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PubMed1990

Morbidity prevalence study of workers with potential exposure to epichlorohydrin.

This study examined the morbidity experience from 1981 to 1988 of two cohorts (Shell cohort and Enterline cohort) of workers who had potential exposure to epichlorohydrin (ECH). The morbidity prevalence data for this study were extracted from the morbidity section of the Shell health surveillance system which included all illness and absence records in excess of five days. For both cohorts, the standardised morbidity ratios (SMRs) for all causes and all neoplasms were similar to an internal comparison group. There were no increases in heart disease morbidity for the Shell cohort (SMR = 97) or the Enterline cohort (SMR = 90). The SMRs for heart disease in the lower exposure group of the Shell cohort were 101 and 93 for the corresponding Enterline cohort. They were 92 and 87, respectively, in the higher exposure group. The increased risk of heart disease mortality reported by Enterline et al in workers more heavily exposed to ECH was not confirmed in this morbidity study. Morbidity from skin and subcutaneous tissue disorders, however, was found to be increased significantly in the Shell cohort. The SMR was 98 for the lower exposure group and 195 for the higher exposure group. A review of the original morbidity reports for each case suggested that factors unrelated to exposure to ECH such as the physical demands of a particular job, amount of time outside--for example, exposure to poison ivy--and other underlying medical conditions may be of greater importance than exposure to ECH.

Adult↗

PubMed1998

Hospital readmission and morbidity following early newborn discharge.

To examine causes of newborn hospital readmission and morbidity related to early nursery discharge, we reviewed the charts of 664 newborns readmitted from home under the age of 15 days, between 1993 and 1995. Early discharge (ED) was defined as nursery length of stay of < or = 2 days. Morbidity related to ED: onset of symptoms within 1 day of ED; and in diseases with insidious onset: serum bilirubin level > 20 mg/dL (340 mumol/L), or dehydration following poor breastfeeding since birth. Seventeen percent of all readmitted infants had ED-related morbidity; 9% had major morbidity. Onset of symptoms prior to the age of 3 days occurred in 43% of ductal-dependent cardiac lesions, intestinal obstruction, seizures, and major infections. Morbidity was less pronounced in infants who were followed up within 2 days following ED. Specific findings related to subsequent morbidity were identified in the perinatal history of infants who were readmitted with major infections and with hyperbilirubinemia. Our findings suggest that: (1) close to half of the cases with acute-onset major morbidity can be identified within 3 days of birth, and (2) attention to the perinatal history and timely follow-up will contribute to a reduction in both morbidity and complications.

Hospitals, Pediatric↗

PubMed2007

A comparative study of the complications of surgical tracheostomy in morbidly obese critically ill patients.

INTRODUCTION: There is little objective comparative information about the postoperative complications of tracheostomy in morbidly obese patients. The aim of this study was to determine the incidence and severity of complications associated with open tracheostomy in critically ill morbidly obese patients during hospitalization. METHODS: During a six year period, all consecutive morbidly obese patients (body mass index [BMI] of greater than or equal to 40 kg/m2) who underwent an elective open tracheostomy were compared to a control group (BMI of less than 40 kg/m2) of the same institution. Variables examined included age, gender, BMI, Charlson index, and reasons for tracheostomy. All postoperative tracheotomy-related complications that occurred during hospitalization, including death, were recorded. RESULTS: A tracheostomy was performed in 89 morbidly obese patients out of 427 critically ill patients. A total of 27 complications were recorded in 22 morbidly obese patients (25%) compared to 65 complications in 49 patients (14%) of the control group (p = 0.03). The majority of these complications were minor in origin. Overall, nine serious events were responsible for two deaths in the morbidly obese compared to seven cases and two deaths in the control group (p = 0.001). Life-threatening complications were attributed to tube obstruction and malpositioning of the tracheostomy after being dislodged. In multivariate analysis, morbid obesity (odds ratio 4.4, 95% confidence interval 2.1 to 11.7) was independently associated with increased risk of tracheostomy-related complications. CONCLUSION: In the present series, morbid obesity is associated with increased frequency and life-threatening complications from conventional tracheostomy. Special techniques and operative policies must be applied to overcome loss of airway control.

