Higher In-hospital Mortality Research Articles

Changes in Neutrophil-to-Lymphocyte Ratio During Venoarterial Extracorporeal Membrane Oxygenation

Mortality remains elevated during venoarterial extracorporeal membrane oxygenation support (VA-ECMO) for cardiogenic shock and the role of inflammation is uncertain. By using the neutrophil-to-lymphocyte ratio (NLR), we investigated inflammatory dynamics during VA-ECMO and their relation to clinical outcomes. A single-center, retrospective cohort study was conducted. Patients receiving steroids or on-device support for less than 48 hours were excluded. Patients were grouped as those who did and did not have a persistent rise in NLR during the 24–48 hour interval after VA-ECMO placement. Overall, 253 patients comprised the study cohort. In-hospital mortality was 56%. Neutrophil-to-lymphocyte ratio was higher at 24 hours after VA-ECMO placement compared to pre-ECMO (Δ4.36, interquartile range [IQR]: −0.23 to 8.61, p < 0.001). Persistent increase in NLR during the 24–48 hour interval after VA-ECMO placement was associated with higher in-hospital mortality (adjusted hazard ratio [aHR]: 1.51, 95% confidence interval [CI]: 1.02–2.25, p = 0.04). The magnitude of this rise in NLR was incrementally related to greater in-hospital mortality (Δ0–5: 72%, aHR: 1.61, 95% CI: 1.03–2.54, p = 0.039; Δ>5: 79%, aHR: 1.64, 95% CI: 1.03–2.63, p = 0.037) in comparison 52%, for those with a drop in NLR. Venoarterial extracorporeal membrane oxygenation exacerbates inflammation, as evident by a rise in NLR, which is progressively higher in nonsurvivors.

Minimally invasive versus open surgery for colonic diverticular disease: a nationwide analysis of German hospital data

Abstract Background This study aims to evaluate the current rates and outcomes of minimally invasive versus open surgery for colonic diverticular disease in Germany, using a nationwide dataset. Methods We analyzed data from 36 hospitals, encompassing approximately 1.25 million hospitalizations from 1 January 2019 to 31 December 2023. Patients aged 18 years and older with colonic diverticular disease (International Classification of Diseases, Tenth Revision (ICD-10): K57.2 and K57.3) who underwent surgical treatment were included. Surgeries were classified as open or minimally invasive (laparoscopic or robotic). Outcomes such as in-hospital mortality, complications, and length of stay were assessed using multivariable logistic and linear regression models. Results Out of 1670 patients who underwent surgery for colonic diverticular disease, 63.2% had perforation and abscess. The rate of minimally invasive surgery increased from 34.6% in 2019 to 52.9% in 2023 for complicated cases and from 67.8% to 86.2% for uncomplicated cases. Open surgery was associated with higher in-hospital mortality (odds ratio (OR): 7.41; 95% CI: 2.86–19.21) and complications compared with minimally invasive surgery. The length of hospital stay was significantly longer for open surgery patients, with an increase of 4.6 days for those with perforation and abscess and 5.0 days for those without. Conclusions Minimally invasive surgery for colonic diverticular disease is increasingly preferred in Germany, especially for uncomplicated cases. However, open surgery remains common for complicated cases, but is associated with higher mortality, more complications, and longer hospital stays.

Utilization of Palliative Care in Cardiogenic Shock Patients: A Retrospective Analysis of the National Inpatient Sample Database, 2020.

Background: Cardiogenic shock (CS) is one of the leading causes of death in patients with myocardial infarction, myocarditis, and congestive heart failure. The utilization patterns of specialist palliative care (PC) consultation in these patients are currently unknown. Objectives: To determine the utilization of PC in patients with CS and the overall comorbidities of that population. Methods: Review of the 2020 National Inpatient Sample identified 6,471,165 hospitalizations of which 38,531 patients were hospitalized with CS via International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10 CM) code R57.0. Demographics and details of hospitalization were compared for patients who received PC evaluation (N = 8457) and those who did not (N = 30,074) as identified via ICD-10 CM code Z51.5. Results: Patients who received PC evaluation were older (≥65 years: 69.01% vs. 55.04%, p < 0.001), had shorter hospital stays (<14 days: 78.92% vs. 70.35% patients, p < 0.001), and higher in-hospital mortality (65.80% vs. 24.23%, p < 0.001) with higher Charlson Comorbidity Index (≥4, 55.22% vs. 48.09%, p < 0.001). Furthermore, the patients who received PC had significantly higher odds of death than those who did not (adjusted odds ratio = 6, p < 0.0001). Conclusion: Despite high mortality rates, specialist PC is not routinely involved in the care of those who die with CS, although does appear to be utilized among those most likely to die. This suggests preferential utilization of specialist PC for terminal patients; however, further research will be helpful to better understand current consult practices and increase PC utilization for this highly morbid population.

