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Watters DA, Wilson L. The Comparability and Utility of Perioperative Mortality Rates in Global Health. CURRENT ANESTHESIOLOGY REPORTS 2021. [DOI: 10.1007/s40140-020-00432-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Rostagno C, Cartei A, Civinini R, Prisco D. Hip fracture unit: beyond orthogeriatrics. Intern Emerg Med 2018; 13:637-639. [PMID: 29508226 DOI: 10.1007/s11739-018-1818-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 03/01/2018] [Indexed: 12/26/2022]
Affiliation(s)
- Carlo Rostagno
- Dipartimento Medicina Sperimentale e Clinica Università di Firenze, Viale Morgagni 85, 50134, Florence, Italy.
| | | | | | - Domenico Prisco
- Dipartimento Medicina Sperimentale e Clinica Università di Firenze, Viale Morgagni 85, 50134, Florence, Italy
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Mortality Following Bariatric Surgery Compared to Other Common Operations in Finland During a 5-Year Period (2009-2013). A Nationwide Registry Study. Obes Surg 2018; 27:2444-2451. [PMID: 28382506 DOI: 10.1007/s11695-017-2664-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE A concern regarding the safety of bariatric surgery may explain the fact that only a minor fraction of morbidly obese patients has access to it. This is a population-based, nationwide study reporting 30-day, 90-day, and 1-year mortality rates following bariatric surgery in comparison with mortality rates after other common operations in Finland. MATERIALS AND METHODS Patients undergoing surgery between January 2009 and December 2013 were included. Data on surgical procedures were obtained from the national hospital discharge registry, and cause of death was obtained from Statistics Finland. RESULTS Inclusion criteria were met by 156,536 patients. Of these, 3918 underwent surgery for morbid obesity. Three patients (0.08%) died within 30 days following bariatric surgery. The 30-day mortality rate was lower only following prostatectomy. Compared with bariatric surgery, the hazard ratios (HR) for 1-year postoperative mortality were significantly higher for elective cholecystectomy (HR 2.38, 95% CI 1.39-4.08, p = 0.002), hysterectomy (HR 2.87, 95% CI 1.68-4.92, p < 0.001), knee arthroplasty (HR 2.23, 95% CI 1.31-3.81, p = 0.003), hip arthroplasty (HR 11.7, 95% CI 6.90-19.8, p < 0.001), colorectal resections (HR 27.5, 95% CI 16.2-46, p < 0.001), gastric resection (HR 53.0, 95% CI 30.2-93.2, p < 0.001), gastrectomy (HR 74.7, 95% CI 43.0-130, p < 0.001), and coronary artery bypass grafting (HR 30.7, 95% CI 17.4-54.3, p < 0.001). CONCLUSION Mortality rates following bariatric surgery are low and similar or lower than mortality rates following all other common elective surgeries.
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Watters DA, Guest GD, Tangi V, Shrime MG, Meara JG. Global Surgery System Strengthening. Anesth Analg 2018; 126:1329-1339. [DOI: 10.1213/ane.0000000000002771] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Watters DA, Babidge WJ, Kiermeier A, McCulloch GAJ, Maddern GJ. Perioperative Mortality Rates in Australian Public Hospitals: The Influence of Age, Gender and Urgency. World J Surg 2017; 40:2591-2597. [PMID: 27255941 DOI: 10.1007/s00268-016-3587-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION A decline in surgical deaths has been observed in Australia since the introduction of the Australian and New Zealand Audit of Surgical Mortality (ANZASM). The current study was conducted to determine whether the perioperative mortality rate (POMR) has also declined. METHODS This study is a retrospective review of the POMR for surgical procedures in Australian public hospitals between July 2009 and June 2013, using data obtained from the Australian Institute of Health and Welfare. Operative procedures contained in the Australian Refined Diagnosis Related Groups were selected and the POMR was modelled using urgency of admission, age and gender as explanatory covariates. RESULTS The POMR in Australian public hospitals reduced by 15.4 % over the 4-year period. The emergency admissions POMR dropped from 1.40 to 1.12 %, and the elective admissions POMR from 0.09 to 0.08 %. The binary logistic regression model used to predict patient mortality showed emergency admissions to have a higher POMR than elective, being more evident at older ages. For emergency admissions, the difference in POMR between females and males increased with age, from about 55 years onwards, with females being lower. For elective surgeries, the difference between males and females was of little practical importance across ages. CONCLUSIONS The reduction in the POMR in Australia confirms the reduction in surgical deaths reported to ANZASM. Continuing to monitor POMR will be important to ensure the safest surgery in Australia. Further investigations into case-mix will allow better risk adjustment and comparison between regions and time-periods, to facilitate continuous quality improvement.
