Re-operation within 30 days of radical cystectomy: Identifying high-risk patients and complications using ACS-NSQIP database

Introduction: Radical cystectomy (RC) is a highly morbid procedure, with 30-day complication rates approaching 31%. Our objective was to determine risk factors for re-operation within 30 days following a RC for non-metastatic bladder cancer. Methods: We included all patients who underwent a RC for non-metastatic bladder cancer using The American College of Surgeons National Surgical Quality Improvement Program database between January 1, 2007 and December 31, 2014. Logistic regression analyses were used to evaluate predictors of re-operation. Results: A total of 2608 patients were included; 5.8% of patients underwent re-operation within 30 days. On multivariable analysis, increasing body mass index (BMI) (odds ratio [OR] 1.04; 95% confidence interval [CI] 1.01–1.07), African-American race (vs. Caucasian OR 2.29; 95% CI 1.21–4.34), and history of chronic obstructive pulmonary disease (COPD) (OR 2.33; 95% CI 1.45–3.74) were significant predictors of re-operation within 30 days of RC. Urinary diversion type (ileal conduit vs. continent) and history of chemotherapy or radiotherapy within 30 days prior to RC were not. Patients who underwent re-operation within this timeframe had a significantly higher mortality rate (4.0% vs. 1.6%) and were more likely to experience cardiac (7.2% vs. 1.9%), pulmonary (23.0% vs. 3.0%), neurological (2.0% vs. 0.49%), and venous thromboembolic events (10.5% vs. 5.4%), as well as infectious complications (64.5% vs. 24.1%) with a significantly longer hospital length of stay (16.5 vs. 7.0 days). Conclusions: Recognizing increasing BMI, COPD, and African-American race as risk factors for re-operation within 30 days of RC will allow urologists to preoperatively identify such high-risk patients and prompt them to adopt more aggressive approaches to minimize postoperative surgical complications.

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Radical cystectomy for high risk patients with superficial bladder cancer in the era of orthotopic urinary reconstruction

Cancer ◽

10.1002/1097-0142(19950901)76:5<833::aid-cncr2820760518>3.0.co;2-m ◽

1995 ◽

Vol 76 (5) ◽

pp. 833-839 ◽

Cited By ~ 128

Author(s):

John A. Freeman ◽

David Esrig ◽

John P. Stein ◽

Anne R. Simoneau ◽

Eila C. Skinner ◽

...

Keyword(s):

Bladder Cancer ◽

High Risk ◽

Radical Cystectomy ◽

Superficial Bladder Cancer ◽

High Risk Patients ◽

Risk Patients ◽

Urinary Reconstruction

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The Risk of Stroke Using CHA2 DS2 -VASc Score in Hemodialysis Patients at a Tertiary Hospital in Riyadh, Saudi Arabia

Journal of Clinical Review & Case Reports ◽

10.33140/jcrc.04.07.01 ◽

2019 ◽

Vol 4 (7) ◽

Keyword(s):

Risk Factors ◽

High Risk ◽

Stroke Risk ◽

Hemodialysis Patients ◽

Low Risk ◽

High Risk Patients ◽

Stroke Risk Factors ◽

Increased Risk ◽

Risk Patients ◽

History Of

Introduction: Patients undergoing hemodialysis are at increased risk of stroke. However, less known about the impact of some of the stroke risk factors, and the value of stroke risk scores in determining the risk in those patients. Our main goal. To assess the risk factors for stroke in hemodialysis patients and the use of the new CHA2DS2-VASc score for stroke assessment. Methods: Single center, retrospective cohort study of 336 patients undergoing hemodialysis from June 24, 2018, to September 6, 2018, was recruited. Baseline demographics, clinical, and laboratory data were collected. We calculated the CHA2 DS2 -VASc score for stroke assessment in all patients and categorized them into high, moderate and low risk patients according to CHA2 DS2 - VASc score and subcategorized them to two groups atrial fibrillation (AFib) and Non- Atrial fibrillation (Non AFib) patients. Results: 336 patients were included in our study; the majority of patients were at high risk with a CHA2 DS2 -VASc Score mean of 2.9± 1.5, although history of stroke was observed only in 15 patients (4.46%). According to CHA2 DS2 - VASc score, 280 patients were at high risk, 172 (51.19%) were high-risk patients on treatment (anticoagulant or antiplatelet) and 108(32.14%) patients were high risk patients not on treatment 48 were at moderate risk (14.28%) and 8 were at low risk (2.38 %). Patients were divided into subgroups as non-AFib and AFib. In non-AFib patients 320 (95.23%), high-risk patients 103 (32.18%) were not treated; high-risk patients with treatment are 162 (50.62%), moderate patients were 47 (14.68%), 8(2.5%) was in low risk. AFib patients were 16 with a mean CHA2 DS2 -VASc score of 4.4±1.1. Patients with AFib were all at high risk except 1 was at moderate risk (6.25%). There were 11 (68.75%) patients on treatment and 5 (31.25%) patients not on treatment. The risk factors for stroke that were statistically significant in increasing score risk for all patients were: age > 65 (95% CI, -2.04– -1.29; p = 0.000), being female (95% CI, -1.36– -0.68; p = 0.000) hypertension (95% CI, -2.59– -1.37; p = 0.000), diabetes (95% CI, -2.10– -1.50; p = 0.000), CVD (95% CI, -2.07– -1.24; p=0.000), history of stroke or TIA (95% CI, -3.70– -2.03; p = 0.000), CHF or LVEF (95% CI, -2.28– - 0.91; p = 0.000). Conclusions: The risk of stroke in hemodialysis patients is significant according to the use of CHA2 DS2 -VASc score in Non-AFib hemodialysis patients shows supportive evidence of increased risk of stroke in those patients, which suggest the importance of close monitoring of patients with stroke risk factors by the nephrologist and the stroke team which will lead to the initiation of early prophylaxis in those patients.

