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PubMed2006

Thyroid function in humans with morbid obesity.

Morbidly obese subjects may present with abnormal thyroid function tests but the reported data are scarce. Therefore, we studied the thyroid parameters in 144 morbidly obese patients, 110 females and 34 males, to assess the prevalence of hypothyroidism. Eleven percent (11.8%) carried the diagnosis of hypothyroidism and were undergoing levothyroxine (LT4) replacement therapy, 7.7% had newly diagnosed subclinical hypothyroidism, 0.7% had subclinical hyperthyroidism and 7.7% were euthyroid with positive antibodies (anti-thyroid peroxidase antibodies [TPOAb]). From the 144 subjects, we selected a cohort of 78 euthyroid subjects with negative TPOAb, who did not receive LT4 replacement or suppression therapy (the experimental group) and compared them to 77 normal-weight euthyroid subjects, TPOA-negative, matched for age and gender who served as controls. The experimental group had higher serum levels of triiodothyronine (T3), thyroxine (T4), free triiodothyronine (FT3), and thyrotropin (TSH) compared to the control group. Serum TSH concentration was associated with fasting serum insulin levels and insulin resistance but not with serum leptin levels, body mass index (BMI), fat mass, and lean body mass. In conclusion, in morbidly obese individuals, the prevalence of overt and subclinical hypothyroidism was high (19.5%). The morbidly obese subjects have higher levels of T3, FT3, T4, and TSH, probably the result of the reset of their central thyrostat at higher level.

Adult↗
PubMed1992

Strategies for reduction of morbidity.

The future health of our increasingly senior populations depend upon the interrelationship between two critical points: the onset time of the first major disease, infirmity, or disability and the time of death. Reduction of morbidity requires compressing the average period between these points and reducing the average level of morbidity during this period. The goal of compression of morbidity currently is being achieved in some areas. Life expectancy increases in the United States above age 65 y have plateaued, with further increases becoming ever more difficult. Some major chronic diseases, such as atherosclerosis and lung cancer, now occur later in life. Work disability prevalence has begun to decline. Intergenerational comparisons demonstrate improved health at specific ages. Randomized-controlled trials of primary prevention have failed to decrease total mortality in risk subjects while markedly decreasing the morbidity experienced by the same subjects. Compression has been documented for higher socioeconomic class subpopulations. These observations have major implications for health policy and mandate initiatives directed at prevention of disability and infirmity.

Age Factors↗
PubMed1995

Vitamin A supplementation and morbidity among preschool children in south India.

A randomized, double-blind, placebo-controlled trial was conducted in an ongoing Growth Monitoring Research project in TamilNadu, India, to assess the impact of high-dose vitamin A supplementation on morbidity among mildly to moderately malnourished children aged < 3 y. Every 4 mo, the treatment group received 60 mg vitamin A (200,000 IU) whereas the control group received a placebo. Cases of xerophthalmia and severe malnutrition were excluded. Anthropometric measurements and serum retinol determinations were made at baseline and at the end of 1 y. Morbidity data were collected by trained village-level workers throughout the study period by using the weekly recall method. The two groups had similar nutritional status, serum retinol concentrations, age-sex composition, and other sociodemographic indicators at baseline. The mean number of episodes per child-year was 2.62 +/- 2.95 and 2.56 +/- 2.5 for respiratory illness and 1.9 +/- 2.2 and 1.77 +/- 1.77 for diarrhea for the vitamin A (n = 309) and placebo (n = 274) groups, respectively. The differences in respiratory and diarrheal morbidity between the two groups were not statistically significant and these findings remained unaltered after multivariate analysis in which the effects of age, sex, socioeconomic status, sanitation, etc, were considered. These findings are similar to other recent findings and indicate that vitamin A supplementation does not reduce common morbidity in children with mild-to-moderate vitamin A deficiency in areas where access to health care and immunization are good.

Analysis of Variance↗
PubMed1998

Randomized placebo-controlled clinical trial of the effect of a single high dose or daily low doses of vitamin A on the morbidity of hospitalized, malnourished children.

