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PubMed1999

[Update of the morbidity of radical retropubic prostatectomy: retrospective analysis of 100 consecutive operations during the period 1996-1997].

OBJECTIVE: To retrospectively evaluate the morbidity of radical prostatectomy, with the exception of sexual complications, based on a recent single-centre series. MATERIAL AND METHOD: From January 1996 to January 1998, the morbidity of 100 consecutive patients undergoing radical retropubic prostatectomy was compared to the morbidity of the first 150 patients operated by the same technique in our department for the period 1983-1993. The perioperative morbidity was studied retrospectively on case files, while continence was evaluated in the last 50 patients by a self-administered questionnaire. Sexual complications could not be evaluated objectively for methodological reasons and were not addressed in this study. RESULTS: The single operative complication was a rectal injury (1%). The transfusion rate was 31%. The early complication rate was 23% with a major complication rate of 5% (four thromboembolic complications and one gastrointestinal haemorrhage). The most frequent minor complications (18%) were wound abscess (5%). The reoperation rate was 3%. The mean duration of vesical catheterization was 7 days (range: 4-30) and the mean hospital stay was 8 days (range: 5-30). With a mean follow-up of 14 months, 73% of patients are perfectly continent, with no incontinence pads, while 15% of the patients required incontinence pads "as a precaution". Incontinence required implantation of an artificial sphincter in 2 patients (2%). Only one patient developed stenosis of the anastomosis requiring internal urethrotomy. The reduction of morbidity in these 100 recently operated patients compared to the first 150 operated patients concerned the transfusion rate (31% versus 65%), the reoperation rate (3% versus 8%) and the minor complication rate (18% versus 32%). The reduction of operative morbidity partly explains the reduction of mean duration of vesical catheterization (7 days versus 15 days), and hospital stay (8 days versus 18 days); the anastomotic stenosis rate was also decreased from 17.3% to 1%. CONCLUSION: This study confirms the reduction of overall morbidity of retropubic radical prostatectomy. This improvement is probably multifactorial: increased operative experience and better postoperative management. These retrospective data must be taken into account in the diagnostic and therapeutic decisions concerning localized prostate cancer.

Aged↗
PubMed2001

[Postoperative morbidity and mortality after microsurgical exclusion of cerebral arteriovenous malformations. Current data and analysis of recent literature].

BACKGROUND AND PURPOSE: Microsurgical exclusion of a cerebral arteriovenous malformation (AVM) can compare favorably with radiosurgery. We sought to assess its rate of morbidity-mortality as it is presently reported in the literature, and to discuss some of its current and worthwhile indications. METHODS: Through Medline and additional searches by hand, we retrieved studies reporting the clinical and angiographic results after microsurgical excision of an AVM published between january 1990 and december 2000. RESULTS: a) Postoperative mortality was 3.3% (68/2 452 patients from 25 studies). Permanent postoperative morbidity was 8.6%. Morbidity was never absent varying from 1.5% to 18,7%. The morbidity-mortality rate increased with an increasing Spetzler-Martin's grade, and was related to the location of the AVM. A 4.6% morbidity (from 1.5% to 9.7%) and a zero mortality were reported after microsurgical removal of small lesions of less than 3 cm in diameter. b) Postoperative angiography confirmed a total excision of the AVM in 97% of the cases (1 050/1 076 patients over 11 series), varying from 91% to 100%. c) Permanent morbidity related to pre-surgical embolization varied from 4% to 8.9%. Results from multiple or combined treatment including microsurgery could not be summed up. CONCLUSIONS: A complete and definitive microsurgical excision of an AVM can be achieved with a high success rate and a low morbidity-mortality rate, according to sound indications and to the neurosurgeon's personal experience. The choice for a best treatment of an AVM is no longer limited to microsurgery; it is a team decision where the neurosurgeon plays a determining role.

Adult↗
PubMed2001

Burden of morbidities and the unmet need for health care in rural neonates--a prospective observational study in Gadchiroli, India.