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Affiliation(s)
- David A Watters
- Research, Audit and Academic Surgery Division, Royal Australasian College of Surgeons, Spring St, Melbourne, VIC, 3000, Australia.
- Deakin University, Barwon Health, Bellerine St, Geelong, VIC, 3220, Australia.
| | - Wendy J Babidge
- Research, Audit and Academic Surgery Division, Royal Australasian College of Surgeons, Spring St, Melbourne, VIC, 3000, Australia
- Discipline of Surgery, The Queen Elizabeth Hospital, University of Adelaide, Adelaide, SA, Australia
| | - Andreas Kiermeier
- Research, Audit and Academic Surgery Division, Royal Australasian College of Surgeons, Spring St, Melbourne, VIC, 3000, Australia
- Discipline of Surgery, The Queen Elizabeth Hospital, University of Adelaide, Adelaide, SA, Australia
| | - Glenn A J McCulloch
- Research, Audit and Academic Surgery Division, Royal Australasian College of Surgeons, Spring St, Melbourne, VIC, 3000, Australia
| | - Guy J Maddern
- Research, Audit and Academic Surgery Division, Royal Australasian College of Surgeons, Spring St, Melbourne, VIC, 3000, Australia
- Discipline of Surgery, The Queen Elizabeth Hospital, University of Adelaide, Adelaide, SA, Australia
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Chua TC, Mittal A, Nahm C, Hugh TJ, Arena J, Gill AJ, Samra JS. Pancreatoduodenectomy in a public versus private teaching hospital is comparable with some minor variations. ANZ J Surg 2017; 88:E526-E531. [DOI: 10.1111/ans.14191] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 07/17/2017] [Accepted: 07/18/2017] [Indexed: 12/30/2022]
Affiliation(s)
- Terence C. Chua
- Upper Gastrointestinal Surgical Unit; Royal North Shore Hospital; Sydney New South Wales Australia
- Discipline of Surgery; The University of Sydney; Sydney New South Wales Australia
| | - Anubhav Mittal
- Upper Gastrointestinal Surgical Unit; Royal North Shore Hospital; Sydney New South Wales Australia
- Discipline of Surgery; The University of Sydney; Sydney New South Wales Australia
| | - Chris Nahm
- Upper Gastrointestinal Surgical Unit; Royal North Shore Hospital; Sydney New South Wales Australia
- Discipline of Surgery; The University of Sydney; Sydney New South Wales Australia
| | - Thomas J. Hugh
- Upper Gastrointestinal Surgical Unit; Royal North Shore Hospital; Sydney New South Wales Australia
- Discipline of Surgery; The University of Sydney; Sydney New South Wales Australia
| | - Jenny Arena
- Upper Gastrointestinal Surgical Unit; Royal North Shore Hospital; Sydney New South Wales Australia
- Discipline of Surgery; The University of Sydney; Sydney New South Wales Australia
| | - Anthony J. Gill
- Cancer Diagnosis and Pathology Group; Kolling Institute of Medical Research; Sydney New South Wales Australia
- The University of Sydney; Sydney New South Wales Australia
- Department of Anatomical Pathology; Royal North Shore Hospital; Sydney New South Wales Australia
| | - Jaswinder S. Samra
- Upper Gastrointestinal Surgical Unit; Royal North Shore Hospital; Sydney New South Wales Australia
- Discipline of Surgery; The University of Sydney; Sydney New South Wales Australia
- Macquarie University Hospital; Macquarie University; Sydney New South Wales Australia
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Management of Pharyngeal Fistulas After Anterior Cervical Spine Surgery: A Treatment Algorithm for Severe Complications. Clin Spine Surg 2017; 30:E25-E30. [PMID: 28107239 DOI: 10.1097/bsd.0b013e3182999504] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