The effect of high-dose vitamin A supplementation on recovery from morbidity and on recovery from nosocomial morbidity of hospitalized children has been poorly studied and results are conflicting. The effect of daily, low doses has never been assessed. We investigated the effect of a single high dose and daily, low doses of vitamin A on diarrhea, acute lower respiratory tract infections (ALRIs), and all-cause fevers in 900 hospitalized preschool-age children in the Democratic Republic of Congo in a randomized, double-blind, placebo-controlled clinical trial. The high-dose treatment group received 200,000 IU vitamin A (100,000 IU if aged <12 mo) orally on the day of admission, the low-dose treatment group received 5000 IU vitamin A/d until discharge. Data on all-cause morbidity were collected daily. Mortality rates were not significantly different among the 3 groups. High-dose vitamin A supplementation had no significant effect on the duration of moderate or severe diarrhea nor on the duration and incidence of ALRIs and all-cause fevers. Children in the high-dose group with no edema had an increased risk of severe nosocomial diarrhea (relative risk: 2.42; 95% CI: 1.15, 5.11). Low-dose vitamin A supplementation significantly reduced the incidence of severe diarrhea in severely malnourished children (relative risk: 0.21; 95% CI: 0.07, 0.62) but showed no significant effect on the duration of moderate or severe diarrhea or on the duration and incidence of ALRIs and all-cause fevers. Supplementation with high doses of vitamin A did not reduce morbidity in this population of malnourished and subclinically vitamin A-deficient children; daily, low doses appeared more beneficial for severely malnourished children.

Child↗
PubMed2004

Randomized controlled trial of the effect of daily supplementation with zinc or multiple micronutrients on the morbidity, growth, and micronutrient status of young Peruvian children.

BACKGROUND: Zinc supplements reduce childhood morbidity in populations in whom zinc deficiency is common. In such populations, deficiencies in other micronutrients may also occur. OBJECTIVE: The objective was to determine whether the administration of other micronutrients with zinc modifies the effect of zinc supplementation on children's morbidity and physical growth. DESIGN: Two hundred forty-six children aged 6-35 mo with persistent diarrhea were randomly assigned to 1 of 3 groups to receive a daily supplement of 10 mg Zn alone (Zn; n = 81), zinc plus vitamins and other minerals at 1-2 times recommended daily intakes (Zn+VM; n = 82), or placebo (n = 83) for approximately 6 mo after the diarrhea episode ended. Morbidity information was collected on weekdays. Weight, length, and other anthropometric indicators were measured monthly, and plasma zinc and other indicators of micronutrient status were measured at baseline and 6 mo. RESULTS: Supplement consumption was high ( approximately 90%) in all groups, although slightly more vomiting was reported in the Zn+VM group (P < 0.0001, analysis of variance). The change in plasma zinc from baseline to 6 mo was greater in the 2 zinc groups (6.1, 27.3, and 16.2 micro g/dL in the placebo, Zn, and Zn+VM groups, respectively; P < 0.0001, analysis of variance). The Zn group had fewer episodes of diarrhea, dysentery, and respiratory illness and a lower prevalence of fever and cough than did the Zn+VM group and a lower prevalence of cough than did the placebo group (P = 0.05). No significant effects of supplementation on growth were observed. CONCLUSION: Morbidity was greater after supplementation with zinc plus multivitamins and minerals than it was after supplementation with zinc alone.

Anthropometry↗
PubMed2004

Survival in nephroblastoma treated according to the trial and study SIOP-9/GPOH with respect to relapse and morbidity.

