidance of neuromuscular blockade must be weighed against the possible increased need for narcotics and increased risk of self-extubation. An intensive care unit setting proficient in the care of these patients is necessary for a successful outcome.

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