scholarly journals Institutional actual utilization of postoperative mortality using nationwide survey based risk calculator in patients who underwent major hepatectomy

2021 ◽  
Author(s):  
Atsushi Nanashima ◽  
Naoya Imamura ◽  
Masahide Hiyoshi ◽  
Koichi Yano ◽  
Takeomi Hamada ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Hospital Mortality ◽  
High Mortality ◽  
Major Hepatectomy ◽  
Postoperative Mortality ◽  
Nationwide Survey ◽  
Bile Leakage ◽  
Risk Calculator ◽  
Biliary Malignancy ◽  
Co Morbidity

Background: Relationship between outcomes of major hepatectomy and the mortality rate predicted by National Clinical Database risk calculator (NCD-RC) was examined . Methods: Patient demographics and postoperative morbidity and mortality were compared between 30-day and in-hospital mortality rates among 55 patients who underwent major hepatectomies . The cut-off value for high-risk mortality was set at 5%. Patients were divided into four groups: A) no severe complications and low predictive mortality rate (woML) , B) severe complications or mortality, and low mortality rate (wML) , C) no severe complications and high mortality rate (woMH) , and D) severe complications or mortality, and high mortality rate (wMH) . Results: Morbidity higher than CD III occurred in 17 patients (28%) and 30-day and in-hospital mortality in none and two (3%), respectively. The in-hospital mortality rate was significantly higher for male patients (p<0.01). Age, elderly patients, diseases, and co-morbidity did not significantly differ among groups. Although bile leakage was common in group wML , there were no in-hospital deaths. All surgical procedures performed in group wMH were right hepatectomy with bile duct resection (RH-BDR) for biliary malignancy, and two died of hepatic failure; however, the incidence of RH-BDR was not significantly higher than those in other groups. Conclusions: Preoperative mortality rate predicted by NCD-RC was not always consistent with outcomes in actual clinical settings and further improvements are needed. In case of RH-BDR for biliary malignancy with high predictive mortality rate, careful decision making for liver function and perioperative management are required.

scholarly journals Does Risk Calculator by Nationwide Survey Match The Postoperative Outcome in Patients Who Underwent Major Hepatectomy?

2020 ◽  
Author(s):  
Atsushi Nanashima ◽  
Naoya Imamura ◽  
Masahide Hiyoshi ◽  
Koichi Yano ◽  
Takeomi Hamada ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Hospital Mortality ◽  
High Mortality ◽  
Major Hepatectomy ◽  
Nationwide Survey ◽  
Hospital Death ◽  
Risk Calculator ◽  
Biliary Malignancy ◽  
Co Morbidity ◽  
Hepatobiliary Diseases

Abstract Background: To clarify significance of the present National Clinical Database risk calculator (NCD-RC) for hepatectomy in Japan, relationship between perioperative parameters or outcomes in major hepatectomy and the mortality rate by NCD-RC was examined. Methods: Patient demographics, co-morbidity, surgical records, postoperative morbidity or mortality were examined and compared to the 30 days- or in-hospital-mortality rate among 55 patients with hepatobiliary diseases who underwent hemi- or more-extended hepatectomy and central (segment 458) hepatectomy. The cut-off percent for high risk mortality before hepatectomy was set at 5% in this period. Results: In-hospital morbidity over CD III was 17 (28%), The 30-day mortality and in-hospital mortality was nil and two (3%), respectively. Male patient showed significantly higher in-hospital mortality rate (p<0.01). In the 37 patients (group woML), mean age was 67.8±8.7 years old ranging 45 and 84. Others included A) with severe complications or mortality in whom low mortality rate (group wML, n=13), B) without severe complications neither mortality in whom high mortality rate (group woMH, n=7), and C) with severe complications or mortality in whom high mortality rate (group wMH, n=4 (6.5%)). Age, distribution of elderly patients, gender, the hepatobiliary diseases and the prevalence of preoperative co-morbidity were not significantly different between groups. In the group wML, the bile leakage was dominant and, however, the in-hospital death was not observed. In the group wMH, all operations were right hepatectomy with bile duct resection (RH-BDR) for biliary malignancy and two died of hepatic failure and, however, the prevalence of RH-BDR was not significantly higher in comparison with other groups. Conclusions: Predictive mortality rate by risk calculator under nationwide survey did not always match with patient outcomes in the actual clinical setting and further improvement will be required. In case of RH-BDR for biliary malignancy with high predictive rate, the careful perioperative managements is important under the present nationwide database.

