scholarly journals Neurosurgical Admission Later Than 4 h After the Emergency Call Does Not Result in Worse Long-Term Outcome in Subarachnoid Haemorrhage

2021 ◽  
Vol 12 ◽  
Author(s):  
Asger Sonne ◽  
Jesper B. Andersen ◽  
Vagn Eskesen ◽  
Freddy Lippert ◽  
Frans B. Waldorff ◽  
...  
Keyword(s):  
Subarachnoid Haemorrhage ◽  
Early Retirement ◽  
Time Interval ◽  
Neurosurgical Department ◽  
Emergency Medical Dispatch ◽  
Registration System ◽  
Long Term Outcome ◽  
Risk Of Death ◽  
Emergency Medical ◽  
Increased Risk

Background: Few studies have investigated the importance of the time interval between contact to the emergency medical service and neurosurgical admission in patients with spontaneous subarachnoid haemorrhage. We hypothesised that longer time to treatment would be associated with an increased risk of death or early retirement.Methods: This was a retrospective observational study with 4 years follow-up. Those who reached a neurosurgical department in fewer than 4 h were compared with those who reached it in more than 4 h. Individual level data were merged from the Danish National Patient Register, medical records, the Copenhagen Emergency Medical Dispatch Centre, the Civil Registration System, and the Ministry of Employment and Statistics Denmark. Patients were ≥18 years and had a verified diagnosis of spontaneous subarachnoid haemorrhage. The primary outcome was death or early retirement after 4 years.Results: Two hundred sixty-two patients admitted within a three-and-a-half-year time period were identified. Data were available in 124 patients, and 61 of them were in their working age. Four-year all-cause mortality was 25.8%. No significant association was found between time to neurosurgical admission and risk of death or early retirement (OR = 0.35, 95% confidence interval [CI]: 0.10–1.23, p = 0.10).Conclusion: We did not find an association between the time from emergency telephone call to neurosurgical admission and the risk of death or early retirement.

scholarly journals EP.FRI.552 Evaluating short term and long term outcome for patients undergoing emergency laparotomy in comparison to NELA mortality risk calculator

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Nourelhuda Darwish ◽  
Elsammoual Mohammed ◽  
Ibrahim Warrag ◽  
AdeelAbbas Dhahri ◽  
Bogdan Ivanov
Keyword(s):  
Mortality Risk ◽  
Emergency Laparotomy ◽  
Risk Calculator ◽  
Short Term ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Risk Of Death ◽  
Increased Risk ◽  
The Uk

Abstract Aim NELA is a project that was introduced in the UK since 2013, aiming to improve quality of care for patients undergoing emergency laparotomy.  NELA mortality risk calculator”was launched in 2017, which estimates the risk of death within 30 days of emergency laparotomy.  Our aim is to determine the short-term (30-day) and long-term (12 months) outcome in patients undergoing emergency laparotomy surgery and compare this with the estimated scores that were documented in the NELA website. Methods This is retrospective study involving patients who underwent emergency laparotomy surgery in the year of 2019. The primary outcome is to determine short-term (30-day) mortality. Results A total of 135 patients were included. The overall 30-day mortality was 8.8% (12/135). 55.77% (78/135) had NELA mortality score of < 5%. Only 1 out of these (1.28%) died within 30 days. (4/78,5.12%) died in 6 to 12 months period of this group. 9 patients (11.53%) had NELA score > 30%, of which 6 (66.66%) died within 30 days and 1 died within 6 months. 26.96% (48/135) had NELA scores 55 to 30%, 5 of them (10.41%) died within 30 days while 7 (14.58%) died within 6-12 months.  Patients with NELA scores more than 5% who survived the operation had higher chance of 30-day complications (25.58%, 11/43), when compared to those with scores less than 5% (11.68%, 9/77). Conclusion NELA mortality score has high accuracy especially if it was >30%. In addition, high NELA scores are associated with increased risk of post operative complications.

scholarly journals Right ventricular function and systolic pressure effect on survival of patients with tricuspid regurgitation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
O Vaturi ◽  
E Itelman ◽  
R Kuperstein ◽  
P Fefer ◽  
I.M Barbash ◽  
...  
Keyword(s):  
Tricuspid Regurgitation ◽  
Systolic Pressure ◽  
Pronounced Effect ◽  
Current Analysis ◽  
Poor Survival ◽  
Long Term Outcome ◽  
Risk Of Death ◽  
Kaplan Meier ◽  
Increased Risk