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The LACE Score as a Tool to Identify Radical Cystectomy Patients at Increased Risk of 90-Day Readmission and Mortality

Current Urology ◽

10.1159/000447226 ◽

2018 ◽

Vol 12 (1) ◽

pp. 20-26 ◽

Cited By ~ 2

Author(s):

Jennifer L. Saluk ◽

Robert H. Blackwell ◽

William S. Gange ◽

Matthew A. C. Zapf ◽

Anai N. Kothari ◽

...

Keyword(s):

Bladder Cancer ◽

High Risk ◽

Radical Cystectomy ◽

Multivariable Analysis ◽

Emergency Department Visits ◽

High Risk Patients ◽

Increased Risk ◽

Patients At Risk ◽

Risk Patients

Introduction: Radical cystectomy for bladder cancer is associated with high rates of readmission. We investigated the LACE score, a validated prediction tool for readmission and mortality, in the radical cystectomy population. Materials & Methods: Patients who underwent radical cystectomy for bladder cancer were identified by ICD-9 codes from the Healthcare Cost and Utilization Project State Inpatient Database for California years 2007-2010. The LACE score was calculated as previously described, with components of L: length of stay, A: acuity of admission, C: comorbidity, and E: number of emergency department visits within 6 months preceding surgery. Results: Of 3,470 radical cystectomy patients, 638 (18.4%) experienced 90-day readmission, and 160 (4.6%) 90-day mortality. At a previously validated “high-risk” LACE score ≥ 10, patients experienced an increased risk of 90-day readmission (22.8 vs. 17.7%, p = 0.002) and mortality (9.1 vs. 3.5%, p < 0.001). On adjusted multivariable analysis, “high risk” patients by LACE score had increased 90-day odds of readmission (adjusted OR = 1.24, 95% CI: 0.99-1.54, p = 0.050) and mortality (adjusted OR = 2.09, 95% CI: 1.47-2.99, p < 0.001). Conclusion: The LACE score reasonably identifies patients at risk for 90-day mortality following radical cystectomy, but only poorly predicts readmission. Providers may use the LACE score to target high-risk patients for closer follow-up or intervention.

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Risk factors and outcomes of myocardial injury after non-cardiac surgery in high-risk patients who underwent radical cystectomy

Medicine ◽

10.1097/md.0000000000022893 ◽

2020 ◽

Vol 99 (43) ◽

pp. e22893

Author(s):

Jihion Yu ◽

Bumjin Lim ◽

Yongsoo Lee ◽

Jun-Young Park ◽

Bumsik Hong ◽

...

Keyword(s):

Risk Factors ◽

Cardiac Surgery ◽

High Risk ◽

Radical Cystectomy ◽

Myocardial Injury ◽

High Risk Patients ◽

Risk Patients

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Behavioral Emergencies and Crises

The Oxford Handbook of Clinical Psychology ◽

10.1093/oxfordhb/9780195366884.013.0033 ◽

2010 ◽

pp. 739-762

Author(s):

Phillip M. Kleespies ◽

Justin M. Hill

Keyword(s):

Mental Health ◽

Risk Factors ◽

High Risk ◽

Work Environment ◽

Emotional Impact ◽

High Risk Patients ◽

Risk Patients ◽

Life Threatening ◽

Behavioral Emergencies ◽

And Training

This chapter illustrates the mental health clinician’s relationship with behavioral emergencies. The chapter begins by distinguishing the terms behavioral emergency and behavioral crisis, and underlying themes among all behavioral emergencies are identified. Given that most clinicians will face a behavioral emergency in their careers, the importance of enhancing the process of educating and training practitioners for such situations far beyond the minimal training that currently exists is highlighted. The chapter continues by exploring various aspects of evaluating and managing high-risk patients (i.e., those who exhibit violent tendencies toward themselves or others, and those at risk for victimization). It includes a discussion of the benefits and limitations to estimating life-threatening risk factors and specific protective factors. The chapter concludes by discussing the emotional impact that working with high-risk patients has on clinicians, and an emphasis is placed on the importance of creating a supportive work environment.

