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PubMed1994

[Laparoscopic cholecystectomy in morbid obesity].

In the early days of laparoscopic cholecystectomy (LC) morbid obesity was considered a relative contraindication for this procedure. With increased experience the procedure has been used in obese patients too. To evaluate the influence of morbid obesity on feasibility and outcome of LC, we performed a prospective study in 136 patients in whom LC was attempted between January 1991 and January 1992. Conversion to open cholecystectomy was necessary in 26 cases (19%). The remaining patients were divided into two groups. Group 1 consisted of 92 normal or slightly obese individuals, whereas 18 morbidly obese patients were included in group 2. Intraoperative problems (42% vs 61%) and postoperative morbidity (2% vs 11%) were less frequent in group 1, although not statistically significant. There was no difference in operating time (median for both groups: 110 minutes) and length of hospital stay (4 days). The incidence of late complications (3% vs 6%) was similar. We conclude that LC in morbidly obese patients, as in open surgery, is technically more demanding than in normal individuals. The operative risk was elevated (p < 0.05) as evidenced by a tendency to higher intra- and postoperative complication rates. Cholecystolithiasis in morbidly obese patients is a good indication for LC in the hands of well trained laparoscopic surgeons who are ready to convert to open surgery if problems arise.

Adult↗
PubMed1993

[Development of a simple and reliable method for estimating malaria morbidity according to the modified Muench model].

To evaluate malaria control measures one needs to document morbidity trends over time. Malaria morbidity incidence rates (MMIR) can be estimated from multi-round surveys that use specially designed questionnaires, but they are cumbersome and very expensive. Parasitological incidence rates (PIR), in contrast, can be estimated from malariometric indices, which are simple to collect, but are difficult to interpret in terms of morbidity. We present an extension of Muench's mathematical model which overcomes this drawback. Between June 1990 and May 1991, data were collected in Nyanza-lac, South Burundi, in two parallel studies of children under 6 years old. A fortnightly morbidity recall survey documented MMIR by age. Thick blood films were collected bimonthly to calculate PIR according to Muench's model. The proportion of high parasitaemia (PHP) was defined as the number of slides with 100% of the examined microscopic fields positive for at least one asexual form of Plasmodium falciparum over the total number of slides examined. To test the hypothesis that parasitological data can provide an accurate approximation of malaria morbidity, age specific PIR were multiplied by the corresponding PHP to obtain the incidence rate of high parasitaemia (HPIR). Close agreement was found between MMIR and HPIR (regression coefficient = 1.15; r2 = 98%). Thus, this method offers a simple, accurate and cost-efficient alternative for questionnaire-based morbidity surveys.

Age Factors↗
PubMedDate not supplied

Morbidity and mortality after hepatic resection in the modern era.

BACKGROUND/AIMS: The purpose of this study was to clarify the risk factors associated with complications following hepatic resections and discuss the appropriate types of perioperative management. MATERIALS AND METHODS: A retrospective analysis was made of the complications in 355 patients undergoing hepatic resection between April 1985 and August 1992 at the Second Department of Surgery, Kyushu University Hospital. The patients were placed in two groups according to the occurrence of complications: patients with morbidity and/or mortality (187 patients); patients without either morbidity or mortality (168 patients). RESULTS: The leading complications were the accumulation of fluid in the abdominal and pleural cavities along with septic complications. The only significant factory affecting morbidity and mortality among the preoperative medical conditions was the presence of diabetes while, in addition, the patients with morbidity and/or mortality had higher levels of perioperative transaminase and serum creatinine as compared with those in patients without either morbidity or mortality. CONCLUSIONS: The perioperative strategies for reducing morbidity include the strict control of diabetes to reduce septic complications as well as preserve renal function, which can protect against the refractory accumulation of fluid in the peritoneal and pleural cavities.

Adult↗
PubMedDate not supplied

[The multiyear changes in the epidemic activity of the foci of zoonotic cutaneous leishmaniasis at the Murgab oasis. I. An analysis of the relations of morbidity to heliogeophysical factors].