Abstract   Severe tricuspid regurgitation (TR) is associated with poor outcome. The current analysis investigated the long term outcome of TR patients. Methods Historical retrospective cohort of all cardiovascular patients evaluated at a tertiary heart center between 2007 and 2019. The current analysis included all patients who underwent echocardiographic evaluation. TR severity was extracted for all patients from the echocardiographic reports. Primary outcome was all cause mortality and was available for all patients from the national population register. Results Final cohort included 97,561 subjects, of whom 42,187 (43%) were outpatients. Mean age was 66±17 and 55,976 (57%) were men. Mild, moderate and severe TR was documented in 27,389 (28%), 2,871 (3%) and 1,812 (2%) patients, respectively. During a median follow up of 50 months [IQR 22–83] 18,476 (19%) patients died. Kaplan-Meier survival analysis demonstrated increased risk of death with increasing degree of TR (FIGURE; p Log rank <0.001). Multivariate cox regression with adjustment to age, gender, BMI and echocardiographic predictors of adverse outcome showed that compared with no or mild TR, patients with moderate or severe TR were 10% and 45% more likely to die (95% CI: 1.02–1.18, p=0.009 and 1.34–1.57 p<0.001 respectively). Interaction analysis with adjustment to known predictors of poor survival demonstrated that the association of severe TR with survival was dependent on right ventricle (RV) dysfunction and estimated RV systolic pressure (RVSP) with a more pronounced effect on patients with severe RV dysfunction (HR of 1.38 [1.07–1.80] vs. 1.09 [1.00–1.19], p for interaction = 0.01) and a more pronounced effect on patients with estimated RVSP <40 mmHg (HR of 1.60 [1.21–2.11] vs. 1.14 [1.03–1.25], p for interaction <0.001). Finally, a propensity score matching of patients with severe TR (N=1,154) and matched controls with no or mild TR successfully demonstrated that patients with severe TR were 27% more likely to die during follow up (95% CI: 1.14–1.42, p<0.001). Conclusions Severe TR is independently associated with poor survival. The association is modified by RV dysfunction and estimated RVSP. This report supports the need for studies to evaluate TR interventions on patients' clinical outcomes. Kaplan Meier Survival Curves Funding Acknowledgement Type of funding source: None

scholarly journals Outcomes of the 2019 novel coronavirus in patients with or without a history of cancer: a multi-centre North London experience

2020 ◽  
Vol 12 ◽  
pp. 175883592095680 ◽  
Author(s):  
Nalinie Joharatnam-Hogan ◽  
Daniel Hochhauser ◽  
Kai-Keen Shiu ◽  
Hannah Rush ◽  
Valerie Crolley ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Composite Endpoint ◽  
Time Interval ◽  
Patients With Cancer ◽  
Risk Of Death ◽  
Increased Risk ◽  
History Of ◽  
Novel Coronavirus ◽  
History Of Cancer ◽  
North London

Background: This study aims to compare the outcomes of COVID-19-positive disease in patients with a history of cancer to those without. Methods: We retrospectively collected clinical data and outcomes of COVID-19 positive cancer patients treated consecutively in five North London hospitals (cohort A). Outcomes recorded included time interval between most recent anti-cancer treatment and admission, severe outcome [a composite endpoint of intensive care unit (ITU) admission, ventilation and/or death] and mortality. Outcomes were compared with consecutively admitted COVID-19 positive patients, without a history of cancer (cohort B), treated at the primary centre during the same time period (1 March–30 April 2020). Patients were matched for age, gender and comorbidity. Results: The median age in both cohorts was 74 years, with 67% male, and comprised of 30 patients with cancer, and 90 without (1:3 ratio). For cohort B, 579 patients without a history of cancer and consecutively admitted were screened from the primary London hospital, 105 were COVID-19 positive and 90 were matched and included. Excluding cancer, both cohorts had a median of two comorbidities. The odds ratio (OR) for mortality, comparing patients with cancer to those without, was 1.05 [95% confidence interval (CI) 0.4–2.5], and severe outcome (OR 0.89, 95% CI 0.4–2.0) suggesting no increased risk of death or a severe outcome in patients with cancer. Cancer patients who received systemic treatment within 28 days had an OR for mortality of 4.05 (95% CI 0.68–23.95), p = 0.12. On presentation anaemia, hypokalaemia, hypoalbuminaemia and hypoproteinaemia were identified predominantly in cohort A. Median duration of admission was 8 days for cancer patients and 7 days for non-cancer. Conclusion: A diagnosis of cancer does not appear to increase the risk of death or a severe outcome in COVID-19 patients with cancer compared with those without cancer. If a second spike of virus strikes, rational decision making is required to ensure optimal cancer care.

