1
|
Lee J, Im C. Time-to-surgery paradigms: wait time and surgical outcomes in critically Ill patients who underwent emergency surgery for gastrointestinal perforation. BMC Surg 2024; 24:159. [PMID: 38760752 PMCID: PMC11100233 DOI: 10.1186/s12893-024-02452-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 05/13/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND Waiting time for emergency abdominal surgery have been known to be linked to mortality. However, there is no clear consensus on the appropriated timing of surgery for gastrointestinal perforation. We investigated association between wait time and surgical outcomes in emergency abdominal surgery. METHODS This single-center retrospective cohort study evaluated adult patients who underwent emergency surgery for gastrointestinal perforations between January 2003 and September 2021. Risk-adjusted restricted cubic splines modeled the probability of each mortality according to wait time. The inflection point when mortality began to increase was used to define early and late surgery. Outcomes among propensity-score matched early and late surgical patients were compared using percent absolute risk differences (RDs, with 95% CIs). RESULTS Mortality rates began to rise after 16 h of waiting. However, early and late surgery groups showed no significant differences in 30-day mortality (11.4% vs. 5.7%), ICU stay duration (4.3 ± 7.5 vs. 4.3 ± 5.2 days), or total hospital stay (17.4 ± 17.0 vs. 24.7 ± 23.4 days). Notably, patients waiting over 16 h had a significantly higher ICU readmission rate (8.6% vs. 31.4%). The APACHE II score was a significant predictor of 30-day mortality. CONCLUSIONS Although we were unable to reveal significant differences in mortality in the subgroup analysis, we were able to find an inflection point of 16 h through the RCS curve technique. TRIAL REGISTRATION Formal consent was waived due to the retrospective nature of the study, and ethical approval was obtained from the institutional research committee of our institution (B-2110-714-107) on 6 October 2021.
Collapse
Affiliation(s)
- Junghyun Lee
- Department of Surgery, Yongin Severance Hostpital, Yongin, Korea
- Yonsei University College of Medicine, Seoul, Korea
| | - Chami Im
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.
- Seoul National University College of Medicine, Seoul, Korea.
| |
Collapse
|
2
|
Pérez-Anibal E, Contreras-Arrieta S, Rojas-Suárez J, Coronell-Rodríguez W, Aguilar-Schotborgh M, Borre-Naranjo D, Almanza-Hurtado A, Dueñas-Castell C. Association of Chronic Critical Illness and COVID-19 in Patients Admitted to Intensive Care Units: A Prospective Cohort Study. Arch Bronconeumol 2023; 59:126-128. [PMID: 36400653 PMCID: PMC9622430 DOI: 10.1016/j.arbres.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 10/10/2022] [Accepted: 10/11/2022] [Indexed: 11/07/2022]
Affiliation(s)
- Eduard Pérez-Anibal
- Universidad de Cartagena de Indias, Colombia,Intensive Care and Obstetric Research Group (GRICIO), Universidad de Cartagena de Indias, Colombia
| | - Sandra Contreras-Arrieta
- Intensive Care and Obstetric Research Group (GRICIO), Universidad de Cartagena de Indias, Colombia
| | - José Rojas-Suárez
- Universidad de Cartagena de Indias, Colombia; Intensive Care and Obstetric Research Group (GRICIO), Universidad de Cartagena de Indias, Colombia; Clínica Gestion Salud, Cartagena de Indias, Colombia.