Attempts were made to analyse the relationships of changes in the pattern of zoonotic cutaneous leishmaniasis (ZCL) morbidity by the 1951-1993 statistics of the Turkmenistan Ministry of Health by the areas of Maryĭskiĭ velaiat with heliogeophysical factors. For quantitative characterization of solar activity changes, various indices were used; among them there was the Wolf number, radio radiation flux at a wavelength of 10.7 cm. and the geomagnetic Aa-index. In some many-year observations, vague cyclic variations were detected on a personal computer by spectral and periodogram analyses proved to be effective in other diseases. Correlation and cross-correlation analyses were used to evaluate the possible relationships between the morbidity rates and the changes in heliogeophysical factors. The study has revealed that the epidemic activity of ZCL foci is characterized by cyclicity with variations of about 2.4, 3.6, 6.9, and 11.2 years. The changes in ZCL morbidity in the areas, including the natural ZCL foci of Murgab delta landscapes, slightly differ from those in the areas with valley foci in the south part of the velayat in the duration and expression of cycles. At the same time sun-caused 11-year cycles are observed in all groups of the areas, though they are slightly more pronounced in the north than in the south. The greatest epidemic outbreaks (1956-1957, 1965, 1977, and 1986-1988) occurred in various areas of the Murgab oasis on an average of 1-3 years after the minimum of 11-year solar cycles. Noteworthy, they are greatly marked in odd solar activity cycles (the 1957 and 1977 outbreaks) in many areas. Among the parameters chosen, the radio flux of solar radiation at a wavelenght of 10.7 cm and the Wolf number (the correlation coefficients are as high as 0.30-0.50 at P = 0.95) are closely related with ZCL morbidity changes when the plot is shifted. At the same time the values of the geomagnetic Aa-index are unlikely to greatly affect changes in the epidemiological situation. The regularities revealed are of particular significance for long-term prediction of the greatest rises of ZCL morbidity rates. Taking into account the estimated solar activity changes within the next years, one may expect activation of natural ZCL foci and, in case of untimely use of prophylactic measures, the following rise in the population's morbidity in 1998-1999.

Disease Outbreaks↗
PubMed1997

Percutaneous nephrolithotripsy in the morbidly obese patient.

From 1989 to 1995, 530 patients underwent percutaneous nephrolithotripsy, of which 93 were identified as morbidly obese. A retrospective study was performed comparing results of nephrolithotripsy in patients with near normal ideal body weight versus those patients considered morbidly obese. Outcome parameters measured included size, configuration, and number of calculi, location and number of access sites required, stone-free rates, operative time, number of ancillary procedure, hospital stay, and complications. Stone number was similar between the normal weight and morbidly obese groups; however, the morbidly obese group had smaller stones treated percutaneously. Operative time was similar between the two groups if a single access was required, but then was significantly higher in the morbidly obese group if multiple access sites were necessary. Stone-free rates were not statistically different between normal weight versus obese patients (89% vs. 82%). However, hospital stay was longer (3.5 days vs. 4.4 days) and the overall rate of complications was higher (16% vs. 37%) in the morbidly obese group compared to normal weight group.

Adult↗
PubMed1998

[Morbid obesity: 130 consecutive patients with laparoscopic gastric banding].

Morbid obesity causes co-morbidity such as diabetes mellitus, hypertensive heart disease, sleep apnoea, degenerative bone diseases and increased incidence of malignancy. Life expectancy and quality of life are reduced significantly. Without adequate weight loss, treatment of co-morbidity remains symptomatic only. Surgical treatment of morbid obesity is the one therapy promising long-term success, since conservative procedures normally lead to recurrence of overweight. We performed laparoscopic gastric banding on 130 patients between 1.11.95 and 31.10.97. Mean overweight was 63 +/- 12.7 kg (SD), and mean BMI was 46.5 +/- 4.6 kg/m2. The average hospital stay was 5.5 +/- 1.5 days. 4 patients with postoperative pulmonary embolism were treated with oral anticoagulation. We performed 9 (6.9%) reoperations because of pouch dilatation or dorsal slipping with food intolerance in the first series of 70, and none in the second series of 60 patients. Median weight loss after 3 months was 14.7 +/- 4.2 kg, after six months 24.0 +/- 6.6 kg and after 12 months 33.2 +/- 8.5 kg, corresponding to excessive weight loss (EWL) of 55.9 +/- 14.8% in the first year. 14 (70%) of 20 patients with diabetes mellitus normalised and 6 patients with diabetes mellitus normalised and 6 patients showed improved blood sugar levels. All 36 patients with hypertensive heart disease had normalised blood pressure, 60% of them without further medical antihypertensive treatment after median EWL of 36%. Cholesterol levels normalised in 30 (57%) patients and improved in 20 (38%) after 6 months. Laparoscopic gastric banding is a suitable method for reducing weight in morbid obesity patients and provides a better quality of life in a group of patients who are carefully evaluated and followed. Reducing co-morbidity and improving ability to work have a positive economic impact on health care costs.