scholarly journals A critical analysis of recent data on the long-term outcome of antipsychotic treatment

2018 ◽  
Vol 49 (5) ◽  
pp. 750-753 ◽  
Author(s):  
Joanna Moncrieff ◽  
Sandra Steingard
Keyword(s):  
Negative Symptoms ◽  
First Episode ◽  
Antipsychotic Treatment ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Level Of Functioning ◽  
Risk Of Death ◽  
Increased Risk

AbstractNew studies of long-term outcomes claim to show that taking antipsychotics on a continuous and indefinite basis is the best approach for people diagnosed with a first episode of psychosis or schizophrenia. A 10-year follow-up of a trial of quetiapine maintenance, for example, found a higher proportion of people with a poor composite outcome in the group initially randomised to placebo. However, most people classified as showing poor outcome were rated as having a mild score on a single psychotic symptom; there were no differences in overall symptoms, positive or negative symptoms or level of functioning. Moreover, 16% of participants did not have a follow-up interview and data from the end of the original trial were used instead. A study using a Finnish database suggested that mortality and readmission were higher in people who did not start long-term antipsychotic treatment or who discontinued it as compared with long-term continuous users. However, the analysis did not control for important confounders and is likely to reflect the fact that people who do not comply with treatment are at higher risk of death due to underlying health risks and behaviours. The analysis showed a slightly higher risk of readmission among non-users of antipsychotics compared with long-term users and a more substantial increased risk among people who discontinued treatment. However, follow-up ceased at the first readmission and therefore eventual, long-term outcome was not assessed. Speed of reduction and whether it was done with or without clinical support were also not distinguished.

Neutrophil-lymphocyte and platelet-lymphocyte ratio in patients after resection for hepato-pancreatico-biliary cancers.

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 378-378
Author(s):  
Gaya Spolverato ◽  
Yuhree Kim ◽  
Georgios A Margonis ◽  
Martin Makary ◽  
Christopher Lee Wolfgang ◽  
...  
Keyword(s):  
Liver Tumors ◽  
Performance Status ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Neutrophil Lymphocyte Ratio ◽  
Lymphocyte Ratio ◽  
Risk Of Death ◽  
Platelet Lymphocyte Ratio ◽  
Increased Risk

378 Background: Neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) may be indicative of the immune response around the time of surgery. We sought to determine whether NLR or PLR were associated with outcomes of patients undergoing surgery for a hepatopancreatico-biliary (HPB) malignancy. Methods: Between 2010-2011, 289 patients who underwent an HPB procedure for a malignant indication were identified. Clinicopathological characteristics, NLR and PLR, as well as short- and long-term outcomes were analyzed. High NLR and PLR were classified using a cut-off value of 3 and 150, respectively, based on ROC analysis. Results: Median patient age was 63 years and 52.3% were female. The majority of tumors were pancreatic in origin (67.2%), while a subset were primary (10.3%) or secondary (22.5%) liver tumors. Patients with low vs. high NLR and PLR had similar baseline characteristics with regard to performance status and tumor stage (all P>0.05). Operative interventions included pancreaticoduodenectomy (55.0%), ≤hemi-hepatectomy (29.1%), or extended hepatectomy (2.4%). Within 90-days of surgery, 143 patients experienced a complication for a morbidity of 49.5% (pancreas: 54.9% vs. liver: 40.0%). Patients with either an elevated NLR (OR=1.72) or PLR (OR=2.15) were at higher risk of a postoperative complication (both P<0.05). Among patients with a pancreatic, primary or secondary liver tumor, 3-year survival was 38.6%, 43.0%, and 65.0%, respectively. While elevated NLR was not associated with long-term outcome (HR=1.36)(P=0.14), patients with an elevated PLR had a higher risk of death (HR=2.14)(P=0.01). Conclusions: Patients with a high NLR or PLR had an increased risk of a perioperative complication. Elevated PLR was also a predictor of worse survival among patients with HPB malignancy undergoing resection.

scholarly journals Impact of Post-Procedural Change in Left Ventricle Systolic Function on Survival after Percutaneous Edge-to-Edge Mitral Valve Repair