APACHE↗

PubMed2005

Comparative impact of morbid obesity vs heart failure on cardiorespiratory fitness.

BACKGROUND: We are in the midst of an obesity pandemic. Morbid obesity is associated with dyspnea on exertion and higher overall mortality rates. The relations between measures of cardiorespiratory fitness in morbidly obese persons compared to those with heart failure are unknown. METHODS: We compared cardiorespiratory fitness in patients with morbid obesity (n = 43) and established systolic dysfunction heart failure (n = 235), and in age-matched medical control subjects (n = 222) who had been referred for diagnostic exercise testing with simultaneous metabolic measurements. Only patients who completed an adequate test for maximum exertion manifested by a respiratory exchange ratio of > or = 1.10 were included in the study. RESULTS: The mean (+/- SD) body mass index (BMI) values for the three groups were 47.8 +/- 5.1, 30.1 +/- 5.7, and 33.8 +/- 9.0, respectively (p < 0.0001 for comparisons between morbidly obese patients and each comparator). The mean left ventricular ejection fraction for the heart failure group was 21.5 +/- 8.4%. Despite achieving higher peak heart rate and BP values, the morbidly obese patients had a mean maximum oxygen uptake (V(O2)max) that was similar to that of those with heart failure (17.8 +/- 3.6 vs 16.5 +/- 5.6 mL/kg/min, respectively; p = 0.14) and was considerably lower than that of the control group (17.8 +/- 3.6 vs 21.3 +/- 8.2 mL/kg/min, respectively; p = 0.007). In addition, among subjects in the control group, there was a graded inverse relation between BMI and V(O2)max. CONCLUSIONS: Morbidly obese individuals have severely reduced cardiorespiratory fitness that is similar to those with established systolic dysfunction heart failure. In addition, in those persons who are referred for stress testing for medical reasons, there is an inverse graded relationship between BMI and cardiorespiratory fitness. These data suggest that the impairment in V(O2)max in morbidly obese persons is related to BMI and possibly to other factors that impair peak cardiac performance. These findings are consistent with overall higher expected mortality in morbidly obese persons.

Adult↗

PubMed1999

The relationship between psychosocial factors and asthma morbidity in inner-city children with asthma.

OBJECTIVE: Children living in the inner city are affected disproportionately by asthma morbidity and mortality. Previous research has shown that behavioral and psychosocial factors affect asthma morbidity in children. The National Cooperative Inner-City Asthma Study investigated the factors that contribute to asthma morbidity among inner-city children. This article examines the relationship between psychosocial factors and asthma morbidity in this population. METHODS: A total of 1528 English- and Spanish-speaking children 4 to 9 years of age with asthma and their primary caretakers were recruited from 8 research centers in 7 metropolitan inner-city areas in the United States. Psychosocial variables were assessed at baseline and included measures of child and caretaker mental health, caretaker's problems with alcohol, life stress, social support, and parenting style. Morbidity measures were evaluated at baseline and at 3-, 6-, and 9-month follow-up intervals. These included number of hospitalizations and unscheduled visits for asthma in the past 3 months and number of days of wheeze and functional status in the previous 2-week period. RESULTS: Of the psychosocial variables assessed, mental health had the strongest relationship to children's asthma morbidity. Children whose caretakers had clinically significant levels of mental health problems were hospitalized for asthma at almost twice the rate as children whose caretakers did not have significant mental health problems. Children with clinically significant behavior problems had significantly more days of wheeze and poorer functional status in the follow-up period. CONCLUSION: Psychosocial factors, particularly the mental health of children and caretakers, are significant factors in predicting asthma morbidity. They may need to be included in intervention programs aimed at decreasing asthma morbidity in inner-city children with asthma in order for these programs to be successful.

Asthma↗

PubMed1999

Assessing morbidity in the paediatric community.