BACKGROUND: Majority of the neonates in developing countries are born and cared for in rural homes but the available information is mostly hospital based. OBJECTIVES: To estimate: (i) the incidence of various neonatal morbidities and associated case fatality in home-cared rural neonates, (ii) proportion of neonates with indications for health care, and (iii) the proportion who actually receive it. DESIGN: Prospective observational study. SETTING: Rural homes. METHODS: Neonates in 39 study villages in the Gadchiroli district (Maharashtra, India) were observed during one year (1995-96) by 39 trained female village health workers at birth and during neonatal period (0-28 days) by making eight home visits. A physician checked the data and the morbidities were diagnosed by a computer program. Vital statistics in these villages was independently collected. RESULTS: Out of 1016 live births, 95% occurred at home and 763 (75&%) neonates were observed. The agreement between observations by health workers and physician was 92%. Total 48.2& neonates suffered high risk morbidities (associated case fatality >10%), 72.2% suffered low risk morbidities, and 17.9% gained inadequate weight (less than 300 g). Seventeen percent neonates developed clinical picture suggestive of sepsis. Though 54.4% neonates had indications for health care and 38 out of total 40 neonatal deaths occurred in these, only 2.6% received medical attention. The neonatal mortality rate was 52.4/1000 live births. CONCLUSION: Nearly half of the neonates in rural homes developed high risk morbidities ten times the neonatal morbidity rate and needed health care but practically none received it. The magnitude of care gap suggests an urgent need for developing home-based neonatal care to reduce neonatal morbidities and mortality

Cause of Death↗
PubMedDate not supplied

Postoperative morbidity and mortality after gastrectomy for gastric carcinoma.

BACKGROUND/AIMS: Surgical technique and postoperative care for gastric cancer have significantly improved in recent years. However, whether postoperative morbidity or mortality rates after gastrectomy for gastric cancer were reduced or not in recent years was unclear. In this study, we analyzed the chronological changes of postoperative morbidity and mortality rates, and we analyzed risk factors for postoperative morbidity and mortality in patients undergoing gastrectomy for carcinomas of the stomach. METHODOLOGY: A total of 887 patients with gastric cancer were gastrectomized in our hospital between January 1985 and December 1996. The patients were divided into three groups on the basis of chronology. The first group included patients treated over the period 1985 to 1988 (n = 324); the second group, 1989 to 1992 (n = 300); and the third group, 1993 to 1996 (n = 263). Postoperative morbidity rates and mortality rates were compared among the three groups. Also, significant risk factors affecting postoperative morbidity and in-hospital mortality were analyzed by the multiple logistic regression analysis. RESULTS: Postoperative complications were detected in 95 patients (10.7%) and in-hospital mortality rate was 2.4% (21/887). Postoperative morbidity rates were 10.5%, 11%, and 10.6% in the first, second, and third groups, respectively and postoperative mortality rates were 2.5%, 2%, and 2.7%, respectively. These postoperative morbidity and mortality rates were not different between the groups (P = 0.979 and P = 0.866). The most common postoperative complication was anastomotic leakage (56/95, 58.9%). Significant risk factors affecting in-hospital mortality were Stage IV (P = 0.006) and noncurative gastric resection (P = 0.004). However, the extent of lymph node dissection, combined resection, or the existence of preoperative complications were not significant risk factors of in-hospital mortality by multiple logistic regression analysis. CONCLUSIONS: These results indicate that patients with far-advanced gastric cancer might have a high risk of postoperative mortality. In noncurative operations for patients with advanced gastric cancer, unnecessary lymph node dissection or combined resection should be avoided.

Adult↗
PubMed2002

Morbidity and mortality from birth before arrival at Siriraj Hospital.