Left atrial appendage occlusion: trends in demographics and in-hospital outcomes-a German nationwide analysis.

LAAO is an interventional, prophylactic treatment to prevent cardioembolic stroke in patients with non-valvular atrial fibrillation. The aim of this study was to assess gender differences and age-related in-hospital course of all patients undergoing left atrial appendage occlusion (LAAO) in Germany. The Research Data Center of the Federal Statistical Office accessed interrogation of its Diagnosis Related Groups (DRG) statistics database. In a retrospective observational manner, all German in-hospital cases from 2016 to 2022 with a coded LAAO procedure were analyzed. LAAO was performed on a total of 40,435 patients, 39.2% of whom were female. The relative frequency of procedures in the German male population over the age of 60 was twice as high as in the German female population. The median age was 78 (IQR: 72-82) years. Compared to 28.3% in 2016, in 2022 40.1% of all patients were over 80years of age (increased by 152%). Cases of patients over 85years of age increased from 7.7 to 11.4% during the same time period. We found an in-hospital death rate for patients < 70, 70-75, 80-85 and > 85years of age of 0.8, 1.0, 1.4and 2.2% respectively. Further, we saw significantly higher MACE rates (< 75years: 4%, 75-85years: 5%, > 85years: 7%) in patients with a higher age. Gender was not significantly associated with a higher rate of in-hospital mortality. In Germany, LAAO is increasingly performed in older patients with a strong gender imbalance. Age was independently associated with higher in-hospital MACE and mortality rates. This data provides a further basis to balance risks and benefits of LAAO as a preventive procedure and highlights the need for further prospective studies.

Gender bias in acute myocardial infarction care in India: Nationwide retrospective study of 41832 patients.

Various studies have documented gender differences in the management and outcomes of acute myocardial infarction (AMI) in developed countries. Gender differences in the management of AMI in India is not known. To document the gender differences in the management and outcomes of AMI in India. The current study was a nationwide retrospective, multicenter, cross-sectional study including all consecutive AMI patients admitted from 15th March to 15th June in the year 2020 using a historical control of all cases of AMI admitted during the corresponding period in the year 2019. There were only 9018 females (21.6%) among the 41832 patients with AMI in the study. Females were older and were more likely to present with non ST-elevation MI than men (41.6% vs. 33.2%). Significantly fewer number of females underwent primary percutaneous coronary intervention (29.5% vs 31.2% p value<0.001), thrombolysis (32.9% vs 34.7%, p value<0.001), pharmaco-invasive therapy (18.6% vs 20.7% p value 0.001). Females had higher in-hospital mortality (7.07%vs 4.07%, p<0.001), length of hospital stay (3.9±2.98 days vs 3.8±2.88 days, p<0.001) and complications of AMI [cardiogenic shock (8.6% vs 6.3%), mechanical complications (4.6% vs 3.8%), heart failure (13.9%vs 11.7%) and malignant arrhythmias (3.4%vs2.8%)] than males. Differences between gender in the presentation, management, and outcomes of acute MI are prevalent in India. Women with acute MI presented at older age, had higher in-hospital mortality and complications, and received revascularization therapy less often compared to men.

Comparison of Clinical Characteristics and Mortality Outcome in Critical COVID-19 Patients Infected with Alpha and Omicron Variants.

Early reports have indicated that the Omicron variant of coronavirus disease 2019 (COVID-19) may be associated with low mortality. However, the mortality rate of critical patients in Taiwan with COVID-19 caused by different variants has not been well described. This retrospective cohort study was conducted at the Linkou Branch of Chang Gung Memorial Hospital, Taiwan, from April 2020 to September 2022. Critically ill patients who had confirmed SARS-CoV-2 infection and were on mechanical ventilation (MV) were enrolled. Demographic data, laboratory results, and treatment information were collected and analyzed. In addition, clinical outcomes for different SARS-CoV-2 variants were analyzed. This study included 110 critical patients with COVID-19 who required intubation and intensive care unit (ICU) admission. Among these patients, 46 (41.8%) required intensive care during Alpha predominance period and 64 (58.2%) during the Omicron predominance period. The Alpha group had a higher body mass index, had a longer ICU stay, and included more patients with acute respiratory distress syndrome, and the Omicron group included more active smokers, had more comorbidities, had worse initial laboratory data (including higher white blood cell counts, prothrombin time [PT], activated partial prothrombin time, blood urine nitrogen levels, and creatine levels), and had higher in-hospital mortality rates (40.6% vs 15.2%, p = 0.004). The independent risk factors for in-hospital mortality, were Charlson Comorbidity Index (CCI) ≥ 3 and higher PT and creatine levels. Our study discovered that CCI ≥ 3, elevated serum creatine levels, and prolonged PT were independently associated with a high mortality rate in patients with critical COVID-19. Patients with those risk factors may require intensive monitoring during their treatment course.