Infective endocarditis

2020 ◽  
pp. 115-128
Keyword(s):  
At Risk ◽  
Infective Endocarditis ◽  
Mortality Rate ◽  
Hospital Mortality ◽  
High Mortality ◽  
Clinical Management ◽  
Valve Disease ◽  
Educational Issues ◽  
The Uk

Infective endocarditis (IE) is a condition that most commonly occurs in patients with pre-existing valve disease. It affects one in 30 000 people in the UK and is associated with a high mortality rate (15–30% in hospital mortality). Nurses working in the cardiac arena should be aware of those patients who are at risk of developing IE and its clinical management. This chapter covers the aetiology, diagnosis, complications, treatment, nursing considerations, and specific educational issues that are relevant to the overall management and prevention of IE.

Higher mortality rate in patients hospitalised for acute pulmonary embolism during weekends

2011 ◽  
Vol 106 (07) ◽  
pp. 83-89 ◽  
Author(s):  
Davide Imberti ◽  
Walter Ageno ◽  
Francesco Dentali ◽  
Roberto Manfredini ◽  
Massimo Gallerani
Keyword(s):  
Pulmonary Embolism ◽  
Mortality Rate ◽  
Hospital Mortality ◽  
Acute Pulmonary Embolism ◽  
Diagnostic Techniques ◽  
Co Morbidity ◽  
Emilia Romagna Region ◽  
Morbidity Index ◽  
Hospital Administrative ◽  
Acute Pe

SummaryThe management of acute pulmonary embolism (PE) is often challenging and requires specific medical expertise, diagnostic techniques and therapeutic options that may not be available in all hospitals throughout the entire week. The aim of our study was to evaluate whether or not an association exists between weekday or weekend admission and mortality for patients hospitalised with acute PE. Using routinely collected hospital administrative data, we examined patients discharged with a diagnosis of PE from the hospitals of the Emilia- Romagna Region in Italy (January 1999-December 2009). The risk of inhospital death was calculated for admissions at the weekend and compared to weekday admissions. Of a total of 26,560 PEs, 6,788 (25.6%) had been admitted during weekends. PE admissions were most frequent on Mondays (15.8%) and less frequent on Saturdays and Sun- days/holidays (12.8%) (p<0.001). Weekend admissions were associated with significantly higher rates of in-hospital mortality than weekday admissions (28% vs. 24.8%) (p<0.001). The risk of weekend admission and in-hospital mortality was higher after adjusting for sender, hospital characteristics, and the Charlson co-morbidity index. In conclusion, hospitalisation for PE on weekends seems to be associated with a significantly higher mortality rate than on weekdays. Further research is needed to investigate the reasons for this observed difference in mortality in order to try and implement future strategies that ensure an adequate level of care throughout the entire week.

scholarly journals Predictors of In-Hospital Mortality for Road Traffic Accident-Related Severe Traumatic Brain Injury

2021 ◽  
Vol 11 (12) ◽  
pp. 1339
Author(s):  
Chien-Hung Chen ◽  
Yu-Wei Hsieh ◽  
Jen-Fu Huang ◽  
Chih-Po Hsu ◽  
Chia-Ying Chung ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Mortality Rate ◽  
Hospital Mortality ◽  
Prothrombin Time ◽  
High Mortality ◽  
Clinical Characteristics ◽  
Road Traffic ◽  
Road User ◽  
Severe Tbi