BACKGROUND: Recent Wilms' tumor (WT) trials and studies have tried to determine the minimal therapy needed for cure. The goal was survival without morbidity. PATIENTS AND METHODS: From January 1989 to March 1994 the German Society of Pediatric Oncology and Hematology registered 440 patients (median age 2.9 years; 231 male, 209 female) with WTs (preoperative chemotherapy 362) for therapy according to the International Society of Pediatric Oncology Trial and Study 9. Therapy for relapse depended on site of relapse and therapy already received. Follow-up included inquiries for morbidity. Prognostic factors for relapse and death were evaluated. RESULTS: Five-year survival of WTs was 89.5%; 98.2% (385 of 392) of survivors had a follow-up of 5 years (range 0.8-12.6; median 8). In non-anaplastic WTs, young age (<2 years) was of significance (P = 0.026) for a better survival. Non-anaplastic WTs (407 patients) had a 5-year survival of 92.3%, versus 48.5% in anaplastic WTs (33 patients), and a 5-year relapse-free survival of 87.6% versus 42.4%. Survival after relapse was significantly worse for anaplastic than for non-anaplastic WTs (residual 3-year survival 11.8% versus 54.3%; P <0.0001). In preoperatively treated WTs, anaplasia was a strong prognostic factor for death [relative risk (RR) 4.7], followed by poor response to preoperative therapy (RR 3.6), stage IV (RR 3.2) and abdominal stage III (RR 2.2). Low abdominal stages (<III) dominated (280 versus 82). In the 334 unilateral stage I-IV WTs (median age 3.2 years), diffuse anaplasia (21 patients) had a 5-year relapse-free survival of 38.1%, versus 58.4% in blastemal WTs (25 patients); survival was 42.9% in diffuse anaplasia versus 84% in blastemal WTs. None of 46 patients (median age 1.9 years; 91.3% stages I or II) with differentiated WTs (nine epithelial, 37 stromal) relapsed despite their non-response; two died (one therapy related, one due to bilaterization). In the 25 non-anaplastic bilateral WTs, differentiated cases (one epithelial, eight stromal, 33.3% abdominal stage III) were more frequent (P = 0.048) than in unilateral WTs (one stromal, abdominal stage III relapsed). In all, 52.9% of the 5-year survivors had received adriamycin (250-400 mg/m(2)), 25.7% radiation, 6.4% ifosfamide (24-30 g/m(2)) and 6.7% carboplatin plus etoposide. Abnormal parameters according to the National Cancer Institute score were seen in 18.9% during follow-up, but only 6.4% were treated for morbidity at the end of follow-up. Three WTs developed renal failure due to Drash syndrome, but none due to tumor therapy. After adriamycin 1.9% of WTs (9% of those receiving 400 mg/m(2)) required therapy for cardiac toxicity. CONCLUSIONS: Initial therapy should be more individualized, taking the above risk groups (age in non-anaplastic WTs, poor response, anaplasia, etc.) into account, as morbidity even after relapse therapy with ifosfamide, carboplatin and etoposide was not high. Milder therapy in low stages of differentiated and of well responding WTs should be tested.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1998

One-day general practice morbidity survey in Sri Lanka.

BACKGROUND: National morbidity surveys provide valuable data for monitoring the health needs of populations, health policy planning and design of medical curricula. In order to meet a long-standing need for such information in Sri Lanka, a nationwide general practice morbidity survey was conducted for the first time in 1996. OBJECTIVES: We aimed to identify people's needs by determining the reasons for encounter or the demand for care with GPs/family physicians, to illustrate the pattern of morbidity in general practice and to determine the average daily workload of GPs in Sri Lanka. METHOD: A random sample of 75 GPs were requested to complete a Practitioner Profile Questionnaire (PPQ) and to record on an encounter form (EF) the reason/s for encounter (RFE) and problems managed during all consultations on 4 July. Central coding of the RFEs and problems defined was done using the International Classification of Primary Care (ICPC). RESULTS: Forty GPs (53.3%) completed the PPQ, while the EF received a response from 34 (43.3%). The GP profile showed a male to female ratio of 7:1, none below 35 years and none qualified after 1984. The average daily workload was 74. It was estimated that GPs handle at least 26.5% of the primary care morbidity. Children accounted for 32% of consultations. There was a significantly higher proportion of children (P < 0.0001) and of the elderly (P < 0.05) in the consulting population compared with the general population. In 2068 encounters, 3448 RFEs and 2087 problems had been recorded. Respiratory and General chapters included 55% of the RFEs. By ICPC rubrics, 27 of the top thirty RFEs were for common symptoms. In addition to acute illnesses, asthma, hypertension and diabetes as well as preventive care activities were within the top 12 problems managed. CONCLUSIONS: The fact that many common illnesses, chronic diseases and preventive treatments are dealt with in general practice shows the necessity to include family medicine in the undergraduate curriculum of all medical schools. Undergraduate and postgraduate training in family medicine should concentrate more on child care and care of the elderly. Suitable incentives may be necessary to motivate younger doctors to become GPs to meet the medical care needs of the community.