Adult↗
PubMed2005

Acute and late morbidity in the treatment of advanced bladder carcinoma with accelerated radiotherapy, carbogen, and nicotinamide.

BACKGROUND: Accelerated radiotherapy combined with carbogen and nicotinamide (ARCON) to overcome tumor hypoxia and cell proliferation achieved high tumor control and survival in Phase II studies of patients with advanced head and neck and bladder carcinomas. Thus, morbidity and treatment outcomes from the latter study were analyzed to evaluate the therapeutic potential of ARCON. METHODS: Acute and late morbidity was assessed in 105 patients with high-grade superficial or muscle-invasive bladder carcinoma who were given accelerated radiotherapy (50-55 grays in 4 weeks) with carbogen alone or with ARCON. Urinary dysfunction was scored based on daytime frequency, nocturia, incontinence, dysuria, hematuria, and urgency. Bowel morbidity was based on stool frequency and consistency, rectal discharge, blood loss, and medication. Endpoints for treatment outcome were overall survival, disease-free survival, and locoregional control. RESULTS: Nearly all patients experienced reduced ability to retain urine beyond 2 hours, although 20-30% had almost normal function at night. Incidence of acute moderate or worse dysuria was 41% with ARCON and 56% with carbogen; 96% and 76% of patients, respectively, had bowel frequencies > or = 3 times per day. By 10-12 weeks from the start of radiotherapy, acute reactions returned to baseline levels. At 3 years, the daytime frequency < or = 2 times per hour was approximately 75% in both arms. Incidence of severe hematuria (< or = 25%) and urinary urgency (< or = 16%) was much lower. No more than 6% of patients had severe bowel morbidity. With most assays, the differences between schedules were not significant either for acute or late morbidity. Local tumor control and survival rates at 3 years were 53% and 43%, respectively, for ARCON, similar to the rates for carbogen alone. CONCLUSIONS: Historical comparisons suggested no overt increase in normal tissue radiosensitivity when adding carbogen and nicotinamide. Although, for some endpoints, the incidence of late sequelae was higher than expected, overall morbidity was no worse than reported by others. The data indicated that ARCON could achieve a therapeutic gain in patients with advanced bladder carcinoma. A Phase III, randomized, multicenter trial is underway currently in the United Kingdom to evaluate these findings.

Adult↗
PubMed2005

The consequences of long-time arm morbidity in node-negative breast cancer patients with sentinel node biopsy or axillary clearance.

BACKGROUND: The aim was to evaluate long-time morbidity in breast cancer patients 3 years after sentinel node biopsy (SNB) or axillary clearance (AC) emphasizing the consequences of morbidity like work-related events and the need of physiotherapy. PATIENTS AND METHODS: Morbidity was evaluated in 92 breast cancer patients 3 years after SNB only and in 47 patients after AC using a questionnaire. The circumferences of the upper extremities and the range of the shoulder movements were also measured. RESULTS: Two SNB and eight AC patients were not able to use the ipsilateral upper extremity to former extent P < 0.005. One SNB and one AC patient were retired or on a long-time sick leave because of arm morbidity. Clinically apparent upper extremity lymphoedema was observed in one SNB patient and in six AC patients, P < 0.005. Two SNB patients had received manual lymph drainage, one of them because of breast oedema. Seven patients had received manual lymph drainage after AC, three of them wore also compression sleeve, P < 0.05 between AC and SNB. CONCLUSIONS: The risk of remarkable long-time arm morbidity after SNB is minimal. Work-related events seem uncommon due to arm morbidity, regardless of the extent of axillary surgery.