OBJECTIVE: To identify maternal and infant morbidity and mortality from birth before arrival at Siriraj Hospital. STUDY DESIGN: Prospective case-control study. SETTING: Department of Obstetrics & Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University. SUBJECTS: Three hundred and twenty patients, who had delivered at Siriraj Hospital, were divided into two groups. The study group consisted of 160 patients, who gave birth before admission to the labour room of Siriraj Hospital. The control group consisted of 160 patients, who had normal deliveries in the labour room of Siriraj Hospital at the same period of time. INTERVENTION: Interviewing the patients and reviewing the medical records of the mothers and infants from both groups. The data were analyzed by using the EpiInfo program. MAIN OUTCOME MEASURE: Maternal and infant characteristics after delivery, maternal and infant outcomes including puerperal morbidity, low birth weight, perinatal death and infant morbidity. RESULTS: The study showed that the mothers in the study group had to stay in the hospital longer than the control group (3.9 +/- 2.5 days and 3.6 +/- 1.3 days respectively, p < 0.05). The infants in the study group also had to stay in the hospital longer than the control group (5.1. +/- 6.5 days and 3.3 +/- 1.7 days respectively, p < 0.001). The birth weights of infants in the study group were significantly lower than in the control group (2,753.4 +/- 594.1 grams and 3,016.6 +/- 405.0. grams respectively, p < 0.001). The body temperature of the newborns in the study group were also lower than in the control group (36.2 +/- 0.6 degree Celsius and 37.0 +/- 0.4 degree Celsius respectively, p < 0.05). Concerning maternal and infant outcomes, all variables including low birth weight,perinatal death and infant morbidity were better in the control group significantly (p < 0.05) except for puerperal morbidity that had no significant difference (p = 0.77). CONCLUSION: From the present study, the authors confirmed the higher mortality and morbidity rate of infants who were born unexpectedly before hospital admission. However, there was no difference in morbidity between the mothers of both groups.

Adult↗
PubMed2003

Psychiatric morbidity following endometrial ablation and its association with genuine menorrhagia.

OBJECTIVE: To explore the relation between pre-operative psychiatric morbidity, menstrual blood loss and psychiatric outcome in women receiving endometrial ablation for heavy periods. DESIGN: A prospective cohort study. SETTING: The menorrhagia clinic at Leeds General Infirmary. POPULATION: One hundred and twenty consecutive women referred to the Clinic for endometrial ablation. METHODS: Psychiatric interview and actual menstrual blood loss measurements at presentation pre-operatively and one year post endometrial ablation. MAIN OUTCOME MEASURE: Psychiatric status using the semi-structured interview, Present State Examination, with measurement of menstrual blood loss. RESULTS: Endometrial ablation was performed on 92 women. Of the 87 women evaluated 51 (59%) had clinically significant psychiatric symptoms, mainly depression and anxiety. Psychiatric morbidity fell to 21.8% at one year after endometrial ablation. Women with the best psychiatric outcome (6% post-operative psychiatric morbidity) were those with genuine menorrhagia (> or =80 mL) and low psychiatric morbidity pre-operatively. Those who fared worst (39% post-operative psychiatric morbidity) were women with high pre-operative psychiatric morbidity and low menstrual blood loss. Of seven women with very low losses [mean 19 mL (SD 17)] who did not proceed to surgery after counselling, six (86%) had significant psychiatric morbidity. CONCLUSIONS: Pre-operative psychiatric status and menstrual blood loss are predictors of outcome of surgery for women with reported heavy periods.

Adult↗
PubMed2005

Outcomes of the morbidly obese having cardiac surgery.

OBJECTIVE: Obesity has been perceived to be a risk factor for adverse outcomes following cardiac surgery. The aim of this study was to test the hypothesis that patients with morbid obesity (defined as a body mass index (BMI) greater or equal to 40 kg/m(2)) would have increased rates of mortality and morbidity following cardiac surgery. METHODS: The case records of patients who had cardiac surgery between January 1996 and August 2002, who had a BMI greater or equal to 40 kg/m(2), were reviewed retrospectively and compared with a representative control group randomly selected from the same database. Differences between the two groups were determined using multiple and logistical regression. RESULTS: Out of the 4381 patients who had cardiac surgery, 28 patients were morbidly obese (0.6%). No morbidly obese patients and one control patient died in hospital (p = 0.31). Patients with morbid obesity had non-statistically significant increases in length of postoperative intensive care stay, hospital stay, infections, inotrope use and requirements for pacing. CONCLUSIONS: This study was unable to demonstrate that morbidly obese patients having cardiac surgery had statistically significant increased morbidity or mortality.

