Age of patients undergoing surgery Fowler, A. J.; Abbott, T. E. F.; Prowle, J. ...
British journal of surgery,
July 2019, 2019-07-00, 20190701, Letnik:
106, Številka:
8
Journal Article
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Background
Advancing age is independently associated with poor postoperative outcomes. The ageing of the general population is a major concern for healthcare providers. Trends in age were studied ...among patients undergoing surgery in the National Health Service in England.
Methods
Time trend ecological analysis was undertaken of Hospital Episode Statistics and Office for National Statistics data for England from 1999 to 2015. The proportion of patients undergoing surgery in different age groupings, their pooled mean age, and change in age profile over time were calculated. Growth in the surgical population was estimated, with associated costs, to the year 2030 by use of linear regression modelling.
Results
Some 68 205 695 surgical patient episodes (31 220 341 men, 45·8 per cent) were identified. The mean duration of hospital stay was 5·3 days. The surgical population was older than the general population of England; this gap increased over time (1999: 47·5 versus 38·3 years; 2015: 54·2 versus 39·7 years). The number of people aged 75 years or more undergoing surgery increased from 544 998 (14·9 per cent of that age group) in 1999 to 1 012 517 (22·9 per cent) in 2015. By 2030, it is estimated that one‐fifth of the 75 years and older age category will undergo surgery each year (1·49 (95 per cent c.i. 1·43 to 1·55) million people), at a cost of €3·2 (3·1 to 3·5) billion.
Conclusion
The population having surgery in England is ageing at a faster rate than the general population. Healthcare policies must adapt to ensure that provision of surgical treatments remains safe and sustainable.
The surgical population of England is ageing more quickly than the general population. More than 1·4 million patients aged over 75 years will have surgery each year by 2030.
Worrying prediction
Despite evidence of high activity, the number of surgical procedures performed in UK hospitals, their cost and subsequent mortality remain unclear.
Time-trend ecological study using hospital episode ...data from England, Scotland, Wales and Northern Ireland. The primary outcome was the number of in-hospital procedures, grouped using three increasingly specific categories of surgery. Secondary outcomes were all-cause mortality, length of hospital stay and healthcare costs according to standard National Health Service tariffs.
Between April 1, 2009 and March 31, 2014, 39 631 801 surgical patient episodes were recorded. There was an annual average of 7 926 360 procedures (inclusive category), 5 104 165 procedures (intermediate category) and 1 526 421 procedures (restrictive category). This equates to 12 537, 8073 and 2414 procedures per 100 000 population per year, respectively. On average there were 85 181 deaths (1.1%) within 30 days of a procedure each year, rising to 178 040 deaths (2.3%) after 90 days. Approximately 62.8% of all procedures were day cases. Median length of stay for in-patient procedures was 1.7 (1.3–2.0) days. The total cost of surgery over the 5 yr period was £54.6 billion ($104.4 billion), representing an average annual cost of £10.9 billion (inclusive), £9.5 billion (intermediate) and £5.6 billion (restrictive). For each category, the number of procedures increased each year, while mortality decreased. One-third of all mortalities in national death registers occurred within 90 days of a procedure (inclusive category).
The number of surgical procedures in the UK varies widely according to definition. The number of procedures is slowly increasing whilst the number of deaths is decreasing.
The corrosion susceptibility of Mg and its alloys in humid and aqueous environments limits their widespread application. The performance of several conversion coating technologies is reviewed herein. ...In addition to the assessment of performance based on the literature to date, thermodynamic analysis has been used to compare coating processes. Ongoing research reveals that the search for appropriate conversion coatings to replace toxic Cr-based coatings continues. It is seen that the variability between coatings of the same technology was greater than the averages between coating technologies. Additionally, coating pretreatment also appears to be more significant than the choice of coating technology itself. PUBLICATION ABSTRACT
Here, we present two galaxy shape catalogues from the Dark Energy Survey Year 1 data set, covering 1500 square degrees with a median redshift of 0:59. The catalogues cover two main fields: Stripe 82, ...and an area overlapping the South Pole Telescope survey region. We also describe our data analysis process and in particular our shape measurement using two independent shear measurement pipelines, METACALIBRATION and IM3SHAPE. The METACALIBRATION catalogue uses a Gaussian model with an innovative internal calibration scheme, and was applied to riz bands, yielding 34.8M objects. The IM3SHAPE catalogue uses a maximum-likelihood bulge/disc model calibrated using simulations, and was applied to r-band data, yielding 21.9M objects. Both catalogues pass a suite of null tests that demonstrate their fitness for use in weak lensing science. Finally, we estimated the 1 uncertainties in multiplicative shear calibration to be 0.013 and 0.025 for the METACALIBRATION and IM3SHAPE catalogues, respectively.