| | - Wilfrido Coronell-Rodríguez
- Universidad de Cartagena de Indias, Colombia,Intensive Care and Obstetric Research Group (GRICIO), Universidad de Cartagena de Indias, Colombia,Clínica Gestion Salud, Cartagena de Indias, Colombia
| | - Miguel Aguilar-Schotborgh
- Intensive Care and Obstetric Research Group (GRICIO), Universidad de Cartagena de Indias, Colombia,Clínica Gestion Salud, Cartagena de Indias, Colombia
| | - Diana Borre-Naranjo
- Intensive Care and Obstetric Research Group (GRICIO), Universidad de Cartagena de Indias, Colombia,Clínica Gestion Salud, Cartagena de Indias, Colombia
| | - Amilkar Almanza-Hurtado
- Universidad de Cartagena de Indias, Colombia,Intensive Care and Obstetric Research Group (GRICIO), Universidad de Cartagena de Indias, Colombia,Clínica Gestion Salud, Cartagena de Indias, Colombia
| | - Carmelo Dueñas-Castell
- Universidad de Cartagena de Indias, Colombia,Intensive Care and Obstetric Research Group (GRICIO), Universidad de Cartagena de Indias, Colombia,Clínica Gestion Salud, Cartagena de Indias, Colombia
| |
Collapse
|
3
|
Zhou D, Wang C, Lin Q, Li T. The obesity paradox for survivors of critically ill patients. Crit Care 2022; 26:198. [PMID: 35781349 PMCID: PMC9251913 DOI: 10.1186/s13054-022-04074-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 06/21/2022] [Indexed: 11/10/2022] Open
Abstract
The obesity paradox has been observed in short-term outcomes from critical illness. However, little is known regarding the impact of obesity on long-term outcomes for survivors of critically ill patients. We aimed to evaluate the influence of obesity on long-term mortality outcomes after discharge alive from ICU. The adult patients who were discharged alive from the last ICU admission were extracted. After exclusion, a total of 7619 adult patients discharged alive from ICU were included, with 4-year mortality of 32%. The median body mass index (BMI) was 27.2 (IQR 24–31.4) kg/m2, and 2490 (31.5%) patients were classified as obese or morbidly obese. The morbidly obese patients had the highest ICU and hospital length of stay. However, higher BMI was associated with lower hazard ratio for 4-year mortality. The results showed the obesity paradox may be also suitable for survivors of critically ill patients.
Collapse
|
4
|
Walsh TS, Pauley E, Donaghy E, Thompson J, Barclay L, Parker RA, Weir C, Marple J. Does a screening checklist for complex health and social care needs have potential clinical usefulness for predicting unplanned hospital readmissions in intensive care survivors: development and prospective cohort study. BMJ Open 2022; 12:e056524. [PMID: 35321894 PMCID: PMC8943772 DOI: 10.1136/bmjopen-2021-056524] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES Intensive care (ICU) survivors are at high risk of long-term physical and psychosocial problems. Unplanned hospital readmission rates are high, but the best way to triage patients for interventions is uncertain. We aimed to develop and evaluate a screening checklist to help predict subsequent readmissions or deaths. DESIGN A checklist for complex health and social care needs (CHSCNs) was developed based on previous research, comprising six items: multimorbidity; polypharmacy; frequent previous hospitalisations; mental health issues; fragile social circumstances and impaired activities of daily living. Patients were considered to have CHSCNs if two or more were present. We prospectively screened all ICU discharges for CHSCNs for 12 months. SETTING ICU, Royal Infirmary, Edinburgh, UK. PARTICIPANTS ICU survivors over a 12-month period (1 June 2018 and 31 May 2019). INTERVENTIONS None. OUTCOME MEASURE Readmission or death in the community within 3 months postindex hospital discharge. RESULTS Of 1174 ICU survivors, 937 were discharged alive from the hospital. Of these 253 (27%) were classified as having CHSCNs. In total 28% (266/937) patients were readmitted (N=238) or died (N=28) within 3 months. Among CHSCNs patients 45% (n=115) patients were readmitted (N=105) or died (N=10). Patients without CHSCNs had a 22% readmission (N=133) or death (N=18) rate. The checklist had: sensitivity 43% (95% CI 37% to 49%), specificity 79% (95% CI 76% to 82%), positive predictive value 45% (95% CI 41% to 51%), and negative predictive value 78% (95% CI 76% to 80%). Relative risk of readmission/death for patients with CHSCNs was 2.06 (95% CI 1.69 to 2.50), indicating a pretest to post-test probability change of 28%-45%. The checklist demonstrated high inter-rater reliability (percentage agreement ≥87% for all domains; overall kappa, 0.84). CONCLUSIONS Early evaluation of a screening checklist for CHSCNs at ICU discharge suggests potential clinical usefulness, but this requires further evaluation as part of a care pathway.