(1) Background: Road traffic accidents (RTAs) are the leading cause of pediatric traumatic brain injury (TBI) and are associated with high mortality. Few studies have focused on RTA-related pediatric TBI. We conducted this study to analyze the clinical characteristics of RTA-related TBI in children and to identify early predictors of in-hospital mortality in children with severe TBI. (2) Methods: In this 15-year observational cohort study, a total of 618 children with RTA-related TBI were enrolled. We collected the patients’ clinical characteristics at the initial presentations in the emergency department (ED), including gender, age, types of road user, the motor components of the Glasgow Coma Scale (mGCS) score, body temperature, blood pressure, blood glucose level, initial prothrombin time, and the intracranial computed tomography (CT) Rotterdam score, as potential mortality predictors. (3) Results: Compared with children exhibiting mild/moderate RTA-related TBI, those with severe RTA-related TBI were older and had a higher mortality rate (p < 0.001). The in-hospital mortality rate for severe RTA-related TBI children was 15.6%. Compared to children who survived, those who died in hospital had a higher incidence of presenting with hypothermia (p = 0.011), a lower mGCS score (p < 0.001), a longer initial prothrombin time (p < 0.013), hyperglycemia (p = 0.017), and a higher Rotterdam CT score (p < 0.001). Multivariate analyses showed that the mGCS score (adjusted odds ratio (OR): 2.00, 95% CI: 1.28–3.14, p = 0.002) and the Rotterdam CT score (adjusted OR: 2.58, 95% CI: 1.31–5.06, p = 0.006) were independent predictors of in-hospital mortality. (4) Conclusions: Children with RTA-related severe TBI had a high mortality rate. Patients who initially presented with hypothermia, a lower mGCS score, a prolonged prothrombin time, hyperglycemia, and a higher Rotterdam CT score in brain CT analyses were associated with in-hospital mortality. The mGCS and the Rotterdam CT scores were predictive of in-hospital mortality independently.

scholarly journals ICG Clearance in Assessing Cirrhotic Patients with Hepatocellular Carcinoma for Major Hepatic Resection

HPB Surgery ◽  
1997 ◽  
Vol 10 (3) ◽  
pp. 182-183 ◽  
Author(s):  
Seigo Kitano ◽  
Yang-II Kim
Keyword(s):  
Hepatocellular Carcinoma ◽  
Mortality Rate ◽  
Blood Loss ◽  
Hospital Mortality ◽  
Chronic Active Hepatitis ◽  
Major Hepatectomy ◽  
Selection Criterion ◽  
Tertiary Referral Center ◽  
Icg Clearance ◽  
Cirrhotic Patients

Objective: To deWne the safety of major hepatectomy for hepatocellular carcinoma (HCC) associated with cirrhosis and the selection criteria for surgery in terms of hospital mortality.Design: Major hepatectomy for HCC in the presence of cirrhosis is considered to be contraindicated by many surgeons because the reported mortality rate is high (26% to 50%). Previous workers recommended that only selected patients with Child's A status or indocyanine green (ICG) retention at 15 minutes of less than 10% undergo major hepatectomy. A survery was made, therefore, of our patients with HCC and cirrhosis undergoing major hepatectomy between 1989 and 1994.Setting: A tertiary referral center.Patients: The preoperative, intraoperative, and post-operative data of 54 patients with cirrhosis who had major hepatectomy were compared with those of 25 patients with underlying chronic active hepatitis and 22 patients with normal livers undergoing major hepatectomy for HCC. The data had been prospectively collected.Intervention: Major hepatectomy, defined as resection of two or more liver segments by Goldsmith and Woodburn nomenclature, was performed on all the patients. Main Outcome Measure: Hospital mortality, which was defined as death within the same hospital admission for the hepatectomy.Results: Preoperative liver function in patients with cirrhosis was worse than in those with normal livers. The intraoperative blood loss was also higher (P=.01), but for patients with cirrhosis, chronic active hepatitis, and normal livers, the hospital mortality rates (13%, 16%, and 14%, respectively) were similar. The hospital mortality rate for patients with cirrhosis in the last 2 years of the study was only 5%. Patients with cirrhosis could tolerate up to 10 L of blood loss and survive the major hepatectomy. By discriminant analysis, an ICG retention of 14% at 15 minutes was cutoff level that could maximally separate the patients with cirrhosis with and without mortality.Conclusion: Major hepatectomy for HCC in the presence of cirrhosis is associated with a mortality rate that is not different from the rate for patients with normal livers. An ICG retention of 14% at 15 minutes would serve as a better selection criterion than the 10% previously used.