Smaller Hospital Size is Associated With Higher Mortality in Stanford Type A Aortic Dissection.

Stanford Type A Aortic Dissection (TAAD) is associated with high in-hospital mortality and the need for immediate surgical intervention. Larger hospital size may be associated with better patient care and surgical outcomes. This study aimed to examine the effect of hospital size on TAAD outcomes. Patients who underwent TAAD repair were identified in National Inpatient Sample (NIS) from Q4 2015-2020. NIS stratifies hospital size into small, medium, and large based on the number of hospital beds, geographical location, and the teaching status of the hospitals. Patients admitted to small/medium and large hospitals were stratified into two cohorts. Multivariable logistic regressions were performed to compare in-hospital outcomes, adjusted for demographics, comorbidity, primary payer status, and hospital characteristics including procedural volume. There were 1106 and 3752 TAAD admitted to small/medium and large hospitals, respectively. Among patients admitted to small/medium hospitals, there was higher mortality (17.27% vs 14.37%, aOR = 1.32, P < 0.01), but shorter length of stay (P < 0.01) and lower cost (P = 0.03) compared to larger hospitals. There was no difference in morbidities. Marked higher mortality is associated with admission to smaller hospitals among patients with TAAD, which may in turn decrease the average hospital stay and cost. Given that a significant percentage of patients are already being transferred out of the initial hospital and small/medium hospital is associated with higher mortality, centralization of care in centers of excellence may decrease the high mortality associated with TAAD.

Inpatient hospitalisations for patients with Prader-Willi syndrome: a 2019-2021 National Inpatient Sample analysis.

Prader-Willi syndrome (PWS) is a genetic disorder characterised by hyperphagia, intellectual disability and increased propensity to a range of medical disorders. To better characterise the clinical presentation of PWS across the lifespan, this study reports on the demographics and clinical diagnosis of individuals with PWS hospitalised in the United States. The National Inpatient Sample, an all-payor administrative claims database of hospitalisations in the United States, was queried for patients with a coded diagnosis of PWS from October 2019 through December 2021. Hospitalisations for patients with PWS were matched to five non-PWS hospitalisations based on age, sex, year and hospital characteristics. There were 4400 (95% CI: 3,885 to 4,915) PWS hospitalisations, with a median age of 24. Compared to controls, PWS hospitalisations had longer hospital stays (median 5 vs. 3days) and higher in-hospital mortality (2.2% vs. 1.3%). Infectious (19.0%) and respiratory (16.2%) diagnoses were most common for PWS patients. Codes for overweight or obesity were present in 38.1% of PWS hospitalisations, with Hispanic ethnicity was associated with a higher odds of overweight/obesity in PWS patients (aOR 1.73; 95% CI: 1.11-2.71). PWS hospitalisations are characterised by higher healthcare utilisation and complexity compared to matched controls. The high prevalence of obesity and significant rates of infectious and respiratory conditions highlight specific health challenges for PWS patients. Validation of the Q87.11 administrative claims code is an essential step for ongoing health services research in this condition.

Clinical outcomes following shock team implementation for cardiogenic shock: a systematic review

Abstract Background Cardiogenic shock is a critical cardiac condition characterized by low cardiac output leading to end-organ hypoperfusion and associated with high in-hospital mortality rates. It can manifest following acute myocardial infarction or acute exacerbation of chronic heart failure. Despite advancements, mortality rates remain elevated, prompting interest in multidisciplinary approaches to improve outcomes. This manuscript presents a review focused on the concept of a cardiogenic shock team and its potential impact on patient management and outcomes. Methods A comprehensive search was performed on March 19, 2023, covering PubMed, Web of Science, Scopus, Embase, and Cochrane Library. We included primary studies (prospective and retrospective) only and evaluated their quality using the Newcastle–Ottawa Quality Scale. This review was registered in PROSPERO (CRD42023440354). Results Six relevant studies with 2066 cardiogenic shock patients were included, of which 1071 were managed by shock teams and 995 received standard care. Findings from the reviewed studies indicated the favorable outcomes associated with implementing cardiogenic shock teams. Patients managed by these teams exhibited higher 30-day and in-hospital survival rates compared to those without team intervention. The implementation of cardiogenic shock teams was linked to reduced in-hospital and intensive care unit mortality rates. Additionally, shock team involvement was associated with shorter door-to-balloon times. Conclusion The findings suggest that cardiogenic shock teams play a crucial role in improving patient outcomes through earlier detection and timely interventions. Despite challenges in team implementation, their potential to reduce mortality and improve efficiency in patient care warrants further research and greater integration of multidisciplinary strategies into clinical practice.