Collapse
Affiliation(s)
- Timothy Simon Walsh
- Critical Care Medicine; Usher Institute of Population Health Sciences, University of Edinburgh Division of Clinical and Surgical Sciences, Edinburgh, UK
| | - Ellen Pauley
- Department of Anaesthesia, Critical Care & Pain Medicine, University of Edinburgh Division of Clinical and Surgical Sciences, Edinburgh, UK
| | - Eddie Donaghy
- Department of Anaesthesia, Critical Care & Pain Medicine, NHS Lothian, Edinburgh, UK
| | - Joanne Thompson
- Department of Anaesthesia, Critical Care & Pain Medicine, NHS Lothian, Edinburgh, UK
| | - Lucy Barclay
- Department of Anaesthesia, Critical Care & Pain Medicine, NHS Lothian, Edinburgh, UK
| | | | - Christopher Weir
- Usher Institute of Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - James Marple
- Department of Anaesthesia, Critical Care & Pain Medicine, NHS Lothian, Edinburgh, UK
| |
Collapse
|
5
|
Wu YC, Wong LT, Wu CL, Chao WC. The association between culture positivity and long-term mortality in critically ill surgical patients. J Intensive Care 2021; 9:66. [PMID: 34702345 PMCID: PMC8546784 DOI: 10.1186/s40560-021-00576-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 09/19/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The long-term outcome is an essential issue in critically ill patients, and the identification of early determinant is needed for risk stratification of the long-term outcome. In the present study, we investigate the association between culture positivity during admission and long-term outcome in critically ill surgical patients. METHODS We linked the 2015-2019 critical care database at Taichung Veterans General Hospital with the nationwide death registration files in Taiwan. We described the long-term mortality and proportion of culture positivity among enrolled subjects. We used a log-rank test to estimate survival curves between patients with and without positive cultures and a multivariable Cox proportional hazards regression model to determine hazard ratio (HR) and 95% confidence interval (CI). RESULTS A total of 6748 critically ill patients were enrolled, and 32.5% (2196/6749) of them died during the follow-up period, with the overall follow-up duration was 1.8 ± 1.4 years. We found that 31.4% (2122/6748) of critically ill patients had at least one positive culture during the index admission, and the number of patients with positive culture in the blood, respiratory tract, urinary tract, skin and soft tissue and abdomen were 417, 1702, 554, 194 and 139, respectively. We found that a positive culture from any sites was independently associated with high long-term mortality (aHR 1.579, 95% CI 1.422-1.754) after adjusting relevant covariates, including age, sex, body-mass index, comorbidities, severity score, shock, early fluid overload, receiving mechanical ventilation and the need of renal replacement therapy for critical illness. CONCLUSIONS We linked two databases to identify that a positive culture during admission was independently correlated with increased long-term mortality in critically ill surgical patients. Our findings highlight the need for vigilance among patients with a positive culture during admission, and more studies are warranted to validate our findings and to clarify underlying mechanisms.
Collapse
Affiliation(s)
- Yu-Cheng Wu
- Division of Chest Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Li-Ting Wong
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chieh-Liang Wu
- Department of Critical Care Medicine, Taichung Veterans General Hospital, No, 1650, Section 4, Taiwan Boulevard, Xitun District, 40705, Taichung, Taiwan.,Department of Computer Science, Tunghai University, Taichung, Taiwan.,Department of Automatic Control Engineering, Feng Chia University, Taichung, Taiwan.,Department of Industrial Engineering and Enterprise Information, Tunghai University, Taichung, Taiwan
| | - Wen-Cheng Chao
- Department of Critical Care Medicine, Taichung Veterans General Hospital, No, 1650, Section 4, Taiwan Boulevard, Xitun District, 40705, Taichung, Taiwan. .,Department of Computer Science, Tunghai University, Taichung, Taiwan. .,Department of Automatic Control Engineering, Feng Chia University, Taichung, Taiwan. .,Artificial Intelligence Studio, Taichung Veterans General Hospital, Taichung, Taiwan.
| |
Collapse
|
6
|
Tsang J, Bloomfield K, Lawrey Y, Wu Z, Connolly MJ. The very old in intensive care: Admission characteristics, mortality and supports needed at six months postdischarge. Australas J Ageing 2020; 39:305-309. [PMID: 32279457 DOI: 10.1111/ajag.12794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 02/27/2020] [Accepted: 03/02/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To describe survival and six-month outcomes (residence, community supports) in the very old (≥80 years) admitted to intensive care in Waitemata District Health Board, New Zealand. METHODS Hospital records of patients 80 years and over admitted from August 2015 to June 2017 were reviewed. RESULTS One hundred and seventeen patients were admitted (median age: 83). Standard ICU risk scores predicted survival to hospital discharge. Patients admitted electively were more likely to survive to discharge than emergency ICU/HDU admissions (P = .007). Ninety-two (79%) survived to hospital discharge, and 84 (72%) survived to 6 months. Eighty-four were discharged home (91% of survivors), and 79 were living at home at 6 months (94% of survivors). Community supports increased from admission (34, 29%) to 6 months later (34, 43% of community dwellers). Forty-four (47.8% surviving to discharge) were readmitted within 6 months. CONCLUSIONS Most patients are alive at discharge and 6 months, with a majority requiring no formal supports.