STUDY DESIGN This study is a retrospective database query to identify all anterior spinal approaches. OBJECTIVES The objectives were to assess all patients with pharyngocutaneous fistulas (PCFs) after anterior cervical spine surgery. SUMMARY OF BACKGROUND DATA Patients with the diagnosis of PCFs were treated at the University of Heidelberg Spine Medical Center, Spinal Cord Injury Unit and Department of Otolaryngology (Germany), between 2005 and 2011. METHODS We conducted a retrospective study on 5 patients with PCF after anterior cervical spine surgery between 2005 and 2011 and analyzed their therapy management and outcome on the basis of the radiologic data and patient charts. RESULTS Upon presentation, 4 patients were paraplegic. Two patients had PCF arising from 1 piriform sinus, 2 patients had PCF arising from the posterior pharyngeal wall and piriform sinus combined, and 1 patient had PCF arising only from the posterior pharyngeal wall. Two patients previously underwent unsuccessful surgical repair elsewhere and 1 patient underwent a prior radiation therapy. In 3 patients, speech and swallowing could be completely restored. Two patients died, both of whom were paraplegic. The patients were needed to undergo an average of 2 or 3 procedures for complete functional recovery of primary closure with various vascularized regional flaps and refining laser procedures supplemented with the negative pressure wound therapy wherever needed. CONCLUSIONS On the basis of our experience, we are able to provide a treatment algorithm that indicates that chronic, as opposed to acute, fistulas require a primary surgical closure combined with a vascularized flap that should be accompanied by the immediate application of a negative pressure wound therapy. We also conclude that particularly in paraplegic patients suffering from this complication the risk for a fatal outcome is substantial.
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Rostagno C, Buzzi R, Campanacci D, Boccacini A, Cartei A, Virgili G, Belardinelli A, Matarrese D, Ungar A, Rafanelli M, Gusinu R, Marchionni N. In Hospital and 3-Month Mortality and Functional Recovery Rate in Patients Treated for Hip Fracture by a Multidisciplinary Team. PLoS One 2016; 11:e0158607. [PMID: 27389193 PMCID: PMC4936690 DOI: 10.1371/journal.pone.0158607] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 06/17/2016] [Indexed: 12/21/2022] Open
Abstract
Objectives Medical comorbidities affect outcome in elderly patients with hip fracture. This study was designed to preliminarily evaluate the usefulness of a hip-fracture unit led by an internal medicine specialist. Methods In-hospital and 3-month outcomes in patients with hip fracture were prospectively evaluated in 121 consecutive patients assessed before and followed after surgery by a multidisciplinary team led by internal medicine specialist; 337 consecutive patients were recalled from ICD-9 discharge records and considered for comparison regarding in-hospital mortality. Results In the intervention period, patients treated within 48 hours were 54% vs. 26% in the historical cohort (P<0.0001). In-hospital mortality remained stable at about 2.3 per 1000 person-days. At 3 months, 10.3% of discharged patients had died, though less than 8% of patients developed postoperative complications (mainly pneumonia and respiratory failure). The presence of more than 2 major comorbidities and the loss of 3 or more BADL were independent predictors of death. 50/105 patients recovered previous functional capacity, but no independent predictor of functional recovery could be identified. Mean length of hospital stay significantly decreased in comparison to the historical cohort (13.6± 4.7 vs 17 ± 5 days, p = 0.0001). Combined end-point of mortality and length of hospitalization < 12 days was significantly lower in study period (27 vs 34%, p <0.0132). Conclusions Identification and stabilization of concomitant clinical problems by internal medicine specialists may safely decrease time to surgery in frail subjects with hip fracture. Moreover, integrated perioperative clinical management may shorten hospital stay with no apparent increase in in-hospital mortality and ultimately improve the outcome. These results are to be confirmed by a larger study presently ongoing at our institution.