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Prevention of Hypotension following Spinal Anaesthesia in Caesarean Section - then and now

Kathmandu University Medical Journal ◽

10.3126/kumj.v8i4.6242 ◽

2012 ◽

Vol 8 (4) ◽

pp. 415-419

Author(s):

J K Mitra

Keyword(s):

Risk Factors ◽

Clinical Practice ◽

High Risk ◽

Caesarean Section ◽

Spinal Anaesthesia ◽

Limited Data ◽

First Line ◽

High Risk Patients ◽

Risk Patients ◽

Poor Efficacy

Hypotension during spinal anaesthesia for caesarean section remains a common scenario in our clinical practice. Certain risk factors play a role in altering the incidence of hypotension. Aortocaval compression counteraction does not help to prevent hypotension. Intravenous crystalloid prehydration has poor efficacy; thus, the focus has changed toward co-hydration and use of colloids. Phenylephrine is established as a first- line vasopressor, although there are limited data from high-risk patients. Ephedrine crosses the placenta more than phenylephrine and cause possible alterations in the foetal physiology.http://dx.doi.org/10.3126/kumj.v8i4.6242 Kathmandu Univ Med J 2010;8(4):415-19

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Identifying High-Risk Patients for Hospital Readmission Following Radical Cystectomy and Urinary Diversion

Journal of Surgical Research ◽

10.1016/j.jss.2013.11.048 ◽

2014 ◽

Vol 186 (2) ◽

pp. 496

Author(s):

K.E. Omernick ◽

S.E. Tevis ◽

G.E. Leverson ◽

E.J. Abel ◽

D.F. Jarrard ◽

...

Keyword(s):

High Risk ◽

Radical Cystectomy ◽

Urinary Diversion ◽

Hospital Readmission ◽

High Risk Patients ◽

Risk Patients

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Uptake and detection rate of a stepwise cardiometabolic disease detection program in primary care—a cohort study

European Journal of Public Health ◽

10.1093/eurpub/ckz201 ◽

2019 ◽

Vol 30 (3) ◽

pp. 402-407

Author(s):

Daphne M Stol ◽

Monika Hollander ◽

Ilse F Badenbroek ◽

Mark M J Nielen ◽

François G Schellevis ◽

...

Keyword(s):

Risk Factors ◽

Primary Care ◽

Cohort Study ◽

High Risk ◽

Newly Diagnosed ◽

Additional Risk ◽

High Risk Patients ◽

Detection Program ◽

Risk Patients

Abstract Background Early detection and treatment of cardiometabolic diseases (CMD) in high-risk patients is a promising preventive strategy to anticipate the increasing burden of CMD. The Dutch guideline ‘the prevention consultation’ provides a framework for stepwise CMD risk assessment and detection in primary care. The aim of this study was to assess the outcome of this program in terms of newly diagnosed CMD. Methods A cohort study among 30 934 patients, aged 45–70 years without known CMD or CMD risk factors, who were invited for the CMD detection program within 37 general practices. Patients filled out a CMD risk score (step 1), were referred for additional risk profiling in case of high risk (step 2) and received lifestyle advice and (pharmacological) treatment if indicated (step 3). During 1-year follow-up newly diagnosed CMD, prescriptions and abnormal diagnostic tests were assessed. Results Twelve thousand seven hundred and thirty-eight patients filled out the risk score of which 865, 6665 and 5208 had a low, intermediate and high CMD risk, respectively. One thousand seven hundred and fifty-five high-risk patients consulted the general practitioner, in 346 of whom a new CMD was diagnosed. In an additional 422 patients a new prescription and/or abnormal diagnostic test were found. Conclusions Implementation of the CMD detection program resulted in a new CMD diagnosis in one-fifth of high-risk patients who attended the practice for completion of their risk profile. However, the potential yield of the program could be higher given the considerable number of additional risk factors—such as elevated glucose, blood pressure and cholesterol levels—found, requiring active follow-up and presumably treatment in the future.

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