Journal Article↗
PubMed1985

[Cancer morbidity of the large intestine and its prognosis in the Moldavian SSR].

Colorectal cancer ranks fifth in general cancer morbidity in the Moldavian SSR and second among digestive tumors. Within 1970-1979, the morbidity rate for rectal cancer increased 2.2-fold (from 3.0 to 6.70/0000), cancer of the colon--1.4-fold (from 4.4 to 6.00/0000). Rectal cancer morbidity showed a 4.30/0000 rise in male patients, matched by a 3.20/0000 rise in females. The colonic cancer morbidity rates increased by 1.5 and 1.80/0000, respectively. The results of the analysis of the said indexes suggest that by 1990 the rectal cancer morbidity rate will have reached 8.9 +/- 1.1 and colonic cancer--7.3 +/- 2.40/0000. By 1990, the rate of morbidity for cancer of the large bowel will have surpassed that for stomach cancer and it will rank first among tumors of the digestive tract should the present-day trends of morbidity remain unchanged.

Adult↗
PubMed1985

Respiratory morbidity benefit of awaiting onset of labor after elective cesarean section.

Respiratory morbidity in term neonates is an important complication of elective cesarean delivery. The effect of preceding labor on the incidence and severity of respiratory morbidity in two comparable groups of neonates, 107 with and 80 without labor and with no predisposing factors to respiratory morbidity, was evaluated. Transient tachypnea of the newborn accounted for the majority of cases in term neonates. Respiratory morbidity occurred less frequently in neonates delivered after the onset of labor compared with those delivered before labor (11.2 versus 30%, P less than .002). The risk of respiratory morbidity decreased 1.5 times for each week of advancing gestational age. The presence of labor significantly reduced the risk of respiratory morbidity, independently of gestational age (P less than .03), and disease was less severe in neonates born during labor. Awaiting the onset of labor appears to be beneficial in preventing respiratory morbidity in term neonates delivered by elective cesarean section.

Adult↗
PubMed1995

Drug-related morbidity and mortality. A cost-of-illness model.

BACKGROUND: Preventable drug-related morbidity and mortality represent a serious medical problem that urgently requires expert attention. The costs to society of the misuse of prescription medications, in terms of morbidity, mortality, and treatment, can be immense. To date, research has primarily documented increased rates of hospitalization secondary to medication noncompliance and/or adverse drug effects. OBJECTIVES: To develop a conceptual model of drug-related morbidity and mortality, and to estimate the associated costs in the ambulatory setting in the United States. METHODS: A probability pathway model was developed to estimate the cost of drug-related morbidity and mortality in the United States. Pharmacist practitioners were surveyed to determine conditional probabilities of therapeutic outcomes owing to drug therapy. Health care utilization and associated costs owing to negative therapeutic outcomes were estimated. RESULTS: Drug-related morbidity and mortality was estimated to cost $76.6 billion in the ambulatory setting in the United States. The largest component of this total cost was associated with drug-related hospitalizations. When assumptions of the model were varied, the estimated cost ranged from a conservative estimate of $30.1 to $136.8 billion in a worst-case scenario. CONCLUSIONS: The cost of drug-related morbidity and mortality in the ambulatory setting in the United States is considerable and should be considered in health policy decisions with regard to pharmaceutical benefits. Policies and services should be developed to reduce and prevent drug-related morbidity and mortality.

Cost of Illness↗
PubMedDate not supplied

The impact of co-morbid risk factors at the start of dialysis upon the survival of ESRD patients.