Collapse
Affiliation(s)
| | - Katherine Bloomfield
- University of Auckland, Auckland, New Zealand.,Waitemata District Health Board, Auckland, New Zealand
| | - Ywain Lawrey
- Waitemata District Health Board, Auckland, New Zealand
| | | | - Martin J Connolly
- University of Auckland, Auckland, New Zealand.,Waitemata District Health Board, Auckland, New Zealand
| |
Collapse
|
7
|
Oh TK, Song IA, Jeon YT. Impact of Glasgow Coma Scale scores on unplanned intensive care unit readmissions among surgical patients. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:520. [PMID: 31807502 DOI: 10.21037/atm.2019.10.06] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Physiological instability at discharge from intensive care units (ICU) is known to increase readmission rates among critically ill patients. However, associations between consciousness levels at discharge and readmission rates remain unclear. This study aimed to investigate the association between the Glasgow Coma Scale (GCS) score at discharge and unplanned ICU readmissions in surgical patients. Methods This retrospective cohort study in a single tertiary academic hospital analyzed the electronic health records of adults aged 18 years or older, who were discharged from the ICU between January 2012 and December 2018. The primary endpoint was unplanned readmission within 48 hours after discharge. Multivariable logistic regression analysis was performed. Results Among 9,512 patients, unplanned readmissions occurred in 161 (1.7%). At discharge, GCS and verbal response scores of ≤13 (vs. ≥14) were associated with 2.28-fold higher unplanned readmissions within 48 hours [odds ratio (OR): 2.35, 95% confidence interval (CI): 1.51-3.65, P<0.001]. Sensitivity analysis showed that verbal response scores of ≤4 (vs. 5) at ICU discharge were associated with 2.21-fold higher unplanned readmissions within 48 hours (OR: 2.21, 95% CI: 1.49-3.29, P<0.001), whereas eye or motor responses at time of ICU discharge were not significantly associated with unplanned readmissions (P>0.05). Conclusions In this surgical ICU population cohort, GCS scores at ICU discharge were significantly associated with unplanned readmissions within 48 hours. This association was stronger with GCS scores of ≤13 and with verbal response scores of ≤4 at time of discharge. These findings suggest that surgical ICU patients with GCS scores of ≤13 or verbal response scores of ≤4 should be monitored carefully for discharge in order to avoid unplanned ICU readmissions.
Collapse
Affiliation(s)
- Tak Kyu Oh
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - In-Ae Song
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Young-Tae Jeon
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam-si, South Korea.,Department of Anesthesiology and Pain Medicine, College of Medicine, Seoul, South Korea
| |
Collapse
|
8
|
Zucchelli G, Tavelli L, Barootchi S, Stefanini M, Rasperini G, Valles C, Nart J, Wang H. The influence of tooth location on the outcomes of multiple adjacent gingival recessions treated with coronally advanced flap: A multicenter re‐analysis study. J Periodontol 2019; 90:1244-1251. [DOI: 10.1002/jper.18-0732] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 02/05/2019] [Accepted: 02/25/2019] [Indexed: 01/23/2023]
Affiliation(s)
- Giovanni Zucchelli
- Department of Biomedical and Neuromotor SciencesUniversity of Bologna Bologna Italy
- Department of Periodontics and Oral MedicineUniversity of Michigan School of Dentistry Ann Arbor MI USA
| | - Lorenzo Tavelli
- Department of Periodontics and Oral MedicineUniversity of Michigan School of Dentistry Ann Arbor MI USA
| | - Shayan Barootchi
- Department of Periodontics and Oral MedicineUniversity of Michigan School of Dentistry Ann Arbor MI USA
| | - Martina Stefanini
- Department of Biomedical and Neuromotor SciencesUniversity of Bologna Bologna Italy
| | - Giulio Rasperini
- Department of BiomedicalSurgical and Dental SciencesFoundation IRCCS Ca’ Granda PolyclinicUniversity of Milan Milan Italy
| | - Cristina Valles
- Department of PeriodontologySchool of Dentistry, UniversitatInternational de Catalunya Barcelona SC Spain
| | - José Nart
- Department of PeriodontologySchool of Dentistry, UniversitatInternational de Catalunya Barcelona SC Spain
| | - Hom‐Lay Wang
- Department of Periodontics and Oral MedicineUniversity of Michigan School of Dentistry Ann Arbor MI USA
| |
Collapse
|