INTRODUCTION: Morbidity information is easily available from medical records but its scope is limited to the population attended by the health services. Information on the prevalence of diseases requires community surveys, which are not always feasible. These two sources of information represent two alternative assessments of disease occurrence, namely demand morbidity and perceived morbidity. The present study was conceived so as to elicit a potential relationship between them so that the former could be used in the absence of the latter. METHODS: A community of 13,365 families on the outskirts of S. Paulo, Brazil, was studied during the period from 15/Nov/1994 to 15/Jan/1995. Data regarding children less than 5 years old were collected from a household survey and from the 2 basic health units in the area. Prevalence of diseases was ascertained from perceived morbidity and compared to estimates computed from demand morbidity. RESULTS: Data analysis distinguished 2 age groups, infants less than 1 year old and children 1 to less than 5. The most important groups of diseases were respiratory diseases, diarrhoea, skin problems and infectious & parasitical diseases. Basic health units presented a better coverage for infants. Though disease frequencies were not different within or outside these units, a better coverage was found for diarrhoea and infectious & parasitical diseases in the infant group, and for diarrhoea in the older age group. Equivalence between the two types of morbidity was found to be limited to the infant group and concerned only the best covered diseases. The odds of a disease being seen at the health service should be of at least 4:10 to ensure this equivalence. CONCLUSION: It was concluded that, provided that health service coverage is good, demand morbidity can be taken as a reliable estimate of community morbidity.

Ambulatory Care↗

PubMed2004

Morbidity effects on productivity and profitability of stocker cattle grazing in the Southern Plains.

Effects of bovine respiratory disease (BRD) on stocker cattle systems are unknown under extensive rangeland environments. Three experiments were conducted to test the hypothesis that BRD-based morbidity is a major factor affecting the productivity and profitability of stocker cattle grazing Southern Plains rangelands. In Exp. 1 (658 male calves; average BW = 231 kg), 17% of the cattle were treated for BRD <8 d, 6% for 8 to 14 d, and 8% for >14 d. Morbid cattle had lower ADG than did healthy cattle (P < 0.10). Cattle requiring 14 d of pharmaceutical therapy gained less than cattle having <14 d therapy (P < 0.01). In Exp. 2, (279 steers and bulls; average BW = 216 kg), the ADG by steers (0.74 kg x animal(-1) x d(-1)) was greater (P < 0.05) than by bulls castrated after arrival (0.64 kg x animal(-1) x d(-1)). Castration after arrival led to a 13.5% loss in daily gain and a 10.3% loss in season-long gain. More (P < 0.05) bulls castrated after arrival (60%) were morbid compared with steers (28%). In Exp. 3, 633 heifers (average BW = 251 kg) were used to test the effects of morbidity on weight gain and reproduction. Heifers with lower initial weights exhibited increased (P < 0.05) morbidity. Heifers requiring two or more antibiotic treatments gained 0.03 kg/d less (P < 0.10) than did healthy heifers and had lower (P < 0.05) conception rates (66 vs. 81%). Conception rate in twice-treated heifers was 19% less than healthy heifers. Morbid heifers conceived 0.6 mo later (P < 0.05) than healthy heifers. Under the conditions of Exp. 1 and Exp. 2, morbidity decreased net returns 9.7 to 21.3% per animal. Adjusted gross returns per animal in Exp. 3 for replacement heifers were 3 to 7.8% less for morbid heifers.

Animal Husbandry↗

PubMed1991

Interhospital variations in admission severity-adjusted hospital mortality and morbidity.