By using a computerized database, we have catalogued the presence of 29 co-morbid risk factors in 683 patients with end-stage renal disease who started dialysis from 1970 through 1989, with follow-up through 1992. The authors hypothesized that current end-stage renal disease patients have more serious co-morbid risk factors impacting upon their mortality rate. Quantitation of dialysis patient co-morbidity, as a measure of patient illness, is lacking in the general nephrology literature. Seven co-morbid risk factors have been reserved for new dialysis patients: hypertension, low albumin, cerebral vascular disease, peripheral vascular disease, pre-existing cardiac disease, abnormal EKG/old myocardial infarction, and congestive heart failure. Except for low serum albumin, the proportion of patients with the six other co-morbid risk factors has increased significantly over this 20-year period (p < 0.0001, chi-square test for hypertension, peripheral vascular disease, pre-existing cardiac disease, abnormal EKG/old myocardial infarction, and congestive heart failure, and p < 0.006 for cerebral vascular disease). In addition, the co-morbid risk factors of hypertension, low serum albumin, and pre-existing cardiac disease at the start of dialysis were strongly prognostic of survival. The Cox proportional hazards regression model identified these three risks, among other factors, that were significantly associated with a decreased survival, with risk ratios ranging from 1.40-1.66. These results support the authors' hypothesis that incoming end-stage renal disease patients, who recently start dialysis, are sicker than in the earlier years of the authors' program. If the authors' patients reflect the national end-stage renal disease population, the presence of co-morbid risk factors may, in part, explain the continuing high mortality of dialysis patients.

Adult↗
PubMed1996

Do self-management plans reduce morbidity in patients with asthma?

BACKGROUND: Self-management plans may help patients with asthma intervene when symptoms deteriorate, thus preventing asthma attacks. AIM: A study set out to test whether a self-management plan tailored to the circumstances of the individual reduces morbidity from asthma. METHOD: General practitioners who had participated in a national audit of asthma attacks were randomized into intervention and control groups. Six months after the intervention group had issued self-management plans to patients with asthma, both groups of practitioners completed morbidity questionnaires on patients. Morbidity outcomes were compared for the 6-month periods before and after the issue of the plans. RESULTS: In the 6 months before the study, the 376 patients enrolled by the intervention group experienced higher levels of morbidity than the 530 patients for whom details were recorded by the control group. In the 6 months after the issue of the plans, control group patients showed little change in levels of morbidity, but intervention group patients showed significant reductions in hospital admissions, consultations for asthma symptoms, asthma review consultations, courses of oral steroids and use of emergency nebulized bronchodilators. CONCLUSION: General practitioners appeared to operate enthusiast bias' and issued more self-management plans to patients with uncontrolled asthma. The reduction in morbidity in this group is probably a result of the use of the plans, but the verdict on whether plans reduce morbidity must be deemed 'not proven'.

Asthma↗
PubMed1997

[Health monitor (SERMO study)--concept, methodology and a paradigmatic result on subjective morbidity in headache].

In Austria, microcensus surveys on self-reported morbidity are carried out at regular intervals every ten years, generally by the Federal Statistic Centre. In the following, we describe an epidemiological observational service which could be regarded as an additional public health instrument. This service is termed "health monitor", and the SERMO (self-reported morbidity) study is the scientific project associated with it. The "health monitor" data provide information on the prevalence of various illnesses and impairment, characteristics and variables of background morbidity by repeated short-term representative surveys on self-reported morbidity. The health monitor permits continual observation of the background morbidity of an entire population, while scientific questions pertaining to the SERMO study can be investigated via the health monitor data base. Self-reported morbidity data provide important information about the health of a general population, in addition to clinical and mortality data, and help to make decisions in health policy. By collecting informations (e.g. nearly every month) on background morbidity, "health monitor" and SERMO project could complement other Austrian public health systems to measure the overall health of the population in general.

Adolescent↗
PubMed1997

Risk adjustment of the postoperative morbidity rate for the comparative assessment of the quality of surgical care: results of the National Veterans Affairs Surgical Risk Study.