Organ-specific malperfusion in acute type A aortic dissection: epidemiological meta-analysis of incidence rates.

Acute type A aortic dissection is a life-threatening clinical emergency that necessitates immediate surgical intervention with an estimated mortality rate of approximately 1-2% per hour. When complicated by malperfusion, the perioperative mortality rate is reported to be increased by up to 39%. Malperfusion can affect many vascular beds with varying incidence and severity, resulting in coronary, cerebral, visceral, peripheral, renal or spinal malperfusion. The primary aim of this systematic review and meta-analysis is to investigate the epidemiology of specific types of organ malperfusion in acute type A aortic dissection and to analyse the impact on the survival outcomes associated with each malperfusion type. Electronic databases PubMed, MEDLINE and Embase were searched through to September 2024 to identify original studies that presented data on the incidence and the survival outcome of organ malperfusion in association with acute type A aortic dissection. The extracted data included patient characteristics and incidence of organ-specific malperfusion. Primary outcomes were the respective in-hospital mortality rate associated with each organ-specific malperfusion and a proportional meta-analysis was conducted to pool results. Quality assessment was performed using the modified National Institutes of Health quality assessment tool for single-arm observational studies. A total of 40 studies met the inclusion criteria, including a total of 35 361 patients. Peripheral limb malperfusion was the most prevalent with a pooled incidence of 12% (95% c.i. 10 to 14). This was followed by lower limb or iliofemoral with 11% (95% c.i. 9 to 14). Spinal malperfusion was the lowest with 1% (95% c.i. 1 to 2). The pooled mortality rate with organ malperfusion varied between 18 and 36%. Within this population the highest mortality rate was associated with mesenteric malperfusion with 36% (95% c.i. 28 to 45). Following this the highest mortality rate was found with coronary at 33% (95% c.i. 26 to 40) and cerebral at 28% (95% c.i. 24 to 33) malperfusion. Survival during hospital admission after acute type A aortic dissection can vary depending on the presence and type of malperfusion, with mesenteric, coronary and cerebral malperfusion being associated with the highest in-hospital mortality rates. Organ-specific malperfusion syndromes should be considered when assessing the perioperative risk and surgical planning of patients undergoing surgical repair for acute type A aortic dissection.

Acute kidney injury and in-hospital outcomes after transcatheter aortic valve replacement in patients without chronic kidney disease: insights from the national inpatient sample

Abstract Background Acute kidney injury (AKI) complicates transcatheter aortic valve replacement (TAVR), leading to higher mortality. The incidence and effects of AKI on clinical outcomes in patients undergoing TAVR without chronic kidney disease (CKD) are unclear. We aimed to determine the association between AKI and in-hospital outcomes in patients with TAVR using propensity score matching (PSM). Methods Using International Classification of Diseases-10th Revision codes, we queried the National Inpatient Sample for TAVR performed between 2016 and 2021. Patients were divided into two groups according to perioperative AKI development. Patients with CKD or on permanent hemodialysis at baseline were excluded. We conducted 1:1 PSM to assemble a cohort of patients with similar baseline characteristics. Multivariate logistic regression was used to assess the association between AKI and in-hospital outcomes. Sensitivity analysis was conducted to evaluate the robustness of our inferences. Results Of 47,372 unweighted patient admissions for TAVR, 1617 (3.41%) had a concomitant diagnosis of AKI. The incidence of AKI decreased from 4.82 to 3.18% from 2016 to 2021 (P-trend &lt; 0.01). Before PSM, patients with AKI had a significantly higher rate of in-hospital mortality compared with those without AKI (6.12% vs. 0.48%, respectively; odds ratio [OR] 8.59, 95% confidence interval [CI] 6.32–11.68). Using the PSM algorithm, 1579 well-matched patients were included in each group. After PSM, an association was observed between patients with TAVR and concomitant AKI and a higher risk of in-hospital mortality (6.21% vs. 1.08%, respectively; OR 5.96; 95% CI 3.54–10.04). In subgroup analyses stratified according to age (≤ 80 and &gt; 80 years), sex (male/female), and hypertension status, consistent associations were observed between AKI and the risk of in-hospital mortality. AKI patients were at higher risk for acute myocardial infarction (OR 1.78, 95% CI 1.35–2.34), major bleeding (OR 1.62, 95% CI 1.13–2.33), blood transfusion (OR 1.65, 95% CI 1.28–2.11), and cardiogenic shock (OR 3.73, 95% CI 2.77–5.01). No significant betweengroup differences were observed in stroke (P = 0.12). Conclusion AKI was a strong predictor of in-hospital mortality in patients undergoing TAVR without CKD and was associated with higher post-procedure complication rates.