Adult↗
PubMed1996

Morbidity and mortality in patients with coronary artery disease undergoing orthotopic liver transplantation.

Thirty-two patients with coronary artery disease who underwent liver transplantation between 1990 and 1994 were identified. Coronary artery disease was managed medically (n = 9), by angioplasty (n = 1), or surgically (n = 22) prior to liver transplantation. Two patients underwent simultaneous coronary artery bypass grafting and liver transplantation. Complete preoperative cardiac evaluation was performed in all patients. Perioperative and postoperative morbidity and mortality were retrospectively determined. Overall mortality was 50%, whereas morbidity was 81%. Follow-up was between 1 and 3 years after liver transplantation. Subgroup analysis revealed that medically managed patients had a 56% mortality and a 100% morbidity. The patient who underwent angioplasty survived without morbidity. One patient who underwent simultaneous coronary artery bypass grafting and liver transplantation died intraoperatively. The second patient survived but required pacemaker insertion and inotropic agents postoperatively. The 20 patients with prior coronary artery bypass grafting had a 50% mortality and 80% morbidity. Further, analysis by United Network for Organ Sharing functional status revealed a higher than expected mortality in all groups. The morbidity and mortality associated with liver transplantation is significantly increased in patients with coronary artery disease and is equally high in medically and surgically treated patients. By comparison, patients without coronary artery disease have a 3-year survival of 55.4% (status I) to 79.7% (status III and IV). The increased intraoperative and postoperative risk in patients with coronary artery disease undergoing liver transplantation should be considered when determining the candidacy of these patients as well as when providing informed consent.

Adult↗
PubMed1990

Morbidity and mortality of hepatic resection for metastatic colorectal carcinoma.

Hepatic resection is the only curative therapy currently available for colorectal cancer metastases to the liver. However, concern over high morbidity and mortality of the procedure has limited referral of patients for resection. The authors report on 58 patients undergoing hepatic resection for colorectal metastases at the National Cancer Institute between the years 1976 and 1985. Thirty-two patients underwent a major hepatic resection, and 26 patients underwent one or more wedge resections. Mean anesthesia time was 448 minutes, mean estimated blood loss was 3663 ml, and mean hospital stay was 17.5 days. Operative mortality was 3 percent, and morbidity was 62 percent. Using a grading scale for complications, 24 percent of patients had inconsequential complications, 16 percent had moderate complications, and 19 percent had severe complications. Complications were clearly related to extent of procedure. Factors that correlated best with morbidity were high blood loss and trisegmentectomy. The authors conclude that while hepatic resection can carry a high morbidity, much of this morbidity is minor and operative mortality is low. Recent improvements in anesthesia, improved resection technique, and a better understanding of hepatic anatomy have made possible correspondingly lower morbidity and mortality rates. Careful selection of patients can make hepatic resection a safe procedure.

Anesthesia, General↗
PubMed2002

Sensory morbidity after sentinel lymph node biopsy and axillary dissection: a prospective study of 233 women.

BACKGROUND: We prospectively compared the sensory morbidity and lymphedema experienced after sentinel node biopsy (SLNB) and axillary dissection (ALND) over a 12-month period by using a validated instrument. METHODS: Patients undergoing breast-conserving therapy completed the Breast Sensation Assessment Scale (BSAS) at baseline and 3, 6, and 12 months after surgery. Repeated-measures analysis of variance was used to compare ALND and SLNB over the 12-month period. Upper- and lower-arm circumference measurements at baseline and 12 months were used to assess lymphedema. RESULTS: SLNB was associated with substantial sensory morbidity, although significantly less than ALND, over time on all four subscales and the summary score. A statistically significant improvement in sensory morbidity occurred for both groups in the first 3 months, with no further change thereafter. For both types of axillary surgery, younger patients had significantly higher BSAS scores than older patients. There was no significant difference in arm circumference between patients with SLNB and ALND at 12 months. CONCLUSIONS: Among women undergoing breast-conserving therapy, SLNB has significant sensory morbidity, although approximately half that of ALND. Sensory morbidity improves in the first 3 months after surgery, but patients continue to report sensory morbidity at 1 year. Longitudinal follow-up is required to further assess lymphedema.