In this study hospital admissions are categorized into admission severity groups based on key clinical findings. Severity of illness is determined again later in the hospital stay after treatment has been initiated. High severity on this second review is labeled major morbidity or morbidity, depending on the severity level, and these rates serve as a health outcome indicator along with in-hospital mortality. This study's findings show, for ten hospitals randomly selected from MedisGroups users, considerable interhospital variation in standardized mortality and morbidity ratios for ten frequently occurring DRGs on the adult medical service. After adjusting for admission severity and case mix, three of the ten study hospitals have a statistically significant (p less than .01) difference between the hospital's standardized mortality ratio and 1.0. Such a significant difference exists for the standardized major morbidity ratio of four hospitals and for the standardized morbidity ratio of three hospitals. At the DRG-specific level, our results show that 8.9 percent, 4.4 percent, and 15.0 percent of the hospital-specific mortality, major morbidity, and morbidity ratios, respectively, are statistically significant. Most hospital outliers have fewer deaths or morbid cases than expected. We caution that the study hospitals may not be representative of a larger group of U.S. hospitals.

Adult↗

PubMed1993

The morbidity of abdominal hysterectomy.

OBJECTIVE: To determine the morbidity of abdominal hysterectomy. DESIGN: Descriptive. Physician billings to the Quebec Health Care Plan in the 1-month period after abdominal hysterectomy were examined. SETTING: Operations performed in 102 hospitals in the Province of Quebec between Jan. 1, 1989, and Mar. 31, 1989, were selected. PATIENTS: The study group included 3322 patients who had abdominal hysterectomy. Patients who had vaginal or abdominal hysterectomy for invasive cancer or pregnancy-related complications were excluded. A patient was considered to be morbid if the physician's intervention indicated concern for the patient's well-being. MAIN OUTCOME MEASURES: Multiple logistic regression analysis to determine the adjusted rate ratio for inclusion in a categorical list of morbid patients among different subsets of surgeons, hospitals and patients. RESULTS: Postoperative morbidity occurred in 646 patients (19.5%), who spent an average of 1.7 days longer in the hospital than patients with no postoperative morbidity. There were two postoperative deaths (0.1%). Forty-nine patients (1.5%) had postoperative surgical intervention. On 119 occasions (3.6%), patients were treated in the intensive care unit. A consultation was given by a medical specialist in 303 cases (9.1%). The rate ratio for postoperative morbidity was not significantly affected by years in practice or specialty of the surgeon but was increased for operations performed in mid-sized hospitals. The strongest predictor of postoperative morbidity was pre-existing medical disorder (RR). CONCLUSION: The major causes of morbidity in patients who undergo abdominal hysterectomies are medical rather than surgical.

Female↗

PubMed2003

Risk factors for perioperative morbidity and mortality after extended hepatectomy for hepatocellular carcinoma.

BACKGROUND: Extended hepatectomy with resection of more than four segments is a high-risk operation, especially in patients with hepatocellular carcinoma (HCC) associated with chronic liver disease. This study evaluated the risk factors for morbidity and mortality following extended hepatectomy for HCC. METHODS: Preoperative and intraoperative variables of 155 patients who underwent extended hepatectomy for HCC were analysed to identify risk factors for postoperative morbidity and mortality. RESULTS: The overall morbidity rate was 55.5 per cent (n = 86). Most morbidity was due to ascites or pleural effusion. Significant life-threatening complications occurred in 20.0 per cent (n = 31). The perioperative mortality rate was 8.4 per cent (n = 13). Multivariate analysis found that portal clamping (P = 0.023) and perioperative blood transfusion (P < 0.001) were risk factors for morbidity, whereas perioperative blood transfusion (P < 0.001) was the only risk factor for significant morbidity. Co-morbid illness (P = 0.019) and perioperative blood transfusion (P = 0.004) were risk factors for perioperative mortality. CONCLUSION: Meticulous operative techniques to minimize blood loss and transfusion, while avoiding a prolonged Pringle manoeuvre, may help reduce postoperative morbidity. Avoidance of perioperative blood transfusion and careful preoperative selection of patients in terms of overall physiological status are important measures to reduce the postoperative mortality rate.

Adolescent↗

PubMed2005

Predicting psychological morbidity in Chinese women after surgery for breast carcinoma.