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Affiliation(s)
- Carlo Rostagno
- Dipartimento Medicina Sperimentale e Clinica, Università di Firenze, Firenze, Italy
- SOD Medicina Interna e post-chirurgica, AOU Careggi, Firenze, Italy
- * E-mail:
| | - Roberto Buzzi
- SOD Ortopedia e Traumatologia, AOU Careggi, Firenze, Italy
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Risk factor profiles for early and delayed mortality after hip fracture: Analyses of linked Australian Department of Veterans' Affairs databases. Injury 2015; 46:1028-35. [PMID: 25813734 DOI: 10.1016/j.injury.2015.03.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2014] [Revised: 02/22/2015] [Accepted: 03/03/2015] [Indexed: 02/02/2023]
Abstract
INTRODUCTION One-year mortality after hip fracture may exceed 30% with a very large number of reported risk factors. Determinants of mortality beyond 1 year are rarely described. This study employs multiple data linkages to examine mortality rates, risk factor profiles and age-specific excess mortality at intervals from 30 days to 4 years. METHODS Retrospective cohort study of linked administrative datasets describing hospital episodes, residential aged care (RAC) admissions and date of death for 2552 Australian veterans and war widows hospitalised for hip fracture in 2008-09. Associations between time to death and patient age, sex, pre-fracture accommodation, fracture type, treatment options, selected comorbidities and complications were tested in Cox proportional hazards models. RESULTS In a population with mean age of 86.6 years (range 54-100 years), overall death rate was 11% at 30 days, 34% at 1 year, 47% at 2 years and 67% after 4 years. For males hospitalised from RAC 1-year mortality was 72%, contrasting with 19% for females from the community. Risk of death within 1 year was increased by male sex, increasing age, pre-fracture RAC residency, transfer to intensive care and coexistent cancer, cardiac and renal failure, cerebrovascular disease and pressure ulcers. Patients selected for rehabilitation had lower mortality rates. Patterns of determinants for mortality changed over time. Above-expected age-specific mortality was sustained for 4 years except for males 90 years and older. CONCLUSION Pre-fracture RAC residence was the strongest determinant factor for mortality. Patients selected for rehabilitation had lower mortality rates. The profiles of explanatory variables for death altered with increasing time from the index fracture event.
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Watters DA, Hollands MJ, Gruen RL, Maoate K, Perndt H, McDougall RJ, Morriss WW, Tangi V, Casey KM, McQueen KA. Perioperative Mortality Rate (POMR): A Global Indicator of Access to Safe Surgery and Anaesthesia. World J Surg 2014; 39:856-64. [DOI: 10.1007/s00268-014-2638-4] [Citation(s) in RCA: 100] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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McCulloch G. Response from Dr McCulloch to Mortality rates after surgery in New South Wales. ANZ J Surg 2013; 83:297-8. [PMID: 23556497 DOI: 10.1111/ans.12099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Thomson I, Beiles B, Bourke B. Response from Dr Thomson et al. to Mortality rates after surgery in New South Wales. ANZ J Surg 2013; 83:296-7. [PMID: 23556496 DOI: 10.1111/ans.12087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Harris I, Madan A, Naylor J, Chong S. Re: Response from Dr Thomson et al. to Mortality rates after surgery in New South Wales. ANZ J Surg 2013; 83:297. [PMID: 23556498 DOI: 10.1111/ans.12086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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