564 research outputs found
Operation Timing and 30-Day Mortality After Elective General Surgery
No full textHuman factors such as fatigue, circadian rhythms, scheduling, and staffing may have an impact on patient care over the course of a day across all medical specialties. Research by the transportation industry concludes that human performance is degraded by shift work, circadian rhythm disturbances, and prolonged duty. We investigated whether the timing of general surgery (specifically, increasing time of day, increasing day of week, July/August cases versus other months), and moon phase is independently related to 30-day mortality. A secondary outcome of composite in-hospital complications was also evaluated
Erythrocyte storage duration is not associated with increased mortality in noncardiac surgical patients: a retrospective analysis of 6,994 patients
No full textMore than 5 million patients receive erythrocyte transfusions in the United States every year. Previous studies linked the storage duration of allogeneic erythrocytes to the risk of severe postoperative complications, especially after cardiac or trauma surgery. Limited data are available for noncardiac surgical patients. We therefore evaluated the association between storage duration of transfused erythrocytes and postoperative all-cause mortality among general surgery patients
The association between nitrous oxide and postoperative mortality and morbidity after noncardiac surgery
No full textNitrous oxide (N2O) has been widely used in clinical anesthesia for >150 years. However, use of N2O has decreased in recent years because of concern about the drug's metabolic side effects. But evidence that routine use of N2O causes clinically important toxicity remains elusive. We therefore evaluated the relationship between intraoperative N2O administration and 30-day mortality as well as a set of major inpatient postoperative complications (including mortality) in adults who had general anesthesia for noncardiac surgery
Morbidity and mortality after massive transfusion in patients undergoing non-cardiac surgery
No full textMassive transfusion is associated with high morbidity and mortality, yet existing reports of massive transfusion are limited. Our primary aim was to determine the incidence of complications and 30-day mortality among patients who received massive transfusions and to explore risk factors associated with 30-day mortality
Angiotensin converting enzyme inhibitors are not associated with respiratory complications or mortality after noncardiac surgery
No full textGeneral use of angiotensin-converting enzyme inhibitors (ACEIs) is associated with upper-airway complications such as cough, angioedema, and bronchospasm; furthermore, preoperative use is associated with increased morbidity or mortality. Our primary goal in this study was thus to evaluate the association of ACEI therapy with perioperative respiratory morbidity in adult noncardiac surgical patients. Our secondary goals were to evaluate the association between preoperative use of ACEI and 30-day mortality, as well as to a composite outcome of in-hospital morbidity and mortality in adult noncardiac surgical patients having general anesthesia
Preoperative Prolonged Steroid Use Is Not Associated with Intraoperative Blood Transfusion in Noncardiac Surgical Patients
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Background
Prolonged steroid therapy is reportedly associated with changes in coagulation, suggesting increased intraoperative bleeding or hypercoagulability. The aim of this retrospective study was to assess whether long-term steroid use was associated with increased transfusion requirements, infection, or hypercoagulability in adults undergoing noncardiac surgery.
Methods
In this study the authors evaluated 363,897 patients from the American College of Surgeons National Surgical Quality Improvement Program database. Patients with current pneumonia, ventilator dependence, coma, tumor involving the central nervous system, disseminated cancer, preoperative open wound/wound infection, and/or bleeding disorders were excluded. Each steroid user was matched to a nonsteroid user based on propensity score and type of surgery.
Results
296,059 patients met the inclusion criteria, of whom 7,760 (2.6%) were taking steroids preoperatively. The incidence of intraoperative erythrocyte transfusion was 3.6% in the steroid user and 7.3% in non-steroid-user groups. After matching, the mean [95% confidence interval] number of units transfused was 0.22 [0.19, 0.25] units in the nonsteroid group and 0.19 [0.17, 0.22] units in the steroid group which was not statistically significant (P = 0.24, Wald test). Steroid users were 24% [2, 49] more likely to experience 30-day postoperative systemic infection and 21% [3, 41] more likely to experience postoperative wound infection than nonusers. The risks of postoperative thromboembolic complications did not differ significantly.
Conclusions
The effect of prolonged steroid use on bleeding, if any, thus seems likely to be small and is probably of limited clinical consequence. In contrast, corticosteroid use augments the risk of both systemic and wound infections.
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Development and Validation of a Risk Quantification Index for 30-Day Postoperative Mortality and Morbidity in Noncardiac Surgical Patients
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Background
Optimal risk adjustment is a requisite precondition for monitoring quality of care and interpreting public reports of hospital outcomes. Current risk-adjustment measures have been criticized for including baseline variables that are difficult to obtain and inadequately adjusting for high-risk patients. The authors sought to develop highly predictive risk-adjustment models for 30-day mortality and morbidity based only on a small number of preoperative baseline characteristics. They included the Current Procedural Terminology code corresponding to the patient's primary procedure (American Medical Association), American Society of Anesthesiologists Physical Status, and age (for mortality) or hospitalization (inpatient vs. outpatient, for morbidity).
Methods
Data from 635,265 noncardiac surgical patients participating in the American College of Surgeons National Surgical Quality Improvement Program between 2005 and 2008 were analyzed. The authors developed a novel algorithm to aggregate sparsely represented Current Procedural Terminology codes into logical groups and estimated univariable Procedural Severity Scores-one for mortality and morbidity, respectively-for each aggregated group. These scores were then used as predictors in developing respective risk quantification models. Models were validated with c-statistics, and calibration was assessed using observed-to-expected ratios of event frequencies for clinically relevant strata of risk.
Results
The risk quantification models demonstrated excellent predictive accuracy for 30-day postoperative mortality (c-statistic [95% CI] 0.915 [0.906-0.924]) and morbidity (0.867 [0.858-0.876]). Even in high-risk patients, observed rates calibrated well with estimated probabilities for mortality (observed-to-expected ratio: 0.93 [0.81-1.06]) and morbidity (0.99 [0.93-1.05]).
Conclusion
The authors developed simple risk-adjustment models, each based on three easily obtained variables, that allow for objective quality-of-care monitoring among hospitals.
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