BACKGROUND: Between 30% and 70% of western women experience psychological morbidity after undergoing surgery for breast carcinoma; however, the rates and risk factors among Chinese women are unknown. Identifying at-risk women enables preventive intervention. METHODS: Among 430 Chinese women who were approached within 1 week after undergoing surgery for early-stage breast carcinoma (baseline), 405 women (94%) completed measures of self-efficacy and psychological morbidity (the Chinese Health Questionnaire 12-item instrument [CHQ12]) and completed retrospective measures of treatment decision-making (TDM) difficulties, satisfaction with TDM involvement, and satisfaction with consultation and treatment outcome expectations. One-month postsurgery follow-up (follow-up), CHQ12 scores for 367 of 405 women (91%) were adjusted for concurrent physical symptom distress and trait optimism (the revised Chinese Life Orientation Test) and baseline predictors using stepwise multivariate regression. RESULTS: At baseline 28% of women evidenced mild psychological morbidity, and 42% of women evidenced moderate-to-severe psychological morbidity: At follow-up, the respective rates were 32% and 36%. Preferred TDM involvement was associated with lower psychological morbidity (F = 6.702; P < 0.001). Baseline CHQ12 scores were predicted by outcome expectancies and TDM difficulties (adjusted regression coefficient [R(2)] = 0.192). Baseline CHQ12 scores and follow-up chemotherapy, in turn, predicted physical symptom distress at follow-up. After adjustment, high physical symptom distress, baseline psychological morbidity, low optimism, and no chemotherapy independently predicted follow-up CHQ12 scores (adjusted R(2) = 0.585). CONCLUSIONS: Psychological morbidity was linked to women's TDM difficulties, their inability to anticipate treatment effects accurately, and physical symptom distress, possibly exacerbated by symptom misattribution. Optimizing TDM support and helping women accurately determine outcomes in terms of symptom experience and meaning and physical appearance may help to reduce psychological morbidity. Women who have TDM difficulties should be considered to be at high risk for psychological distress.

Adult↗

PubMed1996

Morbidity and mortality of discordant twins up to 34 weeks of gestational age.

UNLABELLED: The combination of weight discordance and prematurity implies a high perinatal morbidity and mortality for the affected twins. Several pathomechanisms may be responsible for the weight difference in twins including a different genetic growth potential in dizygotic twins, placenta insufficiency in one twin, and chronic feto-fetal transfusion (CFFT). Little is known about neonatal morbidity and mortality of discordant twins. Therefore, a retrospective, case-controlled study on preterm discordant twins up to 34 weeks gestation was carried out. Twenty-seven (27,3%) of 99 twin pairs born in our clinic had a birth weight difference of more than 20%. The control group consisted of 27 non-discordant twins matched for gestational age. Discordant twins showed a significantly higher mortality (19%) than the control twins (2%). Severe intracranial haemorrhage (ICH) and persistent ductus arteriosus Botalli (PDA) were found more often in discordant twins than in the control group. The increased mortality and morbidity of discordant twins compared with concordant twins matched for gestational age indicates that the increased morbidity and mortality of preterm weight discordant twins is not only due to prematurity, but is also related to the discordance itself. Thirteen (48.1%) of the weight discordant twin pairs fulfilled the criteria for CFFT. Twins with CFFT differed significantly from controls with respect to the incidence of mortality and the rate of severe ICH, PDA, and the necessity of postnatal cardiopulmonary resuscitation. By contrast, no significant differences were found between discordant twins without CFFT and controls. Thus, CFFT appears to be a major contributing factor for increased mortality and morbidity of weight discordant twins. Intra-twin pair analysis revealed a higher rate of postnatal hypoglycaemia in the smaller twins only, probably caused by insufficient glycogen storage due to intra-uterine malnutrition. Mortality was the same for both the larger and the smaller twins. It may be concluded that neonatal outcome of smaller twins who have survived intra-uterine malnutrition is the same as in larger twins. Intra-twin pair analysis in twins with CFFT revealed no significant differences except for a higher rate of ICH grade 2-4 in the larger twins which might be explained by hypervolaemia of the recipient. CONCLUSION: Morbidity and mortality of weight discordant twins are increased. CFFT appears to be a major contributing factor for the increased mortality and morbidity. Postnatal mortality was the same in acceptor and donor; however, the acceptor had a higher postnatal morbidity.