Low dose whole lung radiotherapy for older patients with corona virus 19 disease (COVID-19) pneumonitis: practical protocol by the International Geriatric Radiotherapy Group (Preprint)

2020 ◽  
Author(s):  
Nam Nguyen ◽  
Meritxell Arenas ◽  
Te Vuong ◽  
Alice Zamagni ◽  
Vincent Vinh-Hung ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Inflammatory Response ◽  
High Mortality ◽  
Older Patients ◽  
Low Dose ◽  
Artificial Ventilation ◽  
Ordinal Scale ◽  
Co Morbidity ◽  
Lung Radiotherapy ◽  
The Impact

BACKGROUND Coronavirus disease 19 (COVID-19) carry a high mortality rate among older patients and minorities such as ethnic Africans and Latinos. The chronic baseline systemic inflammation of older patients and minorities may make them more vulnerable to the cytokines storm generated by the viral infection in addition to preexisting co-morbidity. Even though multiple organs failure result from the cytokine storm, pneumonia and respiratory failure often lead to death. OBJECTIVE Low dose whole lung radiotherapy (LDWLRT) may modulate the inflammatory response and may decrease the need for artificial ventilation, thus improving mortality rate. METHODS A phase I-II prospective trials enrolling 500 patients, 65 years old or older from 25 countries will be conducted to investigate the impact of LDWLRT on mortality rate of COVID-19 patients. The patients who will be selected would have developed pneumonias but did not require artificial ventilation. These patients will be followed for a year after receiving this treatment. Their physical activities will be monitored through the ordinal scale and will be correlated with their cytokines status and oxygen saturation rate to assess the impact of the residual inflammation on their daily life. Mortality rates between different ethnic group will be compared and correlated with their cytokines response to the virus and number of co-morbidities. RESULTS We postulate that LDWLRT may improve survival rates of all patients by preventing the need for artificial ventilation which is associated with a high mortality. The inflammatory response between different ethnic groups before and following radiotherapy will be valuable to serve as baseline for future prospective pandemic studies as it has not been reported before. CONCLUSIONS Once the study is complete, we may be able to demonstrate that LDWLRT may improve survival through its anti-inflammatory property CLINICALTRIAL NCT 04493294

Darmkrebs-OP: Auf die Erfahrung kommt es an

2020 ◽  
Vol 52 (04) ◽  
pp. 162-164
Author(s):  
Frank Lichert
Keyword(s):  
Rectal Cancer ◽  
Mortality Rate ◽  
Hospital Mortality ◽  
Hospital Volume ◽  
Rectum Resection

Diers J et al. Nationwide in-hospital mortality rate following rectum resection for rectal cancer according to annual hospital volume in Germany. BJS Open 2020; doi:10.1002/bjs5.50254

Pylorus-Preserving Pancreaticoduodenectomy: Evaluation of 50 Cases

2017 ◽  
Vol 13 (1) ◽  
pp. 42-45
Author(s):  
SM Shakhwat Hossain ◽  
Ferdous Rahman
Keyword(s):  
Gastric Emptying ◽  
Mortality Rate ◽  
Wound Infection ◽  
Postoperative Mortality ◽  
Operation Time ◽  
Armed Forces ◽  
Military Hospital ◽  
Morbidity Rate ◽  
Proper Patient Selection ◽  
Periampullary Neoplasms

Introduction: Pancreaticoduodenectomy is the procedure of choice for periampullary neoplasms. It is considered as a major surgical procedure. It is associated with relatively higher postoperative mortality and morbidity rate, however, with development of technology, proper patient selection, meticulous operative technique, appropriate postoperative care, morbidity and mortality rate has decreased subsequently. Up to the 1970s, the operative mortality rate after pancreaticoduodenectomy approached 20% but it has been reduced to less than 5% in recent reports. This study is designed to evaluate the postoperative outcomes of pylorus-preserving pancreaticoduodenectomy procedure in our set up. Objective: To evaluate the outcome of the pylorus-preserving pancreaticoduodenectomy procedure with the intention to measure operation time and per-operative bleeding, observing postoperative anastomotic leakage and gastric emptying time. To find out postoperative wound infection and complications to detect the dumping syndrome. Materials and Methods: A prospective observational study was carried out in the Department of Hepatobiliary Surgery, Combined Military Hospital, Dhaka from July 2013 to January 2017. Fifty patients who underwent pylorus-preserving pancreaticodudenectomy procedure were included in this study. Results: Out of 50 postoperative patients, 12(24%) patients developed complications. Of these patients, 3(6%) developed wound infection, 2(4%) developed bile leakage and 2(4%) developed postoperative haemorrhage. Pancreatic fistula, vomiting, delayed gastric emptying and abdominal collection all were 1(2%) each. Postoperative mortality was 3(6%). Conclusion: The present study demonstrated the development of postoperative complications after pylorus-preserving pancreaticoduodenectomy is as similar as published in different studies. Better outcome can be achieved with meticulous pre-operative evaluation of risk factors and per-operative skill maneuvering. Journal of Armed Forces Medical College Bangladesh Vol.13(1) 2017: 42-45