Adult↗
PubMed2001

Results of a screening survey for co-morbid substance misuse amongst patients in treatment for psychotic disorders: prevalence and service needs in an inner London borough.

BACKGROUND: There is great concern in the UK, and other countries, about the clinical management of psychosis and substance misuse co-morbidity. However, relatively little is known about the UK prevalence and management of co-morbidity. METHOD: We implemented a screening survey of patients who were in treatment with an inner London adult mental health service and measured the prevalence of substance misuse amongst 851 psychotic patients. Caseworkers reported substance misuse and assessed clinical management arrangements. RESULTS: Current prevalence of substance misuse was 24.4% (95% CI: 21.3-27.1). Rates of co-morbidity were higher in males (31% vs 16%, chi2 1df=26.0, P < 0.001) and patients over 51 (chi2 3df=50.1, P < 0.001). Adjusted odds of co-morbidity in patients under 51 were 0.19 (95% CI: 0.10-0.34) and 0.47 for females (95% CI: 0.32-0.69). Substance misuse interventions were provided to 20% of co-morbid patients--Only 5% were compliant. CONCLUSIONS: The findings suggest substance misuse may be highly prevalent amongst psychotic patients. Most co-morbid patients do not receive appropriate treatment. The development of evidence-based interventions should be a priority.

Adolescent↗
PubMed2001

Donor site morbidity after microvascular fibula transfer.

The free microvascular fibula and soft tissue transfer has become a widely used method to reconstruct the head and neck region. Only few reports focus on the donor site morbidity of purely mandibular reconstructions. On the basis of the hospital charts, a standardized patient interview and a standardized physical examination, the present study evaluates the early and late donor site morbidity in 42 mostly oncologic patients after an average follow-up interval of 34 months. Of these, 16 patients (38.1%) exhibited complicated wound healing that did not correlate with the patient's age, sex, type of transplant, use of a skin graft, result of preoperative angiography, rate of postoperative mobilization or the incidence of late donor site morbidity. At the time of follow-up examination, about one-fourth of the patients reported discomfort, pain or swelling. Objective findings included sensory deficits in 76.3%, motor deficits in 39.5% and reduced strength in 44.7% of the patients. Even though objectively measured morbidity exceeded subjectively perceived morbidity, it can be concluded that there is significant early and late donor site morbidity, which should be considered when opting for a fibula graft. Patients should be informed accordingly.

Adolescent↗
PubMed1995

Influence of ejection fraction on hospital mortality, morbidity, and costs for CABG patients.

BACKGROUND: Preoperative ejection fraction (EF) has been shown to adversely affect postoperative hospital mortality and morbidity for patients undergoing isolated coronary artery bypass grafting. METHODS: To investigate influence of EF on isolated coronary artery bypass grafting outcomes (overall hospital mortality, hospital cardiac mortality, hospital morbidity, and hospital costs), data were reviewed from 1,354 consecutive patients who underwent isolated coronary artery bypass grafting between January 1, 1990, and April 30, 1992, at a single nonprofit hospital. Overall hospital mortality was 4.06% (cardiac, 2.36%). Hospital morbidity was 14.25% (including mortality). Hospital costs (not charges) averaged $16,673 per patient. To explore the impact of preoperative EF, EF was stratified into regular intervals. Each interval was then compared with regard to hospital mortality, morbidity, and average costs. A new statistical tool, discharge analysis, was developed to analyze the cost data. This was necessary because previous efforts at cost analysis have used tools inappropriate for real world cost data. RESULTS: The statistical analysis showed that patients with EF of 0.40 or greater had the best outcomes (lowest mortality, morbidity, and cost). Once the EF is 0.40 or greater the EF does not carry further predictive value. At EF less than 0.40, patients with EF less than 0.30 have a poorer outcome than patients with EF of 0.30 to 0.39. CONCLUSIONS: (1) Ejection fraction is a valid predictor of mortality, morbidity and resource utilization based on statistical analysis. (2) Patients can be broadly grouped as having EF greater than 0.40, less than 0.30, or from 0.30 to 0.39 with regard to clinical and cost outcomes. (3) Postoperative length of stay is not predicted by risk-adjusted EF. (4) A new tool, discharge analysis, is presented to facilitate cost analysis.