2021 ◽  
Vol 10 (20) ◽  
pp. 4748
Author(s):  
Magnus J. Hagnäs ◽  
Carmelo Grasso ◽  
Maria Elena Di Salvo ◽  
Anna Caggegi ◽  
Marco Barbanti ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Left Ventricle ◽  
Mitral Regurgitation ◽  
Mitral Valve Repair ◽  
Vascular System ◽  
Valve Repair ◽  
Long Term Outcome ◽  
Risk Of Death ◽  
Increased Risk ◽  
Secondary Mitral Regurgitation

Objectives: To investigate how the changes of left ventricle ejection fraction (LVEF) between admission and discharge affected the long-term outcome in patients who underwent percutaneous edge-to-edge mitral valve repair for secondary mitral regurgitation. Background: An acute impairment of LVEF after surgical repair of mitral regurgitation, known as afterload mismatch, has been associated with increased all-cause mortality. Afterload mismatch after percutaneous edge-to-edge mitral valve repair has been postulated to be a transient phenomenon. Methods: This study is based on a single-center, retrospective, observational registry of patients who underwent percutaneous edge-to-edge mitral valve repair with the MitraClip (Abbot Vascular) system for the treatment of symptomatic, moderate-to-severe mitral regurgitation. We included data on 399 patients who underwent percutaneous edge-to-edge mitral valve repair for secondary mitral regurgitation. Expert echocardiographers assessed LVEF before the procedure and at discharge. The patients were divided into three groups according to the difference of periprocedural LVEF measurements: unchanged (n = 318), improved (n = 40), and decreased (n = 41) LVEF. Results: The median follow-up time was 2.0 years. When adjusted for gender, NYHA class and estimated glomerular filtration rate, decreased postprocedural LVEF was associated with an increased risk of death (adjusted HR 2.05, 95% CI 1.26–3.34) and increased postprocedural LVEF with a reduced risk of death (adjusted HR 0.47, 95% CI 0.24–0.91) compared to unchanged LVEF. Conclusion: Among patients who underwent percutaneous edge-to-edge mitral valve repair, decreased postprocedural LVEF was associated with increased mortality, while improved LVEF was associated with lower mortality compared to unchanged LVEF.

scholarly journals Impact of chronic kidney disease on long-term outcome of patients with valvular heart defects

2020 ◽  
Vol 52 (11) ◽  
pp. 2161-2170
Author(s):  
Łukasz Kuźma ◽  
Jolanta Małyszko ◽  
Hanna Bachórzewska-Gajewska ◽  
Marta Maria Niwińska ◽  
Anna Kurasz ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Mitral Valve ◽  
Kidney Disease ◽  
Aortic Valve ◽  
Heart Defects ◽  
Long Term Outcome ◽  
Risk Of Death ◽  
Valvular Heart Diseases ◽  
Increased Risk

Abstract Introduction Valvular heart diseases (VHD) are becoming a significant problem in the Polish population. Coexistence of chronic kidney disease (CKD) in patients with VHD increases the risk of death and affects further therapeutic strategy. Aim Analysis impact of CKD on long-term prognosis in patients with VHD. Material and methods The inclusion criteria were met by 1025 patients with moderate and severe VHD. Mean observation time was 2528 ± 1454 days. Results The average age of the studied population was 66.75 (SD = 10.34), male gender was dominant 56% (N = 579). Severe aortic valve stenosis (AVS) occurred in 28.2%, severe mitral valve insufficiency (MVI) in 20%. CKD occurred in 37.1% (N = 380) patients mostly with mitral stenosis (50%, N = 16) and those with severe MVI (44.8%, N = 94). During the observational period, 52.7% (N = 540) deaths were noted. Increased risk of mortality was associated mostly with age (OR: 1.02, 95% CI: 1.00–1.03, p < 0.001), creatinine (OR:1.27, 95% CI: 1.12–1.43, p < 0.001), CKD (OR: 1.30, 95% CI: 1.17–1.44, p < 0.001), reduced ejection fraction (EF) (OR: 0.98, 95% CI: 0.97–0.99, p = 0.01) and coexisting of AVS (OR: 1.19, 95% CI: 1.04–1.35, p = 0.01). Conclusions Mitral valve defects more often than aortic valve defects coexist with chronic kidney disease. Regardless of the stage, chronic kidney disease is an additional factor affecting the prognosis in patients with heart defects. Factors increasing the risk of death were age, creatinine concentration and reduced EF. The monitoring of renal function in patients with VHD should be crucial as well as the implementation of treatment at an early stage.