Birth Weight↗

PubMed2004

Co-morbidity and acute decompensations of COPD requiring non-invasive positive-pressure ventilation.

OBJECTIVE: To assess the prevalence and the impact of chronic and/or acute non-respiratory co-morbidity on short and longer-term outcome of non-invasive positive pressure ventilation (NIPPV) in acute decompensations of chronic obstructive pulmonary disease (COPD) with acute hypercapnic respiratory failure (AHRF). DESIGN AND SETTING: An observational study in a three-bed respiratory monitoring unit in a respiratory ward of a non-university hospital. PATIENTS: We grouped 120 consecutive COPD patients requiring NIPPV for AHRF (pH 7.28+/-0.05, PaO2/FIO2 ratio 192+/-63, PaCO2 78.3+/-12.3 mmHg) according to whether NIPPV succeeded (n=98) or failed (n=22) in avoiding the need for endotracheal intubation and whether alive (n=77) or dead (n=42) at 6 months. MEASUREMENTS AND RESULTS: The prevalence of chronic and acute co-morbidity was, respectively, 20% and 41.7%; most of the cases were cardiovascular. In-hospital NIPPV failure was greater in patients with than in those without chronic (33.3% vs. 14.6%) or acute co-morbidity (32% vs. 8.6%). Six-month mortality was worse in patients with than in those without chronic (54.2% vs. 30.5%) or more than one acute co-morbidity (66.7% vs. 30.8%). Multiple regression analysis predicted in-hospital NIPPV failure by acute co-morbidity and forced expiratory volume in 1 s, while death at 6 months was predicted by having more than one acute co-morbidity, non-cardiovascular chronic co-morbidity and Activities of Daily Living score. CONCLUSIONS: Chronic and acute co-morbidities are common in COPD patients with AHRF needing NIPPV and their presence influences short and longer-term outcome.

Acute Disease↗

PubMed1996

Cancer morbidity in subjects occupationally exposed to high frequency (radiofrequency and microwave) electromagnetic radiation.

Cancer morbidity was registered in the whole population of military career personnel in Poland during a period of 15 years (1971-1985). Subjects exposed occupationally to radiofrequencies (RF) and microwaves (MW) were selected from the population on the basis of their service records and documented exposures at service posts. The population size varied slightly from year to year with a mean count of about 128,000 persons each year; each year about 3700 of them (2.98%) were considered as occupationally exposed to RF/MW. All subjects (exposed and non-exposed to RF/MW) were divided into age groups (20-29, 30-39, 40-49 and 50-59). All newly registered cases of cancer were divided into 12 types based on localisation of the malignancy; for neoplasms of the haemopoietic system and lymphatic organs an additional analysis based on diagnosis was performed. Morbidity rates (per 100,000 subjects annually) were calculated for all of the above localisations and types of malignancies both for the whole population and for the age groups. The mean value of 15 annual rates during 1971-1985 represented the respective morbidity rate for the whole period. Morbidity rates in the non-exposed groups of personnel were used as 'expected' (E) rates for the exposed subjects, while the real morbidity rates counted in the RF/MW-exposed personnel served as 'observed' (O) rates. This allowed the calculation of the observed/expected ratio (OER) representing the odds ratio for the exposed groups. The cancer morbidity rate for RF/MW-exposed personnel for all age groups (20-59 years) reached 119.1 per 100,000 annually (57.6 in non-exposed) with an OER of 2.07, significant at P < 0.05. The difference between observed and expected values results from higher morbidity rates due to neoplasms of the alimentary tract (OER = 3.19-3.24), brain tumours (OER = 1.91) and malignancies of the haemopoietic system and lymphatic organs (OER = 6.31). Among malignancies of the haemopoietic/lymphatic systems, the largest differences in morbidity rates between exposed and non-exposed personnel were found for chronic myelocytic leukaemia (OER = 13.9), acute myeloblastic leukaemia (OER = 8.62) and non-Hodgkin lymphomas (OER = 5.82).