Long-term Follow-up Optical Coherence Tomography Assessment of Primary Percutaneous Coronary Intervention for Unprotected Left Main

Background: Elective unprotected left main (ULM) percutaneous coronary intervention (PCI) has long-term mortality rates comparable to surgical revascularization, thanks to advances in drug-eluting stent (DES) design, improved PCI techniques, and frequent use of intravascular imaging. However, urgent PCI of ULM culprit lesions remains associated with high in-hospital mortality and unfavourable long-term outcomes, including DES restenosis and stent thrombosis (ST). This analysis aimed to examine the long-term outcomes and healing of DES implanted in ULM during primary PCI using high-resolution optical coherence tomography (OCT) imaging. Methods: A total of 15 consecutive patients undergoing long-term OCT follow-up of ULM primary PCI from a high-volume center were included in this analysis. During the index primary PCI all subjects underwent angio-guided DES implantation, and follow-up was uneventful in all but one subject who had a non-target PCI lesion. The primary endpoint was the percentage of covered, uncovered, and malappossed stent struts at long-term follow-up. Secondary endpoints included quantitative and qualitative OCT measurements. For the left main bifurcation, a separate analysis was performed for three different segments: left main (LM), polygon of confluence (POC) and distal main branch (dMB), in all cases. Results: The average follow-up interval until OCT was 1580 ± 1260 days. Despite aorto-ostial stent protrusions in 40% of patients, optimal image quality was achieved in 93.3% of cases. There were higher rates of malapposed (11.4 ± 16.6 vs. 13.1 ± 8.3 vs. 0.3 ± 0.5%; p &lt; 0.001) and lower rates of covered struts (81.7 ± 16.8 vs. 83.7 ± 9.2 vs. 92.4 ± 6.8%; p = 0.041) observed for the LM and POC segment compared to the dMB. Significantly malapposed stent struts (&gt;400 μm) were less likely to be covered at follow-up, than struts with a measured strut to vessel wall distance of &lt;400 μm (15.4 ± 21.6 vs. 24.8 ± 23.9%; p = 0.011). Neoatherosclerosis was observed in 5 (33.3%) and restenotic neointimal hyperplasia (NIH) in 2 (13.3%) patients, requiring PCI in 33.3% of patients. Conclusions: Long-term OCT examination of DES implanted during primary PCI for culprit ULM lesions demonstrated high rates of incomplete strut coverage, late malapposition, and high subclinical DES failure rates. These negative OCT results highlight the need for image optimization strategies during primary PCI to improve DES-related long-term outcomes.

The performance of different prognostic scores in cirrhotic patients admitted to intensive care unit

Background and aimCritically ill cirrhotic patients exhibit high in-hospital mortality and require substantial healthcare resources, including multiorgan support. Egypt has the highest age-standardized death rate from cirrhosis worldwide. This study aimed to compare the performance and accuracy of different prognostic scores for mortality prediction, including Child-Turcotte-Pugh (CTP), Model for End-Stage Liver Disease (MELD), MELD with serum sodium incorporation (MELD-Na), Royal Free Hospital (RFH), as well as general intensive care unit (ICU) prognostic models, Acute Physiology and Chronic Health Evaluation II (APACHE II), and Chronic liver failure -sequential organ failure assessment (CLIF-SOFA), in cirrhotic patients admitted to an ICU in an Egyptian tertiary facility.Patients and methodsThis prospective observational study included ninety patients admitted to the ICU between July 2021 and June 2022. All patients underwent clinical assessment with the estimation of all included scores within the first 24 h of admission, alongside basic laboratory and radiological investigations.ResultsMortality occurred in 56.7% (n = 51) of the patients. Non-survivors exhibited statistically significantly higher APACHE II, CLIF-SOFA, RFH, and CTP scores but lower Glasgow Coma Scale (GCS) than survivors. However, no statistically significant difference was found regarding the performance of the scoring systems. At cut-off levels > 20 for APACHE II and > 46 for CLIF-SOFA, these scores were the most independent predictors of in-hospital mortality.ConclusionsWhile CTP, MELD, and MELD-Na scores demonstrated satisfactory performance in critically ill cirrhotic patients, APACHE II and CLIF-SOFA scores were superior in predicting short-term mortality in this patient population.