We report the results of a systematic search for ultra-faint Milky Way satellite galaxies using data from the Dark Energy Survey (DES) and Pan-STARRS1 (PS1). Together, DES and PS1 provide multi-band ...photometry in optical/near-infrared wavelengths over ∼80% of the sky. Our search for satellite galaxies targets ∼25,000 deg2 of the high-Galactic-latitude sky reaching a 10 point-source depth of 22.5 mag in the g and r bands. While satellite galaxy searches have been performed independently on DES and PS1 before, this is the first time that a self-consistent search is performed across both data sets. We do not detect any new high-significance satellite galaxy candidates, recovering the majority of satellites previously detected in surveys of comparable depth. We characterize the sensitivity of our search using a large set of simulated satellites injected into the survey data. We use these simulations to derive both analytic and machine-learning models that accurately predict the detectability of Milky Way satellites as a function of their distance, size, luminosity, and location on the sky. To demonstrate the utility of this observational selection function, we calculate the luminosity function of Milky Way satellite galaxies, assuming that the known population of satellite galaxies is representative of the underlying distribution. We provide access to our observational selection function to facilitate comparisons with cosmological models of galaxy formation and evolution.
The primary objective of this research was to remove recalcitrant nutrients from anaerobically digested sludge dewatering centrate. A struvite precipitation methodology is proposed where salt ...crystals are encouraged to ballast colloidal particles through heterogeneous nucleation and subsequent crystal growth. The secondary objective was to assess presence of micropollutants in precipitates. Four biologically unique dewatering centrates were used to test the precipitation methodology on the variety of anaerobic digester configurations that can be expected from municipal wastewater treatment plant. The effect of digestion sludge retention time (2 day, 20 day) and digestion temperature (35 °C, 55 °C) on the removal of dissolved unreactive phosphorus (P) and nitrogen (N) was monitored. Averaged across all four centrates, the precipitation methodology resulted in dissolved unreactive P and N removal of 82.4% and 66.6%, respectively. Antimicrobial contaminants (triclosan, triclocarban) were observed in the precipitates at minute concentrations (<18 ng/g-dry solids). Therefore, mass struvite precipitation can provide a means of recalcitrant nutrient treatment and reactive nutrient recovery without the micropollutant burden of biosolids land application.
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•Mass struvite precipitation removes non-reactive dissolved phosphorus (NRDP).•Mass struvite precipitation removes dissolved organic nitrogen.•Polyacrylamide polymer dose affects centrate NRDP.•Minor amounts of antimicrobials are found in precipitates.
Abstract
We perform a joint analysis of intrinsic alignments and cosmology using tomographic weak lensing, galaxy clustering, and galaxy–galaxy lensing measurements from Year 1 (Y1) of the Dark ...Energy Survey. We define early- and late-type subsamples, which are found to pass a series of systematics tests, including for spurious photometric redshift error and point spread function correlations. We analyse these split data alongside the fiducial mixed Y1 sample using a range of intrinsic alignment models. In a fiducial non-linear alignment model analysis, assuming a flat Λ cold dark matter cosmology, we find a significant difference in intrinsic alignment amplitude, with early-type galaxies favouring $A_\mathrm{IA} = 2.38^{+0.32}_{-0.31}$ and late-type galaxies consistent with no intrinsic alignments at $0.05^{+0.10}_{-0.09}$. The analysis is repeated using a number of extended model spaces, including a physically motivated model that includes both tidal torquing and tidal alignment mechanisms. In multiprobe likelihood chains in which cosmology, intrinsic alignments in both galaxy samples and all other relevant systematics are varied simultaneously, we find the tidal alignment and tidal torquing parts of the intrinsic alignment signal have amplitudes $A_1 = 2.66 ^{+0.67}_{-0.66}$, $A_2=-2.94^{+1.94}_{-1.83}$, respectively, for early-type galaxies and $A_1 = 0.62 ^{+0.41}_{-0.41}$, $A_2 = -2.26^{+1.30}_{-1.16}$ for late-type galaxies. In the full (mixed) Y1 sample the best constraints are $A_1 = 0.70 ^{+0.41}_{-0.38}$, $A_2 = -1.36 ^{+1.08}_{-1.41}$. For all galaxy splits and IA models considered, we report cosmological parameter constraints consistent with the results of the main DES Y1 cosmic shear and multiprobe cosmology papers.