Adolescent↗
PubMed1992

An evaluation of a nurse-run asthma clinic in general practice using an attitudes and morbidity questionnaire.

A before and after longitudinal study was conducted to evaluate a nurse-run asthma clinic in general practice. Sibbalds morbidity and attitudes questionnaire was used to monitor the changes in association with attendance at the clinic. One hundred and five patients aged 3-83 years attended the clinic. Over the 12 months of the study patients reported significant reductions in attacks of wheeze, nocturnal attacks, overall trouble (P eta 0.005) and GP home visits (P = 0.02). Patients also reported a significant improvement in feelings of stigma (P less than 0.001), and confidence in self-care (P less than 0.001). There was a significant association between morbidity criteria such as 'overall interference' and stigma at the outset of the clinic (R = -0.44; P less than 0.001; 95% confidence interval -0.58 to -0.26). A patient's feelings of stigma towards their asthma at the outset did not predict the eventual improvement in morbidity. As the patient's asthma improved the feelings of stigma became less apparent. This would suggest that improving a patient's morbidity should be one of the first priorities in asthma care. Confidence in the doctor was high at the outset and did not change throughout the study, despite the fact that a large proportion of patients wanted more information about their asthma but found it difficult to talk to their doctor. General practitioners are often restrained by how much time and resources they can devote to each patient. The nurse-run asthma clinic with its programme of structured care represents a possible solution to these problems.

Adolescent↗
PubMed2004

Quality of morbidity coding in general practice computerized medical records: a systematic review.

BACKGROUND: Increased use of computers and morbidity coding in primary care delivery and research brings a need for evidence of the quality of general practice medical records. OBJECTIVE: Our aim was to assess the quality, in terms of completeness and correctness, of morbidity coding in computerized general practice records through a systematic review. METHODS: Published studies were identified by searches of electronic databases and citations of collected papers. Assessment of each article was made by two independent observers and discrepancies resolved by consensus. Studies were reviewed qualitatively due to their heterogeneity. RESULTS: Twenty-four studies met the inclusion criteria for the review. There was variation in the methodology and quality of studies, and problems in generalizability. Studies have attempted to assess the completeness and correctness of morbidity registers by reference to a gold standard such as paper notes, prescribing information or diagnostic tests and procedures, each of which has problems. A consistent finding was that quality of recording varied between morbidities. One reason for this may be in distinctiveness of diagnosis (e.g. coding of diabetes tended to be of higher quality than coding of asthma). CONCLUSIONS: This review highlights the problems faced in assessing the completeness and correctness of computerized general practice medical records. However, it also suggests that a high quality of coding can be achieved. The focus should now be on methods to encourage and help practices improve the quality of their coding.

Disease↗
PubMed1998

The relation between morbidity and cognitive performance in a normal aging population.