The serum biomarkers NSE and S100B predict intracranial complications and in-hospital survival in patients undergoing veno-venous ECMO

Neurological complications in patients undergoing veno-venous extracorporeal membrane oxygenation (V-V ECMO) are challenging, with new intracranial pathologies posing a grave risk. We aimed to evaluate the utility of neuron-specific enolase (NSE) and S100B biomarkers for predicting outcomes in new-onset intracranial pathology during V-V ECMO. A retrospective analysis spanning 2013–2021 at a German university hospital was conducted. Cases with electronically available data on NSE and S100B serum levels, new intracranial pathologies (intracerebral hemorrhage [ICH], subarachnoid hemorrhage [SAH], cerebral ischemia, hypoxic-ischemic encephalopathy [HIE]), and survival during or after V-V ECMO were screened. The primary objective was to assess the prognostic value of NSE and S100B for in-hospital survival during V-V ECMO. Secondary objectives included analyzing clinical characteristics, outcome parameters, and biomarker distribution in V-V ECMO patients. Additionally, the prognostic value of NSE and S100B for in-hospital death and occurrence of intracranial pathology was calculated. Among 744 ECMO recipients, 426 underwent V-V ECMO. No significant differences in disease severity or organ failure scores were observed between groups, except for SAPS at discharge, which was higher in patients with new intracranial pathologies. Patients with new intracranial pathologies had lower median survival and higher in-hospital mortality. Weaning success from ECMO was also significantly reduced in these patients. Cut-off values of 58.4 µg/lfor NSE and 1.52 µg/l for S100B were associated with detrimental outcomes, characterized by significantly reduced median survival. A significant difference in maximum serum NSE concentration was found between patients with and without new intracranial pathology. All screened cases with new intracranial pathology had an unfavorable neurological outcome (modified Rankin Score [mRS] > 3) at discharge, with a higher proportion having an mRS of 6 in the high NSE group. The emergence of intracranial pathology during V-V ECMO significantly increases the risk of death. Changes in NSE and S100B levels serve as valuable follow-up parameters for predicting new intracranial pathology and survival during V-V ECMO therapy.

Urgent Coronary Angiography Following Cardiac Surgery: Insights from a High-Volume Cardiac Surgery Center.

Post-operative myocardial infarction is a possible complication following cardiac surgery. Data on the incidence, predictors and prognosis of urgent coronary angiography (UCA) after cardiac surgery are scarce. This study aims to report in hospital and 1-year follow-up outcomes of a recent large cohort of patients undergoing UCA after cardiac surgery. This study provides a retrospective analysis of an high volume cardiac center (Maria Cecilia Hospital, Italy), from 2016 to 2021 regarding patients treated with coronary artery bypass grafting (CABG), valve, or aortic root surgery, focusing on those who required UCA within the same hospitalization. Out of 6505 cardiac surgeries, 119 patients (1.83%) underwent UCA, with a median age of 69 years. The study found that UCA was more frequent post-CABG (2.62%) than non-CABG interventions (1.35%, p < 0.001). A graft failure was detected in 31.1% of the cases, while a native vessel complication in 36.1%. The leading reasons for UCA included ST/T abnormalities, ventricular arrhythmias, and hemodynamic instability, with 92% of UCAs performed within a week post-surgery. The in-hospital mortality rate was 32%, with no significant difference between CABG and non-CABG patients. Predictive factors for in-hospital mortality included Euroscore II, hemodynamic instability and late UCA. One-year follow-up showed a low mortality rate (2.5%) among discharged patients. UCA resulted to have a pivotal role in detecting coronary complications after cardiac surgery, guiding subsequent treatment decisions. Despite the high in-hospital mortality rate, survival showed an overall low mortality at the 1-year mark.

Weekday effect of surgery on in-hospital outcome in pancreatic surgery: a population-based study.

