To evaluate the association between surgical modality (RARC vs. ORC) and the risk of 30-day complications.
We utilized the American College of Surgeons-National Surgical Quality Improvement Program ...(ACS-NSQIP) Cystectomy-Targeted database from 2019 to 2021. The primary outcome was a composite of major complications including 30-day mortality, reoperation, cardiac events, and stroke. Secondary outcomes included individual major and cystectomy-specific complications. Propensity score matching (PSM) was employed to minimize inherent differences within our cohort. We performed logistic regression to assess the association between outcomes of interest and operative modality.
We found no difference between operative modality and the primary outcome, however, RARC was associated with a 70% lower risk of 30-day mortality (OR 0.30, 95% CI 0.13-0.70) and had favorable outcomes with respect to respiratory, deep venous thrombosis, wound complications, and length of stay. Limitations are related to residual confounding given the observational methodology.
RARC was associated with reduced risk of multiple 30-day complications, including mortality, as well as organ system and cystectomy-specific outcomes. These data support the clinical benefit of increased adoption of RARC.
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Italy was the first European country hit by the COVID-19 pandemic and has the highest number of recorded COVID-19 deaths in Europe.
This prospective cohort study of the correlates of ...the risk of death in COVID-19 patients was conducted at the Infectious Diseases and Intensive Care units of Luigi Sacco Hospital, Milan, Italy. The clinical characteristics of all the COVID-19 patients hospitalised in the early days of the epidemic (21 February -19 March 2020) were recorded upon admission, and the time-dependent probability of death was evaluated using the Kaplan-Meier method (censored as of 20 April 2020). Cox proportional hazard models were used to assess the factors independently associated with the risk of death.
Forty-eight (20.6 %) of the 233 patients followed up for a median of 40 days (interquartile range 33–47) died during the follow-up. Most were males (69.1 %) and their median age was 61 years (IQR 50–72). The time-dependent probability of death was 19.7 % (95 % CI 14.6–24.9 %) 30 days after hospital admission. Age (adjusted hazard ratio aHR 2.08, 95 % CI 1.48−2.92 per ten years more) and obesity (aHR 3.04, 95 % CI 1.42−6.49) were independently associated with an increased risk of death, which was also associated with critical disease (aHR 8.26, 95 % CI 1.41−48.29), C-reactive protein levels (aHR 1.17, 95 % CI 1.02−1.35 per 50 mg/L more) and creatinine kinase levels above 185 U/L (aHR 2.58, 95 % CI 1.37−4.87) upon admission. Case-fatality rate of patients hospitalized with COVID-19 in the early days of the Italian epidemic was about 20 %. Our study adds evidence to the notion that older age, obesity and more advanced illness are factors associated to an increased risk of death among patients hospitalized with COVID-19.
Abstract
OBJECTIVES
The goal was to develop a scoring system to predict the 30-day mortality rate for patients undergoing surgery for acute type A aortic dissection on the basis of the German ...Registry for Acute Type A Aortic Dissection (GERAADA) data set and to provide a Web-based application for standard use.
METHODS
A total of 2537 patients enrolled in GERAADA who underwent surgery between 2006 and 2015 were analysed. Variable selection was performed using the R-package FAMoS. The robustness of the results was confirmed via the bootstrap procedure. The coefficients of the final model were used to calculate the risk score in a Web-based application.
RESULTS
Age odds ratio (OR) 1.018, 95% confidence interval (CI) 1.009–1.026; P < 0.001; 5-year OR: 1.093, need for catecholamines at referral (OR 1.732, 95% CI 1.340–2.232; P < 0.001), preoperative resuscitation (OR 3.051, 95% CI 2.099–4.441; P < 0.001), need for intubation before surgery (OR 1.949, 95% CI 1.465–2.585; P < 0.001), preoperative hemiparesis (OR 1.442, 95% CI 0.996–2.065; P = 0.049), coronary malperfusion (OR 1.870, 95% CI 1.386–2.509; P < 0.001), visceral malperfusion (OR 1.748, 95% CI 1.198–2.530; P = 0.003), dissection extension to the descending aorta (OR 1.443, 95% CI 1.120–1.864; P = 0.005) and previous cardiac surgery (OR 1.772, 95% CI 1.048–2.903; P = 0.027) were independent predictors of the 30-day mortality rate. The Web application based on the final model can be found at https://www.dgthg.de/de/GERAADA_Score.
CONCLUSIONS
The GERAADA score is a simple, effective tool to predict the 30-day mortality rate for patients undergoing surgery for acute type A aortic dissection. We recommend the widespread use of this Web-based application for standard use.