Emamectin benzoate is a safe and effective anthelmintic against coelomic nematode Philometra rubra in striped bass Morone saxatilis

2020 ◽  
Vol 142 ◽  
pp. 47-53
Author(s):  
K Béland ◽  
G Séguin ◽  
S Lair
Keyword(s):  
Mortality Rate ◽  
Striped Bass ◽  
High Mortality ◽  
Morone Saxatilis ◽  
Treatment Results ◽  
Emamectin Benzoate ◽  
Once Daily ◽  
Fish Hatchery ◽  
Parasitic Burden

An unusually high mortality rate due to verminous (Philometra rubra) coelomitis was documented in wild-hatched striped bass Morone saxatilis raised in a fish hatchery as part of a stock restoration program. To decrease the parasitic burden and therefore potentially minimize mortality, the effectiveness of 2 different anthelmintics was evaluated. Two trials were conducted on wild-collected fingerlings naturally infected by P. rubra. In 2006, 144 yearling fish were randomly assigned to 4 experimental groups: (1) levamisole (Levasol®) at 2 mg l-1 via immersion for 8 h once weekly for 3 wk; (2) levamisole at a dose of 2.5 mg kg-1 biomass via feed once daily for 7 d; (3) emamectin benzoate (Slice®) at a dose of 0.05 mg kg-1 biomass via feed once daily for 7 d; and (4) control. Emamectin successfully eliminated live nematodes in 84.9% of the fish, whereas the administration of levamisole, either via immersion or feed, was not successful in significantly reducing the number of live P. rubra. In 2007, the administration of the same dosage of emamectin to approximately 1000 naturally infected yearling striped bass was associated with a 100% mortality rate of P. rubra in the 30 fish randomly examined 5 wk after the beginning of the treatment. Results of these trials indicate that, at the dosage used, the administration of emamectin at the end of the summer is safe for striped bass yearlings and considerably reduces the prevalence and intensity of the infection by this parasite.

Inovasi Teknologi Pembuatan Pakan Udang dengan Penambahan Tepung Kopasanda (Chromolaena odorata L.) di Desa Tamangapa Kecamatan Ma’rang Kab. Pangkep

2019 ◽  
Vol 3 (2) ◽  
pp. 140
Author(s):  
Harlina Harlina ◽  
Hadijah Hadijah ◽  
Kamaruddin Kamaruddin ◽  
Ernaningsih Ernaningsih
Keyword(s):  
Mortality Rate ◽  
Community Service ◽  
High Mortality ◽  
Raw Materials ◽  
Development Program ◽  
Chromolaena Odorata ◽  
Farmed Fish ◽  
Counseling Training ◽  
Shrimp Feed ◽  
Simple Technology

Tamangapa village, Ma’rang district is part of the community development program conducted by Universitas Muslim Indonesia in Pangkajene Kepulauan regency. The local shrimp farmers of Tamangapa village have been facing major issue due to expensive artificial feed and high mortality rate. In order to solve the needs of feed and high mortality rate for farmed fish or shrimp, the source of the natural ingredients using kopasanda leaves Chromolaena odorata L is required. The use of a natural ingredient is also used to prevent the vibriosis using simple technology such as the utilization of local raw materials which is affordable and locally available. The present community service aimed to provide the proper knowledge and skills to members of the fish/shrimp farmer’s group through counseling, training and mentoring. This community service program encouraged the local farmers to be able to utilize the local raw materials as a source of shrimp feed, use the feed pellet machine, and packaging leading to independent feed production. The participatory training method, lectures, forum group discussions, and practices of making shrimp feed and packaging were applied. The Implementation of the Community Partnership Program of Shrimp and Fish Cultivation Groups is independently able to produce organic fish or shrimp feed for farmer’s group leading to higher productivity of aquaculture.

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