There is conflicting evidence regarding weekday dependent outcome in complex abdominal surgery, including pancreatic resections. To clarify weekday-dependency of outcome after pancreatic resections in a comprehensive nationwide context. Retrospective cross-sectional study of anonymized nationwide hospital billing data (DRG data). Germany between 2010 and 2020. PARTICIPANTS AND EXPOSURE: all patient records with a procedural code for a pancreatic resection. Primary endpoint was complication occurrence and failure to rescue, i.e. mortality in case of complications, by weekday of index surgery. 94,661 patient records with a pancreatic resection were analyzed, of whom 45.2% were female. Mean age was 65.3 years. In 46.3% of all patient records, the main diagnosis was pancreatic carcinoma. The most common index surgery was pancreaticoduodenectomy (61.2%). Occurrence of at least one of predefined complications was 67.6% (64,029 cases) and was highest following a Monday index surgery. In-hospital mortality in case of at least one complication, i.e. failure to rescue (FtR), accounted for 8,040 deaths (97.7% of 8,228 total deaths, 12.6% FtR, 8.7% in-hospital mortality). FtR was highest (13.1%) following a Monday index surgery and lowest (11.8%) after a Thursday index surgery. Overall in-hospital mortality followed the same trend as FtR. In a multivariable logistic regression, in the overall cohort, in addition to increased age, frailty, male sex, benign entities, and total pancreatectomy performance, Wednesday (adjusted Odd's Ratio, OR, 0.92, 95% Confidence Interval, CI, 0.85-0.99) and Thursday (adjusted OR, 0.89, CI, 0.82-0.96) index surgeries were associated with lower FtR in reference to Monday. Stratified by patient volume, complication occurrence and FtR was only dependent of the weekday of index surgery in low volume hospitals. Pancreatic resections are complex procedures with high complication rates and FtR, resulting in high in-hospital mortality. Complication occurrence and FtR is dependent on the weekday of index surgery and mediates the same distribution pattern for overall in-hospital mortality. Stratified by patient volume, this weekday dependency of the index surgery on complication occurrence and FtR was only observed in low volume hospitals.

The role of the neutrophil-to-lymphocyte ratio in predicting outcomes among patients with community-acquired pneumonia.

The value of the neutrophil-to-lymphocyte ratio (NLR) in predicting outcomes in patients hospitalised with community-acquired pneumonia (CAP) remains debated. This study evaluated whether NLR independently predicts clinical outcomes and enhances the predictive performance of the CURB-65 score in patients with CAP. Data from CAP admissions at two Australian hospitals from 2018 to 2023 were analysed. NLR was calculated using admission neutrophil and lymphocyte counts. Patients were categorised into NLR >12 and NLR ≤12. Multilevel-multivariable regression models, adjusting for age, sex, Charlson index, CURB-65 score, Hospital Frailty Risk Score (HFRS) and C-reactive protein (CRP), assessed outcomes including length of stay (LOS), intensive care unit (ICU) admission and in-hospital mortality. Over 6 years, 7,862 patients with CAP were hospitalised (mean age 75.1 years, 54.6% male). Mean NLR was 12.6, with 2,877 (36.6%) patients having an NLR >12. Those with NLR >12 were older males with higher disease severity and Charlson index (p<0.05). Adjusted analyses showed that NLR >12 was independently associated with prolonged LOS (IRR=1.11, 95% CI 1.08-1.13, p<0.001), increased risk of ICU admission (adjusted odds ratio (aOR) =1.41, 95% confidence interval (CI) 1.06-1.88, p=0.019), and higher in-hospital mortality (aOR=1.27, 95% CI 1.06-1.53, p=0.009). The predictive ability of the CURB-65 score for in-hospital mortality was good (area under the curve (AUC) 0.68, 95% CI 0.66-0.70), while it was modest for the NLR (AUC 0.58, 95% CI 0.56-0.60). Incorporation of NLR to the CURB-65 score did not enhance its predictive ability (AUC 0.69, p>0.05). NLR independently predicts adverse outcomes in patients hospitalised with CAP but does not improve the predictive performance of the CURB-65 score.

Perioperative Complications and In-Hospital Mortality in Radical Nephroureterectomy Patients with Heart Valve Replacement.