BACKGROUND: The National Veterans Affairs Surgical Risk Study was designed to collect reliable, valid data on patient risk and outcomes for major surgery in the Veterans Health Administration and to report comparative risk-adjusted postoperative mortality and morbidity rates for surgical services in the Veterans Health Administration. STUDY DESIGN: This was a cohort study conducted at 44 Veterans Affairs Medical Centers closely affiliated with university medical centers. Included were 87,078 major noncardiac operations performed under general, spinal, or epidural anesthesia between October 1, 1991, and December 31, 1993. The main outcomes measures in this report are 21 postoperative adverse events (morbidities) occurring within 30 days after the index procedure. Multivariable logistic regression risk-adjustment models for all operations and for eight surgical subspecialties were developed. RESULTS: Patient risk factors predictive of postoperative morbidity included serum albumin level, American Society of Anesthesia class, the complexity of the operation, and 17 other preoperative risk variables. Wide variation in the unadjusted rates of one or more postoperative morbidities for all operations was observed across the 44 hospitals (7.4-28.4%). Risk-adjusted observed-to-expected ratios ranged from 0.49 to 1.46. The Spearman rank order correlation between the ranking of the hospitals based on unadjusted morbidity rates and risk-adjusted observed-to-expected ratios for all operations was 0.87. There was little or no correlation between the rank order of the hospitals by risk-adjusted morbidity and risk-adjusted mortality. CONCLUSIONS: The Department of Veterans Affairs has successfully implemented a system for the prospective collection and comparative reporting of postoperative mortality and morbidity rates after major noncardiac operations. Risk adjustment had only a modest effect on the rank order of the hospitals.

Female↗
PubMed2006

Perioperative outcomes and risk factors in gastric surgery for morbid obesity: a 9-year experience.

OBJECTIVE: Surgical treatment of severe obesity is the most rapidly growing specialty area of surgery. The rapid expansion of bariatric surgery has raised questions and concerns regarding possible increased surgical mortality and morbidity rates in both academic and community settings. The purpose of this study was to evaluate postoperative outcomes and risk factors for bariatric gastric surgery for severe obesity. METHODS: A community experience of 1009 consecutive patients who underwent open surgical treatment of morbid obesity during a 9-year period was reviewed from a prospective database. The series included 858 primary gastric bypass operations and 151 revision operations. Perioperative outcomes, late complications, and weight loss results were recorded. Morbidity and mortality rates were analyzed according to patient age, body mass index (BMI), and gender. RESULTS: The mortality rate in the series was 0.6%, and the morbidity rate was 20%. The major complication rate was 6.6%. There were no deaths in the 151 revision patients. The gastrointestinal leak rate was 0.8%, and the thromboembolism rate was 1%. Statistical analysis indicates that BMI is a risk factor for surgical complications. CONCLUSION: Open gastric surgery for morbid obesity can be carried out in the community setting with low mortality and morbidity rates. BMI is a proven surgical risk factor.

Adult↗
PubMed2003

The duodenal switch operation for the treatment of morbid obesity.

OBJECTIVE: To determine the safety and efficacy of the duodenal switch procedure as surgical treatment of morbid obesity. SUMMARY BACKGROUND DATA: The longitudinal gastrectomy and duodenal switch procedure as performed for morbid obesity involves a 75% subtotal greater curvature gastrectomy and long limb suprapapillary Roux-en-Y duodenoenterostomy. This results in a restricted caloric intake and diversion of bile and pancreatic secretions to induce fat malabsorption. Broad acceptance of this procedure has been impeded because of concerns that the malabsorptive component may produce serious nutritional complications. METHODS: Review of data collected prospectively from all patients who underwent duodenal switch as the primary surgical treatment of morbid obesity at a single institution during the 10-year period beginning September 1992. Operative morbidity and mortality, weight loss, volume of food intake, and bowel function were recorded. Sequential measurements of serum albumin, hemoglobin, and calcium levels were obtained to assess metabolic function and nutrient absorption. RESULTS: Duodenal switch was performed as the primary operation in 701 (81%) of a total 863 patients undergoing bariatric surgery during the period of study. The average body mass index (BMI) was 52.8 (range, 34-95). Perioperative mortality was 1.4%, and morbidity (including leaks, wound dehiscence, splenectomy, and postoperative hemorrhage) occurred in 21 patients (2.9%). Weight loss averaged 127 pounds at 1 year, 131 at 3 years, and 118 at 5 or more years (% EBWL of 69%, 73%, and 66%, respectively). The mean number of bowel movements was fewer than 3 per day. Patients reported and maintained a mean restriction of 63% of their preoperative intake (approximately 1600 calories), with no specific food intolerance, at 3 or more years follow-up. At 3 years, serum albumin remained at normal levels in 98% of patients, hemoglobin in 52%, and calcium in 71%. No patients reported dumping, and marginal ulcers were not seen. CONCLUSIONS: The longitudinal gastrectomy with duodenal switch is a safe and effective primary procedure for the treatment of morbid obesity. It has the advantage of allowing acceptable alimentation with a minimum of side effects while producing and maintaining significant weight loss. These results are achieved without developing significant dietary restrictions or clinical metabolic or nutritional complications.

