Industries With the Highest Occupational Blood Lead Test Results, California Occupational Blood Lead Registry, 2020‒2021

Objectives. To evaluate the focused surveillance of blood lead results of 20 micrograms per deciliter (µg/dL) of venous blood and higher received by the California Occupational Blood Lead Registry (Registry) because of new legislation concerning occupational lead poisoning. Methods. We used occupational blood lead results reported to the Registry from January 1, 2020, to December 31, 2021, to describe the current industries with workers having the highest levels of lead poisoning. Results. The Registry received 239 blood lead levels (BLLs) of 20 µg/dL or higher for 151 adults with occupational lead exposure in 28 industries over the study period. Worker BLLs ranged from 20 µg/dL to 55 µg/dL. The industries with the greatest number of workers were storage battery manufacturing, painting contractors, and shooting ranges. Conclusions. Occupational lead poisoning is a health concern across numerous industries in California. The current outdated state and federal occupational lead standards would not require removal from lead work for any of the workers in this study despite extensive evidence of harm at lower BLLs. Strengthened standards could support public health initiatives for worker protection and reduce take-home lead to family members. (Am J Public Health. 2022;112(S7):S690-S694. https://doi.org/10.2105/AJPH.2022.307002).

Predictive factors of mortality after colectomy in ischemic colitis: an ACS-NSQIP database study

Background

Surgical intervention for ischemic colitis is associated with significant postoperative morbidity and mortality. Predictive factors of adverse outcomes have been reported in the literature, but are based on small sample populations. We sought to identify risk factors for mortality after emergent colectomy for ischemic colitis using a clinical outcomes database.

Methods

The American College of Surgeons National Surgical Quality Improvement Project database was queried from 2010 to 2015 to identify emergent colectomies performed for ischemic colitis using Current Procedural Terminology and International Classification of Diseases, Ninth Revision codes. Univariate and multivariate logistic regression analysis was used to identify independent risk factors associated with increased risk of mortality.

Results

A total of 4548 patients undergoing emergent colectomies for ischemic colitis were identified. Overall, 30-day postoperative mortality was 25.3%. On univariate analysis, preoperative risk factors associated with a higher rate of mortality include dyspnea, functional status, ventilator dependency, history of chronic obstructive pulmonary disease, ascites, congestive heart failure exacerbation, hypertension, dialysis dependency, cancer, open wounds, chronic steroids, weight loss >10%, transfusions within 72 hours before surgery, septic shock and duration from hospital admission to surgery. Factors that were significant for mortality on logistic regression analysis include elderly age, poor functional status, multiple comorbidities, septic shock, blood transfusion, acute renal failure and the duration of time from hospital admission to surgery.

Conclusions

Postoperative morbidity and mortality rates for ischemic colitis remain significantly high. Identification of risk factors may help patient selection for surgical interventions, and make informed decisions with patients and family members. Although it is certainly challenging, early diagnosis and prompt surgical intervention for patients with ischemic colitis may improve outcomes.

Study type and level of evidence

Therapeutic/care management, level II