Aged↗
PubMed1987

Family morbidity in chronic pain patients.

Family morbidity in chronic pain patients could indicate genetic vulnerability to depressive spectrum disorders or presence of pain behaviour models. Assessment of family morbidity is an area of chronic pain research which has been neglected. In the present study, the frequency and nature of the family psychiatric morbidity of 203 consecutive chronic pain patients has been assessed and compared with that of 140 non-pain psychiatric patients. 30% of chronic pain patients and 33.6% of non-pain psychiatric patients had family psychiatric morbidity. The commonest illness in families of pain patients were found to be alcoholism, psychosomatic disorders and chronic pain. Schizophrenia and affective disorders were reported significantly more often in families of non-pain patients. 53% of psychogenic pain disorder patients had a positive family morbidity. Alcoholism among male relatives, and chronic pain and hypertension more often among female relatives, was another significant observation. No significant difference was found between chronic pain patients with and without family morbidity with regard to socio-demographic variables and clinical diagnosis.

Adolescent↗
PubMed1996

Carcinoma of the uterine cervix. II. Lack of impact of prolongation of overall treatment time on morbidity of radiation therapy.

PURPOSE: Several reports document a negative impact of prolongation of overall treatment time in a course of irradiation on tumor control and survival. A correlation has been documented of incidence of significant treatment sequelae with increasing doses of irradiation, volume of the specific organ, and dose per fraction. However, no data were found on the potential correlation of overall irradiation treatment time with significant sequelae. METHODS AND MATERIALS: Records were reviewed of 1,269 patients with carcinoma of the cervix (Stage IB to HI) treated with definitive irradiation (combination of external beam and two intracavitary insertions). Follow-up was obtained in 97% of patients (median, 12 years; minimum, 3 years; maximum, 28 years). The relationships between overall treatment time and time of brachytherapy and incidence of treatment sequelae were analyzed for each stage. RESULTS: Overall incidence of Grades 2 (moderate) sequelae was 7% and of Grade 3 (severe) sequelae, 11%. There was no significant correlation of various incidences of Grade 2 and 3 sequelae with overall treatment times (8% in patients treated in less than 7 weeks, 9% in 7.1 to 9 weeks, and 12% when treatment time was longer than 9 weeks) (p = 0.08). In patients with Stage IB and IIA tumors, incidence of rectal toxicity (mostly proctitis) was comparable in patients treated in less than 7 or 7.1 to 9 weeks (4.1 and 6%, respectively) and slightly higher in those treated in longer periods (11.5%) (p = 0.24). In patients with Stage IIB and III, the incidence of Grade 2 and 3 small bowel morbidity was 2% in those treated in less than 7 weeks, 6% for 7.1 to 9 weeks, and 4.9% for longer times (p < or = 0.01). This increased morbidity was also correlated with total dose of irradiation to the lateral pelvic wall: 5 of 257 (2%) for less than 60 Gy and 21 of 438 (4.8%) for higher doses (p < or = 0.01). There was no significant correlation between the timing of brachytherapy (usually two low dose rate intracavitary insertions performed within 4.5 to 6.5 weeks of initiation of external beam therapy) and significant treatment sequelae. CONCLUSIONS: We observed a varied average incidence of Grade 2 and 3 morbidity in the bladder, rectum, and small intestine with different overall treatment times, without a definite pattern to suggest an impact of prolongation of treatment time on morbidity. Likewise, there was no significant correlation with the timing of intracavitary insertions and morbidity of therapy. Because prolongation of the overall treatment time has a well-documented detrimental effect on pelvic tumor control and survival in carcinoma of the cervix with no significant impact on morbidity, it is imperative to deliver radiation therapy in the shortest possible time and without schedule interruptions.