Adult↗

PubMed2004

Impact of neoadjuvant therapy of perioperative morbidity in patients with esophageal cancer.

BACKGROUND: Conflicting results of preoperative radiochemotherapy in patients with esophageal cancer have been obtained; only patients with a complete pathological response seem to benefit from this therapy. However, there is evidence that preoperative radiochemotherapy leads to considerable postoperative morbidity. Therefore, postoperative morbidity was retrospectively investigated in 82 patients with an esophageal cancer who received preoperative radiochemotherapy. METHODS: One hundred twenty-two consecutively operated on patients were included (1991 to 2001). Preoperative radiochemotherapy was initiated in 1994 for cT >1, cNx, cM0 regardless of histology (n = 82); 36 Gy was applied (1.8 Gy daily, days 1 to 5, weeks 1 to 4), concurrently 5-fluorouracil (500 mg/m(2) days 1 to 5, weeks 1 to 4), and cisplatin (20 mg/m(2) days 1 to 5, weeks 1 and 4). Postoperative morbidity was categorized as surgery- and nonsurgery-related morbidity. Survival was calculated by the Kaplan-Meier method. Results were stratified into histology and compared with patients who were operated on only (n = 40). RESULTS: Complete pathological response after preoperative radiochemotherapy was achieved in 22%. An increase in surgery-related morbidity was observed after preoperative radiochemotherapy due to lesion of recurrent nerve (38% versus 12.5%, P = 0.009), as well as a marked difference in pulmonary morbidity (57% versus 37.5%, P = 0.05). The proportion of combined morbidity was increased after preoperative radiochemotherapy (49.4% versus 15%, P = 0.02), which led to a considerable prolongation of postoperative hospital stay (33 versus 21 days median, P = 0.0022). Patients with a longer postoperative hospital stay (>30 days; 43.2%) lived significantly shorter than patients with a shorter postoperative hospital stay (56.8%, P = 0.001). There was no statistical survival benefit in the neoadjuvant treated group. However, calculation of long-term survival revealed a significant survival advantage in patients with squamous cell cancer and a complete pathological response compared with patients without response (median 642 days versus 302, P = 0.026). CONCLUSIONS: Perioperative morbidity was significantly increased after preoperative radiochemotherapy. Long-term survival was clearly affected by the length of postoperative stay. Therefore, we need better patient selection for application of preoperative radiochemotherapy.

Adenocarcinoma↗

PubMed2006

Surgical risk factors, morbidity, and mortality in elderly patients.

BACKGROUND: The aging population of the United States results in increasing numbers of surgical operations on elderly patients. This study observed aging related to morbidity, mortality, and their risk factors in patients undergoing major operations. STUDY DESIGN: We reviewed our institution's American College of Surgeons National Surgical Quality Improvement Program database from February 24, 2002, through June 30, 2005, including standardized preoperative, intraoperative, and 30-day postoperative data points. This required review and analysis of the prospectively collected data. We examined patient demographics, preoperative risk factors, intraoperative risk factors, and 30-day outcomes with a focus on those aged 80 years and older. RESULTS: A total of 7,696 surgical procedures incurred a 28% morbidity rate and 2.3% mortality rate, although those older than 80 years of age had a morbidity of 51% and mortality of 7%. Hypertension and dyspnea were the most frequent risk factors in those aged 80 years and older. Preoperative transfusion, emergency operation, and weight loss best predicted morbidity for those 80 years of age and older. Operative duration predicted "other" postoperative occurrences and emergent case status predicted respiratory occurrences across all age groups. Preoperative impairment of activities of daily living, emergency operation, and increased American Society of Anesthesiology classification predicted mortality across all age groups. A 30-minute increment of operative duration increased the odds of mortality by 17% in patients older than 80 years. Postoperative morbidity and mortality increased progressively with increasing age. Age was statistically significantly associated with morbidity (wound, p = 0.021; renal, p = 0.001; cardiovascular, p = 0.0004; respiratory, p < 0.0001) and mortality (p = 0.001). CONCLUSIONS: Although several risk factors for postoperative morbidity and mortality increase with age, increasing age itself remains an important risk factor for postoperative morbidity and mortality.