BACKGROUND: Factors related to physical health have been implicated in both normal and pathological aging of cognitive abilities. To substantiate this notion, we studied existing morbidity, as diagnosed by the general practitioner according to well-defined criteria, as a potential predictor of cognitive test performance. METHODS: A sample of 1360 individuals, aged 24-81 years and living in the community, was stratified for age, sex, and general ability. Active and total morbidity in this group were classified according to the International Classification of Primary Care. Neurocognitive tests were used to assess the domains of verbal memory, sensorimotor speed, and cognitive flexibility. RESULTS: Multiple regression analyses with adjustment for age, sex, and educational level showed both insulin-dependent and noninsulin-dependent diabetes to be negatively associated with all cognitive measures. More specific negative associations were found for chronic bronchitis (performance speed) and presbyacusia (memory). Single or aggregated cardiovascular morbidity (including hypertension) was unrelated to test performance. CONCLUSIONS: Existing morbidity as a whole contributes only modestly (up to 3.5%) to total variance in cognitive function. However, some specific, relatively common diseases of the elderly, such as diabetes and chronic bronchitis, may aggravate the age-related decline in cognitive ability.

Adult↗
PubMed1979

Quantity and variation in morbidity: THAID-analysis of the occurrence of gastroenteritis among Ethiopan children.

Morbidity figures from a one-year longitudinal child health study comprising 749 children in an urban area in Ethiopia are reported. Aggregated morbidity measures, based on frequency distributions according to morbidity level, demonstrate gastroenteritis among infants and young preschool children as a quantitatively important morbidity problem. Variation in the occurrence of gastroenteritis is studied among 390 children under 5 years by means of a multi-variate method, THAID-analysis, designed for a categorical or, as in this study, a categorized criterion variable. The results indicate that variables expressing nutrition, housing, hygiene and sanitation are dominating predictors of childhood diarrhoeal disease.

Age Factors↗
PubMed2006

Morbidity in expatriates--a prospective cohort study.

BACKGROUND: Expatriates comprise an important, but rarely studied subset of international travellers. This study was performed to assess the incidence of health events in an expatriate group and to evaluate factors affecting this incidence. METHODS: A cohort of 2020 Foreign and Commonwealth Office (FCO) staff and partners living abroad were followed-up over 1 year. The main outcome measure was incidence of illness or injury serious enough to require consultation with a doctor. Data collection was by means of a self-administered questionnaire. Poisson regression was used to estimate the rates of health events and to test for association between health events and a number of independent variables. RESULTS: The incidence of health events was 21%. Trauma (incidence 5%), musculoskeletal disorders (incidence 4%) and infectious disease (incidence 3%) were the principal causes of morbidity. The incidence of psychological disorders was low (1%). Of significance, employees were at increased risk of morbidity when compared to partners, with a higher incidence of health events [incidence rate ratio (IRR) 1.4, 95% CI 1.1-1.9] and psychological disorders (IRR 5.9, 95% CI 1.0-34.1). Moreover, unaccompanied employees were at increased risk of health events (IRR 1.3, 95% CI 1.0-1.7), and of traumatic injury (IRR 2.3, 95% CI 1.3-4.3) when compared to accompanied employees. CONCLUSION: While the morbidity in FCO personnel is low in comparison to other expatriate groups, the higher risk of morbidity in employees and unaccompanied individuals merits further research, particularly to ascertain whether work demands, isolation or risk-taking behaviour are contributory factors.

Adult↗
PubMed1998

Measuring the burden of common morbidities: sampling disease experience versus continuous surveillance.

Longitudinal prevalence, the proportion of all days of observation that a given individual manifests symptoms of illness, is a measure of disease frequency that is easy to generate from daily morbidity data and has been shown to be strongly related to subsequent health outcome. It is hypothesized that this measure could be derived using a representative sample of days of observation rather than continuous surveillance. The authors use 1990-1991 data from a Brazilian supplementation trial comprising a year's daily records of the occurrence of diarrhea, fever, and cough in 906 children under 5 years of age to examine how many days of morbidity data need to be observed to rank subjects into quintiles of illness frequency. Systematic samples of the full data set, based on every 2nd, 3rd, 5th, 10th, 15th, 20th, and 30th day of data, are compared with the continuous record. For diarrhea and fever, estimates based on less than 72 days of observation result in over one fourth of individuals who should have been in the extreme quintiles of the morbidity distribution being misclassified, and over one fifth of all subjects appear (falsely) to suffer no morbidity. Estimates of longitudinal prevalence should be based on at least 72 days of observation.