Adolescent↗
PubMedDate not supplied

Major morbidity and mortality within 1 month of ambulatory surgery and anesthesia.

OBJECTIVE: To determine the incidence and time sequence of mortality and major morbidity after ambulatory surgery. DESIGN: Prospective outcome survey of patients at 16 to 72 hours and 30 days after their surgical procedures. SETTING: A tertiary care rural referral center providing ambulatory care. PATIENTS: A total of 38,598 patients aged 18 years and older undergoing 45,090 consecutive ambulatory procedures and anesthetics. Contact rates for 72 hours and 30 days were 99.94% and 95.9%, respectively. MAIN OUTCOME MEASURES: Mortality and major morbidity incidences, including myocardial infarction, central nervous system deficit, pulmonary embolism, and respiratory failure. RESULTS: Thirty-three patients either experienced major morbidity or died (1:1366 [proportional risk]). Four patients died (1:11,273), two of myocardial infarction and two in automobile accidents. No patient died of a medical complication within 1 week of surgery. Of the 31 patients who developed a major morbidity (1:1455), 14 (45%) had myocardial infarction (1:3220), seven (23%) had a central nervous system deficit (1:6441), five (16%) had pulmonary embolism (1:9018), and five (16%) had respiratory failure (1:9018). Four events (13%) occurred within 8 hours of surgery (1:11,273), 15 (48%) in the next 40 hours (1:3006), and 12 (39%) in the next 28 days (1:3758). CONCLUSION: In this ambulatory surgical population, more than one third of major morbidity occurred 48 hours or later after surgery. Overall morbidity and mortality rates, however, were very low.

Adult↗
PubMed1993

Active morbidity surveillance after Hurricane Andrew--Florida, 1992.

OBJECTIVE: To describe the health status of and to detect disease outbreaks in the population affected by Hurricane Andrew in south Dade County, Florida. DESIGN: The Florida Department of Health and Rehabilitative Services and the US Army conducted active surveillance for gastrointestinal illness, respiratory illness, injury, and other index conditions by monitoring civilian and service member visits to care sites (civilian and military free care sites and hospital emergency departments) from August 30 (1 week after the hurricane's landfall) through September 30, 1992. SETTING: South Dade County, Florida. MAIN OUTCOME MEASURES: Proportional morbidity: the number of daily visits for each index condition divided by the total number of visits, expressed as a percentage. Morbidity rate: the total number of daily visits by service members divided by the total number of service members, expressed as a percentage. RESULTS: Six index conditions accounted for 41.3% of visits to civilian free care sites: diarrhea (4.7%), cough (4.7%), other infection (9.6%), rash (5.4%), animal bite (1.2%), and injury (15.7%). At military free care sites, five index conditions accounted for 75.7% of civilian visits: injury (23.7%), dermatologic illness (12.4%), respiratory illness (9.9%), gastrointestinal illness (5.3%), and other medical conditions (24.4%). Two index conditions accounted for 54.1% of service member visits: injury (36.2%) and dermatologic illness (17.9%). During the 5 weeks after the hurricane, proportional morbidity from injury decreased; proportional morbidity from respiratory illness increased; and proportional morbidity from diarrhea was stable. No infectious disease outbreaks occurred. CONCLUSIONS: Injuries were an important source of morbidity throughout the surveillance period, especially among service members. Enteric and respiratory agents did not cause disease outbreaks, despite alarming rumors to the contrary.

Disasters↗