Perioperative complication rates and in-hospital mortality after radical nephroureterectomy (RNU) in patients with a history of heart valve replacement are unknown. Within the National Inpatient Sample (2000-2019), we identified non-metastatic upper urinary tract carcinoma patients treated with RNU according to the presence or absence of a history of heart valve replacement. Propensity score matching (1:10 ratio) and multivariable logistic regression as well as Poisson regression models were used. Of 15,423 RNU patients, 151 (1.0%) harbored heart valve replacement. This proportion increased over the study span from 0.5% to 1.4% (p=0.02). Heart valve replacement patients were older (median 78 vs. 72 years; p<0.001), more frequently male (73 vs. 60%; p=0.002), and more frequently harbored a Charlson Comorbidity Index (CCI) ≥3 (36 vs. 27%; p=0.002). After 1:10 propensity score matching for age, sex, and CCI, the patients exhibited higher rates of perioperative bleeding (7.4 vs. 2.4%; odds ratio [OR] 3.2; p<0.001), blood transfusions (24.0 vs. 17.0%; OR 1.6; p=0.02), and cardiac complications (24.0 vs. 14.0%; OR 2.1; p<0.001). Conversely, heart valve replacement patients did not exhibit higher rates of critical care therapy (OR 1.06; p=0.8), higher rates of in-hospital mortality (OR 0.8; p=0.8), and longer length of stay (OR 1.4; p=0.052) than their RNU counterparts without a history of heart valve replacement. RNU patients with a history of heart valve replacement are at significantly increased risk of perioperative bleeding, blood transfusions, and cardiac complications; however, despite these increased risks, they neither exhibited higher critical care therapy rates or higher in-hospital mortality rates, nor did they require significantly longer hospital stay.

Trends in Management of Malignant Bowel Obstructions: A Longitudinal Analysis of the National Inpatient Sample.

Malignant bowel obstructions (MBO) are complex, heterogeneous disease processes which can be managed with surgical or endoscopic interventions. Patients with MBO often have advanced metastatic disease and poor functional status, which makes it difficult for providers to determine the best treatment strategy. Patients with urgent or emergent admissions and a primary or secondary ICD-9/ICD-10 diagnosis of bowel obstruction with an additional diagnosis of disseminated cancer were identified from the National Inpatient Sample (2000-2017). Patients were stratified into operative and non-operative intervention groups. Multivariate regression determined factors associated with surgical treatment of MBO based on significant factors on univariate analysis. Trends in treatment over time were calculated using log-linear regression to determine the annual percent change (APC). Of 1118 patients, 18% underwent surgery and 7% underwent endoscopic intervention. From 2000 to 2017, a decreasing proportion of patients underwent surgery (APC -2.4, p = 0.023) with a commensurate increase in endoscopic interventions (APC 5.3, p = 0.042). There was also a decrease in the proportion of patients who died during hospitalization (APC -4.3, p = 0.029). Surgery was associated with longer mean lengths of stay (13 days vs. 7 days, p < 0.001) and higher rates of in-hospital mortality (13% vs. 6%, p = 0.001) compared to non-operative management. The proportion of patients receiving surgery for MBO is decreasing and that receiving endoscopic interventions is increasing. In-hospital mortality is also decreasing proportionately, suggesting an improvement in patient selection.

Relationships between adrenal insufficiency and cardiovascular outcomes in patients with congestive heart failure.

Patients with adrenal insufficiency (AI) face elevated risks during various hospitalizations including cardiovascular related admissions. Despite this, limited data exist specifically regarding congestive heart failure (CHF) in the context of AI. This investigation leveraged a comprehensive national database to examine the association between AI and cardiovascular outcomes among patients admitted with CHF. Admissions for CHF were identified in the 2016-2019 National Inpatient Sample. In-hospital outcomes were compared between patients with and without AI. The primary outcome was in-hospital mortality. Secondary outcomes included cardiogenic shock, ventricular tachycardia (VT), acute kidney injury (AKI), vasopressor use, mechanical circulatory support (MCS) use, mechanical ventilation use, hospital length of stay (LOS), and total charges. Multivariable regression models were used to adjust for potential confounders. Among 1,270,784 CHF hospitalizations, 3812 (0.3%) had a diagnosis of AI. AI was associated with higher odds of in-hospital mortality (aOR 2.6, 95% CI 2.1-3.7), VT (aOR 1.40, 95% CI 1.1-1.8), AKI (aOR 1.29, 95% CI 1.10-1.52), the need for vasopressors (aOR 3.3, 95% CI 1.9-5.63), mechanical ventilation use (aOR 3.8, 95% CI 2.9-4.99), cardiogenic shock (aOR 3.08, 95% CI 2.38-3.98), and MCS (aOR 2.12, 95% CI 1.14-3.95). Patients with AI also had a longer LOS (8.62 days vs. 5.25 days, p<0.001) and higher total charges ($103,248 vs. $50,280, p<0.001). Patients with AI admitted for CHF had higher in-hospital mortality, non-fatal adverse outcomes, and incurred higher hospital charges compared to patients without AI.