Brazil↗
PubMed1998

Long term mortality and morbidity related to degree of damage following the 1998 earthquake in Armenia.

To assess the relation of increased mortality and morbidity to personal loss and damage following the 1988 earthquake in Armenia, the authors conducted a prospective study of mortality and a nested case-control analysis of incident morbidity. Employees of the Armenian Ministry of Health and their immediate families (n = 35,043) who survived the disaster formed the study population. Two sets of interviews with the employees, carried out over a period of 4 years of follow-up, were used as the primary source of data for this study. The highest numbers of deaths from all causes and from heart disease were observed within the first 6 months following the earthquake. The nested case-control analysis of 483 cases of newly reported heart disease and 482 matched non-heart-disease controls revealed that people with increasing levels of loss of material possessions and family members had significant increases in heart disease risk (odds ratios for "loss scores" of 1, 2, and 3 were 1.3, 1.8, and 2.6, respectively). The findings were similar with regard to the relation of damage and loss to newly reported hypertension, diabetes mellitus, and arthritis. The findings of this study support the hypothesis that longer term increased rates of heart disease and chronic disease morbidity following an earthquake are related to the intensity of exposure to disaster-related damage and losses. People sustaining such losses should be closely monitored for increased long term morbidity.

Adolescent↗
PubMed1999

Calorie restriction in nonhuman primates: mechanisms of reduced morbidity and mortality.

Long term chronic calorie restriction (CR) of adult nonhuman primates significantly reduces morbidity and increases median age of death. The present review is focused upon an ongoing study of sustained adult-onset calorie restriction, which has been underway for 15 years. Monkeys, initially calorie restricted at about 10 years of age, are now approximately 25 years old. The median life span of these restricted monkeys is increasing, now exceeding that of ad libitum (AL)-fed monkeys. In our laboratory, maximum life span for AL-fed monkeys appears to be about 40 years. Thus, whether CR can also increase maximal life span, as it does in rodents, cannot be determined for at least another 15 years. The earliest detectable positive benefit on morbidity in these monkeys was previously reported as the prevention of obesity. Current evidence, as reviewed here, suggests that much obesity-associated morbidity is also mitigated by sustained calorie restraint in nonhuman primates. Furthermore, probably because of the prevention of obesity, diabetes has also been prevented. Recent findings include the identification of extraordinary changes in the glycogen synthesis pathway, and on the phosphorylation of glycogen synthase in response to insulin. This calorie restriction-induced prevention of morbidity does not require excessive leanness, but is clearly present when body fat is within the normal range of 10 to 22%, and this is likely to be true in humans as well.

Animals↗
PubMed2000

Morbidity and risk factors of diarrheal diseases among under-five children in rural Upper Egypt.

Diarrhea is a leading cause of mortality and morbidity in developing countries. In Egypt, researchers have traditionally been targeting diarrhea-related mortality. This study is an attempt to portray the morbidity and risk factors of diarrhea among children under 5 years old (under-fives) in rural Upper Egypt. The incidence of diarrhea in the 6 months before the study was determined among 1025 under-fives in six sentinel sites by interviewing mothers or caretakers. The association between diarrhea and a set of risk variables was examined using a multivariate logistic regression model. Variables that appeared to have a significant predictive power were then included in a forward wald stepwise logit analysis model to estimate statistical functions which best predict the diarrheal morbidity. The incidence rate of diarrhea was found to be 3.6 episodes per child semiannually and the point prevalence was 19.5 per cent. The average duration of current episodes was 4.8 +/- 3.7 days; 33.6 per cent of children had had diarrhea more than three times (recurrent diarrhea). Four variables were found to have a significant association with recurrent diarrhea. The logit coefficients and their significance levels indicated that, in order of contribution to risk prediction, the variables ranked as follows: household meat consumption, mother's age at the time of birth of the child, child's age, and father's illiteracy. A total of 74.8 per cent of overall children were correctly predicted by these risk factors, a figure which indicates the goodness of fit of the model. It is concluded that the diarrheal morbidity is still unacceptably high in rural Upper Egypt. More interventions are needed to control for specific risk factors.