A significant increased risk of complications and mortality in immunocompromised patients affected by COVID-19 has been described. However, the impact of COVID-19 in solid organ transplant (SOT) ...recipients is an issue still under debate, due to conflicting evidence that has emerged from different observational studies.
We performed a systematic review with a meta-analysis to assess the clinical outcome in SOT recipients with COVID-19 compared with the general population.
PubMed-MEDLINE and Scopus were independently searched until 13 October 2021.
Prospective or retrospective observational studies comparing clinical outcome in SOT recipients versus general populations affected by COVID-19 were included. The primary endpoint was 30-day mortality.
Participants were patients with confirmed COVID-19.
Interventions reviewed were SOTs.
The quality of the included studies was independently assessed with the Risk of Bias in Non-randomized Studies of Interventions tool for observational studies. The meta-analysis was performed by pooling ORs retrieved from studies providing adjustment for confounders using a random-effects model with the inverse variance method. Multiple subgroups and sensitivity analyses were conducted to investigate the source of heterogeneity.
A total of 3501 articles were screened, and 31 observational studies (N = 590 375; 5759 SOT recipients vs. 584 616 general population) were included in the meta-analyses. No difference in 30-day mortality rate was found in the primary analysis, including studies providing adjustment for confounders (N = 17; 3752 SOT recipients vs. 159 745 general population; OR: 1.13; 95% CI, 0.94–1.35; I2 = 33.9%). No evidence of publication bias was reported. A higher risk of intensive care unit admission (OR: 1.56; 95% CI, 1.03–2.63) and occurrence of acute kidney injury (OR: 2.50; 95% CI, 1.81–3.45) was found in SOT recipients.
No increased risk in mortality was found in SOT recipients affected by COVID-19 compared with the general population when adjusted for demographic and clinical features and COVID-19 severity.
Coronary artery disease requiring surgical revascularization is prevalent in United States Veterans. We aimed to investigate preoperative predictors of 30-day mortality following coronary artery ...bypass grafting (CABG) in the Veteran population. The Veterans Affairs Surgical Quality Improvement (VASQIP) national database was queried for isolated CABG cases between 2008 and 2018. The primary outcome was 30-day mortality. A multivariable logistic regression was performed to assess for independent predictors of the primary outcome. A P-value of <0.05 was considered statistically significant. A total of 32,711 patients were included. The 30-day mortality rate was 1.37%. Multivariable analysis identified the following predictors of 30-day mortality: African-American race (OR 1.46, 95% CI 1.09-1.96); homelessness (OR 6.49, 95% CI 3.39-12.45); female sex (OR 2.15, 95% CI 1.08-4.30); preoperative myocardial infarction within 7 days (OR 1.49, 95% CI 1.06-2.10) or more than 7 days before CABG (OR 1.34, 95% CI 1.04-1.72); partially/fully dependent functional status (OR 1.44, 95% CI 1.07-1.93); chronic obstructive pulmonary disease (OR 1.54, 95% CI 1.24-1.92); mild (OR 1.48, 95% CI 1.04-2.11) and severe aortic stenosis (OR 2.06, 95% CI 1.37-3.09); moderate (OR 1.88, 95% CI 1.31-2.72), or severe (OR 2.99, 95% CI 1.71-5.22) mitral regurgitation; cardiomegaly (OR 1.73, 95% CI 1.35-2.22); NYHA Class III/IV heart failure (OR 2.05, 95% CI 1.10-3.83); and urgent/emergent operation (OR 1.42, 95% CI 1.08-1.87). The 30-day mortality rate in US Veterans undergoing isolated CABG between 2008 and 2018 was 1.37%. In addition to established clinical factors, African-American race and homelessness were independent demographic predictors of 30-day mortality.
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This study aimed to create a risk model of mortality associated with esophagectomy using a Japanese nationwide database.
A total of 5354 patients who underwent esophagectomy in 713 hospitals in 2011 ...were evaluated. Variables and definitions were virtually identical to those adopted by the American College of Surgeons National Surgical Quality Improvement Program.
The mean patient age was 65.9 years, and 84.3% patients were male. The overall morbidity rate was 41.9%. Thirty-day and operative mortality rates after esophagectomy were 1.2% and 3.4%, respectively. Overall morbidity was significantly higher in the minimally invasive esophagectomy group than in the open esophagectomy group (44.3% vs 40.8%, P = 0.016). The odds ratios for 30-day mortality in patients who required preoperative assistance in activities of daily living (ADL), those with a history of smoking within 1 year before surgery, and those with weight loss more than 10% within 6 months before surgery were 4.2, 2.6, and 2.4, respectively. The odds ratios for operative mortality in patients who required preoperative assistance in ADL, those with metastasis/relapse, male patients, and those with chronic obstructive pulmonary disease were 4.7, 4.5, 2.3, and 2.1, respectively.