Follow-up after emergency laparotomy suggests high 1- and 5-year mortality with risk stratified by ASA

2021 ◽  
Author(s):  
K Nicoll ◽  
J Lucocq ◽  
T Khalil ◽  
M Khalil ◽  
H Watson ◽  
...  
Keyword(s):  
Emergency Laparotomy ◽  
Long Term Outcomes ◽  
Local Data ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Mortality Estimation ◽  
Risk Of Death ◽  
Increased Risk ◽  
And Gender

Introduction We investigated all-cause mortality following emergency laparotomy at 1 and 5 years. We aimed to establish a basis from which to advise patients and relatives on long-term mortality. Methods Local data from a historical audit of emergency laparotomies from 2010 to 2012 were combined with National Emergency Laparotomy Audit (NELA) data from 2017 to 2020. Covariates collected included deprivation status, preoperative blood work, baseline renal function, age, American Society of Anesthesiologists (ASA) grade, operative time, anaesthetic time and gender. Associations between covariates and survival were determined using multivariate logistic regression and Kaplan–Meier analysis. We used patients undergoing laparoscopic cholecystectomy between 2015 and 2020 as controls. Results ASA grade was the best discriminator of long-term outcome following laparotomy (n=894) but was not a predictor of survival following cholecystectomy (n=1,834), with mortality being significantly greater in the laparotomy group. Following cholecystectomy, 95% confidence intervals for survival at 5 years were 98–99%. Following laparotomy these intervals were: ASA grade 1, 79–96%; ASA grade 2, 69–82%; ASA grade 3, 44–58%; ASA grade 4, 33–48%; and ASA grade 5, 4–51%. The majority of deaths (%) occurred after 30 days. Conclusions Emergency laparotomy is associated with a significantly increased risk of death in the following 5 years. The risk is strongly correlated to ASA. Thirty-day mortality estimation is not a good basis on which to advise patients and carers on long-term outcomes. ASA score can be used to predict long-term outcomes and to guide patient counsel.

Abstract 3242: Transient Post-Operative Atrial Fibrillation is Associated with an Increased Rate of All-Cause Mortality

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Matthew C Becker ◽  
John M Galla ◽  
Ryan P Daly ◽  
Femi Philip ◽  
Stephen O Chen ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Beta Blockers ◽  
Cleveland Clinic ◽  
Term Survival ◽  
Long Term Outcome ◽  
Risk Of Death ◽  
Increased Risk ◽  
All Cause Mortality ◽  
First Time

Background : Atrial fibrillation (AF) is the most common arrhythmia observed following coronary artery bypass grafting surgery (CABG) and is associated with increased morbidity and mortality. While the majority of affected patients are discharged in sinus rhythm, little is known about their ultimate outcome. We evaluated the effect of transient post-operative AF (TPAF) on long-term outcome in this population. Methods : The Cleveland Clinic Cardiothoracic Database was used to identify 5,205 consecutive patients who underwent first time, isolated CABG from January 1993 to December 2005. Patients diagnosed with post-operative AF (n=1560, 30%) were separated into two groups: transient AF (confirmed AF with discharge rhythm of sinus; n=1490, 28.6%) and persistent AF (confirmed AF with discharge rhythm of AF; n=70, 1.3%). These groups were compared to those patients that did not develop post-operative AF (n=3645). Endpoints of death, myocardial infarction (MI), and stroke were evaluated using the Chi squared and Fischer Exact tests. Long-term survival was evaluated with multivariate Cox proportional hazards methods to account for baseline differences. Results : Overall rates of 1 year mortality, MI and stroke were 12.5, 2.2, and 3.3 % respectively. TPAF was associated with an increased risk of death at 1 year as compared to patients with persistent AF (6.4 vs 2.9%; p<0.001) or without post-operative AF (6.4 vs 2.7%; p<0.001) but was not associated with increased risk of stroke or MI. Multivariate analysis identified TPAF as an independent predictor of both death (HR 1.93 95% CI [1.45, 2.56]; p<0.001) and the combination of death, MI, or stroke (1.8 [1.37, 2.36]; p<0.001). Use of beta-blockers (0.52 [0.34, 0.80]; p<0.003) and statins (0.26 [0.11, 0.64]; p<0.003), but not antiplatlet agents or warfarin, were associated with a reduced risk of death. Conclusion : In those undergoing first-time, isolated CABG, the presence of TPAF identifies patients at increased risk for all-cause mortality. In addition, the use of post-operative statins and beta-blockers appear to reduce this risk. These data suggest that morbidity unrelated to stroke or MI are responsible for the poor outcome in this population and warrant prospective investigation.

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