Age Distribution↗
PubMed2005

Child morbidity and healthcare utilization in the slums of Nairobi, Kenya.

Rapid urbanization and inequitable distribution of social services in African cities significantly contribute to the current deterioration of child health indicators in the region. Determinants of child morbidity and healthcare utilization among slum residents in Nairobi City, Kenya were assessed. Using a morbidity surveillance system, we visited 1691 households every 90 days for 9 months and registered 696 children below 5 years. 264 (37.9 per cent) children were reported to have been sick or injured at least once during the study period. A total of 447 illness episodes were reported among the 264 children (an average of 1.7 episodes per child). Cough, fever, diarrhea, skin problems and eye diseases made up the top five causes of morbidity. Child age below 1 year (OR=2.7; 95 per cent CI=1.33, 5.49) and having a working-mother (OR=2.0; 95 per cent CI=1.19, 3.31) were significantly associated with child morbidity report. About half of the mothers sought proper medical care for their sick children mostly from health institutions located outside the slum. Healthcare seeking within the slum heavily relied on informal private clinics. Working mothers sought medical care more often than non-working mothers (OR=0.29; 95 per cent CI=0.12, 0.7) and infants got priorities compared to older sick children (OR=0.2; 95 per cent CI=0.05, 0.83). We conclude that maternal engagement in non-formal low-paying jobs might in the long-run have a questionable gain in child survival among slum residents.

Age Distribution↗
PubMed1993

Perioperative morbidity in patients randomized to epidural or general anesthesia for lower extremity vascular surgery. Perioperative Ischemia Randomized Anesthesia Trial Study Group.

BACKGROUND: Perioperative morbidity may be modifiable in high risk patients by the anesthesiologist's choice of either regional or general anesthesia. This clinical trial compared outcomes between epidural (EA) and general (GA) anesthesia/analgesia regimens in a group of patients at high risk for cardiac and other morbidity who were undergoing similarly stressful surgical procedures. METHODS: One hundred patients scheduled for elective vascular reconstruction of the lower extremities were randomized to receive either EA for surgery followed by epidural analgesia, or GA for surgery followed by intravenous patient-controlled analgesia. Hemodynamic monitoring, blood pressure, and heart rate limits were determined prior to randomization. Management of anesthesia in the immediate postoperative period was standardized. The data collected included continuous electrocardiographic monitoring from the day before surgery through the third postoperative day, serial electrocardiograms, and cardiac enzymes. Cardiac ischemia, myocardial infarction, unstable angina, and cardiac death were identified by a cardiologist blinded to the type of anesthesia received. Other major morbidity was determined at the time of hospital discharge and at 1 and 6 months after surgery. RESULTS: Eleven patients who received GA required regrafting or an embolectomy during their hospital stay, compared with two patients who received EA. This association of GA with reoperation remained significant after adjustment for baseline differences. Cardiac outcomes were similar in the two groups with respect to perioperative death (1 EA and 1 GA), death within 6 months (4 EA and 3 GA), nonfatal myocardial infarction within 7 days (2 EA and 2 GA), unstable angina (0 EA and 2 GA), and myocardial ischemia following randomization (17 EA and 23 GA). Rates of major infections in the two groups (1 EA and 2 GA), renal failure (3 EA and 3 GA), and pulmonary complications (3 EA and 7 GA) also were similar. CONCLUSIONS: Carefully conducted epidural and general anesthesia appear to be associated with comparable rates of cardiac and most other morbidity in patients undergoing lower extremity vascular surgery. However, compared with general anesthesia, epidural anesthesia is associated with a lower incidence of reoperation for inadequate tissue perfusion and, therefore, may be advantageous for this surgical population.

Aged↗