The population of Milky Way (MW) satellites contains the faintest known galaxies and thus provides essential insight into galaxy formation and dark matter microphysics. Here we combine a model of the ...galaxy-halo connection with newly derived observational selection functions based on searches for satellites in photometric surveys over nearly the entire high Galactic latitude sky. In particular, we use cosmological zoom-in simulations of MW-like halos that include realistic Large Magellanic Cloud (LMC) analogs to fit the position-dependent MW satellite luminosity function. We report decisive evidence for the statistical impact of the LMC on the MW satellite population due to an estimated 6 2 observed LMC-associated satellites, consistent with the number of LMC satellites inferred from Gaia proper-motion measurements, confirming the predictions of cold dark matter models for the existence of satellites within satellite halos. Moreover, we infer that the LMC fell into the MW within the last 2 Gyr at high confidence. Based on our detailed full-sky modeling, we find that the faintest observed satellites inhabit halos with peak virial masses below at 95% confidence, and we place the first robust constraints on the fraction of halos that host galaxies in this regime. We predict that the faintest detectable satellites occupy halos with peak virial masses above , highlighting the potential for powerful galaxy formation and dark matter constraints from future dwarf galaxy searches.
Increased baseline heart rate is associated with cardiovascular risk and all-cause mortality in the general population. We hypothesized that elevated preoperative heart rate increases the risk of ...myocardial injury after non-cardiac surgery (MINS).
We performed a secondary analysis of a prospective international cohort study of patients aged ≥45 yr undergoing non-cardiac surgery. Preoperative heart rate was defined as the last measurement before induction of anaesthesia. The sample was divided into deciles by heart rate. Multivariable logistic regression models were used to determine relationships between preoperative heart rate and MINS (determined by serum troponin concentration), myocardial infarction (MI), and death within 30 days of surgery. Separate models were used to test the relationship between these outcomes and predefined binary heart rate thresholds.
Patients with missing outcomes or heart rate data were excluded from respective analyses. Of 15 087 patients, 1197 (7.9%) sustained MINS, 454 of 16 007 patients (2.8%) sustained MI, and 315 of 16 037 patients (2.0%) died. The highest heart rate decile (>96 beats min−1) was independently associated with MINS {odds ratio (OR) 1.48 1.23–1.77; P <0.01}, MI (OR 1.71 1.34–2.18; P <0.01), and mortality (OR 3.16 2.45–4.07; P <0.01). The lowest decile (<60 beats min−1) was independently associated with reduced mortality (OR 0.50 0.29–0.88; P=0.02), but not MINS or MI. The predefined binary thresholds were also associated with MINS, but more weakly than the highest heart rate decile.
Preoperative heart rate >96 beats min−1 is associated with MINS, MI, and mortality after non-cardiac surgery. This association persists after accounting for potential confounding factors.
NCT00512109.
The COVID-19 response required the cancellation of all but the most urgent surgical procedures. The number of cancelled surgical procedures owing to Covid-19, and the reintroduction of surgical ...acivirt, was modelled.
This was a modelling study using Hospital Episode Statistics data (2014-2019). Surgical procedures were grouped into four urgency classes. Expected numbers of surgical procedures performed between 1 March 2020 and 28 February 2021 were modelled. Procedure deficit was estimated using conservative assumptions and the gradual reintroduction of elective surgery from the 1 June 2020. Costs were calculated using NHS reference costs and are reported as millions or billions of euros. Estimates are reported with 95 per cent confidence intervals.
A total of 4 547 534 (95 per cent c.i. 3 318 195 to 6 250 771) patients with a pooled mean age of 53.5 years were expected to undergo surgery between 1 March 2020 and 28 February 2021. By 31 May 2020, 749 247 (513 564 to 1 077 448) surgical procedures had been cancelled. Assuming that elective surgery is reintroduced gradually, 2 328 193 (1 483 834 - 3 450 043) patients will be awaiting surgery by 28 February 2021. The cost of delayed procedures is €5.3 (3.1 to 8.0) billion. Safe delivery of surgery during the pandemic will require substantial extra resources costing €526.8 (449.3 to 633.9) million.
As a consequence of the Covid-19 pandemic, provision of elective surgery will be delayed and associated with increased healthcare costs.
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