Aged↗
PubMed1996

Impact of preoperative risk and perioperative morbidity on ICU stay following coronary bypass surgery.

Prolonged intensive care unit treatment (> 3 days) contributes to increased health costs and resource utilization. In order to devise strategies to limit intensive care unit stay, and provide cost-effective medical care, it is necessary to identify the pre- and perioperative risk factors of prolonged treatment. Over 100 potential risk variables were collected prospectively in 889 consecutive patients undergoing isolated coronary bypass surgery between 1990 and 1992. The incidence of intensive care unit therapy lasting > 3 days was 6.8%. Univariate statistics identified 23 pre- and perioperative variables that were potential contributors to prolonged intensive care unit therapy. However, multivariate analysis of preoperative risk variables identified only recent myocardial infarction (within 30 days of surgery) and continued preoperative smoking (within 30 days of surgery) to be independent risk factors. Only 6.3% of patients without preoperative myocardial infarction and 6.1% of non-smokers required prolonged intensive care unit treatment, compared with 14.8% of patients with preoperative myocardial infarction (P = 0.01) and 10.1% of smokers (P = 0.07). When multivariate analysis was repeated with both pre- and perioperative variables, only ischemic morbidity (inotropes, myocardial infarction and low-output syndrome; 138 patients) and non-ischemic morbidity (infection, stroke or bleeding; 37 patients) predicted prolonged intensive care unit treatment. Intensive care unit treatment for > 3 days occurred in 26.8% of patients with ischemic morbidity compared with 3.2% of patients without ischemic morbidity (P = 0.001). Prolonged intensive care stay occurred in 32.4% of patients who suffered non-ischemic complications compared with 5.7% of patients who did not suffer these complications. The multiple logistic regression analysis odds ratio for ischemic morbidity was 7.4 (95% c.i. 4.0-13.4) compared with 4.8 (95% c.i. 1.9-10.1) for non-ischemic morbidity. Strategies designed to reduce the incidence of prolonged intensive care unit treatment should include prevention of stroke, infection and bleeding. However, the greatest reduction of intensive care unit utilization would be mediated by prevention of ventricular dysfunction secondary to myocardial ischemia or inadequate myocardial preservation.

Adult↗
PubMed2004

Morbidity, mortality, physiologic and functional parameters in elderly and non-elderly patients in the Valsartan Heart Failure Trial (Val-HeFT).

BACKGROUND: The Valsartan Heart Failure Trial (Val-HeFT) demonstrated the favorable effects of the addition of valsartan to prescribed heart failure (HF) therapy on HF hospitalization, and functional and physiological parameters. As the prevalence of HF morbidity and mortality are increased in the elderly, the effect of valsartan in the elderly is of clinical significance. METHODS: In this post-hoc analysis, morbidity, mortality, left ventricular (LV) size and function, brain natriuretic peptide (BNP), aldosterone, norepinephrine (NE), quality of life, and treatment effect with valsartan were examined by subgroups of 2350 elderly (>or= 65 years) and 2660 non-elderly (< 65 years) patients enrolled in Val-HeFT. RESULTS: While the overall incidence of morbidity and mortality was higher in the elderly, valsartan produced beneficial effects in reducing risk of morbidity in the elderly by 11.8% (P = .07), and the non-elderly by 14.6% (P = .09). Valsartan had no effect on mortality compared to placebo in the non-elderly, 15.2% vs 15.0% (P = .87), and elderly, 25.1% vs 24.0%, (P = .64). Valsartan had statistically significant beneficial effects in both the elderly and non-elderly on LV size and function, BNP, aldosterone and quality of life. Beneficial effects on NE were also observed with valsartan in both subgroups with statistically significant reductions produced in the non-elderly. CONCLUSIONS: Val-HeFT demonstrated that elderly patients present with more advanced HF as evidenced by higher morbidity and mortality along with greater neurohormonal activation. In Val-HeFT, valsartan produced a consistent beneficial effect on morbidity, LV function and size, quality of life, and neurohormonal levels in both the elderly and non-elderly.

Adult↗