This study was the first, as per our knowledge, to perform risk stratification for esophagectomy using a Japanese nationwide database. The 30-day and operative mortality rates were relatively lower than those in previous reports. The risk models developed in this study may contribute toward improvements in quality control of procedures and creation of a novel scoring system.
Purpose: The number of visits to the emergency department (ED) is growing among older patients. Older people are at risk of acute delirium, which is associated with mortality. Our primary objective ...was to determine the 30-day mortality outcome between older patients with and without acute delirium. Methods: From August 2018 to October 2019, we conducted a prospective cohort study in the ED of a tertiary care and university hospital. Patients over the age of 65 years who presented to the ED were included in the study. Within the first 12 h after the ED visit, delirium was assessed by using the Thai version of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). We collected data on 30-day mortality, ED LOS, hospital length of stay (LOS), and the 30-day ED revisit rate. Results: We enrolled 173 patients in this study; 49 (28%) patients had acute delirium according to the CAM-ICU. The overall 30-day mortality was 4% (7/173). Delirium had no effect on 30-day mortality (adjusted odds ratio OR, 2.15; 95% confidence interval CI, 0.37–12.55; P = 0.40). Delirium was not associated with hospital LOS (adjusted mean difference −18.83 h; 95% CI, −71.94–34.28; P = 0.49) and the 30-day ED revisit rate (adjusted OR, 1.55; 95% CI, 0.59–4.11; P = 0.37). However, an increasing trend in ED LOS was observed (adjusted mean difference 16.39 h; 95% CI, −0.160–32.96; P = 0.05). Conclusions: We found insufficient evidence to establish an association between delirium and 30-day mortality, hospital LOS, or 30-day emergency department revisits. Trial registration: The trial was retrospectively registered in the Thai Clinical Trial Registry, identification number TCTR2021082700 on August 27, 2021.
Ruptured abdominal aortic aneurysms (rAAAs) are a serious disease that can lead to high mortality; thus, their early prediction can save patients' lives. The aim of this study was to compare the ...accuracies of various models for predicting rAAA mortality—including the Glasgow Aneurysm Score (GAS), Vancouver Scoring System (VSS), Dutch Aneurysm Score (DAS), Edinburgh Ruptured Aneurysm Score (ERAS), and Hardman index—based on rAAA treatment outcomes at our institution.
Between 2016 and 2022, we retrospectively analyzed the early outcome data—including 30-day mortality—of patients who underwent emergency surgery for rAAA at our institution. Receiver operating characteristic (ROC) curve analysis was performed to compare the aneurysm scoring systems for mortality using the area under the ROC curve (AUC).
The AUC was better for the ERAS (0.718; 95% confidence interval CI, 0.601–0.817) than for the other scoring systems. Significant differences were observed between ERASs and Hardman indices (difference: 0.179; p=0.016). No significant differences were found among the GAS, VSS, and DAS predictive risk models.
Among the models for predicting mortality in patients with rAAA, the ERAS model demonstrated the highest AUC value; however, significant differences were only observed between ERASs and Hardman indices. This study may help develop strategies for improving rAAA prediction.
Durable left ventricular assist device (LVAD) implantation is traditionally performed via median sternotomy (MS). Less-invasive implantation may lower the incidence of post-implant right ventricular ...failure (RVF). Our primary objective was to determine whether less-invasive implantation reduces the odds of severe RVF compared to MS.
Retrospective cohort study.
St. Paul's Hospital, Vancouver, BC, Canada.
198 adult patients between January 2008 and August 2021.
Isolated LVAD implantation either via median sternotomy or via a less-invasive surgical approach.
Multivariable logistic regression was used to adjust for confounders. A sensitivity analysis using inverse probability of treatment weighting (IPTW) analysis based on propensity scores was conducted.
172 patients were analyzed. 54% (94/172) underwent LVAD implantation via MS, and 45% (78/172) via less-invasive approaches. Age, sex and comorbidities were comparable, but the MS group tended to be more critically ill prior to surgery. After adjusting for confounders, less-invasive approaches did not show significant protection against severe post-implant RVF compared to MS (adjusted OR 0.53; 95% CI 0.20-1.44; p = 0.21). However, patients undergoing less-invasive techniques had reduced adjusted odds of 30-day mortality (OR 0.29; 95% CI 0.09-0.99); p = 0.049). No observed benefit of less-invasive approaches over MS for major bleeding, prevention of blood product transfusion, and listing for transplantation.
No reduction in the odds of severe RVF following LVAD implantation using less-invasive approaches versus MS. However, we found improved odds of 30-day survival in the less-invasive group. The underlying mechanism requires further investigation.
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