Age Factors↗

PubMed2003

Association of prematurity and neonatal infection with neurologic morbidity in very low birth weight infants.

OBJECTIVE: To identify risk factors predictive of neurologic morbidity in very low birth weight (VLBW) infants. METHODS: This is a case-control study of all infants weighing 1500 g or less admitted to a single tertiary neonatal intensive care unit between April 1999 and December 2001. The case group were those neonates with neurologic morbidity including intraventricular hemorrhage, seizures, hydrocephalus, and periventricular leukomalacia. The control group were those without neurologic morbidity. Wilcoxon rank-sum, Fisher exact test, chi(2), and univariate and stepwise multiple logistic regression were performed, with P < 0.05 considered significant. RESULTS: Of 213 VLBW infants, 77 had neurologic morbidity: 61 had intraventricular hemorrhage, eight had seizures, 13 had hydrocephalus, and nine had periventricular leukomalacia. Several infants had more than one morbidity. Gestational age (odds ratio [OR] 0.95; 95% confidence interval [CI] 0.94, 0.96; P <.005), birth weight (OR 0.62; 95% CI 0.49, 0.79; P <.005), and neonatal infection (OR 1.36; 95% CI 1.17, 1.58; P <.005) were highly associated with neurologic morbidity. There was no difference in mean umbilical arterial cord pH (7.25 +/- 0.15, 7.28 +/- 0.09, P =.45) or base excess (-3.8 +/- 4.8 mEq/L, -2.3 +/- 3.0, P =.10). Only three of 52 infants (5.8%) in the case group had an umbilical arterial pH of less than 7. CONCLUSION: Prematurity and neonatal infection were the dominant factors associated with neurologic morbidity in VLBW infants. Intrapartum acidosis occurred in less than 6% of those with neurologic morbidity.

Adult↗

PubMed1997

Pelvic fluid collections by sonography and febrile morbidity after abdominal hysterectomy.

OBJECTIVE: To assess the range of normal findings at endovaginal sonography after abdominal hysterectomy and to assess the relationship these findings and febrile morbidity. METHODS: Fifty-eight women had endovaginal ultrasound at a median of 4 days after abdominal hysterectomy. The volume of fluid in the cul-de-sac and its sonographic characteristics were assessed. Ultrasound findings, which were not released to the patients' physicians, were correlated with febrile morbidity and clinical outcomes. RESULTS: The median pelvic fluid volume was 3.4 mL (interquartile range 0-16.8 mL). No pelvic fluid was detected in 22 of 58 women (37.9%). In the other 36 women, fluid volumes ranged between 0.2 and 76.3 mL. Febrile morbidity was present in 15 of 58 women (26%) overall: eight of 36 (25%) with and seven of 22 (32%) without pelvic fluid. There was no association between the presence of pelvic fluid collections and febrile morbidity (P = .54) or prolonged fever (P = 1.00). There was no difference in the median or mean fluid volumes between women with and without febrile morbidity. The study had a power of 90% with alpha = .05 to detect a difference of 20 mL. Even women with fixed, markedly echoic fluid collections larger than 35 mL did not have significantly more febrile morbidity than women with no pelvic fluid (P = .33). CONCLUSION: The volume of pelvic fluid 3-5 days after hysterectomy does not predict febrile morbidity or the need for drainage. Large or complex fluid collections may be present without adverse clinical consequences, and discovering such a collection in a patient with febrile morbidity after hysterectomy does not necessitate antibiotic therapy or surgical drainage of the fluid collection.

Adult↗